B.C.’s Outdated ambulance model jeopardizing lives of All British Columbians

B.C.’s ambulance model is failing all British Columbians, none more so than rural and remote residents. Firstly, there are nowhere near enough Advanced Life Support (ALS/ACP) paramedics in our province-wide EMS system. Secondly, the 1974 EHS Act legally prohibits any other first responder agency to provide EMS care beyond ‘First Responder’ level, which is akin to first aid. Thirdly, the same EHS Act actually makes it illegal for any doctors, nurses, firefighters or other emergency personnel to provide full scope medical care (even if they are licenced and trained to do so by the Province of BC) if they are at work. Meaning the no hospital worker can even take one step outside a hospital to bring even a dying patient into a hospital!  Meaning the no firefighter, police officer, Search and Rescue team member are also prohibited by BC law (the EHS Act again) to transport a patient to a hospital even if they are at risk of death or permanent injury. How is such a bizarre set of restrictions good for patients, especially those at risk of dying?  Well its not of course but it is good for job security for BCEHS’s 3,700 EMT, which are the only group legally allowed to transport a patient to inside a hospital, even if that is only from the hospital parking lot into the Emergency Room; if any other first responder profession does that – while on duty – they can lose their job – literally, for saving a person’s life.

Here is where it gets even more bizarre for all BC prehospital patients; if the same first responder is ‘off duty’, he/she can render all the help they are able, including transporting the patient to a hospital. In fact, once they start providing care, they MAY NOT leave the patient, at least not until a person with a higher care ability will take over care of the patient. This is what you can expect from our chosen, 45 year old EMS model still employed by BCEHS today, this, when in high functioning EMS model, major surgery is routinely carried out on the scene by multi-speciality doctors which arrive by rapid response helicopter or special fast ground car!  Oh and if your loved one has a stroke, other EMS jurisdictions have mobile CAT scanner to both diagnose patients at the scene and if necessary give the needed drugs or even drill a hole into the skull to save the patient. To be crystal clear on this point: BCEHS has nothing even remotely close to these medical capabilities, yet they brag about being the largest EMS service in North America. Remember these facts when your loved one falls critically ill or is seriously injured. The BC EMS model is not at all like what you seen on TV, on series like 9-1-1 or Chicago Fire, not even close.  So have we motivated you yet to have a chat with you local MLA?  If not, remember that you indifference today, cost one of your loved ones their lives in the future.

BC completely lacks a ‘rapid-response’ emergency medical services (EMS) system capable of bringing definitive medical care to any one, regardless of where you live, work or play, so if you live in rural BC you are even worse off as long ambulance response times are the norm followed by even longer return to hospital ambulance rides, this prolonged patient suffering for many primary care needs patients and definitely and unnecessarily places all acute care needs patients at much higher risk of permanent injury and or death. Remember this fact; statistically circa 11,800 British Columbians will have a cardiac event each year, circa 3,800 will occur in rural BC. All cardiac event patients should, at the very least, have an Advance Life Support Paramedic level response, best of course is a doctor response, however there are so few ALS/ACP paramedics employed by BCEHS, the only EMS provider in the province legally allowed to provide higher levels of EMS care to the general public, all of which work in BC’s urban areas and none in rural BC, almost 1.5 million British Columbians, do not have viable timely access to neither ALS or doctors as prehospital critical care needs patients. Again, does that motivate you to go chat with your MLA, if it doesn’t then that’s too bad for all of us, as we all pay the price of your indifference now that you know the facts.

“B.C. continues to lag dangerously behind other provinces and countries which realized decades ago that investing in modern prehospital emergency care, to provide the soonest possible advanced medical treatment for sick or injured people, not only saves lives but reduces health care costs,” said B.C. HEROS vice-president Ted Clarke.

“What is so appalling, is that the B.C. government and our health authorities, do not seem interested in changing this antiquated and inadequate EMS system which continues to penalize people who are not close to hospitals when they are having what could be the worst day of their lives. Our current health minister and our premier have the power to fix this mess but have refused to meet with our organization to discuss what for some people will be a matter of life or death in the near future.”

B.C.’s vast distances, sparse populations and adverse driving conditions make sole-reliance on ground ambulance transport a poor choice. Most of B.C.’s most dangerous jobs are in resource-based industries and most often people working at those jobs are not close to major hospitals. Many First Nations communities are isolated and when their people become sick or injured the province’s air ambulance system lacks the resources to respond to their location directly and without definitive capabilities in anything even close to a timely fashion.

