Dallas Schwartz, a community paramedicine paramedic with Medavie Health Services West, describes his role as the 'Kinder Surprise' of Saskatchewan health care. Unlike traditional ambulance paramedics who often never know what happens after dropping a patient at the hospital, Schwartz gets to witness the long-term impact of his work. 'We get to see the change, we get to see people get sober, we get to see people get placed in long-term care,' he says.
Schwartz began his career as a lifeguard, inspired by watching paramedics respond to a diving board accident. Eighteen years later, after working in Yorkton, Regina, and Spiritwood, he transitioned to community paramedicine, a program launched in Saskatchewan in 2011. This lesser-known profession aims to fill gaps in the health care system, provide ongoing support, and prevent unnecessary emergency room visits.
What is Community Paramedicine?
While regular ambulances respond to emergencies, community paramedics focus on proactive care. Schwartz explains that they 'focus on the long term' by building relationships with patients. For example, if someone calls with withdrawal symptoms, Schwartz performs an assessment and connects them with appropriate services, such as home detox, therapy, or a nurse practitioner. 'Even if you're unhoused, you're temporarily displaced, you're living in a church or in a friend's apartment, we come to you,' he says.
Many patients have traumatic experiences with the health care system, and community paramedicine aims to prevent further trauma by providing accessible, compassionate care.
Follow-Up and Building Relations
Community paramedics may see the same person multiple times or maintain contact for years. Schwartz is part of the Emergency Communication Nurse System (ECNS), which responds to 9-1-1 calls where patients can stay home for an assessment instead of going to the emergency room. This allows for follow-up and relationship building, something traditional paramedics rarely experience.
Struggling Health Care System
Over 18 years, Schwartz has witnessed the health care landscape change significantly. Saskatchewan's growing population faces limited resources, long wait-lists, and burnout among health care professionals. 'We have a lot of people that are trying to find a new career path,' he notes. Schwartz emphasizes the importance of setting boundaries and avoiding the 'slippery slope' of overtime shifts. He works a 5-5-4 shift pattern, which allows him to spend time with his family without the exhaustion of night shifts.
Paramedics interested in community paramedicine must complete a two-year endorsement program, including schooling and a practicum, covering palliative care, withdrawal management, and phlebotomy. Schwartz sees about eight patients daily, comparing his days to a 'Kinder Surprise' where assembling the 'toy' involves coordinating with various support fields.
Systemic Gaps
Much of Schwartz's work involves overdoses, but he also connects patients with housing, outreach, and mental health supports. 'Just being so adaptable and accommodating to keeping people where they're most comfortable at, and giving them that equitable, accessible health care,' he says. However, services for substance use disorders, homelessness, and mental health are often at capacity. Community paramedicine allows Schwartz to stay in touch with patients until they receive the right support.
Transportation is a common barrier, as many patients lack means to attend appointments. Schwartz also conducts wellness checks in temporary housing, posting sign-up sheets for residents with health concerns. The program is referral-based, so many people are surprised when they learn about it. Schwartz describes community paramedicine as a 'short-term bridge to the long-term goal.'
