Tuesday, 30 January 2018 11:42

HSAA concerned about cutbacks hurting rural ambulance service

Written by  Jamie Rieger
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The state of ambulance service in rural Alberta is hitting the crisis stage as government cutbacks, according to the president of the HSAA union.

"Ambulance resources are in crisis in Alberta. Far too often, Albertans experiencing a health care emergency are being forced to wait far too long to get the help they need and deserve," said Mike Parker, president of Health Sciences Association of Alberta (HSAA/NUPGE), the union that represents about 25,000 health care professionals, including just over 3,400 paramedics, said in a statement issued in late 2017. "The number of events that led to emergency calls has increased nearly 36 percent since 2009, while the population of Alberta has increased by more than 15 percent. Yet, we have virtually the same number of ambulances."
Back on Nov. 15, dozens of uniformed paramedics gathered in Legislature in Edmonton to demand the provincial government provide more resources to front-line emergency care. They were also in attendance in the gallery of the legislature to be recognized for their service.
The issue first came to light in 2009 when ground ambulance responsibility was shifted from municipalities to the centralized system under the provincial health authority and has been escalating ever since and Parker warned in March when the province released its annual budget, that cuts to ambulance services to the tune of $17 million to $471 million for 2017-18 from $488 million for the previous budget year would result in more ambulance shortages and more code red alerts (when there are no ambulances available to respond to medical emergencies).
"Resources have been stretched to the breaking point. Injured and sick Albertans are paying the price for the lack of resources as they wait for help to arrive. Paramedics also pay the price with increased stress and mental health injuries that result from them not being able to provide the quality of care they believe Albertans deserve, and from working longer and longer unhealthy shifts, often with no times or bathroom breaks or meals," Parker continued.
Tilley fire chief and former EMS worker, Patrick Fabian said the situation for the frontline workers is very real and very serious.
"The front-line workers are terribly under-staffed and it started in 2009. Since then, there has not been an increase to staff or ambulances to grow in accordance with the population," said Fabian, who said oftentimes, an ambulance from the south zone may have had to transport a patient to Calgary and before returning to the south, has to respond to calls in Calgary and the city's surrounding area because they are the nearest ambulance.
"I can tell you with assurance that there will be travels from Brooks or Bassano to Calgary and then coming back, they get diverted to within Calgary, Chestermere, or Drumheller. The province says they are using the closest available ambulance, but it is the smaller centres that are being sacrificed," said Fabian. "There was one ambulance from the south zone that was sent to a call and then was delayed getting back by four hours because they had to respond to two calls in Calgary."
The big problem lies at the top, according to Fabian, who said inaccurate information is being relayed to the public.
"The other issue is their artful interpretation of the facts and denying there is no problem with red alerts and in Medicine Hat specifically. This is a systematic problem that comes right from the politicians. They double-speak everything and tell the public everything is well," he said.
"I consider the EMS my family and I have seen the struggles and the mental health issues and I can say everything is not well."
Also, as many firefighters are have certified emergency response training, they are often the first on-scene, but are limited as far as transporting the patient to the hospital.
"In Edmonton and Calgary, (EMS) co-respond with the fire department and the firefighters are certified EMS," said Fabian. "But, fire is not allowed to transport, so now the firefighters have to stay on the scene and that is how some of these red alert numbers are being manipulated."
In addition, the fire departments are not allowed by law to charge a fee and be re-imbursed for these calls.
"It is coming out of the fire department's budget and they can't be reimbursed," he said.
Change needs to start at the top, but before that can happen, acknowledgment that a problem exits has to happen.
"It has almost gotten to be like the Roman Empire. It's gotten too big with too much control," he said. "Until we get the people at the upper management level to see there is a problem, nothing will change, You will see more staff burnout, more people quitting, and more mental health issues. Upper level management is being dictated by the politicians. They spin it to tell the public there is not a problem, but it is a horrible situation with the staffing and the ambulances."
However, according to according Nick Thien, executive director for the south zone, EMS for AHS response times for rural ambulance services are meeting the targets set out by Alberta Health Services and work is being done to alleviate the workload for emergency response workers.
"For Brooks, Bow Island, and Oyen, the average response time is 6.5 minutes, so they are meeting the targets," said Thien.
Other situations such as inter-facility transfers can have an impact on that response time, including leaving the community without an ambulance and they may be dispatched to other calls after transporting their patient.
"There are times when the communities are without an ambulance. Yes, that does happen," said Thien.
"If they are the closest ambulance, they will be used, but rural ambulances are used in only four percent of the calls. Metro does 96 percent. If a Brooks ambulance is closest to a cardiac arrest in Calgary, it will be used. If it's a lower acuity situation, then it wouldn't. If that ambulance is leaving Foothills (Hospital) and comes across an MVC in Calgary, they would respond."
An ambulance making its return trip home could be called out at Strathmore or Bassano, for instance. Thien noted that the ambulances are being closely monitored during their travels.
"Our dispatcher tracks where the ambulance is at all times," he said.
Several years ago, AHS began installing non-ambulance transportation into communities to help ease the strain being put on emergency response personnel in small communities, who would often be doing inter-facility transfers for patients who did not require the emergency medical attention.
Non-ambulance transportation (NAT) has been introduced in some communities such as Brooks, Fort McMurray, and most recently, Taber. NAT vans first went into operation in the AHS south zone in 2013, with two vans in Brooks providing transport between Brooks, Bassano, and Medicine Hat. The NAT vans are staffed by emergency medical responders and come equipped with automated electronic defibrillators, first-aid kids, as well as GPS and communications equipment.
"We have six non-ambulance transportation vehicles that have been used almost 3,000 times this year. That's almost 10 times a day," he said.
Thien says under-staffing continues to be an issue in many communities, but that AHS is monitoring staffing levels.
"The staffing model is based on historic staffing and we are constantly watching it," Thien said.

(Note: this story originally appeared in the Dec. 22 of the Prairie Post)

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