Responsibility of Ambulance Service Delivery
IT IS THEREFORE RESOLVED THAT that the AUMA advocate for the Government of Alberta to immediately consult with municipalities and the Health Sciences Association of Alberta to develop a plan to make urgently needed improvements to the delivery and performance of the ambulance system where municipalities are recognized and compensated for the role they play in support of the provincial health care system.
WHEREAS the Province of Alberta took responsibility for the delivery of ambulance service as it was a provincial health responsibility;
AND WHEREAS at the time the ambulance service transitioned from a municipal responsibility to a provincial responsibility there was a commitment that there would be no degradation of service to citizens;
AND WHEREAS the entire provincial health system has been operating on overdrive because of the COVID-19 pandemic;
AND WHEREAS the number of code reds, where no ambulances are available in the Province is impacting the ability of Albertans, especially rural Albertans, to access emergency medical care;
AND WHEREAS municipalities continue to provide support to the provincial health care system with the operation of our fire departments;
AND WHEREAS the health and safety of citizens continues to be a priority for municipalities as we arrive on scene as first responders to medical calls approximately 40% if the time;
AND WHEREAS the length of time, fire is on scene until an ambulance arrives is trending upwards exponentially, in some areas up over 50% and some rural areas as much as a 200% increase in wait time for fire services over the last year or 2 years;
AND WHEREAS municipalities are acting as a stop gap in the provincial health system with no compensation, and it is impacting the ability of municipalities to meet their own operational requirements; and
AND WHEREAS everyday Albertans’ access to health is being compromised due to a lack of emergency health care.
When the province transitioned ambulance service from a municipal responsibility to a provincial responsibility there was a commitment that there would be no degradation in the capacity of these services. Since that transition, and especially over the last several months, the impacts on municipal fire services include:
- Increasing need for fire services to be the first response and first to arrive on the scene;
- Increasing need for co-response when EMS are more than 10 minutes out;
- Municipal fire crews are tied up at incidents longer and are required to stay until they can pass the patient to someone with at least the same level of qualification or higher which means fire crews once on scene cannot leave until EMS arrives;
- Increasing number of concurrent calls, which is affected by increased response times for lower level incidents (more than 10 minutes) and results in fire being dispatched; and
- Increasing need for call outs to protect the municipality from other occurrences which increases staffing costs for over time and relies on the availability of off duty staff. There is no contractual requirement for staff to attend call outs outside of their scheduled hours.
The effects on municipal staff include:
- Increasing stress on staff being exposed to more medical incidents;
- Dealing with patients and families concerned about delayed EMS transportation;
- Not being able to deliver the scope of practice of an Advanced Care Paramedic (ACP);
- Reduction of availability for other incidents, impacts capability, staffing and safety.
- Not being able to respond to other emergency situations.
- Experiencing delayed response of care for family members when seconds in response can affect long-term health outcomes;
- Potential increase in mental health issues; and
- Burn out.
Every citizen experiencing a medical crisis across Alberta is impacted, as the time of EMS response increases the survival rate of patients decreases. EMS are usually staffed with an ACP with a higher scope of practice than Firefighters Primary Care Paramedic (PCP), this restricts the care provided which could prove critical.
Ambulance service levels have become an urgent, emergent issue. As an example, in Okotoks, within the space of four days, July 28 – 31, two incidents required the use of the STARS helicopter. On one of these occasions, Okotoks did not have a ground ambulance available. On another occasion, August 3, dispatch informed the Incident Commander that EMS was 45 minutes out, eventually arriving from Strathmore. This is an unacceptable level of service provided by AHS and has shifted the burden substantially to municipalities across Alberta with dire health outcomes for citizens.
This resolution was sent to the Minister of Health on January 4, 2022. A further letter was sent to the Minister jointly by Alberta Municipalities and RMA on January 10, highlighting that both municipal associations' members had passed similar resolutions at their 2021 fall Conventions and they share similar concerns about the current state of the EMS system in Alberta.
