This week is National Paramedic Services Week here in Canada and we are feeling really lucky to be joined by four awesome paramedics from the Paramedic Association of Canada. We are very excited to learn all about becoming a paramedic and to hear about the struggles facing paramedics right now. Come along with us as we talk to Derek Cassista, Melanie Stephens, Steven Leu and Ashley Chasse, paramedics from across Canada!
Steve: I've been a paramedic for 37 years this May. I started out at Algonquin College. The paramedic course in Ontario at that point in time was one year long. I came out of there. I worked in rural and urban environments. Part-time was very difficult to get a full-time job back then. So I worked part-time for approximately nine years at multiple different services in rural and urban environments. I was a primary care paramedic when I graduated, which is what happened when you came out of Algonquin College. I was fortunate enough to get into Advanced Care paramedic training that was offered in Ottawa through Kitchener College out of Toronto and I became an advanced care paramedic. I did that for a few years, became full-time, and I then went on to become an advanced care flight paramedic, worked two and a half years or so on a helicopter, air ambulance out of Ottawa, and then the city of Ottawa was amalgamating their paramedic services. All of Ontario was amalgamating their paramedic services, going to large municipalities. I was hired as one of the first 12 superintendents for the New Ottawa Paramedic Service, and I've been there now for 23 years doing that.
Ashley: Hi, my name is Ashley Chasse. I'm a 22-year-old primary care paramedic. I am on my third year practicing in the rural northwest of New Brunswick. I took the primary care Paramedics program at Oulten College in Moncton.
Melanie: My name is Melanie Stevens. I am a primary care paramedic. I've been working for B.C. Ambulance Service for just over ten years. This is my second career, so it's been really interesting. I had kind of a unique start into paramedics and I never thought of it actually as a job option until the small rural community I was living in suddenly wasn't going to have ambulance service. So, here I am ten years later. Now I am a clinical educator, so I travel around the province educating other paramedics, and I also work for our critical incident stress team. I'm one of a couple of coordinators in the province supporting paramedics with their psychological health.
Derek: I'm Derek Cassista. I'm a primary care paramedic here in New Brunswick. I entered the profession in 2007. Geographically, the nearest paramedic school was a bit further away than I was willing to travel. The closest one was actually in the United States, so I hopped the border and went to school in the U.S. I took my paramedic schooling over there when I graduated the program I hopped back over the border into Canada here in New Brunswick and went through the regular regulatory process, became licensed and I began my career as a paramedic. It was a unique time to enter the profession because in 2007, New Brunswick went from private operators to a provincially standardized system. I jumped in, in August, and the magic date was December 16th, 2007, when everything was flipping the switch. Some people called it a takeover, some people called it a step back. Some people called it a step up. But it was a really cool time to enter the profession. Everyone had an opinion about everything at the time. I got to see the best of both worlds. Then we weathered the takeover in 2007 and saw that transition happen. Then about three or four years after that, I became involved in the Paramedic Association, and I really took an interest in promoting the professional standards of the profession, advocating on behalf of the profession. I've held roles within the Paramedic Association since then and then more recently became involved at the federal level advocating on behalf of paramedics across Canada. I have a really keen interest in promoting the profession while still an active, practicing primary care paramedic as well. I wear a lot of hats. Here in New Brunswick, I operate as a field trainer, clinical support paramedic and just really do a lot of advocacy on behalf of the profession so we can talk about the profession all night here on this broadcast.
Derek: I would say it this way: I came for the lights and sirens like a lot of paramedics do. Right? It's the flash and rush of seeing an accident happen in front of you and all these uniformed professionals whisk in and pull out all sorts of fancy tools and do stuff. You're like, Well, that's cool. I came for that. As you're aware, if you're a paramedic listening to this podcast, that sort of wears off, right? Then it becomes, oh, what am I going to do now with my life? That is what keeps me going is the same thing that motivates me to continue to expand my role. It's to raise the bar for the profession and ask myself 20 years from now when I'm on my deck and I have my massive heart attack, what is the type of person or persons I want to swoop in and pick me up? I think that's the easiest way to say it. I want the highest trained people in the world to pull out all the technology that's available in the world and snap their fingers and fix me instantly. That's what we're all working towards.
