The union representing BC Ambulance Service paramedics is concerned with the downloading of costs to municipalities after Cranbrook firefighters recently received legal approval to provide increased medical response services.
Cameron Eby, the president of Ambulance Paramedics of B.C. – CUPE 873, says trials of firefighting departments providing Emergency Medical Response services in other areas of the province concluded there was no finding of improved patient care or patient outcome.
Eby added that municipalities shouldn’t have to fund an EMR service when the BC Ambulance Service (BCAS) is responsible for providing those services province-wide.
“Our position is that this has essentially been a downloading of responsibility from the provincial government to the municipal government, which therefore comes with a downloading of cost and liability to those municipalities,” Eby said, who will be in Cranbrook to present to city council next week.
“…So we question whether, quite frankly, it’s worth it, and one of the things we’ll be highlighting is the municipal cost to the taxpayers, which of course, are already paying provincial taxes, so you’re essentially getting double-hit.
“Those costs, some of them we can define is the training and then the ongoing costs of equipment and that sort of thing.”
Eby said he pulled statistics showing that Cranbrook Fire and Emergency Services (CFES) assist BCAS on 64 per cent of their calls. From a funding perspective, Eby said that translates into $2.75 million that the city is paying to have CFES assist BCAS on medical calls.
That could mean two additional ambulances staffed 24 hours a day with 18 full-time positions, Eby continued.
As far as EMR services are concerned, Eby says most of it has to do with diagnostics rather than live-saving procedures.
“It really adds a bunch of diagnostic skills; there’s no life-saving immediate intervention that’s added with the EMR level,” Eby said. “Those life-saving interventions are things like CPR, ventilation, defibrillation, choking, airway clearing and bleeding control, and those are all skills within the role at the first-responder level.”
Other issues around the provision of EMR services include legal liability and the ongoing training that is required with EMR certification.
Eby says there must be 20 credits of Continuing Medical Education (CME) per year, which equates to roughly 20 hours of annual training that comes with a cost.
“Obviously, we’re advocates for the best patient care possible and we believe that paramedics in BCEHS ambulances are the definitive pre-hospital care in British Columbia,” Eby said, “so we think that municipalities shouldn’t take on this download and that cost and liability.”
The issue arose a few weeks ago, when Cranbrook received a legal validation to respond to calls and deliver EMR, which gave CFES the go-ahead to provide the service upon completing the necessary training.
CFES Director Wayne Price hopes to have 23 CFES personnel trained for EMR Services by August and implemented in September. There will be a one-time cost of $45,000 to get the program started.
Right now, Cranbrook has five full-time paramedic positions; four are currently full while a fifth is currently in the process of being filled, all of which work a daytime shift. Additionally, there are 29 on-call paramedics, who work daytime and night time shifts as well as an on-call basis.
There are three fully staffed ambulances during the day and two at night at any given time, Eby said.
As far as response times go, Cranbrook averages out at 7:57 for urgent priority calls, while the national average is nine minutes.
When filled, Cranbrook’s fifth full-time paramedic will be an advanced care paramedic, which is one of six levels of paramedic care under the BC Emergency Health Services umbrella.
“Cranbrook has never had a paramedic at that skill level before, so the community is in the process of being upgraded, as far as qualifications,” said Eby, “so there’s only five rural communities in the province that are receiving those so far, and Cranbrook is one of them, so I think that’s an exciting development for the town.”
Community para-medicine a success
The province recently expanded a community para-medicine program to 76 communities across the province after using Creston and Elkford as pilot projects in 2015.
According to the BCEHS, the objective of community paramedicine is to help stabilize paramedic staffing in small and rural communities while identifying and bridging gaps in local health care service.
Eby points to two initiatives that help connect medical service providers with a patient, while another helps keep patients in their home who require palliative care instead of having to relocate to a health care facility.
“One of them is called Home and Health Care Monitoring, so that’s a partnership with the Ambulance Service, Health Authority and Telus to provide a device to patients in their home for a daily basis,” said Eby, “Basically an iPad, and they are able to enter in information about their own health status, such as their own blood pressure, and their heart rate and their weight and that sort of stuff.
“It connects the community paramedic and their primary physician all together with the patient and they can monitor their health status. So both the paramedic and the physician involved can see if there’s any change in their health status and intervene right away.”
The community paramedicine program has been well received throughout the province, Eby added.
“In general, the community paramedic staff, we’ve got about 100 people that have moved into those roles province-wide,” he said, “It’s become a popular program and we’re getting lots of applications. It’s now moving from part time positions into more full time positions so a lot of growth expected there.”
The BCAS employs 3,600 paramedics across BC and Eby says there’s a need for not just more staff, but a change in how staffing is currently utilizing a part-time, on-call system.
“Our paramedics just can’t rely on a steady source of income from that, so that’s leading to real difficulties with recruitment and retention and we’re losing qualified paramedics to other provinces and places like the oilfields in industry,” he said. “So we’ve been advocating for more resources but also for the conversion of those on-call resources into actual paid positions.
However, a number of reviews are underway which is leading to change and this is encouraging, he added.
Staff and resources have recently been added in Vancouver and Nanaimo, while reviews are underway in Williams Lake, Dawson Creek, Trail, Kamloops, Kelowna and the Fraser Valley.