Back when Ron Stewart was starting out as a young doctor he worked with a public health nurse in the most remote corner of the already remote island of Cape Breton. Nurse Isabel MacDonald knew everybody in the region, and thanks to her trusted relationship with the community members, Stewart realized that she was preventing potential illnesses at a rate far greater than he could ever cure them [source: Meek].
This early example stayed with him for the rest of his career, long after he had made a name for himself in the U.S. and returned to Nova Scotia. As the Minister of Health, not only did he standardize emergency services in the province, he pioneered an innovative form of paramedicine [source: District of Muskoka].
Inhabitants of the remote islands of Long and Brier off the southwest coast of Nova Scotia were having trouble accessing medical care. Stewart helped develop a pilot project in which paramedics stationed on the islands would not only react to emergencies, but they would also go out into the community and do what they could to prevent them. This might involve answering health-related questions over a cup of tea, administering medications or recommending the best shoes to wear to avoid falls. The results were dramatic: Visits to the hospital on the mainland dropped by 24 percent to 28 percent between 2001 and 2006 [source: Accreditation Canada].
The model has been so successful that it has spread around the world from Scotland to Australia. In San Francisco, for instance, a program that sent paramedics out among the homeless population helped reduce 911 calls by 75 percent over the course of a year and a half, saving roughly $12 million. In Colorado, a community paramedic leads fitness training courses at a senior home and makes home visits to ensure elderly community members are taking their prescriptions correctly [source: Johnson].
Programs like these are promising, but unless funds are specifically set aside for a project, paramedics and other caregivers will encounter a major stumbling block. Federal rules say that prehospital caregivers get paid only when they load somebody into their ambulances and move them to or from a health care facility [source: Johnson]. These rules may change in time.
In 2005, Ron Stewart hosted 50 delegates from the U.S., Canada, Scotland and Australia at a conference called the International Roundtable on Community Paramedicine (IRCP). Since then, the IRCP has been going strong with meetings held every year around the world [source: IRCP].