“If a tragedy like the Humboldt Broncos bus accident had happened in rural B.C., it’s doubtful that our first responders could have dealt with a situation of multiple severe injuries as efficiently and effectively,” said Clarke. “That’s because none of our ALS paramedics are based in rural areas. There’s no provision to bring doctors to the scene because it is illegal for them to work outside of hospitals, and there’s no way to get advanced medical care to a remote accident scene quickly because BCEHS lacks a properly-equipped rapid-response air ambulance system. Four medical helicopters to serve a province as huge as B.C. is simply not enough.”

The potential problems that stem from inadequate ambulance coverage are complicated by the level of training of the majority of B.C.’s paramedic force. Ninety-four per cent of BCEHS’s 550 ambulances are staffed by Basic Life Support (BLS) attendants (which only have 680 hours of total training) and are NOT trained to administer serious pain-relieving intravenous medications, nor can they give blood products or perform life-saving surgical procedures. Our BLS paramedics are asked to perform miracles to save lives and do so regularly but are limited in what they can provide patients in a prehospital setting by the chosen, bizarre EMS model, BCEHS still chooses to use today.

“Our current (EMS) system is inefficient and under-resourced in B.C. to provide the prehospital resources needed for our rural population,” said BC HEROS medical advisor Dr. Marietjie Slabbert, a B.C. intensivist / anesthesiologist and prehospital care trained physician. “To overcome the challenging geography and vast distances in rural Canada we should have the best prehospital and patient transport system there is for all our patients. We need to cut down on the vacuum of inactivity between time of injury and time of intervention. This is the only way to save lives. From the moment you are injured or become critically ill, the clock is ticking and the time to save your life is running out.”

B.C. HEROS estimates it would cost each person in the province about $18 per year (just five cents a day – the price of a plastic grocery bag) to pay for a modern EMS prehospital system capable of bringing timely advanced care to everybody in the province. B.C. needs to hire at least 2,000 more full-time ambulance attendants and most, if not all, should be ALS/ACP-qualified. We need at least 200 more ambulances, 50 more ambulance stations and teams of multi-specialty doctors and nurses able to bring prompt EMS critical care outside of a hospital setting to treat the most critically ill and injured patients.

“Things have to change,” said Dr. Slabbert. “Medicine is changing, prehospital care needs to change with it. Alberta, Manitoba, Saskatchewan, most European countries, Australia and several states in the USA have a system that has the capacity to take the expertise of a doctor to the scene of an accident or to go and stabilize a patient in a rural hospital and safety retrieve them back. Why does British Columbia not provide that level of care to its people?

“Geography and distance should not be used as excuses but should motivate us to establish a world-class service that provides the best care to all people in B.C. Putting more and better prehospital resources in our province can mean the difference between life or death and between full recovery or permanent disability.”

Public pressure is the only way we can change the system which makes this an election issue and if your elected official does not demand the best possible pre-hospital care for all British Columbians, vote them out. If you care about protecting your loved ones, we need your support – go and tell your MLA, give us what other jurisdictions have had for over 50 years, if not, I will vote for someone that will!

 

Delayed ambulance response time

worked against injured tree-faller

In May 2017 the Prince George Citizen published a magazine-format publication called Town Proud which includes two HEROS-related stories. The first focuses on Tony Beetlestone, a self-employed tree-faller who lost his foot in a logging accident north of Terrace. It took 5 1/2 hours for Tony to be brought to hospital and by the time he was operated on in Vancouver it was too late to save his foot. You can read his story here:

Tony Beetlestone was in agony, his foot crushed by the butt end of a 20-inch tree he was falling in the forest in a remote area of northwestern B.C. Beetlestone’s job on that fateful day five years ago was to fall a line of trees in mountainous terrain still buried under several feet of snow.

“I was working in a gully where all the trees leaned over the creek and they didn’t want anything falling in the creek, so I wedged every last tree out and it was the last tree standing that got me,” said Beetlestone.

“I was wedging (using plastic wedges) and actually got the tree standing straight up and down and I was waiting to hear the pop. Generally when they pop off, the tree goes downhill. As soon as I heard the pop I dropped my stuff and didn’t even look at the tree and that was my mistake. I went up the steep hill and I was 20 feet from the stump and thought I was perfectly fine.”

