First in a series looking at serious issues with emergency health services in British Columbia. Reporters Betsy Kline and Chelsea Novak and editor John White have been looking into the state of ambulance services both locally and across the province for the last two months.
This week we look at the gap in services between B.C. and Alberta and a call for citizens to take action. Future stories look at the rural/urban divide, air ambulance services, financial implications and reactions from officials.
If you have a story to share with us about your experiences, send an email to firstname.lastname@example.org.
CASTLEGAR — The executive director of the emergency medical care advocacy group BC HEROS (BC Helicopter Emergency Rescue Operations Society) Hans Dysarsz says the state of ambulance services in British Columbia is in critical condition and problems are systemic and province-wide.
Dysarsz isn’t the only one who thinks so — the BC Auditor General and the Ombudsman for Forest Safety have produced critical reports and the employees’ union for ambulance attendants has bemoaned response time delays and staffing shortages.
Dysarsz also believes that things aren’t likely to change until the citizens of the province take a stand and demand better pre-hospital care from their legislative representatives.
Dysarsz describes BC HEROS as an organization dedicated to bringing modern emergency medical services to British Columbia — that includes more staff, more ground ambulances, a vastly improved air ambulance service and a different way of thinking about pre-hospital medical care.
One thing Dysarsz wanted to emphasize right from the beginning is that the problems in the system have nothing to do with the ambulance attendants and paramedics on the ground.
“I want to be clear on one thing — I do not have a beef with the rank-and-file membership,” he said. “They are doing as much as they possibly can with the tools and training and the respect they are given to work with by the employer. Those people are burning out at an alarming rate — because they are asked to do miracles.”
British Columbia Emergency Health Services (BCEHS) relies on a large number of part-time and on-call attendants and when compared to other provinces, has a much lower staff-to-population ratio.
According to BCEHS statistics, there are 3,600 trained emergency services personnel including primary, advanced and critical care paramedics and emergency medical services dispatchers in the province.
Alberta Health Services (AHS) reports about 5,600 emergency medical service (EMS) practitioners working for AHS and their contracted operators.
Compared to the B.C. population of 4.817 million that gives a ratio of one emergency services personnel to every 1338 residents.
For Alberta’s population of 4.286 million, the ratio is one practitioner to 765 residents.
BC HEROS believes BC needs at least 2,000 more full-time EMS ambulance attendants — most if not all of whom should be Advanced Life Support (ALS) qualified, 200 more ambulances, at least 50 more ambulance stations, a dozen more modern air-rescue helicopters and at least 50 multi-specialty doctors providing EMS treatment in the pre-hospital setting.
They would also like to see the government train all active BCEHS Basic Life Support (BLS) attendants to the ALS licence level — with full pay — as soon as possible.
Considering B.C. has a larger population and a larger land area — 944,735 sq. km compared to Alberta’s 661,848 sq. km — it also seems that B.C. is lagging behind Alberta as far as it’s fleet and stations are concerned as well.
BCEHS operates 188 ambulance stations and 540 ambulances.
Alberta Health Services and its contractors operate 204 ambulance stations and 390 ambulances.
That’s one ambulance station per 5,025 sq. km for B.C. and one station per 3,244 sq. km for Alberta.
B.C. has one ambulance per 1,750 sq. km and Alberta has one per 1,697 sq. km.
One striking difference between the two provinces is the number of ambulances that operate at the Advanced Life Support (ALS) level. Only 28 of B.C.’s ambulances are ALS and those are used primarily in larger communities.
Two-thirds of Alberta’s ambulances are ALS units.
ALS ambulances offer a higher level of care including the ability to administer more medications, perform intubations and offer advanced cardiac resuscitation.
In the air, BCEHS operates four air ambulance helicopters through contractors, six air ambulance airplanes and a dedicated plane in Fort St. John. They also call on charter aircraft as needed.
About 7,000 patients are transported annually, with a large number of those being patient transfers between hospitals.
According to an August 2017 BCEHS release, about 2,000 of those patients were transported by helicopter air ambulances. Of those flights, 432 originated in Prince Rupert and 1,382 in Vancouver — meaning the remaining 186 were split up around the rest of the province.