Steve: I ended up I started as a paramedic. Ironically, I was a member of the Canadian Ski Patrol for a few years. I was involved with them on multiple different levels. There was this paramedic program that was happening, and we actually crossed paths with somebody and he started to tell me about it. It seemed like a logical progression for me. As for what motivated or what continues to motivate me is very similar to Derek. I want to see the people who are going to come and pick me up, as I was joking with some of my new our new hires recently, Honestly, you are the paramedic who when I call you, are going to be the ones who come and pick me up. You know, we're I'm very close to retirement and I've got, you know, young, young, brand new, freshly minted paramedics coming out. It's very motivating and watching them learn and come from coming out from school, far better trained than we were with the technology that's progressing as Derek said, I mean, the technology is progressing across Canada. Everybody kind of grows leaps and bounds. You start where I started, I mean, we didn't carry defibrillators, there were no drugs of any description in the vehicle. And it's come a huge, long way. And I'm motivated when I go in to work and I see the brand new paramedic who comes out and identifies as a STEMI and it pulls out the EKG tracing from the patient and shows me and says, Look at this, this is what we did last shift. Those are things like living through that, living vicariously through them. I'm still a frontline paramedic. I still am on the road. I don't work 24-hour shifts or full-day nights anymore. I work a partial, a split shift. But living vicariously through the new people is super motivating.
Ashley: I'm going to be honest; it wasn't as an easy choice for me as it was for them. I had to write down choices and ideas of careers that I would be interested in. I narrowed it down after some research and talking with people in the fields that I was interested in. One night, when I sat down with my dad, he made me realize how very instinctive it is for me to go and be out there and help people. I remember I was just five and I was just always after my brother telling him what to do, what to wear, how to help him in any task he was doing. Some people might think it is cute, but he thought I was being pretty bossy. That’s how I got to enroll in the paramedics program.
Melanie: My story is a bit unique. I was a stay-at-home mom raising kids and kind of got roped into this by my community because I did a lot of work for my community and felt quite passionate that we needed to have an appropriate staffing level of our local ambulance service there. Quickly I realized how much I love it, but also came to the quick realization that there is a lack of support when it came to psychological help with paramedics. That has become my “why”. I love interacting with patients and families and being in car, but I also really love supporting other paramedics and making sure they maintain their psychological health because it was sorely lacking when I started. That and in my clinical education role as well, making sure that we start people on the right foot with supporting their psychological health early on in their career.
Ashley: The program at Oulten College was 15 months long. We started off our weeks with three days and then we finished off the week with labs. Approximately 12 to 15 weeks were dedicated for clinical and practical on-track experience. We got to do some shifts in the hospital and different departments with nurses and the respiratory therapist. We were then assigned for the on-track experience to preceptors, whose jobs were to monitor our skills and to guide us on calls. To this day, I still use every tip that they gave us. They were very helpful with the transition from being a student to working the onsite job. Personally, the hardest thing for me was to do the whole program in a secondary language. It was quite a journey for me. Prior to the course, I wasn't really considered bilingual in the slightest, but I pushed through and I had friends that I made through the program that were very supportive and they were always gently and very nicely correcting me if I had to pronounce things different ways and my instructors were very patient. They really helped me push through as well.
Melanie: My experience in B.C. was quite a bit different probably than anybody else's. I started as an emergency medical responder, which at that time was a two-week course, quickly realized that that was not enough to be able to do calls in the back of an ambulance in a rural and remote community. I took a part-time primary care paramedic course, which was one weekend and a month, if I can recall a lot of self-study. Then one weekend a month for about a year of workshops and then setting as well for a month straight. It was a long journey, but it was well worth it for me. The skill level is quite a bit different from a two-week course to a one year.
Steve: I think that that they should go in with the attitude that it's going to be lifelong learning. If you look back to 1986, when I did my primary care paramedic course, things have changed and things change every year, whether it's a new protocol that's come out, whether standards have changed and you're now using a new medication, a different medication, you need to stay on top of it. In my career, some of the best medicine was when I was working on the helicopter because every year we had oral board exams. Essentially you were recertified. We went to Toronto once a year for ten days and you did oral board exams and what it forced you to do as a paramedic was to stay on top of learning. It's really easy if you have downtime. Some services have very little downtime, but it's very easy when you have downtime to get lost in other things. If you can set aside time to stay on top of what you need, it's going to help you immensely in the long run.
Ashley: Mental health, it is very important to incorporate and educate yourself on the subject, get tips on how to handle stress, especially after very hard calls, because a difficult call for me could be very different from Derrick's or Steve's or Melanie's to handle. Rely on your peers and do not be afraid to talk it out. We all understand each other. We're all going through the same thing. We're all doing the same job and don't try to tough it out. Being tough will catch up to you.
