Ontario Expanding Innovative Models to Deliver Better, Connected Care in Middlesex-London

Published on May 05, 2021

MIDDLESEX-LONDON — The Ontario government is launching new 9-1-1 models of care to now cover 33 municipalities across the province. These new models of care will ensure paramedics have more options to provide safe and appropriate treatment for patients while helping to protect hospital capacity as the province continues to respond to the third wave of COVID-19.


Details on Middlesex-London’s model of care, which began in 2020, were provided today by Jeff Yurek, MPP for Elgin-Middlesex-London. 


“I am very proud that the provincial government is supporting the delivery of specialized rapid care when and where patients need it most,” said MPP Yurek. “The success rates already being reported locally are a testament to the dedication of the Middlesex-London Paramedic Service and indicate that this is an effective model for use across the province.”


Currently, paramedics are required to bring 9-1-1 patients to overcrowded hospital emergency departments, even when there are other appropriate care and treatment options available in the community. Under the innovative patient care model pilots, eligible palliative care patients and those experiencing mental health and addictions challenges can receive appropriate care by the paramedic directly or in the community as appropriate. The patient will remain in ultimate control of the care they receive and can at any time request to be taken to the emergency department.


“Throughout the COVID-19 pandemic, we have seen more than ever how critical it is for patients to receive timely and effective care – when and where they need it,” said Christine Elliott, Deputy Premier and Minister of Health. “As Ontario’s hospitals face unprecedented capacity pressures during the third wave of the COVID-19 pandemic, these new models of care will enable our world-class paramedics to support our most vulnerable patients in the most appropriate setting, while avoiding unnecessary emergency department visits.”

In Middlesex-London, the Middlesex-London Paramedic Services (MLPS) has implemented this pilot in collaboration with the Canadian Mental Health Association (CMHA), from March 2, 2020. Four- and eight-month result submissions indicate an 88% overall satisfaction rate and 95% in service effectiveness to address patient needs. Over 95% of cases that received community-based care did not need to visit an emergency department within 72 hours.




“Through phase 1 and 2 of the MHA Alternate Destination pilot, Middlesex County has been proud to support an alternative pathway that will ensure community members in mental health crisis are supported.  Phase 1 and Phase 2 demonstrated success in achieving many program objectives – including reduction of ED visits, decrease in ambulance offloading time, and enhanced individual and caregiver perceptions of care.The Province of Ontario has recognized the value of this essential program, and acknowledges how the MLPS MHA Alternate Destination is a great example of how we can support alternative pathways to ensure that all patients are going to the right place for the right care.” Cathy Burghardt-Jesson, Warden of Middlesex County


“In the 12-month study of Phase Two, 345 MLPS patients were accepted for the MHA Alternative Destination which saw 240 patients accepting transport to 648 Huron Street, 94 accepted mobile crisis response service, and 29 accepted Reach Out services. Success of this valued program has been proven with 97 % overall positive experience reported by patients, 0 adverse patient outcomes, and 94% successful discharge to CMHA Crisis Service.” Chief Neal Roberts, Middlesex-London Paramedic Services


Each pilot project will be in place for one year, after which it will be evaluated to assess outcomes, identify where program adjustments may be needed, and how to implement new models of care throughout the province.



  • To date, 9-1-1 models of care pilots have been approved for implementation in regions across Ontario covering 33 municipalities, with additional details to become available in the coming weeks.


  • Under the Alternate Destination model, specially trained paramedics assess the patient’s condition on-scene, per the Patient Assessment Standard of the Basic Life Support Patient Care Standards, followed by transport to a local hospice for palliative care patients, or to a local crisis centre for patients experiencing symptoms of mental health and addictions challenges. This model is currently available in select regions for both palliative care patients and patients experiencing symptoms of mental health and addictions challenges.


  • Under the Treat and Refer model, specially trained paramedics treat palliative care patients on-site in their home, which can include administering medication for pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Once the patient has been treated, paramedics would directly coordinate follow-up care with a local hospice or the patient’s primary palliative care team to provide longer-term treatment options. This model is currently only available for palliative care patients in select regions. 


  • Patient eligibility criteria varies from model-to-model. Paramedics responding to 9-1-1 calls for select palliative care patients and mental health and addictions patients will conduct an assessment on-scene for eligibility to participate in new models of care. If patients are not registered, paramedics would ask the patients on-scene if they would like to be registered with their local centres in order to be eligible for the next time they dial 9-1-1.