By Jennie Helmer, BCEHS
Imagine moving away from doing things simply because that’s the way they’ve always been done. What if there was a model where “paramedics are the clinical leaders and provide system-wide peer medical oversight based on best practice and evidence-based medicine (1). According to BC-based Paramedic Specialist Kathy Pascuzzo, this is what CliniCall -a peer-based system of collaborative and consultative care at the British Columbia Emergency Health Services (BCEHS)-aims to achieve.
She and her three women Paramedic Specialist (PS) colleagues are the leaders of a new culture, where paramedics feel safe to say, “Hey, maybe I can call up a PS, and run this by someone, because this patient presentation is new to me, or likely to be challenging, and they will have an intimate understanding of my situation.”
They began practicing their craft at a time when “eminence-based medicine” set the standards for patient care, and women were generally underrepresented in both the clinical and leadership field. In BC in 2018/19, women made up 38% of the workforce, compared to 33% in 2010/11 (2). Pioneers of a new path, these four forged their clinical practice built on communication, best practice and evidence-based medicine.
Gender inequalities in the paramedic workplace is a complex phenomenon, and the workplace has sometimes been referred to as an inhospitable place, when it comes to leadership positions (3). However, the world is changing, and so are gender disparities in paramedic leadership. The singularly, male model of leadership is becoming obsolete. The modern paramedic leader must display attributes which arguably belie the traditional male style-collaborative leadership approaches that reflect patient-centered care (4).
The Paramedic Specialist Program
Paramedics now contribute far more than just emergency care and are expected to manage a broad range of conditions in the out-of-hospital environment (5). Part of the reason for this evolution is necessity. Only a small percentage of 9-1-1 calls are from people with life-threatening illnesses or injuries (6).
Accordingly, in 2017, BCEHS undertook a number of initiatives resulting in a new role called the Paramedic Specialist (PS). The first of its kind in Canada, and based upon the Advanced Paramedic Practitioner from the UK (7), the PS program was designed to enhance the in-house Emergency Physician Online Support (EPOS) system, and provide clinical peer-support for frontline BCEHS paramedics, operating as a physical presence in Dispatch. The PS team now field the vast majority of paramedic-consults, and request EPOS involvement on a small percentage of calls. When not at the CliniCall, the specialists are out in the field, responding to calls, providing safety for tactical event, multi-agency rescues, and infectious disease response.
Supplementing the EPOS system with paramedics was unchartered territory, as historically, online emergency medical support has been the domain of physicians. This stark departure from the historical reliance on physician support, was an opportunity for front-line paramedics to be leaders of clinical change in the field, breaking the taboo that solely physician-led medical direction, improves patient safety or quality (8). Recent research into paramedic support, posits that physician-led systems represent great financial cost, and can be perceived by paramedics to provide ambiguous medical directives, an absence of support for critical thinking, and a mutual lack of trust between the physician and the paramedic (8,9)
A Focus on the Female Paramedic Specialists
Fast-forward to 2020, and of the 4,000 paramedics and dispatchers in B.C., the PS team is now 18-members strong, of which four are women. Legendary women. Accordingly, Jade, Kristina, Jodi and Kathy have shared their leadership perspectives on being a woman immersed in a peer-based, clinical consult system.
Jade Munro, PS
Jade was one of the featured paramedics on the Knowledge Network documentary television series “Paramedics: Life on the Line” (10). For months, Jade was an action hero. Camera crews captured her fearless style, her clinical-accomplishments from the highly-pressurized Dispatch Centre, to the mayhem, intensity and uncertainty of the street. In typical paramedic fashion, she was thrust into a series of complex patient presentations requiring physical feats, moments of pure charismatic leadership and wondrous glimpses of irrefutable ingenuity.
Following a stellar career as an advanced care paramedic and unit chief, work for which she received an Exemplary Service Medal in 2018, Jade was a natural fit for the PS role. Leading a team through virtual support seems to come naturally to her, and when Jade answers the CliniCall phone, one can tell from her firm and gentle tone, that she has successfully captained legions of teams through challenging calls.
“Working at the CliniCall desk gives me the ability to influence patient care well into the remote reaches of British Columbia. This powerful support system is changing practice for paramedics, and ultimately benefiting the patient,” said Jade
Kristina Anton, PS
Kristina spent countless years working as an ACP in the Vancouver Downtown Eastside; a place that both captivates the imagination and contains all the horrors, distresses and rewards that being a paramedic has to offer. Naturally compassionate, Kristina’s soft voice and gentle mannerisms, contradict her courageous and tenacious character. From early in her career, Kristina recognized that she didn’t always feel safe saying she didn’t know something, that she had questions or would like some help. She is proud to be part of a new culture and practice where paramedics feel safe to say “Hey, maybe I can call up a PS, and run this by someone,” because this is new to me or likely to be challenging. Although she knows she might not have the answer, Kristina is always ready to help talk-it-out and find a solution that will work for that moment.
