Dr. Andrew Travers - How One Canadian Province Is Helping Redefine Health Care - Afternoon Pint

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:14):
Cheers.
Cheers.
Cheers.
Welcome to the afternoon boy,Dog White Tobin.

SPEAKER_04 (00:20):
I am Matt Conrad.

SPEAKER_02 (00:21):
And who do you have with us today?

SPEAKER_03 (00:23):
My name is Andrew Travers.
Andrew Travers.
Dr.

SPEAKER_04 (00:25):
Andrew Travers.
Welcome to the show.
Do you have a deck of cards withyou?

SPEAKER_00 (00:30):
Mass.
It's one of the things which uhit's a tradition.
Uh in terms of meeting patientsor new friends and that kind of
stuff.
We always start off with a cardtrick and stuff like that.
And it's a one.
If I if I can bear with you fora minute.
A card trick.
A card trick.

SPEAKER_04 (00:43):
And so the first card trick on our show ever.
I don't like magic.

SPEAKER_00 (00:47):
If I can just move your phone for a second.
Again, you're going to bechecking wallets after this.

SPEAKER_05 (00:52):
Okay.

SPEAKER_00 (00:53):
So there's three calls into 911 for emergency and
stuff.
Okay.

SPEAKER_02 (00:59):
So three cards for our listeners.
Three cards are now placed facedown in front of us.
All right.

SPEAKER_00 (01:04):
So there's the first call at uh see, the second call,
and the third call.
All right.
So there's three patients afour-year-old, a nine-year-old,
and an eight-year-old.

SPEAKER_02 (01:14):
Okay.

SPEAKER_00 (01:15):
They're all okay, but the four-year-old,
nine-year-old, eight-year-old.

SPEAKER_02 (01:17):
Four four is of diamonds and the nine and eight
cart variety.
I just want to make sure ourlisteners know in case they're
getting two tears.
Okay.

SPEAKER_00 (01:26):
So watch my hands really closely.
There I just did the trick.
This one here.
What card is that one?
Oh, is it four?
And the middle one here?
Nine.
And the list one here?

SPEAKER_01 (01:34):
Eight.

SPEAKER_00 (01:35):
So four nine eight, eight, nine, four.
We send out the ambulances topick them up.
The ambulance went out to thefirst case, picked up these two
patients.
Which patients are in my hand?

SPEAKER_02 (01:43):
The eight and probably the four?

SPEAKER_00 (01:45):
Exactly.
So what's this one here?
It should be the nine.
Take a look.

SPEAKER_02 (01:48):
See, this is the best part.
Oh, there's a queen of spadesthere.
That's not a good one.

SPEAKER_00 (01:53):
But see, the deal is that 24 hours from now, anytime
we cross paths, if you bring ajoker from a card deck, I keep
the joker, and then you keep thecard track, and you can show it
to anybody you want.
But you have to keep thattradition going forwards.

SPEAKER_04 (02:06):
Okay.

SPEAKER_00 (02:14):
So literally over the course of the past 15 years,
we've had thousands of patients,residents, medical students,
paramedics, nurses in the commcenter, nurses at telehealth
swinging by saying, Oh, dearsweet Jesus, you ran into
Andrew.
Did he torment you with a cardtrick?

SPEAKER_03 (02:31):
All right.

SPEAKER_02 (02:34):
I don't understand card tricks.
I'm not a I don't spend muchtime looking into card tricks
and stuff.
Do you, Matt?
I know very little.
I mean, I I don't know reallyany.

SPEAKER_00 (02:44):
Just for your listeners that aren't there,
they both of them were justchecking their wallets as they
were just talking to you, makingsure that their wallets were in
there.

SPEAKER_02 (02:50):
I am missing a tic-tac.
Just one tic tac.
Just one.
So uh Andrew, you um you're amedical doctor, uh Nova Scotian
native.
Uh you completed yourundergraduate and uh at uh
Delhouse University, pursued apostgraduate in epidemiology at
the University of Alberta.

(03:13):
Um Fellowship of Training inEmergency Medicine with the
Royal College of Physicians andSurgeons in Canada in 1999.
Currently you are the professoruh attending medical staff in
the Delhousie Department, and mygosh, there's like a hundred
other things here.

SPEAKER_03 (03:28):
I've been lucky.
You've been lucky.
I'm blessed.

SPEAKER_04 (03:31):
Well, that's lucky.
I think that's a whole lot ofhard work.
You've been busy.

SPEAKER_00 (03:34):
Uh the thing I'm most proud of is that I'm a um
I'm the fat uh the son of six, ahusband of one, and a father of
two.
Oh wow.
And uh but most uh one of thethings I'm also very proud about
is that uh I have the best jobon the planet.
I get to work with an incredibleteam of uh paramedics, nurses,
and docs as the medical directorfor EEHS.

(03:55):
And that's my full-time gig.

SPEAKER_02 (03:56):
Wow.
So I've got to tell you how wemade our connection.
So my friend Rob, he was aparamedic.
Uh I met Rob probably in ourteens.
When he was in his 20s, early20s, I read a book by Joe
Connolly.
It was called Bringing Out theDead, and it was about a guy as
a paramedic in Hell's Kitchen.
Okay.
Long story short, the book wasamazing, read, but mortifying.

(04:18):
It wasn't totally based onreality, but it was based this
guy was an ambulance driverbefore he wrote the book, and it
had a lot of spiritual stuffincorporated into it.
It was a really interestingread.
And then when the movie cameout, Rob, my buddy, you know, I
was showing him the movie.
I was mortified, and he waslike, Wow, that's awesome.

SPEAKER_05 (04:34):
Yeah.

SPEAKER_02 (04:35):
And he decided to be a paramedic, and I thought it
was the scariest thing in theworld.
Was it because of the movie?
No, it wasn't because of themovie.
He was already on his way.
But if I watched the movie, hewas like highly endorsing of it,
like, oh my gosh, this is reallygreat.
And I was just like completelylike, oh my gosh, like
horrified.

SPEAKER_00 (04:50):
I see Rob Groom, I see Nicolas Cage.
One and the same in many ways.

SPEAKER_04 (04:54):
Nice hundred percent.
Yes, I can't disagree with that.
Uh listen, I I I heard I readthis in uh, you know, bringing
out your dead, and I immediatelywent to Monty Python, the Holy
Grail, and was like, Bring outJesus.

SPEAKER_02 (05:06):
Well, I guess my question is stemming from that
though.
It's like, so I mean, there'ssome people that pursue a
medical career, and there's somepeople that don't.
My partner, again, likes the thebiology of things of us, and I'm
mortified by it, right?
So, what made you want to uhpursue a career in medicine?

SPEAKER_00 (05:27):
I'm the youngest of six.
I come from a family ofengineers uh on the on the boys
side.
Bunch of slackers in yourfamily, and uh nurses on the
other and stuff, and so again,being the youngest of six, my
middle name is oops, and uh so Iwasn't quite sure which path I
was gonna go on.
But of all things, I was gonnabe a brewmaster.
Oh, really?
Oh wow, my undergrad was uh inmicrobial biochemistry, and I

(05:50):
was gonna work at the what usedto be the distillery uh on uh
Woodmill Road.
That's now an office interiorslocation.
That used to be a brewery, andit was just a fascinating thing
of saying I'm gonna be abrewmaster.
As I got towards my fourth yearin the undergrad, I had a kind
of a light that went off andsaid, I think I'm gonna go into
medicine.

(06:11):
And when I went to medicalschool, uh fell in love with
emergency medicine, but then Iswitched gears, orthopedics in
second year, urology and thirdyear.

SPEAKER_02 (06:19):
Wow.

SPEAKER_00 (06:20):
Uh it was my focus.
But in my final year of school,and you had to choose what you
were gonna do postgraduation,the happiest people that I saw
were people that were inemergency medicine.
And it's thanks to paramedics atthe old VG Emerge.
When I was walking through in myfirst year, and over my years,
um, it was paramedics thatwelcomed me into a family, and

(06:41):
that had a big impact on me.
And so emergency medicine iswhat I chose.
And I still am learning from myparamedic peers uh since uh
1994.

SPEAKER_03 (06:50):
Wow.

SPEAKER_00 (06:50):
That's why we call it a practice.
We never get it right.
That's why docs always use theword practice.
So it scares scares patientswhen you say practice.
You wouldn't mean you're stillpracticing.

SPEAKER_04 (06:58):
So the answer is beer.
The answer is beer.
Beer to medicine.
Uh listen, uh I'm I I thinkthey're one and the same.
I think uh beer makes Guinness'suh Guinness's uh slogan for a
long time is it's good for you.
Beer, it's good.
Guinness is good for you.

SPEAKER_00 (07:11):
It's also a source of a lot of patience that we see
in the emergency department.

SPEAKER_04 (07:14):
So it's yeah, probably that too.
Yeah, that's fair.
Yeah, you know what that youknow what Homer Simpson is?
What's that?
There's new studies thatconflict that.
No, no, no, no.
The wise words of Homer Simpson.
Alcohol, the cause of andsolution to all life's problems.
So yes.
Um, but yeah, no, uh the weactually we had a quick little

(07:36):
chat about this uh being on theo and over in the UK, about how
the the pubs are attached tohospitals over there.

SPEAKER_00 (07:42):
I don't know how they pull that off, but uh
remember when I was uh a studentin early residency, people will
be doing electives overseas andthey'd be doing the rotations in
hospital and then in betweenrounds heading to the
in-hospital pub.
And I always thought that wasreally interesting that they had
that type of thing, but also youcould smoke a pipe in said pub,
and I guess that only in the UKcould you have something like

(08:04):
that, pull it off the ground.
But nevertheless, um there's nosuch uh similar kinds of things
within the Canadian healthcaresystem.