Only 10 per cent of all air ambulance transports were for emergency 911 responses completed by air ambulance helicopters.
In 2016, Northern B.C. accounted for 38 per cent of all air transports and the Interior accounted for 25 per cent.
As for air ambulance services in Alberta — AHS contracts 12 fixed-wing aircraft which transport about 7,000 patients annually.
AHS also has an affiliation agreement with the Shock Trauma Air Rescue Society (STARS) which has bases in Calgary, Edmonton and Grand Prairie and the Helicopter Emergency Response Organization, which operates from Fort McMurray. That gives Alberta the same number of helicopters as B.C.
STARS flew more than 1,500 missions during the last fiscal year. STARS crews — advanced life support paramedics, critical care nurses and transport physicians — are in the air approximately 10 minutes after receiving a call.
So with its smaller population and land area, Alberta transports about 8,500 patients a year by air compared to B.C.’s 7,000.
Alberta, Saskatchewan and Manitoba all have non-profit air ambulance services that operate at a higher level of care than those run in B.C. by BCEHS.
The Province of Alberta is considered the leading provider of a pre-hospital care system in Canada.
But while a grab-and-go approach is still being used here, jurisdictions all around the world are using a more integrated approach, incorporating more paramedics with advanced life support skills, doctors and specialists on ambulances or aircraft and bringing more advanced medical help right to the patient — beginning life-saving and outcome-improving treatments long before the patient arrives at a hospital.
“When you look at other jurisdictions you realize something very quickly, the way the system is set up, it directly contributes to the deaths of treatable conditions of patients province-wide, especially in rural B.C. more so than greater Vancouver,” said Dysarz.
“There is no question whatsoever that people are dying from completely treatable medical conditions today in British Columbia — the only thing that is up for debate is how many.”
The Provincial Health Services Authority reports that major trauma is the principal cause of death for people under age 45 in Canada and that over 700,000 people are injured yearly in B.C.
Of those with injuries, approximately 1,800 die, 9,000 suffer permanent disabilities, 27,000 are hospitalized and an estimated 41,000 potential years of life are lost.
Petition demanding change
BC HEROS has started an online petition hoping that if government officials see a public outcry for better pre-hospital care they will finally be influenced to move to a system that is forward-thinking and patient-outcome centred.
The petition “1.5 Million Rural BC Residents Still Have No Viable Access to Prehospital Critical Care” can be found on change.org.
The petition states: “The demands of BC HEROS for change will not only save far more lives each year in B.C. but will also save B.C. (even Canadian) society billions more in annual health care costs. That is the real reason why other countries (and provinces) invested heavily in modern state-of-the-art pre-hospital emergency care decades ago; because it saves far more money than it costs. The sooner a critical-care-needs patient receives definitive care, the higher the chances of survival, the lesser the chances of permanent injury, the lower the cost to society and taxpayers.”
The petition asks Premier John Horgan and the B.C. Ministry of Health to:
• Make immediate changes to the highly restrictive Emergency Health Services Act to once again allow all first responders to provide EMS care beyond only first aid provision to all persons in medical distress province-wide.
• Remove the current restriction that makes it illegal for all first responders, other than BCEHS employees, to transport urgent or critical-care-needs patients to a hospital.
• Carry out an independent universal cost-benefit analysis.
• Stand up a Royal Commission, composed of highly experienced international EMS experts, to review all aspects of how B.C. chooses to deliver pre-hospital critical care to all regions and communities.
• Replace the currently used B.C. Emergency Medical Attendant Licensing Board with a College of Paramedics as the sole EMS personnel licensing body for B.C.
• Overhaul the current (medical) 9-1-1 dispatch system with seasoned ALS paramedics to better triage critical and urgent care needs patients.
• Move B.C. from a “perceived lowest-cost-per-patient-transported-EMS-model” to a “best-possible-patient-outcome-EMS-model.”
Editor’s note: Based on new information from BCEHS the number of ambulance stations in B.C. was changed from 183 to 188 and the number of ambulances was changed from 519 to 540. As a result we also amended our further analysis to one ambulance station per 5,025 sq. km rather than one per 5,162 sq. km and one ambulance per 1,750 sq. km rather than one per 1,820 sq. km.