BC's Broken EMS System: Changes to Emergency Health Act are needed to save more lives, reduce patient suffering

Foreword:

The following is not intended to be an indictment of the hard working men and women of BC’s ambulance service, they are doing the very best they can given the working conditions they are forced to work under by their employer, the BC Emergency Health Services BCEHS (formerly knows as the BC Ambulance Service or BCAS).

Ask any BCEHS attendant and they will tell you that they are understaffed, undertrained, under-resourced and have been for decades. We know for a fact that every single BC ambulance attendant only wants the very best outcome for every one of their patients, and the only thing standing in their way - is the BC government! 

BC HEROS strongly support all rank and file first responders in BC, including every single BC EHS attendant.  

Perspective:

Alberta has 9,327 registered Emergency Medical Attendants (EMTs) every single of which are legally allowed to assist any person in medical distress, by comparison, BC has 6,786 registered EMTs (license holders) yet only 3,700 of these are legally allowed to assist the average person on the street if they are in medical distress. These 3,700 EMTs are all employees of BCEHS. BCEHS is the only legal EMS provider in the province of BC, no other person, including doctors, nurses, fire Rescue personnel, SAR personnel, Police officers, are legally allowed to assist a person in medical distress in BC in the prehospital setting beyond a first aid level of care. That is the law in BC and has been since the 1974 Dave Barrett NDP government legislated the Emergency Health Service Act (EHSA).

Of Alberta’s 9,327 EMTs, 2,770 are Emergency Medical Responders (EMR have 107 hours of training), 3,933 are Basic Life Support attendants (BLS/PCP have 680 hours of training) and fully 2,668 are Advanced Life Support Paramedics (ALS have roughly 1,770 hours of training). By comparison, as mentioned, BC EHS has 3,700 EMTs, they break down as follows: 534 EMR, of which 512 are part timers, 2,850 BLS/PCP of which 1,787 are part timers, and 240 ALS of which 49 are part timers (another 80 or so are assigned to non-community-based ambulance services). BC has an additional almost 5,600 EMTs but since they are not BCEHS employees, they are not legally allowed to assist persons in medical distress in BCs communities; they can only work for private employers on company property.   

As mentioned above, in 1974, the NDP government created the EHSA by way of recommendations made by the Foulkes commission report. Dr Richard Foulkes and his team had a mandate to reviewed all aspects of how health care was provided to British Columbians and what needed to be changed to make our health care system better. With the 7 volumes of recommendations made, only 14 and a half pages were on what they thought should be done about ambulance services in BC (We invite you to read the recommendations for yourself at (bcheros.org/…7/12/Foulkes-Report-1974.pdf). We also invite you to read the actual EHS Act immediately afterward to see what was actually recommend and what the NDP legislated; as you will see, the recommendations and the EHS Act are quite different; so what was Dennis Cocke, NDP Minister of Health at the time, thinking? 

The recommendations made were to create a ‘province wide ambulance service’ but with definite regional input/control, as one would expect given the size of BC, but what BC ended up with was quite different, BC got a single EMS service provision unit, with a single union seniority system. There in lay a number of the problems which have never been addressed by any subsequent government. More on that below. 

The Foulkes Commission also called for the use of doctors to work prehospital, further more Foulkes called for an EMS system that put patients first, what BC ended up with a EMS system that was not a patient-centric / best possible patient outcome EMS system, but rather a ‘service provider-centric EMS system’, one which was thought to be a ‘lowest-cost-per-patient- transported’ EMS system, of course we now know that is not even close to be true. 

Back to the single service provider union seniority system BC ended up with and why that isn’t good for rural BC. While a single seniority system works for other local or regional unions, it does not work for EMS systems which cover a land area the size of France and Germany combined or the size of the 27^th largest country on earth. With respect to EMS service provision, such a seniority system assures two negative aspects with respect to best possible patient outcomes, the first is that the most junior, the least-experienced, the least trained BCEHS members are still forced to move to the most remote ambulance stations in BC, regardless of where they live when they join the BCEHS. The second is that advancing through the BCESH training process is also seniority based, hence, the most trained, e.g. ALS paramedics are the most senior and hence, remain the most densely populated urban areas of BC. Consequently, there are exactly zero ALS paramedics in rural communities in BC. This becomes a deadly problem for too many critical care needs patients in rural BC as they inherently have longer return times to tertiary care treatment facilities. So if you have the bad luck of sustaining at time sensitive but treatable critical injury or illness in rural BC, your chances of making are dramatically lower than in BC’s urban areas which have at least some ALS paramedics. And that is one of the reasons why BC HEROS wants a vastly more capable doctor staffed EMS helicopter program throughout BC. If tiny Norway can afford 17 state of the art doctor-staffed EMS helicopters, surely BC can afford 12 doctor-staffed EMS helicopters. But alas, the no one in Victoria cares about you if you live in rural BC, only at election time, then you are their best friend, for about the duration of the election campaigning. Oddly, the NDP is supposed to be BC ‘people oriented government’, even highly union friendly government, yet they don’t seem to care about all the union worker and their loved ones which live work and play in BC rural areas. By the numbers, BC has roughly 450,000 union members, with their extended families and loved ones, they make up over half the population of the province, yet the NDP, Adrian Dix seems to not care about all those union family members that require critical care in rural BC.  

