Before the Regulation was implemented, a 911 call for medical assistance had only one possible service path: an ambulance to the ER, regardless of how critical the need. The Regulation, which was introduced by the CISSS de la Montérégie-Ouest in partnership with the Groupe Alerte Santé and the Montérégie pre-hospital emergency services, improves the process by promoting access to services that are better suited to the patient’s condition.

Specifically, nurses responding directly from the Alerte Santé central (911), assess, with the caller, whether it is safe 1) to redirect them to somewhere other than to the ER and 2) to use a means of transport other than an ambulance, if a trip to the ER is required. Depending on the situation, the assessment may be done with the caller in conjunction with a paramedic emergency medical technician (EMT).

The Regulation makes it possible to tailor the care trajectory based on a patient’s needs and not vice-versa. Nurses carefully assess the caller’s situation to suggest suitable options for their situation.

This project was gradually implemented in Montérégie-Ouest in the summer of 2021 to relieve the pressure on our emergency services during a particularly critical period heightened by the pandemic. The Regulation protocol is currently being used seven days a week, 16 hours a day. Around the clock coverage will be available by spring 2022.

Implementing the Regulation project required teamwork between several players who hadn’t worked together before. For the first time, alternatives to ER and ambulance services were developed between Alerte Santé and several CISSS services, including home support, medical clinics and an alternative transport hub.

Project submitted by Sophie Poirier, Assistant Director of the Multidisciplinary Services Directorate, Practice Quality and Evolution

Other contributors to the project: Claude Marie Hébert, Head of the Clinical Division; Groupe Alerte Santé; Diane Verreault, Nursing Consultant, Groupe Alerte Santé; Dr. Dave Ross, Regional Medical Director, Pre-hospital Emergency Services, CISSS de la Montérégie-Centre; Jean-Marc Breton, Regional Coordinator, Pre-hospital Emergency Services, CISSS de la Montérégie-Centre; Geneviève Demers, Planning, Programming and Research Officer, CISSS de la Montérégie-Ouest; and Jennifer Mascitto, Head of Practice Development and Evolution, CISSS de la Montérégie-Ouest