The Minister responded on March 25, 2022 confirming strategies announced in January 2022 to improve the EMS system in Alberta and providing updates on their progress. These strategies included establishing a provincial emergency medical services advisory committee to provide immediate and long-term recommendations to the Minister of Health (which are to be made public by September 2022, and implementing a 10-point plan to add capacity to EMS. Cathy Heron, President of Alberta Municipalities, was appointed to sit on the advisory committee.
The 10 actions in the plan are:
- Hiring more paramedics.
- Launching pilot projects to manage non-emergency inter-facility transfers.
- Initiating an 'hours of work' project to help ease staff fatigue.
- Transferring low priority calls to other agencies in consultation with EMS physicians.
- Stopping the automatic dispatch of ambulances to motor vehicle collisions that don't have injuries.
- Evaluation by an emergency communications officer to determine if an ambulance from out of area, though it may be closest to a 911 call, is most appropriate to respond.
- Allowing ambulances to be pre-empted from assignments, instead of being automatically dispatched when a 911 call is received, to ensure more ambulances are available for critical patients.
- Creating a new integrated operations centre in Calgary, bringing paramedic leads and hospital staff together to improve integration, movement of resources and flow of patients.
Implementing a pilot project in Red Deer that will manage most patient transfers between facilities with dedicated transfer units, freeing up ambulances to handle emergency calls.
- Developing a strategic provincial service plan for EMS delivery in the province.
The Minister’s March letter also clearly state that the Alberta Health has no plans to directly compensate municipalities for Medical First Response (MFR) activities. The Ministry’s position is that MFR is part of municipalities’ public safety responsibility rather than the health system and that municipalities should be enrolling in the Alberta MFR Program to choose the types of EMS events to which they respond following a request from EMS dispatch.
ABmunis’ Rating of the Government’s Response
Intent partially met - further action will be taken.
ABmunis’ Notes and Actions
In addition to the joint letter that ABmunis and RMA sent to Alberta Health, the two municipal associations developed shared "Principles for an Alberta Emergency Medical Services (EMS) System' to guide future advocacy efforts.
The union representing Alberta paramedics, the Health Sciences Association of Alberta (or HSAA), referred to in this resolution, began issuing media releases in the fall of 2021 highlighting a shortage of available ambulances and the longer-than-usual response times.
Representatives of ABmunis and HSAA (various Board members, committee members and staff) met virtually in March 2022 to discuss the state of EMS in Alberta. ABmunis positions are aligned with HSAA in most areas, however one notable difference is HSAA supports centralized dispatch. They point to a lack of resources (i.e. not enough ambulances, paramedics and supports) as the cause of current issues with EMS.On January 16, 2023, the Minister of Health, announced the release of the Alberta EMS Provincial Advisory Committee’s final report and PwC’s Alberta Emergency Medical Services Dispatch Review. During a press conference, the Minister stated that the province has accepted all of the recommendations in both reports. The advisory committee’s final report contains 53 recommendations, 10 of which were previously approved in May 2022 and prioritized for implementation. The majority of the report’s recommendations align with RMA and ABmunis’ joint principles; however, the recommendations that have been prioritized for implementation do not reflect the principles of sustainability, patient- and community-centred care, and accountability and transparency.
Planned actions for 2023 based on the recommendations in the two reports include:
1. More ambulances and paramedics
2. Safe timely transfer of care from EMS to emergency departments
3. Transferring non-urgent 911 calls to Health Link
4. EMS assess, treat and refer guidelines
5. Non-ambulance transfer policy and process
In April 2023, AHS released its EMS operating plan for 2023-24. This plan was developed using input from the Alberta EMS Provincial Advisory Committee report, the PwC Alberta EMS dispatch review, and other reports and engagement. The plan identified the projects that will be implemented over the next 12 months in priority sequence to have the greatest impact on improving response time. The plan will also form the basis of what AHS reports on and how the agency is accountable to Albertans.
ABmunis will continue to monitor the implementation of the EMS operating plan in 2023-24 and have regular touch points with AHS EMS staff to learn about progress.