Ambulance service called into question

© Lethbridge Herald photo by Ian Martens- Non-emergency transfers are causing frustrations among some EMS workers who are worried about losing timely ambulance coverage in their areas when transfers force ambulances to travel out-of-area.

By J.W. Schnarr
Southern Alberta Newspapers
Ambulance service in Alberta is a borderless system designed to inhale and exhale as needed, with metro areas drawing in rural ambulances during shortages, and expelling service to those communities when shortages occur.
The problem with that metaphor, say some, is that those inhales are too deep, and the breath held too long. When this happens, rural communities can go hours without prompt coverage in their areas.
George Porter is a veteran paramedic who says he has been lobbying Alberta Health Services for more than seven years over the lack of emergency coverage.
According to Porter, the results have not been encouraging. One of the primary issues are inter-facility transfers drawing ambulances out of areas where they are needed, which can sometimes cause long waits for ambulance service during emergencies.
“What it’s going to take is a high-profile politician, or their family, having to wait an hour for an ambulance to show up in an emergency,” he said. “Or a child, or a baby to die, before anybody is going to pay attention.”
Porter said EMS workers are frustrated when they are sent to do non-emergency transfers.
“We see it every day,” he said. “You know you are doing a routine transfer that shouldn’t be in an ambulance, and you know there are emergency calls waiting while you are being utilized by something else.
“When you are taking a transfer from Vulcan to Calgary to get insoles fitted for shoes, or a dental appointment, you know there’s nobody available in that whole big Champion/Milo/Lomond area for four or six hours. The patient didn’t need an ambulance ? they just needed a ride.”
But Nick Thain, Executive Director of EMS and Inter-Facility Transfer Operations for the South Sector of AHS, says the borderless system is working how it was designed. He said there is a fairly complex matrix in place for inter-facility transfers, as they work to ensure the best resources are available for patient movements.
“In the South Zone specifically, we have six non-emergency transport vehicles ? which include wheelchair-equipped vans ? that last year did greater than 2,800 stable patient movements,” he said. “This allows us to keep ambulances in the community.”
Porter said the colour-code system for high and low acuity patients is often ignored by hospital staff who may be mis-coding patients to high-acuity transfers in order to make sure they don’t miss scheduled appointments.
“It’s not based on the patients,” he said. “It’s based on their appointment times.”
Before Christmas, a serious incident in Raymond occurred while the ambulance there was on a transfer. With no help available in Magrath, the Raymond Fire Department were first responders on the scene to stabilize the patient. Unable to transfer the patient, however, they were forced to wait about 45 minutes for an ambulance from Coaldale to arrive.
While the Coaldale EMS was responding to the Raymond call, a serious incident occurred in Coaldale and there was nobody available. This forced Lethbridge EMS to respond to the Coaldale incident.
Speaking off the record, some EMS workers said if an area loses ambulance coverage but no serious incidents occur, the incident can go unnoticed by the general public.
Medicine Hat-Cardston-Warner MLA Grant Hunter said he has been hearing about this issue for years.
“They kind of describe it as a vortex,” he said.
“Ambulances getting sucked into the major centres like Lethbridge or going into Calgary. And then, while waiting for patients in emergency, they don’t have the emergency medical responders in the areas when they need them. And then to exacerbate the problem, as they are heading home, they often get called into taking calls from areas as they pass. So they can be out for a long time.”
Mike Parker, President of the Health Sciences Association of Alberta, the union that represents paramedics, said the issue puts the citizens of Alberta at a higher level of risk when there are no available resources in these communities.
He said it is more constructive to focus on how transfers draw the resources out of communities.
“Today, whether it’s in our large metro centres or the rural areas in the province, we don’t have effective resourcing of our EMS system. It puts the citizens of Alberta and our workers at risk.”
Parker said it is a generalized issue that has come about as a result of austerity moves taken by provincial governments of the past number of years reducing health-care funding in order to try and balance their books.
“At the end of the day, that’s not going to work. We have to invest in health care, and we have to invest in our frontline workers.”
But Thain disagreed with the idea that there is not enough coverage in rural areas.
“Do I think the system has enough ambulances?” he asked. “I would tell you, yes I do. But I also believe we need to continuously monitor that.”
Thain said satisfaction surveys have shown 98 per cent of people who utilize ambulance resources are satisfied with the care they receive.
Parker said added workloads are creating added stress, which could be causing some EMS workers to leave the industry ? or worse.
“You can dry the lines between increased workload for these members, decreased downtime, being stuck in hospitals, being frustrated by a health-care system that is not working quite right right now. It’s hard to find an out,” he said.
“When you have an employer saying you have to do more and work harder, that pressure on you is relentless for these guys. It is not a perception. These folks are in a very tough spot.
“By stretching our resources further than they have ever gone, we are burning them out. It is our families and our patients paying the ultimate price for this, and we have to resource health care properly.”
Thain said stress levels and other health issues are something AHS looks at and tries to monitor closely.
“The psychological wellness of our staff is something we take incredibly seriously,” he said. “The entire leadership team is incredibly proud of the great work all of our EMS practitioners do, at times, in what can be a very difficult environment.”