From the Foulkes commission recommendations, other thing that was ignored by the NDP of the day; "... It should not be possible for one region to provide a higher standard of care than another by a diversion of funds either to or from the service ….” Money makes the world go round and BCEHS's ALS paramedics are well-paid because they are recognized as true EMS medical professionals. Current and past governments simply don't / didn't want to spend the necessary money to train sufficient ALS attendants to service BC's rural residents. At the same time, the still-in-force Emergency Health Services Act  makes it ILLEGAL for any rural community or region, to pay for their own ALS paramedics. That is still the law in BC today and there is absolute no question that people die as a direct result of this law in BC every day. Such a byzantine restrictions are not what anyone can call a 'world class, first class', fully modern, best-possible-patient-outcome EMS system. What we have is not even close.

Further reducing your loved one's chances of survival from a life-threatening condition or injury in B.C. is another strange twist of the BC EHS Act, one which was never recommended by the Foulkes commission report. Only BCEHS union staff are legally allowed to provide EMS care beyond First Responder level (which is equivalent to an industrial first aid ticket, or 42 hours of training). No other health professionals from any other agency can provide that service, regardless of their medical backgrounds. Even if your loved one is involved a car crash directly in front of a medical clinic or hospital in B.C., no doctor or nurse working within the clinic or hospital is legally allowed to attend to that injured patient to the full scope of their medical training. They are allowed to provide nothing more than a First Responder level of care; even if the patient is clearly dying! That is still the law in BC today and has been since the 1974 Dave Barrett NDP government created the Emergency Health Services Act. The law must be changed.

What needs to be done to modernize BC's EMS system?

So why do we have this bizarre, byzantine EHS Act in the first place, especially since most of what is in the EHS Act was never recommended by the Foulkes Commission, which was / is the very reason for our province-wide ambulance service. We can only guess what the motivations were for the NDP government of the day to take such a radical departure from what was recommended, but all British Columbians should care.

As a direct result of the existing EHS Act, today, every day, somewhere in BC one or more patients will be stricken with a treatable but time-sensitive and perhaps fatal condition or injury. While we concede that not all patients with time-sensitive conditions will survive, a high number will if they receive timely medical care. But because of our chosen EMS model, in combination with the handcuffs placed on first responders due to BC's byzantine EHS Act which has created an extreme lack of EMS resources provincewide. Due to the aforementioned medical restrictions placed on the 21,000 non-BCEHS first responders in BC and all doctors and nurses as well, far too many of these patients will die or end up with permanent injures as a result. There should be no restrictions placed on medical professionals who want to provide emergency pre-hospital medical care to the highest degree possible. So when a doctor tells you that "We did everything possible,” what that doctor should be saying to grieving relatives is, “We did all the EMS system we have in BC allowed us to do, and that was nowhere near all we could have done to save your loved one's life.”

BC HEROS believes the path to modernizing BC's EMS system must include all BCEHS part time attendants be offered a full time position. Secondly, BC HEROS demands that all current BCEHS attendants be offered medical training upgrades - paid for by the government - while remaining on salary for the duration of the upgrade course, that should include EMR upgrade to BLS and BLS upgrade to ALS. Thirdly, BC HEROS demands that at last 200 more BCEHS ambulance be put into service throughout BC along with at least 50 more ambulance stations all to be filled by CUPE 873 members. Finally, BC HEROS demands that the bizarre EMS service provision restriction be lifted once and for all, this, so that any and all so licensed and appropriately trained first responders will once again be legally allowed to assist all persons in medical distress, regardless of where they may present, on private property or public area. The cost of the aforementioned will be more than recouped by the better patient outcomes, shorter hospital stays, lower insurance claims, lower WorkSafe premiums paid, lower ICBC insurance premiums paid and by a 5 cents per per person per day 'EMS modernization levy' for the next 5 years. Such a purpose specific levy would give BC all the called for EMS enhancements and would save Billions per year moving forward. Don't believe us? BC Trauma, a branch of BCEHS estimates that trauma alone, cost BC society between $2.8 and $5 billion per year !!  yes per year. FYI, in a socialized society like ours, we all pay for those costs, via higher taxes, high auto insurance lower wage increases and so on. That is the exact reason why the Europeans has such aggressive EMS systems, not because they are nicer, more caring people than we in BC, they came to understand decades ago the better EMS systems / models save their societies far more than they cost! That is fact and not opinion. Hence, making 2,000 more BCEHS part timers full timers is but a start, allowing doctors to work on rapid response EMS helicopters should become an election issue for every single rural BC resident - not only do your loved one's lives depend on it, you will end up keeping more of your hard earned money in your bank account!