Steve: The time to go see a psychologist is before you're having any kind of problems or issues, to get yourself a baseline, get yourself set up, get them so they know you so they have somewhere where they can bring you back to after that traumatic event.
Derek: Wow, that's a great question. I just come back from Ottawa and this is paramedic week. If you think back to the 1st of May, the Paramedic Association of Canada, hosted a group of paramedics across the country in Ottawa for a day we call ‘Paramedics on the Hill’. The purpose of that is to bring a group of professionals together and gather the current issues that are facing us and talk to MP senators, policymakers etc. A couple of the key things that we heard from across the country were issues related to violence against paramedics which is one thing that we're really seeing a lot of, and that's for a number of reasons. We've just come through the pandemic and we all know what that did to the mental health of practitioners as well as our patients. We're seeing increased levels of violence against all first responders. We have seen a lot of tragedy around law enforcement and what I tell everyone is that on all those calls that we hear about those terrible tragedies where there are deaths to police officers, guess who else was attending those calls? Paramedics. Were exposed to that same level of violence. We're raising awareness about that.
One of the key things that we focused on was Bill C3 21, which is going to raise the level of punishment for anyone who commits a violent act against a first responder to that, the same as if it were a peace officer. Because right now with myself and a police officer on the scene and we both get assaulted, the charges against the individual for the assault on me is less than the police officer. We don't think that's right, and we think that needs to be changed. Paramedics deserve that level of protection.
Another big one that we're facing right now is the lack of available data. So when you talk to policymakers and even paramedic leaders or health care leaders, if you're listening to this podcast, if I came to you as a government and said I have a bunch of money to give you to fix all of your problems, show me where your problems are right now, that would be really difficult to point to a publicly available data either on, we just talked about mental health, if I said to you what's the number one mental health strain on paramedics? Some provinces like B.C., for example, they're ahead of the curve. They have a lot of good data available. I'm sure they would want more. But in New Brunswick, we don't have a lot of information. We just scribble on the back of a napkin and say, well, these are our problems. We're seeing a lot of commitment from policymakers on making investments into fixing our problems, but we don't have the data available to justify where those needs are. Those are a couple of the biggest things.
Then I would say the other big one is around the community paramedic model. Something that's talked about across the country and it's available in pockets, but it's not really gone viral in health care. There are certain portions of the profession within provinces and there's pockets, Steve could talk to you about Renfrew County as an example. Where they have a robust community paramedic program in New Brunswick. There's not a community paramedic to be found in the entire province. Those are big things. Those are struggles we're facing.
Then I'd say like everyone else has already talked about mental health after we've just come through the pandemic, I think a lot of paramedics now are starting to feel the effects of that. We kept our chin up, kept putting on the PPE every day and treating people so just imagine how stressful it was on the public with changing standards. Well, imagine being the practitioner and dealing with all that stress and the goalposts were changing on a daily basis; wear this type of gear for this, wear this type of gear for that. It was stressful times. We worked through it all. Now when it's all over, it's like when you come off the ice after a shift to say, poof, now I really feel tired, and I think a lot of paramedics are feeling that right now. We're pushing through all that. We're seeing increased call volume across the country. We're seeing a decrease in the number of practitioners. So, there are a lot of challenges for sure.
Melanie: The one thing that came to my mind with this was I don't know that the public understands how much care, kindness, and compassion we have for people and human beings in general. As paramedics, we do this job for a very specific reason, most of us because we get a lot of value out of helping others. I'm not sure that that's accurately portrayed to the public in how much we actually care about the patient care journey and trying to make their worst day just a little bit better.
Ashley: I can give a main thing that comes around often is that our lights and sirens, it happens often: we still get cut off. People are not necessarily moving to the right. The only thing they must do is to simply slow down and move to the right. We'll do the rest. We can see and understand how stressful it can be and overwhelming for drivers to hear the sirens, see the lights, hear the lights and the sirens altogether. It is safer for everyone just to move on the side and wait for us to go by that.