But when he looked back, the big balsam fir jumped as it was falling. The stump acted as a fulcrum as it made contact on the high side of the tree, skidding it up the hill, right to where Beetlestone was scrambling through the snow.

“When I looked back, there was the face of the butt coming at my leg about 20 miles an hour and I slipped on a root under the snow,” he said. “So I had a nice root backing for the other side of my foot and the whole tree’s weight hit me right in the foot and ankle.”

Unable to stand on his injured leg, Beetlestone dragged himself up the hill to where his coworkers were and they carried him to the highway, where he was taken by a truck/ambulance to a nearby heliski lodge. The prime contractor arranged for a private helicopter to evacuate him. It arrived shortly after he was brought to the lodge and he was flown 90 minutes to Terrace airport, then transferred to a ground ambulance which took him to the hospital.

“It took 3 ½ hours to pack me out of the bush in a stretcher (to the highway),” he said. “All I remember is the horrified look on their faces and that they were huffing and puffing. You go into shock. The pain was unimaginable, it’s definitely the worst I’ve ever felt.”

Beetlestone was transferred to Vancouver and woke up after surgery with his foot pinned in multiple places. His surgeon had bad news. Because of the extent of the damage, he was told his leg would have to be amputated at mid-calf.

“I assume it was the right decision, I’ll never know,” said Beetlestone, who returned to his job just two months after the accident. “I think if a helicopter would have been on site or if there had been one closer, ready to go, they might have been able to save my leg.”

As a hand-faller, the 45-year-old Beetlestone has had his share of injures and close calls working in one of the province’s most dangerous occupations. Twenty-two years ago near Narrow Lake, his chainsaw kicked back on him and the chain broke and slapped him across the forearm, leaving him with a deep gash which just missed his major blood vessels. He knows of colleagues who have been killed on the job.

“The shocker to me was the air ambulance came for me and they had no drugs, no blood, nothing. I would have died that day if I had severe bleeding,” Beetlestone said. “Five hours, there’s no way you’re going to last that long. It’s crazy to say that we don’t need the service. If it saves one life, it’s worth it. It will save lives for sure.”

For five years, the Northern B.C. Helicopter Emergency Rescue Operations Society has been working to create awareness and raise public support to create a doctor-led, rapid-response medical helicopter to north central B.C. Currently, Prince George is the only major city in Western Canada which lacks the coverage of any dedicated helicopter service.

“Time is a killer when someone is severely injured or gravely ill but if you bring the right level of medical care to that patient the chances of making a full recovery are vastly improved,” said Northern B.C. HEROS vice-president Ted Clarke. “Why should people who live and work in north central B.C. not expect the best possible pre-hospital care?

“If we get hurt in a highway accident we don’t bleed any slower than someone who gets hurt in the Lower Mainland or Alberta or Alaska, or countries like Germany and England, which realized the value of investing in helicopter services decades ago. People in rural B.C. are dying or suffering needlessly from treatable conditions because we lack this essential service.”

In advance of the provincial election in May, HEROS approached local MLAs Shirley Bond, Mike Morris and John Rustad to consider establishing a pilot project to base a medical helicopter in Prince George staffed by paramedics from the B.C. Ambulance Service with advanced life skill or critical care training. In the most serious cases, a provision would allow an emergency doctor trained in anesthesia to board those flights and, in essence, bring the hospital to the patient.

“We were encouraged by the meeting,” said Clarke. “All three MLAs seemed receptive to what it is we are trying to accomplish with HEROS to bring the service to the Prince George region as soon as possible. The people of the north deserve the protection it would provide.”

Provincial health authorities are still not convinced there is an urgent need. BC Forest Safety Council ombudsman Roger Harris, in his two-year study into the province’s medical helicopter emergency medical system, interviewed a number of representatives of the B.C. Ambulance Service and B.C. Emergency Health Services who suggested that people who live and work in remote areas of the province “choose” to do so and should not expect the same level of service as they would receive in the Lower Mainland or Victoria.

That’s an appalling slight to residents of northern B.C., considering a majority of the economic wealth of the province is derived from resource-based operations north of Cache Creek. Harris suggests the province needs to reassess how it protects its workers with emergency rescue services, especially considering the most dangerous jobs are disproportionally located in rural areas.

