Pre-hospital chain of care
The pre-hospital chain of care refers to all the actions and interventions undertaken by various care providers to assist a person in an emergency situation.
The 9‑1‑1 emergency service and ambulance services are essential elements in the pre-hospital chain of care and are probably the best known. However, they are surrounded by other services that play an equally important role in the chain to ensure an effective response to an emergency situation.
The pre-hospital chain of care includes:
- the lay responder or designated first aider (if on site);
- the 9‑1‑1 emergency service;
- the health communication centre;
- first responder services;
- ambulance services;
Lay responder or designated first aider
A “lay responder” is a witness, a passerby, a designated first aider or any other person on the scene of an emergency. Section 2 of the Charter of Human Rights and Freedoms states:
“Every person must come to the aid of anyone whose life is in peril, either personally or calling for aid, by giving him the necessary and immediate physical assistance, unless it involves danger to himself or a third person, or he has another valid reason.”
Therefore, the obligation to provide assistance applies to anyone who witnesses a situation requiring urgent action. Do not hesitate to assist a person in distress by calling 9‑1‑1 as quickly as possible; the person’s survival may depend on it. Be aware that Québec laws protect lay responders when they provide assistance in good faith.
9‑1‑1 emergency service
In Québec, the 9‑1‑1 emergency service receives more than one million calls a year. Each 9‑1‑1 call is handled by the emergency call centre of the municipality or territory the call originates in. In just a few seconds, the person answering the call can determine whether the situation requires the assistance of the police, firefighters or ambulance services. When ambulance services are required, the call is immediately transferred to the health communication centre.
Health communication centre
Emergency medical dispatchers at the health communication centre ask simple questions to quickly determine the nature of the situation and establish the priority of dispatch of ambulance services. It is important to answer the dispatcher’s questions calmly and clearly.
If the dispatcher deems the case urgent, they contact paramedics or first responders, if the municipality has this service, during the first seconds of the call. If necessary, they stay on the line with the person in distress or the caller to give them useful advice while they are waiting for help to arrive.
First responder services
Some municipalities have a first responder service. This local service means that first responders can be sent to the scene quickly in emergency situations. First responders make sure that the condition of people in distress does not worsen while waiting for the ambulance attendants to arrive.
First responders are trained to:
- administer first aid:
- use an automated external defibrillator when a person is in cardiac arrest;
- administer epinephrine with an auto-injector in the event of a serious allergic reaction;
- administer glucagon and naloxone (available in some services).
Once the ambulance arrives on the scene, the first responders hand over responsibility for the intervention to the paramedics. The work of first responders and paramedics is complementary.
Québec has around 3,800 first responders in more than 327 municipal services. For example, the Montréal territory has around 1,700 first responders. Not all Québec municipalities have a first responder service, but new services are added every year. To find out if there is a first responder service in your municipality and how it works, contact the integrated health and social services centre (CISSS) or integrated university health and social services centre (CIUSSS) in your area. For the Montréal and Laval areas, contact Urgences-santé .
The paramedic is responsible for assessing the person's health, providing them with the necessary care and transporting them to a hospital centre. They must also inform the hospital centre of the patient's condition using the pre-hospital intervention report. This report is added to the patient's medical record.
The care provided by the emergency medical technician includes:
- administering medication such as aspirin, nitroglycerin, glucagon, epinephrine, naloxone, fentanyl and salbutamol in the event of a severe allergic reaction, hypoglycemia, difficulty breathing, opioid intoxication, heart problems and acute pain;
- using a semi-automatic defibrillator during cardiovascular resuscitation;
- doing an electrocardiogram in the case of suspected heart problems;
- assisting ventilation and breathing using various mechanical devices.
Rigorous and continuous training
Paramedics receive rigorous pre-hospital emergency care training that allows them to respond effectively to people in distress in any emergency situation. Several CEGEPs and some private colleges provide this training. All active paramedics must also complete a mandatory continuing education program each year. Through this training program, paramedics keep their skills up to date and learn the new clinical protocols essential to their work.
In Québec, ambulance services are provided by:
- private companies;
- companies incorporated as worker cooperatives;
- the public sector company Urgences-santé for the Montréal and Laval territories.
These companies employ more than 6,303 emergency medical technicians, 57 advanced care paramedics and manage a fleet of nearly 815 emergency response vehicles.
The hospital centre the patient will be transported to is determined by the emergency medical dispatcher and the paramedics. It may be the hospital where the person has a record, but the organization of services in the health network may be taken into account. Other factors may also play a role in the decision, such as:
- the patient’s condition;
- the distance to be covered;
- the specialized services offered by the hospital centre;
- the institution's emergency room capacity.
Emergency room triage
Triage involves prioritizing treatment based on the severity of the condition of each patient who goes to a hospital emergency room. Arriving at the emergency room by ambulance does not guarantee priority treatment. A person who arrived in an ambulance but whose condition is stable may be treated less quickly than a person who arrived in the emergency room by another means. If the second person’s condition requires immediate care, their treatment will be considered a priority at triage.