SPEAKER_04 (08:10):
No, too bad.
That's too bad.
I don't know.
I I think I think the NovaScotia is is due for like we
have school house and thingslike that and everything for
like you know, themed churchbrewing.
So it's like, where's like thethe the medical themed brewery?
Oh my goodness.
That like we can do like uh likeuh blood donor Irish red or

(08:35):
something like that.

SPEAKER_00 (08:35):
I just think it's the color of the beer.

SPEAKER_04 (08:37):
Triple bypass IPA.

SPEAKER_01 (08:39):
Bypass IPA, yeah.
Nice.
Yeah, there you go.

SPEAKER_00 (08:42):
It's but the colors too.
You could it'd be maybe not themost appetizing uh beverage
that's out there, but you canmatch the color of the beer to
the bottle he flew with that uhthere you go.

SPEAKER_02 (08:52):
Yeah.
He's gonna ruin beer for ushere.
Shoot.

SPEAKER_00 (08:55):
We'll switch to martinis.
There you go.
Nice and clear.

SPEAKER_02 (08:58):
So so I guess today you you are the director for EHS
Emergency Healthcare Services,is that correct?

SPEAKER_00 (09:04):
I'm part of a team.

So think of it this way: anything to do with uh health or (09:05):
undefined
clinical care, when someonecontacts 911, I get to have a
hand in it.
So whether it's the back of anambulance, uh back of uh an
airplane or a helicopter or uhour teams that are out there,
anything to do with health whenyou call 911.
Um I have the good fortune ofworking with teams that help uh

(09:28):
help provide care.

SPEAKER_02 (09:29):
Right on.
And and do you find just highlevel, do you think the last few
years have been challenging incertain ways or immensely do you
feel the last few years havebeen I mean, I'm not gonna go
back to COVID, but just withinthe last few years of after
COVID, kind of getting gettingback to a normalcy.

SPEAKER_00 (09:44):
I think I'll be honest, every year that I've had
uh with the system, I think hasbeen better than the previous
year.

SPEAKER_01 (09:49):
Yeah.

SPEAKER_00 (09:49):
Okay.
I've I've been incredibly proud.
I'm excited about what happenswhen you call 911 in Nova
Scotia.
The the at the end of the day,your care begins when you call
911.
And I think that's important forNova Scotians to understand.
And that's the exciting part isthat 30 years ago when EHS
started, if you call it for 911,it always meant an ambulance

(10:13):
transport to eMERGE.
And if you call um 911 now,transport is ancillary, it's not
mandatory.
We can figure out things, dosomething different, but it
doesn't necessarily mean uh uhtransport to the emerge.
So we're doing more and more ofthat this year than we did last
year.
And last year we're gonna beable to do that.
It's everything.

SPEAKER_02 (10:32):
Yeah?

SPEAKER_00 (10:32):
Yeah, so it's not just the uh the IH is the
integrated health programs, um,but that's just one piece, one
of the tools.
A lot of times that people call911 is the worst day of their
life and that type of thing.
And we're able to kind of justask more questions.
And then sometimes that callthen is answered by one of our
nursing colleagues in the compcenter, and we don't even

(10:54):
dispatch an ambulance.
And we plug them into adifferent pathway, or we do
dispatch somebody, but as theambulance is going there,
they're speaking to one of thedocs or the paramedics or both
uh as the ambulance isresponding.
So, I mean, how it's just cool.
It's so cool that that's nowhappening.

SPEAKER_02 (11:10):
So technology's majorly helped thus far in kind
of making those connectionshappen as well.

SPEAKER_00 (11:15):
Yeah, technology, everyone's got a smartphone, so
now we're using video.
Uh, it's called text to video.
So some of the patients we'rehaving contact with, we're on
the phone with them, and we say,you know what, you're describing
things really well.
We're gonna send you a textmessage right from the comm
center.
They click on it, don't have todownload anything, and then
we've got a video connection.
And so they're like a Spielbergon scene, and they're kind of

(11:37):
controlling the camera andshowing their uh the cut and
saying, Do I need to go to thehospital to manage this cut or
this rash or whatever it turnsout to be?
But we've been doing that foralmost two years.

SPEAKER_04 (11:47):
And do you feel like that is gonna be like continuing
to do that work is going to bethe biggest thing in terms of
like because I mean obviouslythe burning question is is
ambulance wait times, right?
Do you feel like that's gonnacut that down?
Yeah, yeah.
Yeah, I I think just have youseen that over the last couple
of years since you started doingthis?

SPEAKER_00 (12:04):
I think uh absolutely.
I think when the more importantmeasure isn't is you don't
measure success by how quick itdid an ambulance get to someone.
You measure how quickly someonegot care.

SPEAKER_04 (12:15):
Yeah.

SPEAKER_00 (12:15):
So I think that's the change that we're looking at
now.
So we always ask people to say,okay, don't measure the
response, but whether or not yousaw an ambulance driving down
the street or arriving on scene.
Think about what was theinteraction between the the
caller, the family member, thenext of kin, whoever's on the
phone speaking with someonewho's actually listening.

(12:36):
And so your timed nurse isfaster, your time to uh a
physician assessment is faster.
It's just different in how we'redoing it.

SPEAKER_04 (12:43):
Right.
No, that makes sense.
Yeah, I it's not differ reallythat different than how we have
to revamp and how we think ofhealthcare in general at this
point, like whether usingpharmacists for things or using
nurse practitioners and thingslike that, right?
Right.
Some of the recent changes thatwe've seen in the last two
years.

SPEAKER_00 (12:58):
Absolutely.
And every bit of the province isslightly different.
So some of the tricks are okay,you know what?
Uh for you, you live in a ruralpart of the province and you
don't may not have much accessto resources.
And so you have to think outsidethe box and pivot and say, okay,
maybe we're gonna do somestructured follow-up with your
local pharmacist.
Um, but again, the key thing isjust that during that worst
moment of someone's life whenthey've called 911, that you're

(13:21):
able to just have more of aconversation, unpack things, and
even sometimes it's like that'sokay to wait, or you should go
into the emergency department,but it's gonna have to be by an
ambulance.
Maybe uh you're good to go onyour own, you're clear to go on
your own, and tell you what,we're gonna be on overwatch from
your home to hospital.

(13:41):
And not to sound paternalistic,but just you know, send a text
message and you get there andmake sure you're I've safe.
But if there's any problems fromthis point forwards, know that
there's a someone in clinicaloverwatch watching to see if
anything unfolds.
So again, I think that's whatpeople want.
Um the provinces just they wantsome answers, they want to know
if they're gonna be okay.
And if they have a plan, it'slike, oh, that plan's perfect,

(14:02):
you're gonna get to care fasterand in a safer way if you begin
moving now, as opposed to saywaiting for an ambulance,
because even if you ride byambulance, it doesn't always
mean that you're fast trackedthrough the merge faster.
It's quite often we'll actuallyjust drop you off at the front
door and you go into the waitingroom.

SPEAKER_04 (14:20):
I think that's a common like misunderstanding
that people seem to think thatif they go in by ambulance,
they're gonna get seen first.

SPEAKER_00 (14:28):
Yeah, it's it all depends on severity.

SPEAKER_02 (14:30):
And so I don't people still think that you
think?

SPEAKER_04 (14:32):
Um pretty sure because I've yeah, I think I I
think so.
Yeah, I I've heard people say,like, well, I'll just go home
and call an ambulance.
And I heard it like someone attriage say, like, that that that
we still triage you.

SPEAKER_02 (14:43):
Wow.
Yeah, that's terrible.

SPEAKER_00 (14:45):
I mean, good.

SPEAKER_02 (14:46):
Yeah.

SPEAKER_00 (14:47):
But it's good though.
So that's how the system'sintegrated.
So that we as a system work withour health partners to make sure
everyone's getting the rightcare at the right time for the
right reason in the right place.
Lots of rights there.
Yeah type of thing.
But it's one that uh it doeswork well.
So just people should restassured that if they're if
they're sick, so EHS health orwe're gonna get some care to
you.

SPEAKER_02 (15:07):
Going back a little bit, like what is IHF to someone
that doesn't really understandit?

SPEAKER_00 (15:11):
I I think the the word that we'd be using is IHP.
Sorry, IHP.
Yeah.
Yeah.
So you got me stuck in the IHFpart.
Um sounded like something likeMission Impossible movie and
that type of that.
The villain's IHF.

SPEAKER_02 (15:24):
Oh, I I mean, anyone's listened to this show
before as I struggle withacronyms to a fault.
So no one will be surprised youuh coming back to listen.

SPEAKER_00 (15:31):
He's he's gonna Andrew, he's gonna be calling
you something else.
It's all right, maybe No, so theI is integrated and the H is
health.
And then it's a program forintegrated health programs, or
and that's where it's a uh acluster of people, a group of
people, medics, nurses, and docsdoing things differently.
But also it's the IHP medic,integrated health paramedic.

(15:55):
And that's uh like Rob Groomthat I personally interviewed,
was one of our first uh kind ofIHPs, and they're woven through
different areas there's uh theseparamedic Jedi that are uh
either in the calm center orthey're in um non-transport
capable ambulances called singleresponse units.
Oh, cool.
But these paramedic Jedi's thatare out there are are doing

(16:18):
things a little bit differently.
And I think uh whether it's anintegrated health program or
it's integrated healthparamedic, that's the the that's
the secret sauce, I think, goingforward.
So we're gonna be doing thingsdifferently.

SPEAKER_02 (16:30):
Was that practice brought in from like other parts
of the world or was that can'tcome in from here?
Like did do was that innovativehere?