B.C. has just four helicopters dedicated for medical purposes, two in Richmond, one in Kamloops and one in Prince Rupert. By comparison, Alberta, which has 500,000 fewer people and is 30 per cent smaller than B.C., has 13 dedicated medical rescue helicopters. Less than half of the population of Western Canada lives close enough to major population centres to have access to trauma centres within minutes of driving time. The rest of the people are hours away. A helicopter shrinks those distances and saves time. It can make the difference between life or death, full recovery or chronic medical condition.

A comparative study of five existing helicopter medical systems (HEMS) in Canada, commissioned by HEROS and conducted by UNBC’s research arm, the Community Development Institute, revealed critical gaps in helicopter coverage in the Prince George region as well as the southeastern and northeastern corners of the province. Many of the subjects interviewed for the study indicated it sometimes takes a crisis or disaster, perhaps involving multiple loss of life, for the need for HEMS to be recognized.

Helicopters are expensive to purchase and maintain, but not when considering the real potential for saving lives and lessening the severity of injuries. In light of the fact BCEHS states that trauma costs British Columbians $5 billion per year and is the third-largest cost contributor to the province’s healthcare system, the Harris study suggests helicopters might prove more cost effective than ground ambulances when patient outcomes are factored in. Other provinces and states guarantee timelines for all residents to be able to access Level 3 trauma care. Why not in B.C.?

“It’s difficult to put a price on human life but we know that patients who aren’t treated early on develop more complications and patients who don’t have access to the right care do develop chronic problems,” said Dr. Marietjie Slabbert, medical director of the intensive care unit at UHNBC. “Early advanced airway management prevents brain damage which has a very longterm financial consequence. I think by putting a little investment in the front end you might gain an advantage when it comes to the cost of longterm medical care.”

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The second Town Proud article examines how other provinces and countries operate their prehospital care systems using advanced care paramedics and doctors who operate in helicopters equipped with highly-specialized medical cabins which can bring the hospital to the patient, drastically reducing the time it takes for seriously ill or badly injured patients to receive definitive medical care. These not-for-profit systems are the kind HEROS envisions for the people of northern B.C. 
You can read that story here:

Helicopter heart surgery

Emergency doctor performs life-saving operations at accident scene

The stab-wound victim was in cardiac arrest when the helicopter swooped down from the London, England sky.

The doctor on board that rescue flight, an emergency room physician trained in anesthetics and critical care, knew after assessing the male patient within minutes of receiving the 911 call that immediate open-heart surgery would offer the only chance for survival. With no time to waste, that surgery would have to be performed in the medical cabin of the rescue helicopter.

With the assistance of a critical-care paramedic, the doctor administered an anesthetic, used a scalpel to open the patient’s chest, sawed through the breast bone and applied a clamp to spread the ribcage and expose the heart. They removed a blood clot that had stopped the heart from beating. With the paramedic pressing his finger on the patient’s aorta, the doctor stitched up the wound where the knife had pierced the heart, then instructed a police officer to begin squeezing in blood. Ultimately, the man was brought back to life, one of two who survived the six open-heart surgeries performed in this doctor’s six-month rotation in London, using a helicopter or emergency car to, in
effect, bring the hospital to the patient.

In B.C., that level of pre-hospital patient care, which Australia and European countries have utilized for decades, does not exist. Our province has some of the best doctors in the world but they do not operate in helicopters. Why is that? Is it because the B.C. government, provincial health authorities and the B.C. Ambulance Service has not heard the amazing stories of lives being saved in other countries or provinces by doctors working in flying intensive care units? No, they are well aware what is happening in other jurisdictions.

The reason is a succession of B.C. governments have continued to rely upon the long outdated scoop-and-run system of patient transport to a hospital instead of providing definitive medical care at the scene.
Bureaucrats have decided it’s not worth the cost of investing in a rapid-response helicopter system which brings an advanced team of medical professionals (paramedics and if needed, a doctor) to the scene. They could not be more wrong.

By spending more on pre-hospital care, not only will lives be spared but vast amounts of money will be saved, not only for the health care system but for B.C. society. Critical care should not start when the patient is brought to the hospital. It should start close to the point where the injury or sickness was suffered. The sooner patients are treated with medical interventions, the more likely they will return to work and resume healthy lives, resulting in fewer surgeries, less time spent in intensive care, lower insurance payouts and cost savings for the insurers (ICBC, WorkSafe BC), ultimately leading to lower premiums and fewer tax dollars lost.

