English to French Medical Economics

Access, Cost of Transport, and Human Resources Considerations

The effectiveness of primary angioplasty depends on the efficiency of patient transport to a qualified treatment centre. In Ontario, the extent to which residents can be served by a primary angioplasty program is limited by where catheterization centres are located. To improve access time for primary angioplasty or pre-hospital thrombolysis, it is necessary to cut transit time by ambulances using strategies that include bypassing the closest hospital to get to a hospital that has the resources to do primary angioplasty. Only 60% of patients with acute MI currently arrive at emergency rooms by ambulance.

An analysis of the emergency medicine and ambulance requirements to enable this bypass or to provide pre-hospital thrombolysis suggested that this could be done only if advanced care paramedics (ACPs) accompanied patients. This would entail upgrading 3,200 primary care paramedics (PCPs) to ACPs. Optimistically, the province can train a maximum of 200 PCPs per year to advance to the level of ACP; therefore, it would take 16 years to have the full number of ACPs, rising progressively to an annual cost of $84 million (Cdn) at 16 years. This excludes any possible efficiency that might be achieved through pre-hospital care. There is likely to be an additional $224 million (Cdn) in one-time/first-year costs.