SPEAKER_00 (16:36):
It innovated here, but also learned from other
places.
And so it's a bit of a blendedmodel.
Um our very first integratedhealth paramedic would have been
a paramedic that was in like thecommunication center, um,
dedicated for providing clinicaldecision support.
There's always been paramedicsin the communication center, but

(16:57):
one focused entirely on clinicalhelp, and that began a long time
ago.
And then the next integratedhealth paramedic that came out
was a paramedic who responded tolong-term care facilities, and
they kind of brought theemergency department to
long-term care facilities tokeep seniors uh safe at home,
suturing, providing antibiotics,those types of things.

(17:19):
So those were innovations kindof born in Nova Scotia that
other provinces, other countriesare saying, like, wow, that's
really cool.
We should be doing that here.
And then we started learningfrom other places about that
mobile integrated healthparamedic.
So these people that uh would beout as single providers, kind of
roving, and there's a few placeswithin North America and and

(17:41):
elsewhere that's doing that.
I'm always hopeful we can getEMS motorcycles and that type of
stuff.
But again, I people listening tosay, oh geez, you said EMS
motorcycles.

SPEAKER_02 (17:51):
Why EMS motorcycle?
I'm curious.

SPEAKER_00 (17:53):
I come from a motorsport family, so I married
into motorsports.
I've been extremely lucky.
My wife got her motorcyclelicense well before me.
I know it's a conflict ofinterest being an eRGE
physician, but being amotorcycle uh fan, but I can't
help it.
Yeah, we don't have motorcyclesyet for our paramedic Jedi, but
uh maybe someday.

SPEAKER_04 (18:09):
That would be kind of badass.
You just have like all yourmedical devices on like
saddlebags.
To put the star on the top ofhis helmet.
I think like Inspector Gadget.
You've been to the UK.
Yeah.

SPEAKER_02 (18:22):
Yeah.

SPEAKER_04 (18:23):
So I I think I I think you know what?
Listen.
So if anyone's listening, youknow, give it some investment
here.
Premier Houston, like let'slet's get some investment in
some motorcycle.

SPEAKER_00 (18:33):
No, I've been that we've been incredibly lucky that
all forms of government havebeen incredibly supportive of us
moving the needle forwards.
And I have to thank someone whoisn't with us anymore, but Ron
Stewart.
Ron Stewart was the uh you're onmy page.

SPEAKER_03 (18:45):
You're reading it right off the page, you're
beating me to my own notes.
So Ron is still here.

SPEAKER_00 (18:49):
He is the he is the S in EHS.
Um Ed Kane is the E in EHS.
These are the the kind offorefathers that that uh kind of
created EHS.
And so um we've been reallyfortunate.
That's reason why when you askabout, you know, how are we now
post-COVID?
We're in a really good place.
I think it's really exciting.
I think there's lots of people.

SPEAKER_02 (19:11):
I don't feel like that's the public perception.
In fairness, if I talk to fivepeople in a day, they'd like, oh
man, I was in the ER for sixhours because I when I broke my
arm, and they'd be, you know.
You'll be in the ER for longerthan six hours if you just broke
your arm.
Yeah, yeah.
Yeah.

SPEAKER_00 (19:23):
But the uh you share with the vignette.
I was on uh I was on one of thedocs in the box, a doc in the
comm center.
And I was working there onSunday, and there was a a
patient that called in from Ron,Nova Scotia for her um her her
mother.
Yeah, and it was a 911 call.
And it was for um it was for theperson having some pain in their
their mouth, some dental pain,and they were terrified.

(19:44):
And they so they called 911.
We do what's called secondarytriage where we'll call patients
back and stuff, and we spokewith this daughter and her mom
and put it on a speakerphone,and we then unpack things and
simply had a conversation aboutokay, what's going on, here's
what we can do, and use thatgood sound video to kind of look
and have an examination of kindof the tooth that was bothering

(20:06):
her.
And usually what happens whenpeople call 911, they would say,
Don't eat or drink anythinguntil the paramedics get there.
And we're like, okay, theparamedics we can get them
there, but let's try thesethings and come up with a plan.
15 minutes we were on the phonecall with this patient.
And by the end of it, they wereboth happy, they were pleased,

(20:28):
they had a plan.
We de-escalated a whole bunch ofthings, and we came up with a
safe care plan kind of goingforwards.
And it was all done in uh weweren't changing their wishes of
of uh calling 911 and expectingto go to hospital.
They were calling 911 saying, Ineed some help.
Right, and I can't explainwhat's going on.
And the daughter says, How longhave we been doing this?

(20:50):
And it's like, we've been doingthis for four years.
It was our four-year birthday ofhaving like a doc in the calm
center.
And it's like, why haven't weheard about it?
And it's like, well, it's it'sone where we don't want people,
you know, calling 911 when it'snot an emergency.
We still want people to payattention to their instincts.
But for me, that was that's asuccess.
And I think I wish you couldjust bottle it up and then show
that uh comfort that's providedto people in their homes when uh

(21:15):
what began is the worst day,which prompted them to call 911,
uh, ending in something which isreally positive.
And I'm really lucky every timeI'm in the comm center, I have
it's a story like that, storyafter story after story.

SPEAKER_03 (21:29):
Amazing.

SPEAKER_04 (21:30):
Yeah, it just goes to show you that like people are
gonna go with their theirfeelings and kind of how they
feel at the time or whetherthey're listening to good
information or not, or whatever,right?
Like I said, you know, if you'regonna go to the emergency,
you're gonna sit there and waitfor longer than six hours.
But that being said, youprobably should.
I mean, you know, if you I Iplayed football and I've had

(21:51):
many broken things, and I've satin the emergency for a decent
amount of time, eight, ten hourssometimes, uh, for broken
things.
But it that's not an emergency.
I need to be at the hospitalbecause I need to get x-rays and
I need to get cast.
I can't go to my family doctorfor that.
But I'm also not having a heartattack and I'm not or I'm like
whatever, right?

SPEAKER_00 (22:09):
Like But the I it's a my it's a great point.
I think everyone defines theirown emergency and stuff like
that.
And I think yeah it's what we'rethere for.
If people are in uh in uh a paincrisis, they're in a uh crisis,
and so we never want to talkpeople out of paying attention
to their instincts.

SPEAKER_03 (22:28):
Yeah.

SPEAKER_00 (22:28):
And it's that's one of the common things which you'd
always tell people when I was inthe emergency department as an
eREG doc was we're gonna sendyou home and here's the
instructions.
Um, and pay attention to yourinstincts.
If you can't explain what'sgoing on, then that's what we're
here for.
And it may be frustrating, maybelong waits, and it may be doing
something different and thatstuff.
But I'm really proud of both oureMERGE colleagues and the EHS

(22:50):
system saying we can do things,we can maybe do things
differently.
And I think that's where we'rein the change right now.

SPEAKER_02 (22:56):
Cool.
And I mean, how about LakeAvenues like 811?
Are you finding those are beingwell utilized today?

SPEAKER_00 (23:01):
It I absolutely and I think that's that connection
of how do things flow from an811 system into a 911 system,
911 into 811 back and forth,it's really just predicated on
communication and using theright words and being there in

(23:22):
the moment when someone'stalking, letting them talk and
and noticing the the signalthat's uh in that what maybe
noise to you or conversations asto what's going on, and then
making connections and stuff.
But I think it's not justbetween 811 and 911.
We make referrals to 211 a lot.

SPEAKER_03 (23:40):
211.
What's 211?
I don't even know.
Well, this is uh this is ahidden gem.
I the um there's three one one,there's two one one, one of
those too many of them.

SPEAKER_00 (23:50):
You call 511 for the weather.

SPEAKER_03 (23:51):
Yeah, and then I didn't know that was a thing.

SPEAKER_00 (23:53):
But this is uh for me, um when I was in the
emergence department, I used tohave a social worker who would
be there to help with uh thingson discharge from the eMERGE.
As a comm center physician, twoone one was our proxy for it.
So you we may have medics thatare seeing someone saying, I'm
I'm I'm seeing a senior.
It's the fifth time we've seenthe senior this month for uh

(24:16):
falls and uh stuff.
But she's never wants to go tohospital.
She has capacity, recover safeplans.
In some areas of the province,we make a referral to a falls
clinic right from the paramedicsassessment.
But part of the discharging planwe do with the medics is saying,
Well, have her contact 211because she needs to get some
supports for some aids, someambulation aids.

(24:38):
Um if there's people that we seethat have um needs for food or
needs for navigating uh somesystems, I don't know how to
take steps towards getting powerof attorney on my uh father who
is showing some signs of uh uhAlzheimer's or has been
diagnosed with Alzheimer's.
I don't know how to navigatethat.

(24:59):
A number of these things, thisis where that uh resource, like
two in one, is really helpful.

SPEAKER_02 (25:03):
So I think as patients call the system, we
have all these agencies that canwork together differently and
collaboratively, all focused onthe So you would call 811 and
say, okay, my you know myfather's showing kind of scary
right now, he doesn't know wherehe is, you know, this type of
scenario, and you'd call 811 andthey might end up pulling into
211 depending on how they surveyyou.

(25:25):
Is that how it would work?