An audacious and bold leader, Kristina is also mother to a toddler. She somehow finds the time to constantly seeks new roles and opportunities. Kristina says, “Being a paramedic has meant that I belong to a uniquely privileged group that are called when people are in the most challenging moments of their life, and there is immense power in these moments.”
Jodi Bender, PS
In addition to navigating a stellar twenty-year career first as an ACP, and now as a PS, Jodi also carved a career as lead instructor for the ACP program at the Justice Institute of BC for a number of years. It was here that she developed a masterful ability to assist and lead students transitioning into the next stage of their career, as they learn to meet the unique demands of paramedicine.
For Jodi, CliniCall provides a unique opportunity to share experiences, resources and provide clinical advice to crews on the front lines. She says, “I am happy and proud to be part of the CliniCall team, and our ability to act as a resource and support to paramedics in the field.”
The role of the PS often involves collaborating with multiple stakeholders to determine the best patient care plan, and communicating the strategy appropriately. Level-headed and well-spoken, Jodi has taken on a quasi-communications role within the team and is often the public-facing image of the more challenging situations common to paramedicine, and of interest to media.
Kathy Pascuzzo, PS
Kathy was one of the first female ACPs at BCEHS. She spent the majority of her career working in downtown Vancouver where paramedics are constantly thrust into abnormal situations, the call volume is tremendous, the physical demands intense and the down-time minimal. As such, she is a greatly-respected paramedic and mentor, and in 2018, Kathy was bestowed the Exemplary Service Medal for EMS.
As a naturally quiet person, Kathy found her voice within the paramedic community and has been instrumental in leading the success of some of the biggest changes within BCEHS. She was one of the first paramedics in BC to trial the concept of ACPs working in Lone Responder Units. Her leadership was particularly notable, because at the time there was uncertainty about whether women could, or even should, manage the physical demands of solo work, not to mention the perceived safety concerns. Kathy has pushed the cultural conversation forward, continues to inspire adoration in the next generation of ACPs and has proven by all accounts that women can do all the jobs, and do them well. Although, and unfortunately for BCEHS, Kathy is close to retirement, there is such excitement in her voice as she envisions the future of paramedicine.
“The biggest change in my career, has been the concept of paramedicine gradually moving away from doing things, because that’s the way we’ve always done them, towards evidence-based medicine,” said Kathy.
Though Kathy has battled through breast cancer in the last year, she is back at work full-time, as well as playing ice-hockey, riding her bike and building a travel-van with her wonderful partner Berglind. The world is a richer place with Kathy in it, her patients are so very lucky to receive her care, and her legacy of leadership continues to flourish.
Throughout history women have played obvious roles as agents of change in the health sector, not only through formal employment as paramedics but also by their contribution to health advocacy. The pioneering work, fearless character and courageous embrace of change that Bender, Munro, Pascuzzo and Anton exemplify, continues to inspire a new generation of women and will help lead the way for positive paramedic evolution and change.
With great thanks to four more amazing women-Madison Brydges, Erin Garrity, Carla Higgins and Tania Johnston, for your support with this article and for sharing your editing prowess.
- O’Meara. (2018). Self-regulation and medical direction. International Journal of Health Governance.
- APBC. (2018). Ambulance Paramedics British Columbia.
- Stamarski. (2015, Sept). Gender inequalities in the workplace. Frontiers in Psychology, 6(1400).
- Sfantou. (2017, Oct). Importance of Leadership style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel), 5(4), 73.
- Eaton. (2018, July). The evolving role of paramedics-a NICE problem to have? J Health Serv Res Policy, 23(3), 193-195.
- Williams. (2013, November). Next generation paramedics, agents of chage, or time for curricula renewal? Adv Med Educ Pract, 4, 245-250.
- NHS. (2019). College of Paramedics.co.uk. Retrieved March 2020, from https://www.collegeofparamedics.co.uk/downloads/College_of_ParamedicsInteractiveCareer_Framework16.pdf
- O’Meara. (2018). Self-regulation and medical direction. International Journal of Health Governance.
- Foerster. (2017, March). A survey of front-line paramedics examining the professional relationship between paramedics and physician medical oversight. Canadian Journal of Emergency Medicine, 238-246.
- Network, K. (2019). https://www.knowledge.ca/program/paramedics?gclid=Cj0KCQiAqY3zBRDQARIsAJeCVxP47x0jmPOxixg6ejzxQ0cCAFffM15mSYxH9UEx2xk2w3IELLNMDBAaAk9dEALw_wcB. Retrieved from https://www.knowledge.ca/program/paramedics?gclid=Cj0KCQiAqY3zBRDQARIsAJeCVxP47x0jmPOxixg6ejzxQ0cCAFffM15mSYxH9UEx2xk2w3IELLNMDBAaAk9dEALw_wcB