BC’s ambulance model flawed; MLAs doing nothing to change it

The most striking and deadly dysfunction of BC’s chosen EMS model is that BC has a law which legally prevents doctors, nurses, police, fire rescue, and search-and-rescue personnel from providing emergency medical care beyond first aid to any person in medical distress outside of a hospital setting.

The BC Emergency Health Services Act makes it ILLEGAL for any first responder and or any medical professional who is not a BCEHS union employee to provide emergency medical care to a pre-hospital patient beyond industrial first aid. This law restricts doctors, nurses, and even fully-licensed Advance Life Support paramedics who are not BCEHS employees from providing life saving care. By contrast, some European countries have federal laws which legally require all appropriately-licensed medical personnel to provide all the care they can to any person in medical distress or face federal charges. But in BC, we have the exact opposite law.

What that means in the case of a dying or critically-injured patient is that even if a fully-trained and licensed trauma doctor or Advanced Life Support paramedic is at hand, they are not legally allowed to provide the best possible medical interventions to your dying loved one. Only BCEHS CUPE 873 ambulance attendants are allowed to provide anything beyond an industrial First Aid in the prehospital setting in BC. So how does such a deeply-flawed Emergency Health Services Act guarantee our critically ill or injured loved ones a best-possible patient outcome?  When a person is dying, does anyone really care about what shoulder patch the person saving their life is wearing?  When a person is having what could be their worst or last day of their life they deserve to have every possible medically-trained professional help them survive. The law must be changed.

The same Emergency Health Services Act also made the B.C. Ambulance Service the only legal provider of patient transport in BC. How does such a restrictive EMS model assure best possible patient outcomes for our critically ill or injured loved ones?

Consider this: if a BCEHS ambulance is not available or has a long delay in arriving due to the ongoing extreme under-staffing policy by successive governments in BC – even if your loved lays dying in a hospital parking lot – no hospital employee, doctor or nurse working in the hospital, is legally allowed to move the patient into the hospital, even if that patient is in severe distress or has a life-threatening condition. To do so would mean breaking the law in B.C. The only exception is that a passerby Good Samaritan could intervene and drag them into the hospital. Otherwise, only a BCEHS union member is legally allowed to do that. We know of no other provincial or international jurisdiction that has such highly restrictive laws in terms of being allowed to save a person’s life outside of a hospital. So how does such a bizarre EMS model, which BCEHS still uses today, guarantee a best-possible patient outcome for our loved ones? It can’t. Its a nonsensical law, one that must be changed as soon as possible. We can only wonder how many British Columbians have died or sustained permanent injury over the past 43 years since this law was brought in by the NDP.

Since the creation of the B.C. Ambulance Service/BCEHS by the NDP government in 1974, a number of attempts were made by stakeholder groups including BC fire chiefs, the B.C. Firefighters’ union, and several concerned non-profit organizations and individuals to make successive governments aware of the many inherent shortcomings of the current EMS model employed in BC. All have tried to show that the chosen provincewide, attendant-led “scoop-and-run” ambulance model is fraught with dysfunction which continues to cause unnecessary deaths. Current NDP MLAs know of these dysfunctions yet have chosen to do nothing. How can they sleep at night knowing that every day in BC their inaction contributes to the deaths of patients with completely treatable but time-sensitive conditions?

As proven in other provinces and countries for decades, critical-care needs patients have far better medical outcomes when they have EMS models which bring appropriately-trained medical teams to the patient at the scene where they can be stabilized first, then taken directly to a hospital best suited to their condition. Such medically more capable EMS models have been used in other jurisdictions for decades. Why? It is indisputable fact that earlier definitive medical interventions save more lives and reduce more permanent injuries. Early interventions not only reduce chain of care/chain of survival health care system costs but also saves socialized societies, like ours in Canada, far more than the added up-front costs of providing a modern EMS system of care.  All efforts from concerned citizens to change BC’s long outdated EMS model have fallen on deaf ears. No successive provincial government – NDP, Social Credit, Liberal (conservative) has even considered a systemic overhaul of B.C.’s highly dysfunctional EMS system. The only political party which has paid any serious attention to the deadly inherent issues of BC’s outdated and surpassed EMS model, has been the BC Green party.

The office of the BC Auditor General is currently conducting a full audit of BCEHS ground ambulance service and their findings should be completed in late 2018. This will be the first such audit of BCEHS’s ground ambulance operations in its entire 43-year history. In a 2013 audit of the BCEHS air ambulance operations, the B.C. Auditor General John Doyle found a number of systemic flaws and shortcomings within BCEHS’s air ambulance operations.

Doyle wrote: “My overall conclusion is that the BC Ambulance Service is unable to demonstrate the quality, timeliness and safety of its patient care…. it has not fully assessed whether it has the right paramedics, in the right locations, to best meet patient needs.”

“It (BCEHS) is not adequately reviewing air ambulance dispatch decisions to ensure aircraft and paramedics are being dispatched to best meet patient needs …. we found that the BC Ambulance Service is not proactively managing quality of care for its air ambulance services.”

It is important to note that the BCEHS’s air ambulance operations are supposed to be the highest-functioning branch of all BCEHS operations. BCEHS contracts (only) seven aircraft but operates more than 580 ground ambulances. If BCEHS has issues managing/operating seven aircraft, imagine what the Auditor General will find in the audit of BCEHS’s 580 ground ambulance fleet. All other sectors of modern medicine have made major advances in patient care (and patient outcomes) over the last 43 years, however, BCEHS’s approach and capabilities have basically remained the same – for the last 43 years.