Steve: I think that people sometimes may not realize the education that the paramedics have across Canada, whether it's a certain demographic believes that you know you're an ambulance driver, and it is that term, but they don't realize that you may have been to school for two or three years to come and help them in the middle of the night. Across Canada, it varies by where you are in the country on who's actually going to show up, what the training is behind the people that are in that vehicle that shows up that when you call 911. We're fortunate that regardless of the training, the people that do show up are caring, empathetic people. The challenge we have sometimes is we're making clinical decisions in the field and explaining to patients why we're not taking you potentially to the closest hospital, but we're taking you to a more appropriate hospital for various reasons and they don't understand our clinical training and the education behind paramedics in Canada.
Ashley: I think it is important to the public to get more educated on our job, how important our role is in the health care system like you said, it is not a load-and-go system anymore. We do get to treat and do something with the patient prior to transport to the hospital.
Steve: As a paramedic who's imminently going to retire, I'd like to encourage people to consider joining this profession. There will be job openings for many years as we fill roles that have been vacated as people retire. There's a large contingent and a lot of providers that are at retirement age and we will be retiring imminently. Whether you're in British Columbia, New Brunswick, Nova Scotia, Ontario, there are colleges and education opportunities out there for you and we would love to have you come and join us.
Derek: That's well done, Steve, and I think maybe I'll talk to the practitioners for a second. If we have paramedics who are listening as this is paramedic week, I just want to thank you all for serving your communities. I think it's important and most times paramedics, when somebody says thank you, you just kind of shrug and keep pushing the stretcher down the hallway because you're busy. We don't do enough of practitioner recognition. On behalf of all paramedics, and there are somewhere between 30 and 40,000 in Canada, we don't have the exact number, but on behalf of all of us, thank you for what you're doing. We're a very diverse group of professionals, and I love that. We're a unique profession that as technology improves, we're going to be the gateway to health care for a lot of people, and we're going to be the access point for people for years to come. The time to enter the profession has really never been better. There's a new national standard coming out at the end of the year that's going to raise the bar on paramedic education again. The NOCP is going away. There's a new NOSP which is going to pave the way for baccalaureate paramedics. It's going to make paramedics much more relevant in health care, it’s going to give you many more options further on in your career and it's going to change the landscape again of our profession. If you're kicking the tires on joining the profession, there's plenty of work to do and the timing is great.
Melanie is a primary care paramedic with BC Emergency Health Services as well as a clinical instructor and coordinator with the Critical Incident Stress Management program. She also has three teens and a love of promoting resiliency, not only at work but through role modelling by riding her motorcycle, going camping and paddle boarding, and skiing.
Derek is a primary care paramedic from New Brunswick. Since 2007 he has worked in various communities as a frontline practitioner and operates as a field trainer and clinical support paramedic. He is most known for his role of leadership in the domain of advocacy, working to expand the role of the paramedic in healthcare systems. He has been elected by his peers to various positions within the Paramedic Association of New Brunswick in the last decade, and is currently the President. He also serves at the national level as COO of the Paramedic Association of Canada, and sits on various committees related to professional standards and government relations. When not at work, he enjoys travelling with his spouse or playing a round of golf at the local club.
Steven has been a paramedic since May 1986 (37 years this month!). His background consists of being a Primary Care paramedic in both urban and rural settings, Ambulance Dispatcher, Advanced Care Paramedic, Advanced Care Flight Dispatcher and for the last 23 years an Operations Superintendent with a large urban paramedic service. Steve has experience in events ranging from Canada Games, Winter Olympics, IIHF Hockey, the NHL and Canada's largest Canada Day celebrations. Steve is married to a Radiation Therapist and they have 3 adult children, none of them in health care. A former director with the Paramedic Ride, he has seen the benefit of having paramedics from across Canada unite for a common goal, the camaraderie and common struggles have created life-long friendships
Ashley is a primary care paramedic in her 3rd year practicing in the northwest of New Brunswick. As the oldest of 3 siblings and generally called the “MOM” in my group of friends; she has always been instinctive when it came to taking care of people around her, or as some would prefer to say: being naturally bossy. Ironically, it turned out to be a great quality in her ability to do her job efficiently, being able to care for, as well as being a good advocate for patients. The combination of Ashley's ambitious and adventurous sides has been very beneficial in pushing her limits and being able to challenge herself. Specifically, when she decided to become a paramedic and made the decision to move across the province to take the course in her second language at Oulton College. This was an important step in building her confidence and character. Ashley strongly believes the human brain is frightened at the idea of facing uncomfortable and unfamiliar things. "I keep reminding myself that to achieve growth, it is important to learn to be comfortable with discomfort. It is something I learned at an early age and it was reinforced by becoming a paramedic."
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