A helicopter is the fastest way to bring a medical team to the patient. But in Prince George, there is no system to allow for a rapid response when a helicopter is needed. Prince George is the only major city in Western Canada which lacks the coverage of a dedicated medical helicopter service. The not-for-profit Northern B.C. Helicopter Emergency Rescue Operations Society (HEROS) has been working the past
five years to bring a doctor-led helicopter rescue service to the Prince George region which would operate day or night, every day, in most weather conditions.

HEROS is convinced a medical helicopter service which has the ability to take a doctor on board, working with a paramedic trained in extrication methods and the use of a hoist system to retrieve patients in even the roughest terrain, will not only save lives but will decrease the number of people left with permanent injuries or who end up in long-term care.
A medical team equipped with anesthetic drugs and blood products can provide immediate interventions to the stabilize the sickest patients and stop the clock within the golden hour, after which survival rates drop dramatically in severely-injured or critically-ill patients.

The HEROS organization has asked the province to fund a pilot project to provide a physician-led medical rescue helicopter service based in Prince George to serve the north central Interior. The service would provide coverage as far as the Alberta border to the east, Chetwynd to the north, Smithers to the east and Williams Lake to the south.

The advantage of having a doctor on the scene is they can stabilize the patient sooner using the appropriate interventions usually only available at a hospital, a considerable advantage considering the vast geography of northern B.C. A doctor has the ability to make the decision to bypass the emergency department and bring the patient straight to a CT scan or directly to the operating room, saving valuable time. Those choices, made promptly in remote locations, can dramatically improve patient outcomes. A properly-equipped helicopter flying at more than 300 kilometres per hour can pick up patient in northern B.C. and deliver them directly to a hospital in Edmonton, Vancouver or Prince George.

Being able to land at the hospital is key. The hospital helipad at Prince George Regional Hospital (now UHNBC) was closed permanently in the late 1990s when it was deemed unsafe. Before it was decommissioned, it was used to fly patients in and pick up doctors to fly them to accident scenes. That ability was lost when the helipad was closed. Now, any patients brought in to the region’s referring hospital by air have to land at the airport and are then brought in by ground ambulance, at least a 20-minute ride, which defeats the purpose of having a helicopter.

Serving rural areas, a helicopter is at least three times faster than a ground ambulance and in poor road conditions that time advantage increases substantially. Given B.C.’s huge distances, challenging topography, rough road conditions and winter weather conditions, a province-wide pre-hospital care model that serves all of the province’s residents, no matter where they are, is medically indicated.

HEROS also advocates that the province update its laws as they apply to first responders. The province’s Emergency Heath Services Act, written in 1974, gives the B.C. Ambulance Service the exclusive right to provide patient transport. That means no other other ambulance service, with the exception of Alberta-based STARS (Shock Trauma Air Rescue Society), which serves the eastern edge of B.C., is allowed to operate in the province. There are still laws in B.C. which make it illegal for doctors to treat patients with emergency lifesaving interventions outside of a hospital. It is also illegal for organization like Red Cross to operate an ambulance anywhere in B.C. or for hospital staff other than BCAS employees to help a patient get from the parking lot through the hospital doors. A fire department in B.C. cannot hire its own advanced care paramedics licensed to work in B.C. and have them ride to scene calls as first responders in fire engines. Only BCAS paramedics can treat patients beyond basic life skills level of care. Is that providing the best possible patient care? How can those laws, working within a scoop-and-run system, possibly make the patient the centre of the medical universe?

Considering that every year, roughly 550,000 patients (12 per cent of the B.C. population) are delivered by ambulance into the health care system, it is incumbent on the provincial government to look at alternative ways to reduce health care costs. In Germany, a federal law adopted in the 1980s requires individual states to conduct universal cost-benefit studies of their respective emergency medical systems to help ensure the national health care system is operating at peak efficiency as demographics change and medical capabilities improve. A similar study is needed in B.C. The reason so many European countries have adopted advanced emergency medical systems is because they realize that the provision of definitive prehospital care saves billions more than it costs.

