A Niagara-on-the-Lake native who began her career as a paramedic in town has been appointed deputy chief of the Niagara EMS.
Karen Lutz-Graul was first hired by the NOTL Hospital in 1991, before Niagara municipalities amalgamated their ambulance services to form the regional EMS.
The regional announcement referred to Lutz-Graul as the first female deputy chief, and while she’s proud of that, she says, she’s progressed up the ladder, and worked hard to be the most qualified for the position. “I don’t want the fact that I’m a woman to detract from the fact that I’ve earned this,” she says.
Along the way to her most recent promotion, she was instrumental in transforming the way EMS operates, developing two programs to reduce the volume of calls, increase efficiency, and provide better care to those who called for emergency services.
Lutz-Graul grew up on East and West Line, graduated from Col. John Butler Elementary School and Niagara District Secondary School, and completed the Niagara College ambulance and emergency care program in 1990. She was hired on as a primary paramedic at the NOTL Hospital, later earning her advanced care diploma.
In 2000, the Niagara Region amalgamated six separate EMS services, some of which had been run by the Province, and others privately operated or run by the municipalities, including NOTL.
In 2009, Lutz-Graul had the opportunity to become a training supervisor, and since she had always enjoyed teaching, took the job.
She says paramedics have to be physically fit, and “your body might not be able to do the work for as long as you’d like it to,” so when offered the training position it seemed like a good time to think about how she could continue to serve in a meaningful way, in a profession she loves.
In 2013, Lutz-Graul became the commander of quality assurance, with oversight of training and education of paramedics and dispatch, at which time she learned to do the job of communications, to ensure resources are used strategically to get calls where they need to go, and on time.
In 2018, the Region challenged the EMS, which had seen call volumes “escalate dramatically,” to find ways to operate more efficiently. About 25 per cent of the increase could be attributed to the aging populations demographic, but other than that, she says, “we had no idea why people were becoming so reliant on emergency services.”
Each year the EMS was asking for more funding, she adds. “It costs taxpayers $1.5 million to operate each ambulance, with all the necessary equipment and staffed around the clock,” and while the Region had given the service significant increases over the years to meet the demand, “they challenged us to fashion a system that would work in a very different way.”
Kevin Smith, the chief of EMS, had the insight to transform the system, to be more evidence-based in its response to calls, in part looking at a system developed in the U.K., she says.
Lutz-Graul was instrumental in developing the emergency communications nurse system, using nurses who were trained to take over some calls from dispatch, and ask more clinical questions to find out what was needed, which isn’t always a trip to the emergency room, she says. For instance, the patient could be suffering a minor illness that requires a call to a family doctor.
About 30 per cent of people actually do worse if they’re taken to the hospital, versus finding the care they need to help them at home, she says. Nurses can help identify the problems and offer more appropriate treatment to prevent further emergency calls, reducing the strain on both EMS and hospital emergency rooms.
Lutz-Graul was also the lead on the project that developed integrated health teams, another change that involves teaming paramedics with other health professionals, such as mental health nurses who are better able to determine what kind of treatment is appropriate in some cases, or falls intervention teams, which include occupational therapists.
The person who called might just need help getting up off the floor, she says, or the fall might be a symptom of something else. The right care could prevent a more serious, life-altering injury, and help seniors stay in their home.
The programs have been successful “because we work with some great partners,” she says. “All of our stakeholders help fashion the changes with us as a community, and with the community on board.”
When Smith asked her about taking on the job of deputy chief, he questioned whether she would be willing to move on, leaving behind her the work about which she is so passionate.
She said yes, and one of the reasons she is happy to take this next step is her interest in helping other ambulance services make some of the same changes, and perhaps further down the road, changes in legislation “to make this a reality across the province. We need to showcase to others what can be done.”
That being said, “our core business is still life-threatening calls. That hasn’t changed.”
Before COVID, call volumes were continuing to rise, although not at the same pace they had been, she says.
Since COVID, they have decreased substantially — people don’t seem to want to call for an ambulance at this time, which has her wondering what they are doing instead.
But the struggle in response time remains an ongoing problem, partly because of delays at the hospital, which the EMS can’t control, as paramedics wait with the patients they’ve transported. Hold-ups are created by those in hospital beds who require an alternate level of care, such as a room in a long-term care home.
The current struggle is about how to help reduce those system-wide delays, she says.
“My next step is trying to figure out how to help the system, as the population continues to age. We have to develop a system based, similar to a business, on how to meet our customer demand, tailoring the care we provide to what people really need.”
Lutz-Graul has spent most of her 50 years living in NOTL. Once both of her parents, Erna and Henry Delesky, passed away, she and her husband Mark decided to move to Burlington, halfway between his job in Toronto and hers at the old Foster Wheeler building on Glendale Ave., now the Niagara Corporate Business Centre, owned by Niagara College.
But of course, she says, “I was born and raised in NOTL, and it will always be my home. It’s such a diverse community, with so much to offer. It’s always been home and always will be.”