SPEAKER_00 (25:26):
I don't know from the 811 side specifically in
terms of protocols, but theillustration, I wouldn't be
surprised if someone called inand said, you know, my my family
member's acting differently.
That's appropriate for the kindof 911 side.
Uh saying, okay, was it a Qchange or not?
So I wouldn't be surprised tocome over.
But that doesn't mean anemergency department visit.
It means, okay, maybe what we'regonna do is we're gonna have one

(25:46):
of our team reach out.
And it could very well be thenurse in our comm center reaches
out and says, tell me more.
We have no, we have all the timein the roll, but let's unpack
this and stuff.
They get information and theymay make the decision saying,
you know what?
I think this is a patient'sgonna benefit from having a set
of eyes on them.
Maybe just make sure his sugarsaren't low, make sure his vitals
are okay.
So we're gonna send out one ofour paramedic Jedi, the single

(26:08):
response units, head out to itand stuff.
And now they're eyes on scene.
And now they're actuallyevaluating the patient, and they
then call back and speak withthe doc in the calm center.
And they say, okay, what are wegonna do?
And then this is where the theteam, the medics on scene, the
nurse, the doc and the calmcenter, take this and say, All
right, here's gonna be the plan.
We're gonna um give thefollowing information to the the

(26:32):
the caller who startedeverything, saying, All right,
here's the plan.
We're gonna maybe have youcontact 211 for kind of next
steps with things.
We're gonna get you to look atthe EHS special patient program
so we can get your fatherenrolled into it, so we can have
a a case-specific tailored planfor your dad in the event of a
911 call, kind of focused onkeeping him at home or keeping

(26:55):
him managed.

SPEAKER_02 (26:56):
That's brilliant.

SPEAKER_00 (26:57):
But this is it's it's simple.
It's just people talking withoutuh uh rushing through things or
having a G-jerk response.

SPEAKER_02 (27:04):
Communicating with each other on a on a and
listening deeply to kind of getto the core of what our problem
is.

SPEAKER_00 (27:10):
The colleague of mine, Jeff Fraser, gave me his
beautiful quote 20 years ago andhe said, you know, Andrew, the
911 system of old used to bethat there was uh we were
looking through the peephole ofa door, a keyhole of a door.
It was short, it wasconstrained, it was limited, it
was a 90 minute, 90 second ortwo-minute health assessment,
but all you could see was whatyou could see through the uh um

(27:31):
that little keyhole.
Where we're at now today withthe teams in place and all of it
is we've opened the door.
You're seeing an entire 360,you're seeing we've opened the
door, and whether the patient'scoming to us or we're going to
the patient, the door's open andit's all built on communicating.

SPEAKER_02 (27:48):
Wow.
Pretty cool.
It's awesome.
Now that I understand like themechanisms to work behind in the
background.

SPEAKER_00 (27:54):
Next step will just make a 9-1.
It'd be faster to dial, just9-1.

SPEAKER_04 (27:57):
Please, please.
Uh just out.
I don't know.
You know, uh you might have moreuh more pocket missed dials.
Yeah, more missed dials.

SPEAKER_00 (28:05):
Yeah, I've been guilty of those.

SPEAKER_04 (28:07):
Yeah, yeah, exactly.

SPEAKER_00 (28:08):
So dear Trevor's just calling again.

SPEAKER_04 (28:12):
So okay, so um I know there was a question you
had there in the that you wantedto kind of ask about.
Um you had a good one here whereit says like uh you have a lens
of emergency and pre-hospitalcare.
So if you want to ask that.
Oh, go ahead, ask that.
Uh so how has the lens informedlike uh informed what you think

(28:33):
the system's strengths andliabilities are?
So like I guess kind of give usan idea of like, you know, this
is what it's really kind of madethe improvements on, and this is
what we kind of need to reallywork on because you know, this
is where there may be some gaps.

SPEAKER_00 (28:46):
I think the improvements is that we have
empowered paramedics to practiceto way beyond anything in many
ways uh compared to otherplaces.
We've in Nova Scotia have faithin paramedics, that's why
they're self-regulating.

unknown (29:01):
Yeah.

SPEAKER_00 (29:01):
Whether it's the implementation of a college, I
think they, as clinicians, areuh fantastic.
And I'm honored to work withthem.
I think that is one of thesuccesses.
And everything we do in EHS isthanks to the paramedic
professionals that are outthere.
I think the the liability, therisk part is sometimes we're
victims of our own success.

(29:22):
And we have to we can helpthings, but then we we have to
be cautious on everyone thenrelying on the 911 system, on
the each system to fill in thegaps.

SPEAKER_04 (29:34):
Yeah, like not having a family doctor.
Right.

SPEAKER_00 (29:36):
And it's the the idea is saying, okay, uh we
always be cautious on saying,oh, I'm gonna call 911 because I
need a prescription refill formy blood pressure medication.
Now it may be that they'reterrified and really worried
about it.
It's like, okay, so maybe we'regonna do we're gonna take that
911 call and we're gonna plugyou into the virtual care
options that the healthauthority is.

(29:57):
Or the it's called VUNS, whichis a virtual urgent nursing, uh
virtual urgent care novoscope.
But these are the illustrationsof kind of just asking more
questions and having a rationalconversation and plugging that
in to a different pathway, evenwith that live.
Ability of saying, okay, I don'tknow what else to do.
I'm I'm lost.
So I'm ending up calling 911.

(30:19):
I just think it's uh that'swhere the area of risk are where
they uh maybe filling in somegaps, which are not in the
original kind of uh uh when thepremise of that really wasn't a
9-1-1 call to begin with.

SPEAKER_05 (30:30):
Right.

SPEAKER_00 (30:31):
Again, we'd always tell anyoscotians rely on your
instincts, you know your bodyand that stuff.
So um we're never gonna talk topeople a 9-1-1 call.
We just want to providedifferent pathways.

SPEAKER_02 (30:39):
I got a not so intelligible question, maybe.
Are you charged if you call9-1-1 you shouldn't have?
Like, don't you get a charge?
No, so the I thought that forsome reason in my head.
I thought if you like called itfor like whatever in a week, is
it by the police?
No, no, but if you called it anddidn't, like, you know, it
wasn't for a good enough reasonat the end of the chair.
I don't know why, believe me.
If you were prank calling them,maybe yes.

SPEAKER_00 (31:01):
No, so that uh it's a great question.
Yeah.
So the there's only an ambulancefee if you're transported to
hospital.

SPEAKER_03 (31:09):
Okay.

SPEAKER_00 (31:10):
And so the and the reason for that is
multifactorial.
It's one of the big things at afederal level, is that the
Canada Health Act doesn'tconsider an ambulance transport
a medical intervention.
It doesn't make any sense.
Wow.
So so every province hasambulance fees tied into it.
So it's federally though thatneeds to change at the Canada
Health Act.

SPEAKER_02 (31:29):
So 250 a trip, is it for a little bit?

SPEAKER_00 (31:32):
750 a trip?
No, it's a hundred uh andforty-ish dollars for an
ambulance transport.

SPEAKER_04 (31:39):
But from I'm pretty sure wasn't it like an event of
a car accident?
It's like 700 bucks orsomething.

SPEAKER_00 (31:43):
Yep.
And for a car accidents, I'drefer your listeners to the
website because I want to makesure I'm not getting the numbers
correct.
But yes, uh, there when there'sthird-party billings like an
insurance company, um, thenthere's a higher related cost.
But relatively speaking, it'snot like someplace in Canada
where they charge both anupfront cost and a per kilometer
cost.
It's very expensive.

SPEAKER_04 (32:03):
It's like Uber.
The US cost.
No, oh, I bet I I learned aboutthat one day.
This is where I'm gonna insert aquick little plug about buying
travel insurance.
Yeah.
There you go.

SPEAKER_00 (32:15):
But the the important part though is if
you're not transported, there'sno cost.
And so one of the questions washow often does a non-transport
happen?
So of all 911 calls, um at leasta third, more than 33% of calls
we don't transport.

SPEAKER_05 (32:33):
Wow.

SPEAKER_00 (32:34):
We treat and release, we follow up on these
patients, we're doing thingssafely, we're applying different
pathways.
So one in three ambulance callswe don't transport.
And that's the regular paramedicteams.
The paramedic single responseunits, when we send them out,
they have a a 60 to 95%non-transport rate.

SPEAKER_02 (32:52):
60 to 95?
Correct.
But that's only five percentthen, as low as wow.

SPEAKER_00 (32:57):
So it means that most cases they're not
transporting, meaning there's nocost borne by the person.
Yet they're getting treatment athome, a palliative care patient,
so on and so forth.
And so um it's one um it itsurprises everyone when we tell
them those numbers.
We thought every call went tothe emergency department.
It's like, no, actually, yeah,only the again, 33%.

(33:18):
And it's been like that for avery long time.
And the idea is we want to wewanna make those numbers even
more efficient, uh, so that wecan still do more treat and
release, more treat and refer, Ishould say.

SPEAKER_04 (33:30):
It's in it it's it's interesting because I mean, like
because EHS is a privatecompany.

SPEAKER_00 (33:35):
No, no, so the uh the that's a a common
misconception.

SPEAKER_04 (33:38):
Okay, I thought it was, yeah.

SPEAKER_00 (33:39):
No, so EHS is a public utility model, and we're
one of the only public utilitymodels in North America, which
means Nova Scotians own it.
Oh, okay.
So EHS is a section ofgovernment, it's the that's the
regulator.
Yeah, and that's where I'm inpoint.
I'm uh have a contract with uhMinister of Health or with uh
within DHW.
And EHS is that arm ofgovernment that oversees the

(34:03):
clinical care protocols, theassets, the uh device, all those
equipment and stuff which areout there.
And in a high performancecontract, our co-lead is EMC.
And EMC is the the the companythat you're referring to, which
is part of Medivh.
And so there's the best way ofthinking about it is that EHS is

(34:24):
the what, and that's government,and then EMC is the how.

SPEAKER_04 (34:28):
So it I guess for anyone to understand it, it's
almost like kind of like Halifaxwater.

SPEAKER_00 (34:32):
It's the many way to describe it.
That's why we use the termpublic utility model.
And for us, as a public utilitymodel, we've got a
responsibility for umhealthcare.

SPEAKER_03 (34:42):
Right.

SPEAKER_00 (34:42):
But that's only one part of it, and that's the like
what happens during the 911call.
We have a responsibility thoughfor public safety.
That's the next 911 call.
And we also have responsibilityfor public health and community
health, and that's the all theprevious 911 calls that we can
then use to inform things andwork with our partners
differently so we can keepcommunities healthy and safe.

(35:03):
So those three things as apublic utility model healthcare,
public safety, and uh publichealth are the main drivers.
But EHS, yeah, is uh he has awing of government.
And that's where my uh my officeis located.
I'm in the good fortune ofworking in the Department of
Health here downtown in Halifax.

SPEAKER_02 (35:22):
Wait, pretty cool.
I'm learning tons of stuff, bythe way.
So thank you so much for beingawesome.
This is very informative.
Yeah.
I have another thing here.
So uh that friend of mine, Rob,when I you know texted him early
this morning and said, Hey man,what should I ask this guy?
You know?
He gave me a couple suggestions.
And this one I thought was quiteinteresting because I didn't
know anything about it.
Um, but I guess the goal here,help me understand the quintuple

(35:48):
aim in Nova Scotia.
First off, what is theQuintuple?
How could that be described?
I'm gonna murder Rob.

SPEAKER_04 (35:59):
Rob, you were gonna have to call 911.

SPEAKER_00 (36:02):
If you can ask Rob what the square root of 72 is,
there's gonna be a big longpause.

SPEAKER_04 (36:08):
We can shorten this up, don't worry about that.

SPEAKER_02 (36:11):
No, no, I I'm I'm I'm I'm thinking um with regards
to precisely for what thequintuple aim is and for those
that are uh I guess first a highlevel for for you know a lot of
us are like me, we we might noteven I I didn't know 211 existed
in this in this in this episode.
I mean, what does that evenmean, the quintuple?

SPEAKER_04 (36:29):
Well you have graphs and charts.

SPEAKER_00 (36:31):
Well, no, it just means it kind of depends in
terms of which group you'retalking about, the quintuple
aim.

SPEAKER_03 (36:37):
Yep.

SPEAKER_00 (36:38):
There used to be that there was uh frameworks
around um if you're providinghealthcare, you could have it
fast and good and cheap.

SPEAKER_04 (36:49):
Oh, this thing.
Okay.

SPEAKER_00 (36:50):
And then you have to choose two of those three
things.
You could have a fast, good, itwouldn't be cheap.
And then it kind of migrated,and people started using this
quintuple aim of saying, allright, there's a few things
there with regards to there's apatient experience, uh
population health, providerexperience, equity, and the
associated cost around things.
I think whatever definitionwe're using for it, that has to

(37:12):
be in the DNA of the EHS system.
We need to be everything we'redoing needs to go back and kind
of be uh tested against it.

SPEAKER_02 (37:19):
How it kind of measures against those five
pillars.
Right.
Right?
Yeah, yeah.

SPEAKER_00 (37:22):
But there's one thing if I can, just um there's
one uh I'm a geek.
You said at the beginning, likesay Andrew, you did a master's
in epidemiology and stuff.
What does that mean?
There's for me the quintuplethings that we can do to improve
lives in Nova Scotians isthere's five things we can do in
healthcare.
Everything that we do uh uhroutinely is what we call

(37:44):
secondary health prevention.
What that means is people arealready sick and we're
preventing the disease fromgetting worse.
They have a heart attack, weopen up the blockage.
They have a knife sticking intheir chest, we take the knife
out and fix things up.
But they have the disease andwe're preventing it from getting
worse by giving them life-savingtherapies.
That's the mainstay of whatsecondary health prevention is.

(38:05):
But then there's these four ofthe things we could be doing as
an EHS system.
Oh no, this is really boring,but it's one of those things.
But the first thing isprimordial health prevention,
reducing the presence of riskfactors.

SPEAKER_01 (38:16):
Okay.

SPEAKER_00 (38:17):
Yeah.
Primary health prevention,reducing people's access to
those risk factors.

SPEAKER_02 (38:22):
Good example.
I left a rake standing up onetime in the garage, and then
Andrea walked into it and gave areally big egg on her forehead
right before she had to get herpicture taken for something.
That's right.
What I could have done is nothave that rake there, right?
You know.
Preventively.

SPEAKER_00 (38:36):
The primordial prevention would have been put
that rake away.
Yeah.
The primary health preventionwould have been, hey, uh, Mike,
watch out for that rake.
The tertiary health preventionis getting people back to
baseline.

SPEAKER_02 (38:47):
Right.

SPEAKER_00 (38:48):
Quaternary health prevention is spread in medical
air.
So the one of the questions issaying, all right, as an EHS
system, we've got the quintupleaim that we can look at and make
sure we're doing things.
But in my world, the clinicalworld, are we doing everything
we can for the communities thatare out there?
How we can use our data and thattype of stuff to make
communities safer.

SPEAKER_02 (39:06):
How would you implement like a guy like me
that leaves a rake?
Well, that's a silly example, Iknow, but like how would you
implement something?

SPEAKER_00 (39:13):
Well, we we pre-filled the Darwin Awards uh
form put that in place for theself-inflicted rake injury.

SPEAKER_04 (39:20):
I always took a drink there.

SPEAKER_00 (39:23):
But I'll give you an illustration about trauma.
So one of the illustrations isthat data from EHS helped inform
legislation about ATV usage.

SPEAKER_03 (39:32):
Right.

SPEAKER_00 (39:33):
It helped then actually uh put legislation in
delimiting the use of ATVs byminors.
Uh primordial prevention wasteaching youth on making sure or
putting mandates in saying youhave to wear a helmet if you're
operating ATV.

SPEAKER_02 (39:46):
You're seeing all these kids or whatever coming in
the ER, and you're just like, mygosh, this could be preventing
with just some pretty simplemeasures.

SPEAKER_04 (39:52):
You know, I'm gonna I'm gonna go I'm gonna go there.
Get your damn kids vaccinated.
How about that one?
Whoa, whoa, cool off there.
No, it's because like I saw areport recently that it was like
25% of all the Scotians don'tvaccinate their kids for
measles.
25%?
Ew.
I didn't know that.
I was like, yeah.

SPEAKER_02 (40:12):
That's that's a scary thing.

SPEAKER_04 (40:13):
Yeah, you're right, I agree.

SPEAKER_00 (40:14):
Your templar artery is throbbing there.
I can see that pulsating.

SPEAKER_04 (40:18):
Oh yeah.
Like parents who don't get theirkids vaccinated, it's just like
they're like, oh, but likebefore they can edit up.
The day before kids died at theage of two.
I don't disagree, but we'regonna move on.

SPEAKER_00 (40:29):
Uh so just we're the guys that couldn't temple, I'm a
fan of it, but I'm a bigger fanfor the five things we can do to
every single community to makethings safer for us.

SPEAKER_02 (40:39):
So one is kind of look and see what's happening.
What are the biggest problems inthe community?
Is that bringing the most peopleto the ER or causing the most
deaths or injuries?

SPEAKER_00 (40:46):
Or well, let me give you one other quick example
opioid use disorder.

SPEAKER_03 (40:49):
Yeah.

SPEAKER_00 (40:50):
So that's uh rampant right across Canada.
What has EHS done been doing totry to help out to minimize the
risk of opioid bad outcomes?
Primordial prevention.
We use a program within oursystem here to identify when
synthetic opioids first arrivedwithin Nova Scotia.
And we use that's called firstwatch.
But data in the communicationcenter that could help inform
where some of these uh hot spotswere.

(41:12):
Primordial health prevention.
Anytime a paramedic is in theback of the end of the year.

SPEAKER_02 (41:16):
You're basically saying, sorry, like so people
come in the air, you're gettingthe postcode or whatever, and
now you're seeing geographicallyall these folks that are
overdosing.
Nope, nope upstream.
Sorry.

SPEAKER_00 (41:24):
During the 911 call, there we have uh programs that
sit in that pay attention tocertain words that can be found.
It's like Shazam on your phone.
And it's called first watch.
We use it for syndromicsurveillance.
But a simple idea of if we putsome things in, we want to know
when carfentanyl entered theNova Scotia system.
So we put in the termcarfentinyl.
Or during COVID, if there wasever any diseases that were

(41:47):
happening where there was uhclusters of things during the
911 call, it would help identifythese hot spots.
That intel can then be used withour agencies to help identify
hot spots, reducing the presenceof risk factors uh in the
community.
But the primary healthprevention is when a medic is

(42:08):
with somebody and teaching themabout an overdose, advocating
for them, saying it's okay to goto the eMERGE or whatever.
Secondary health prevention,yeah, these naloxone kits and
how to manage opioidemergencies.
Tertiary health prevention ishelping that overdose
rehabilitate back.
Maybe they're not transferredthe eMERGE, but giving them an
alloxone kit again, pluggingthem back in, advocating for

(42:30):
them.
And quaternary healthprevention, the last one, the
fifth one, is the whole idea oflooking at errors.
A senior citizen who ismisdosing her medications,
taking too much of a narcotic,our medics are picking that up.
And so being able to identifythat, flag it with the
pharmacist or flag it with thepatient or the family member.
So the illustration is we'remeasuring success of our e-age

(42:54):
system by adding to all five ofthose domains of kind of health
prevention, primordial throughto quaternary.
Now I know all theepidemiologists that are there
are going like, rock on Travers,I'm so excited because you're
talking about epidemiology,health prevention.
But that's the uh epidemiologygeek in me, more so than the
quintopolame.

SPEAKER_02 (43:12):
100%, yeah.
And I mean and there must behealth factors you see in in in
in in your field as well, whereyou know preventative health
measures, like just on a highlevel from what you're eating,
what you're doing, you're areyou exercising.
I know these things soundcontrived, but they probably
make a tremendous difference.

SPEAKER_00 (43:26):
It does.
Uh they the the question which Iuse quite often in merge was
what were you thinking?

SPEAKER_02 (43:32):
Oh, gee guy.

SPEAKER_00 (43:33):
That caused this thing, oh you're right.
I shouldn't have walked into therake as I was walking into the
house in the middle of thenight, having left the rake out
there.

SPEAKER_04 (43:40):
Yeah, no, get it.
Yeah, 100%.
So we have some questions onthese pillars.

SPEAKER_02 (43:45):
Well, yeah, I mean something we kind of really go
through.
I mean, you know, you're reallytouching a lot of this back kind
of going back to this QuinnTemple aim thing.
So some of the uh pillars thatthey talked about were things
such as patient experience,where we which we really touched
on a lot already today, I think,especially the fact of how
you're relating it throughdifferent uh different parts of

(44:06):
the healthcare system and stuff.
I think that's great, right?

SPEAKER_00 (44:09):
I hope the patient experience is positive.

SPEAKER_02 (44:10):
Yeah.

SPEAKER_00 (44:11):
And that the their their experience isn't defined
by an ambulance rolling up, buttheir experience is being
defined by what they uh what'shappening after the conversation
when there's colonymal one.

SPEAKER_02 (44:21):
Okay, and then I guess the next one here, like
one on population health.
So we kind of just talked aboutthat very briefly, with you
know, being healthy uh obviouslywill have a tremendous impact on
how many people go to the ER.
Um however, you know, we alsohave an aging population in Nova
Scotia.
Um so that will eventually atsome point probably put more of
a strain on the industry.

(44:41):
I mean, are there issues likethat that kind of keep you up at
night right now that you think,oh, gee, we have to be prepared
for what's coming in terms ofthis or that?

SPEAKER_00 (44:49):
Yeah, they the absolutely that that population
is a very exciting one to workwith.
Keeping seniors um fit, keepingthem at home is one of the whole
mainstays that we've been doingwith an illustration of uh a
senior who has a fall, referringthem into a falls clinic.
Again, right from the scene bythe paramedic without having to

(45:10):
transport the hospital.
Through to the other end of uhwe used to have a we have
programs which was adopt asenior, uh, where paramedics,
the integrated healthparamedics, would follow up in
seniors um out uh in thecommunity.

unknown (45:23):
Dr.

SPEAKER_00 (45:23):
Judah Goldstein, who's a primary care paramedic
PhD, who's uh one of ourresearch leads in the province,
his specialty is pre-hospitalgeriatrics.
He is a world-leading paramedicresearcher on how we can improve
the lives of seniors in theprovince.
So it's not gonna be achallenge.
We welcome it.
And this is gonna be veryexciting for people to have

(45:45):
generations of uh good health inNova Scotia.

SPEAKER_02 (45:48):
That's a great answer.
Yeah, yeah.
I mean, and I I guess anotherone I'm throwing these out
pretty quick, and I do.

SPEAKER_00 (45:54):
You're being kind of listening to have a sip of your
beer, man.

SPEAKER_02 (45:56):
Have a sip of your beer.

SPEAKER_00 (45:57):
I feel bad you got the most beer here out of all of
us, so we uh I'm just thankfulthat you're giving me the uh the
resolution of the the five itemsof the quintuple aim.
So I'm gonna track down rightafter this.

SPEAKER_02 (46:09):
Well, only part of this.

SPEAKER_04 (46:18):
Well, in particular, this next question I think is
actually or next topic I shouldhave.
This next topic is really.

SPEAKER_02 (46:22):
Yeah, so I mean, and and like again, uh uh one thing
I know, I mean, again, I have afew close friends that are in
the healthcare world, right?
Uh burnout.
COVID.
Oh my dear God.
Like, I mean, there was never asadder time to see, you know,
how much this the system wasstrained when people were being
forced to work beyond 12 hoursand beyond 24 hours, I think, in

(46:46):
some crazy circumstances.
It was insane.
And as a result, I think we lostpeople.
We lost people from thatindustry forever, right?
And some people, you know, endedup having you know uh mental
health uh uh crises andeverything else you could think
of, right?
And that's really unfortunate.
Um what do you what do you thinkis the way out on that?

(47:07):
How do we get better in thoseareas for yeah, fix morale and
burnout for for burnout moralein this in this industry that's
so demanding?

SPEAKER_00 (47:15):
I think the for me, first responders have the uh
have this uh the solution.
Um for transparency, um I was inNew York uh during 9-11 on uh at
ground zero for the first 16hours.

unknown (47:30):
Yeah.

SPEAKER_00 (47:31):
And uh one of the questions was, oh, you must have
had some significant injury fromit.
No.
And the reason being is that uhpeople that I was traveling
with, one was a paramedic, aprimary care paramedic, her name
was Stephanie, and she was myresearch coordinator that I was
working with when I was in NewYork City.
And I learned from her thiswhole idea of diffusing,
debriefing, and normalizingokay, that wasn't right.

(47:54):
And doing that while things werereally fresh kind of set things
in motion for me.
Again, that was 2001.
Twenty-four years later, I'mstill learning from uh our first
responders.
And there's a simple thing whichwhen they talk about operational
stress injury that can then overtime lead to burnout and injury
and that type of stuff,permanent injury, but
normalizing that wholeconversation and the whole

(48:16):
program road to mental readinessis using some simple words uh
like are you green?
Uh you kind of normalize thislanguage.
And I remember there'd be timesWhat does are you green mean?
Like new?
So green, no, green means thatthings are okay.
You're having some, you'reyou're functioning normalizing.

SPEAKER_03 (48:33):
Okay.

SPEAKER_00 (48:34):
Then there's there's yellow, orange, and red.
It's a way of kind ofnormalizing the conversation,
saying, okay, we just had we'reyou the three of us are managing
a case in the eMERGE or in theback of the ambulance or
whatever.
It's bad.
And I'm asking you, say, Matt,are you okay?
And you can come back and say,I'll get back to green.
It's a way of kind of we're inan unspoken way saying, Okay,

(48:56):
I'm a little yellow.

SPEAKER_04 (48:58):
Right.

SPEAKER_00 (48:58):
You're not having to unpack things, personal items
are there, but it's in thelexicon, it's in the vernacular.

SPEAKER_02 (49:05):
And I think that Yeah, you're just kind of
checking the temperature of theroom, I guess, or the person.
Yeah, so is the cultureremissive of that, you think,
though, at this point?
Like everyone's kind of doingthat?
Because sometimes it's like ifyou know someone asks, You're
good, you're like, Yeah, I'mgood, even if you're going
through hell.

SPEAKER_00 (49:18):
Personally, I think so.
I think paramedics and otherfirst responders, this is in
their DNA of helping each other.

SPEAKER_03 (49:25):
Cool.

SPEAKER_00 (49:26):
Personally, I think it all falls apart when you get
to hospital.
That I think there's a lot ofthings that we can learn in
hospital that we're not doingthat could be learned from that
theater, which is uh the out ofhospital environment.
So at the end of the day, uh uhdefusing, debriefing, speaking
about it, I think is healthier.
And uh I'm really proud of myparamedic colleagues for showing

(49:48):
me a way to keep me healthy.
Again, being the youngest ofsix, uh, husband of one, a
father of two, uh, in a waywhich I was able to protect my
family.
And my I I think the the nextsteps is still coming from um
more lessons to be learned fromour paramedic colleagues.

SPEAKER_04 (50:05):
Yeah.
So next is how do we afford itall?
But I mean, like it's seriously,like uh, you know, we have
obviously a finite amount offunds and and uh in the last
couple of years we've seen uh uhat least provincially, we've
seen a government that hasinvested heavily in the Well,
none of us want to be payingmore taxes right now.

SPEAKER_02 (50:26):
I mean we're all stressed.
I mean, we all see the financialpinch probably more than ever.

SPEAKER_04 (50:30):
Yeah.
But we've seen some majorinvestments in in healthcare in
the last two years.
And uh I mean, how where whereare you seeing that we could um
see some efficiencies where wecan change some things?

SPEAKER_00 (50:42):
Great question.
Uh EMS motorcycles.
I'm kidding.

SPEAKER_04 (50:47):
Best I can do is mopes.

SPEAKER_02 (50:48):
That's right.
EMS scooters.
Yeah.

SPEAKER_00 (50:52):
So I'll give you an illustration that it probably
best drives this.
Uh someone has a heart attack,they have a blockage in their
artery.
We can give a medication tothem, which is really expensive.
It's called tenectoplase or TNK.
It's a clotbuster.
And it used to be only given byuh academic cardiologists and
academic centers, but not TNK.
It was a previous version calledTPA and streptokinase, but these

(51:13):
clotbusters.
It was time sensitive, time ismuscle when someone has a heart
attack.
It then went from cardiologiststo um uh emergency departments,
but only academic emergencydepartments, not all emergency
departments.
And then went from all emergencydepartments to saying, well, how
could we actually reduce thetime to treatment?
If time is muscle, uh, maybethat same medication could give

(51:34):
them the back of the ambulance.
And that's why I started doingresearch on down in Edmonton
when I was doing anepidemiologist eMERGE, and what
drew me to Nova Scotia was thenotion is maybe we can give them
the back of the ambulance.
Now, when you give theseclockbusters, it doesn't mean
that they're then getting themagain in the emergency
department, but you're shiftingthat uh medication and the cost
with it upstream to when there'sthat first medical contact, the

(51:58):
back of the ambulance.
And if you do that earlier, yousave more lives, patients do
better, there's cost savingswith it.

SPEAKER_05 (52:04):
Right.

SPEAKER_00 (52:04):
So I think there's a number of things that we can do.
Without putting new dollars in,it's just okay, now we need to
start doing that same thing forother diseases.
Pre-hospital antibiotics,recepsis.
Oh, doesn't mean they can.
100%, but that's the beauty ofthe EHS EMC partnership, of EHS

(52:31):
being a public utility model.
It's one of the most efficientmethods of EMS system design.
And again, it goes thanks to RonStewart and Mike Murphy and Ed
Cain, the kind of help createthis.
Because if you create healthcarein a high performance system
like this, that introduces asone of the main pillars of it is
economic efficiency.
Uh that it's an efficient way ofdoing things because of the the

(52:53):
improved mortality morbidity ofpatients.
So, yeah, I don't think it meansnew dollars.
It just means uh investingexisting dollars into these new
pathways.
And a lot of it is shifting uhthings.
So in Nova Scotia, uh ourformulary, our drug box has
almost 50 medications in it.
Five oh.

(53:13):
Whereas most EMS agencies havemaybe a dozen.

SPEAKER_04 (53:17):
Wow.

SPEAKER_00 (53:18):
So for me, and I think that's good.
That's really good.
Yeah.
And then there's things there,but again, this doesn't mean
cost duplication.
It means we're just shiftingsome of those treatments to the
back of uh uh the that firstpoint of care that it isn't uh
that you again, your carebeginning when you arrive in the
emergency department.
The emergency department carebegins kind of when you're
calling 911.

SPEAKER_02 (53:37):
Even the integration of stuff in drug stores, like
now you can go there for strepthroat and last time.
Last time I had strep throat, Ithink last year I I called uh on
my phone, showed my throat, andhe gave me the medication,
picked it up.
Brilliant.
I'm like, thank goodness Ididn't have to see anybody for
this, right?
Because you know, I knew what itwas, my partner knew what it
was.

SPEAKER_00 (53:57):
He had a man called, those things are terrible.

SPEAKER_02 (54:00):
100%.
Yeah, so I mean, thank you forsurviving through that.
I appreciate it.
So that was the hard part'sover.
Um we had a fun kind of bonusprompt here.
If you were asked to pick of a apillar uh in Nova Scotia, um
which is behind, or or if youdidn't want to do that, or a

(54:21):
pillar that you say, we're noteven looking here, we should be
looking there also.
Either or what would you say,what would you pick?
What would you say that issomething that we should be
doing better?
Or we're not looking at.
Well, however you want to answerthat.

SPEAKER_00 (54:40):
That's a fat great question.
Uh a pillar for me is the thewhole community health and
population health of acommunity.
I think that is the directionthat EMS is heading towards.
People think uh um EMS is theword that people use.

(55:02):
I think it's less emergency,more medicine, and definitely
services.

SPEAKER_01 (55:06):
Okay.

SPEAKER_00 (55:07):
So this whole idea is that uh we're we're not just
taking care of a patient.

SPEAKER_02 (55:13):
Sorry, yeah.

SPEAKER_00 (55:14):
We're taking uh care of uh communities.
And I think that is the thedirection we're heading.
Okay.
I think that's where EMS, thechallenge, is being given to us
more broadly.
But I think that is uh thatongoing new pillar that we're
kind of creating.
But we need the Nova Scotians'help to consider that.

(55:35):
Yeah, it's one that uh againbegins with people understanding
if you call 911, it doesn't meanan ambulance transport to an
emerge.
It can be something different,and how we get there, we do that
shoulder to shoulder with them.

SPEAKER_02 (55:46):
You know, I mean you answered a lot of I mean, I'm
looking through some of my otherstuff here, and we actually,
Matt went through a lot of thisstuff, I mean, right up until
about the 50-minute mark that Ihad here scheduled.
So, I mean, and and plus I wantto get into our fun, dumb
questions, because that's thebest part of this show is when
we ask you questions that reallydon't mean anything.

SPEAKER_04 (56:04):
And then just before we get into that, I think I did
the tech stuff.

SPEAKER_02 (56:07):
Yeah, sure.
Let's let's yeah, I think weshould cover up some of the
tech.
So the last bit, I mean, okay,well, there's there's there's
two things.
I have compliment a complimentin I'm gonna go way back up to
that here.
Uh a lot of stuff here on you,man, because I was nervous for
this one.
I didn't want to mess this up,you know.
My buddy Rob and Andrea, I wouldhave got in trouble if I didn't
do a good job here at Uh.

SPEAKER_04 (56:27):
On top of that, it's a topic that we, you know, as
dummies don't know anythingabout.

SPEAKER_02 (56:31):
It's something we don't know almost we knew
embarrassing little about, so Ikind of overprepared.

SPEAKER_00 (56:36):
You guys have great insight into that.

SPEAKER_02 (56:37):
So thank you.
Yeah.
Uh uh, but uh any of the nursesthis is a compliment to you.
Uh any of the nurses working inthe IHP program have nothing but
great things to say about himand truly love working with him.
He is the best, and he'sawesome.
Direct quotes, lol.
There you go.

SPEAKER_04 (56:54):
I'm I'm less card tricks now.

SPEAKER_02 (56:57):
And his characters are corny.
Oh, I didn't read that one.
I thought it was kind of rude.
But uh, but yeah, so I guess thelast bit that Matt and I we we
were talking about this thismorning, it's something that
excites us because it's I knowit's it's a theme of 2020 uh
five.
Unfortunately, what like it ornot, AI is here.
And and seeing how this is goingto play into healthcare.

(57:20):
I mean, obviously, I I think Idon't know if you know this, but
like just recently, ChatGTP tooka step back and basically
stopped diagnosing peoplebecause too many people were
calling in with their ChatGTPdiagnosis thinking that they had
issues.
Going in and seeing it, and it'slike, I think there's you're
going on about vaccines.
I mean, there was um, you know,uh, if you look deeply enough

(57:42):
into Chat GTP, there'd be thingslike, well, there's cyanide in
the vaccines, but when you lookat it, that type of cyanide
might be different from the typeof cyanide that you'd be
extremely concerned about or adifferent chemical element.
So anyway, so I uh it'sobviously having its challenges
now because it's you know uhwell as it provides us a
generous amount of good greatinformation, there's a lot of

(58:02):
misinterpreted information andmisinformation.
Like, how do you see thisplaying a role in the next few
years to come?
Are you looking at it closely?

SPEAKER_00 (58:10):
Yeah, and it's already already here.
So I'm I'm proud that the umthat our system is incorporating
AI into the communication centerso that we're able to uh move
patients more efficiently andrecognizing patterns and that
type of stuff.
So as opposed to relying upon uhuh uh just a person kind of

(58:31):
listening and saying, okay,we're gonna match this resource
to that patient's need, havingsomeone's AI tools in the
background can make it a bitmore efficient.
There's other items there toowhere AI can be helpful right at
the the coal face during the 911call, where the person's
answering questions, but there'ssomething uh noise, a signal in
the noise as the person'sspeaking that AI can be used

(58:54):
saying, the person said theyweren't short of breath, but we
picked up on the person you'rehearing it.
You can hear it exactly.
Right.
And it's not to replace thathuman judgment, but just to kind
of put alert on it.
They said no to the key directedquestions, these close-ended
questions that the dispatcher orthe call taker is using, but AI
is being uh uh is kind ofpicking that up in the

(59:15):
background and saying, okay,it's a a discordant finding, a
bit of an alert that comes up.
Right again, not to override thedecision, but as an aid to it.
And you guys and the cool thingtoo, just to show you where the
technology is, the phones have athing, the way they sample from
top to bottom, it can pick upsubtle variations in perceptible
human eye.
So the tool that I was talkingabout with Good Sam video,

(59:36):
right?
When we do that with patients,we can click a feature.
When I'm talking to them, theirheart rate appears next to their
image.
I'm not even touching them.

SPEAKER_03 (59:44):
Well, wow.

SPEAKER_00 (59:45):
Because it's recognizing the oscillations and
the person's color.

SPEAKER_04 (59:48):
When do we get robot doctors?
Is that asked?
Drones.
Yeah, yeah, there you go.
Yeah.

SPEAKER_00 (59:54):
But that technology is there.
And we were just getting backfrom Denmark, and in Denmark,
they were using that technologyduring the 9 1 call taking
process uh for people that werein cardiac arrest and saying,
look, I think you should startchest compressions to the
collar.
Based on what you're saying, Ithink the person doesn't have a
pulse, and the person's like,Well, I think they're breathing.
No, those are what we callagonal respirations.
We want you to start chestcompression.

(01:00:14):
And the person's like, no, no, Ican't.
In Copenhagen, they were doingresearch on it where they took,
I could send a link to yourphone, hold your phone over top
of the patient.
And that is able to determine ifthere's any kind of pulsatile
blood flow.

SPEAKER_05 (01:00:25):
Wow.

SPEAKER_00 (01:00:26):
And with that, we can say, okay, no, I can tell
you there's no blood flow there,start chest compressions, and
they would.
It improved the accuracy.
So the technology side ofthings, uh, whether AI or it's
the software or the apps, Ithink we've got an obligation of
matching that tech to thepatient's needs in a positive
way.

SPEAKER_02 (01:00:44):
I'm gonna ask you a weird more philosophical
question on this.
So so here's here's thechallenge.
So we use this technology, andit we we've all medically got to
this point where we're at herenow in life and society.
I mean, are you we have any fearthat the research was stopped?
Like we want to keep going?
Like so if we start relying onAI heavily enough that you know
we we uh No we not uh I think II think you can't beat human

(01:01:07):
conversation.
Yep.

SPEAKER_00 (01:01:08):
There's tones there.
You can tell that there's a soulon the other end of the phone on
both ends.
And uh people help people.
And I don't think AI can dothat.
And I think that whether it's byphone or video or on site, uh
humans are still gonna be here.

SPEAKER_02 (01:01:22):
So that deeper human level and intuition still kind
of gonna override certainthings, certain feelings, no
matter what.

SPEAKER_00 (01:01:27):
Yeah, humans will have a gut impression, and that
gut impression speaks volumes.

SPEAKER_02 (01:01:32):
No, I believe that.
100%.

SPEAKER_00 (01:01:33):
Like that rake outside in the hallway that you
walked into saying, youshouldn't have gone that route.

SPEAKER_02 (01:01:40):
Anyways, do we want to move to 10 questions?
I think it's time we move on toour 10 questions.

SPEAKER_04 (01:01:45):
So this is a fun little game we kind of throw
some semi-rapid fire, right?
Okay here, I'll kick it off withnumber one.
So welcome to 10 questions.
Here we go.

Question number one (01:01:53):
if an ambulance call had a theme song,
what do you think it would be?

SPEAKER_00 (01:02:00):
Theme song.
Uh the James Bond uh introtheme.
Oh, okay.
Like Goldeneye kind of thing.
No, like the ding-ding-ding dingding ding ding ding ding ding
ding ding ding ding ding dingding.

SPEAKER_02 (01:02:14):
I like it.
I thought it'd be a little morepunk rock personally, but but I
I still like it.

SPEAKER_04 (01:02:18):
Yeah, like, you know, dun dun dun dun dun kind
of like I personally, if youwant people's attention, I think
it should be like immigrantsong.

SPEAKER_02 (01:02:24):
Oh that was just playing as the signs are going,
you're pretty cool.
Ah that'd be pretty cool.
Okay.
If you could add one fun orokay, if you could add one fun
or ridiculous feature to everyemergency room in Nova Scotia,
what would it be?

SPEAKER_00 (01:02:43):
Doodle boards.

SPEAKER_02 (01:02:44):
Doodle boards.

SPEAKER_00 (01:02:46):
Yeah, every every patient server should have a
doodle thing so you can doodleon it, and that stuff, uh, I
think it should have that.

SPEAKER_02 (01:02:52):
That's great.
Medical etch a sketch.
I was hoping for like soft serveice cream, where you just be
like, oh, I'm gonna do a littlesundae while you're there.

SPEAKER_04 (01:02:58):
You know, uh while you're waiting.
I certainly would take that.
All right, question numberthree.
In an alternate reality whereyou were a musician instead of a
physician, what would yourinstrument of choice be?
Drums.
Oh, that was quick.

SPEAKER_00 (01:03:12):
You like playing drums now?
I air drums, which I sock at.

SPEAKER_04 (01:03:17):
Right.

SPEAKER_00 (01:03:17):
Yeah, it'd be drums.
I just I I love uh percussion,the precussion drums.

SPEAKER_02 (01:03:23):
All right, cool.
Question number four of you.
What's one thing that you thinkall people should have in their
home to help them in a medicalemergency that most people do
not have?
That they don't have.
So think of something that youknow you should have in your
home in case of a medicalemergency that you may not have.

SPEAKER_04 (01:03:47):
Or if it's no, maybe it's like a metal straw for a
tracheotomy or something.

SPEAKER_00 (01:03:52):
Jeez.

SPEAKER_02 (01:03:54):
Um or or or we we could solve that up.
Maybe something that's thatthat's advisable to have to
avoid a trip to the air, like uhto check blood pressure or uh uh
anything like that.
Is anything of those thingsreally great to have in the
home?
Like a blood pressure cuff or uha good a good tweezer.
Good set of tweezers?

SPEAKER_00 (01:04:13):
Yeah, you know what good tweezers is a good everyday
carry item, have it in the kitavailable.
One the Lee Valley one thatactually is like on the
keychain, that is a uhguaranteed win.

SPEAKER_04 (01:04:27):
Can't sleep on a good set of tweezers, I agree.
We have like four or fivetweezers, and there's only one
I'll use.
Oh, yeah?
Yeah.
I got we have quite a fewtweezers too.
I live with two girls.

SPEAKER_00 (01:04:35):
Really good tweezers.
I'm sorry that took so long.
No, no, no.
It's a great question.
No, you were reaching for thedefibrillator because I took so
long to answer.

SPEAKER_04 (01:04:42):
All right, question number five.
What's one of the most bizarrethings that you have seen in the
ER that you can legally tell us?

SPEAKER_00 (01:04:55):
A moose foot in someone's abdomen brought in as
a major trauma.

SPEAKER_01 (01:05:00):
Whoa.

SPEAKER_04 (01:05:01):
Like the foot.
I'm thinking car accident.
I'm thinking, I'm thinking caraccident.
Yeah.
So yeah.
Yep.

SPEAKER_02 (01:05:09):
Wow.
So what'd they do?
They saw it off the the moosefootball.

SPEAKER_00 (01:05:13):
No, no, no.
The patient was uh was uh didwell in that type of stuff, but
yeah, a moose foot in someone'sabdomen.

SPEAKER_04 (01:05:20):
Wow, okay.
Gotta get my moose by.
Number six over to you, man.
All right.
Holy.

SPEAKER_02 (01:05:25):
If if you could watch one last movie from all
the shows you've seen in yourlifetime, which one would you
pick?
I guess we're asking for anall-time favorite film.
Uh Aliens.
Great movie, dude.
Yeah.
Cheers to that.

SPEAKER_00 (01:05:38):
I can do Aliens Karaoke.
I can turn the volume off.
I got all the lines memorized.
I love that movie.
Fantastic, it's Aliens.
Yeah, number two.

SPEAKER_02 (01:05:46):
Are you watching the new show?

SPEAKER_00 (01:05:47):
Yes, Alien Earth.

SPEAKER_02 (01:05:48):
Enjoying it?
I did.
Okay.

SPEAKER_00 (01:05:50):
I love the pink pan reference.

SPEAKER_02 (01:05:51):
I gotta finish it, but uh most of the way through.

SPEAKER_00 (01:05:53):
Okay, no spoiler.
I loved it.
Yeah, aliens.
Fantastic.

SPEAKER_04 (01:05:57):
Question number seven.
So what we saw one tonight, butwhat is your favorite card trick
that you've ever performed?

SPEAKER_00 (01:06:05):
Um, my favorite card trick is the next one that I do
for my wife.
Oh.
I love her reaction when I do acard trick.
She's been married for 30, over30 years, and she is my uh I
love doing a card trick withher, and that is my next
favorite.

SPEAKER_04 (01:06:21):
I love it.
That's a great answer.
Great answer.
Yeah, yeah.

SPEAKER_02 (01:06:24):
All right, number eight over to you.
Okay.
What is the bad habit?
And please don't say beer, um,that could likely result in the
most ER visit.
You jumped a nine.
What?
Did I where we at?
Oh, sorry.
Okay.
I'll just get I'll finish thisone and then we go to U reading.
Um, what's the bad habit thatlikely results in the most ER
visits?

SPEAKER_00 (01:06:45):
Uh the river disease.
What's the river disease?
Yeah, denial.

SPEAKER_04 (01:06:50):
Oh, what a bad joke, bad pun.

SPEAKER_00 (01:06:52):
Uh, it's it the most common thing is people um they
don't pay attention.
And it kind of goes back to theconversation before.
Uh, it's pay attention to yourinstincts.
Yeah.
Uh I can't say enough.
You know your body, your familyaround you knows you, and if
something's not quite right,seek help.

SPEAKER_04 (01:07:08):
All right.
Question number nine.
Your likeness has been casted inthe ER-based soap opera.
Who plays you as the actor?

SPEAKER_00 (01:07:16):
Um, the fellow who is in uh Knight's Tale, he's
British, he played Chaucer.
Um the voice he was in theMarvel universe, he played uh
computer guy.
Um, oh yeah, okay.

SPEAKER_02 (01:07:32):
Uh uh Vision, the guy that played Vision?
Uh what's his name?
Gosh.

SPEAKER_04 (01:07:35):
Yeah, he all he was also in the the the what's it
called, the Tom Hanks moviethere.
Great actor.
Paul?
Paul Biemini.
BMini?
Biemen Biemini.
We'll just call him our friendPaul.
Yeah.
Yeah.

SPEAKER_00 (01:07:48):
He's a fellow albino.
Um are you albino?

SPEAKER_04 (01:07:51):
No, I just like it's and the last question.
All right.

SPEAKER_02 (01:07:57):
Um, you wrote this in.
I did.
Can you can you take a look atthe mole on my back?

SPEAKER_04 (01:08:09):
There's too much hair there.
I can't make it through thehair.
Okay, so this is really funnytoday.
Uh he sent me over these 10questions, and all he had for
question 10 was when.

SPEAKER_02 (01:08:19):
Oh, did I not finish it?

SPEAKER_04 (01:08:20):
No, it was just when.

SPEAKER_02 (01:08:21):
Oh, geez, I probably just sent it.

SPEAKER_04 (01:08:23):
So I'm gonna finish that.
I was like, you know what?
I'm gonna start this.
I'm gonna make him ask thatquestion.
You did a perfect job.
Yeah, good job.
That was a great question.
10th question.
But last call.
Yes.
So we have a last call, which iswhere we ask you for advice that
you were given in your lifetimethat you would like to share
with us and our listeners.

SPEAKER_00 (01:08:45):
Just stay connected with family.

unknown (01:08:47):
Okay.

SPEAKER_00 (01:08:48):
That's the uh that's the my advice to my kids, uh to
my family, to my friends, mycolleagues, people that are
important to me is just uh stayconnected with your family.
You can't beat it.

SPEAKER_02 (01:08:59):
Great answer.
That's awesome.
Thank you so much for your time.
We really enjoyed this.
We learned a ton.
You're welcome to come backanytime you want to talk about
any issue.
We would definitely welcome thesecond round of the new year.
Thanks again.
Awesome.

SPEAKER_03 (01:09:11):
Thank you, folks.
Stay well.

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Dr. Andrew Travers - How One Canadian Province Is Helping Redefine Health Care

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Dr. Andrew Travers - How One Canadian Province Is Helping Redefine Health Care