Nobody expects to get into a car accident while traveling on a rural highway or have stroke while walking on a remote mountain trail. But life-threatening situations happen to hundreds of people in this province every year and when they do, you have to ask yourself: Will someone come to get me? Or will you or your loved ones die of a treatable medical condition simply because of time delays getting to a hospital. It doesn’t have to happen that way. If you feel you deserve the level of emergency care other people in other jurisdictions have come to expect, make it known to your provincial government representative. They have to power to change it.

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Municipalities support BC HEROS call for Royal Commission/prehospital care cost-benefit study

In June 2017, BC HEROS petitioned members of the North Central Local Government Association to consider drafting letters of support for our proposal that the provincial government establish an independent Royal Commission to examine all aspects of prehospital care in B.C., supported by a universal cost/benefit analysis study. The response was overwhelming. We received letters of support from the council representatives of Prince George, Houston, Terrace, Prince Rupert, Kitimat-Stikine, Burns Lake, Hudson’s Hope, Stewart, Hazelton, Smithers, Chetwynd, Mackenzie, Dawson Creek, Fort Nelson and the North West Regional Hospital District, all of whom endorsed our call for a provincial prehospital (community) care inquiry.

For five years, B.C. HEROS (formerly Northern BC HEROS) has been working to create public awareness of the shortcomings of the current emergency medical services the provincial authorities provide. We are driven to highlight the need for a doctor-led, rapid-response helicopter service capable of reaching rural and remote areas of the province quickly to prevent unnecessary deaths and decrease morbidity of injuries and illnesses by reducing the time it takes to bring definitive medical care to the patient. Everyone who lives, works and travels in and around our region, deserve better prehospital care than is currently available to them.

When you are gravely ill or seriously injured, the medical system should not start once you arrive at the hospital door. Other provinces and countries realized decades ago the shortcomings of their own prehospital medical systems and took steps to improve patient care. That has resulted in fewer deaths and significant cost savings to their medical systems as a result of better patient outcomes and fewer lifelong medical conditions because those patients received timely interventions. B.C. Emergency Health Services estimates the cost to taxpayers of trauma (not including medical conditions such as strokes, heart attacks, and diabetic shock) at $5 billion per year. Yet, in the history of this province, there has never been a non-partisan universal cost-benefit study on pre-hospital care to examine whether our health care system is spending tax dollars wisely. We think the findings of such a study would lead investigators to conclude money spent up front to help bring the hospital to the patient and provide early interventions will not only save lives but money as well. Those patients will recover quicker without the need for extended hospital stays with less of a chance of developing a longterm medical condition. As a result, WorkSafe BC and ICBC payouts will be reduced and premiums for coverage paid by employers and ordinary citizens would drop.

In this initiative to gather a groundswell of support for this pre-hospital care investigation, HEROS is appealing to private industry – foresters, truckers, miners, petroleum producers; public entities such as firefighters and other first responders and health authorities; and elected government officials like yourselves to push for real change in how the province conducts its emergency services.

Employers are reluctant to send their workers into areas where they are not protected and this issue can negatively affect decisions on where resource-based companies will be willing to establish their rural operations. They expect to have a modern system in place to protect their employees, should they need a rapid evacuation. In northern and rural regions of B.C., that system does not exist simply because our provincial authorities believe it is our choice to live in this area and that we should not expect the same level of emergency care as the people of the Lower Mainland and Victoria now receive. That very comment was taken directly from B.C. Forest Safety Council ombudsman Roger Harris two-year study into northern B.C.’s air ambulance helicopter services, released in February,

We encourage municipalities and regional districts across the province to join us in this opportunity to show the support of their constituents in addressing an issue which potentially could affect all British Columbians as well as visitors to this province, by providing BC HEROS letter showing you are in favour of our proposed system-wide prehospital care inquiry.

Ombudsman gives B.C. HEMS a failing grade

In late-January 2017, BC Forest Safety Council ombudsman Roger Harris issued Will It Be There? a long-awaited report on the state of Helicopter Emergency Medical Services in the province and the report says B.C. is not adequately protecting forest workers in rural areas. Harris recommends the provincial government takes steps to provide additional emergency helicopters to enable rapid transport for people to a Level 3 trauma centre within one hour of being dispatched.

The report also recommends the B.C. Health Act be revamped to allow first responders other than B.C. Ambulance Service employees to provide emergency patent transport. Harris advocates the use of rope hoist systems attached to helicopters to rescue people hurt in inaccessible areas. You can read the report here: