BONNYVILLE – While some Lakeland hospitals continue to see bed closures and rolling Emergency Department closures, increased strain has been placed upon paramedic services needed to transfer patients between healthcare facilities.
Over the last several months, EMS has received a 30 per cent increase in 911 calls, according to the Government of Alberta.
In the Bonnyville area, it was common that 50 per cent of local EMS calls involve patient transfers, however inter-hospital patient transfers have continued to rise, says Dan Heney, the regional fire chief for the Bonnyville Regional Fire Authority.
“Bonnyville only as a small amount of (ICU beds), so now when they have a bunch of local cases, they have to transfer patients somewhere else,” explained Heney. “It was a huge percentage even prior to COVID, but COVID has jumped up the sheer number of them as well."
Along with increased pressure from higher call volumes, EMS staff have been dealing with staffing fatigue and illness, delays in hospital-patient offloads and increased requests for patient transfers.
Other challenges that have arisen relate to delays in receiving both new ambulances and specialized parts for fleet ambulances, which have been caused by global supply issues. This is according to information collected by the province.
Ambulances servicing the Bonnyville area through contracts with AHS include two Day-Night ambulances and one Core Flex ambulance.
A Day-Night car means that an ambulance crew works a 12-hour day and then another crew works a 12-hour night.
“Core Flex is a different type of shift. It's one that nobody really likes, but AHS won’t pay to have a third Day-Night car here,” Heney said.
A Core Flex shift sees paramedics work for 12 hours followed by 12 hours on call for four days straight. Then another crew picks up the shift and continues for the next four days straight.
Since the beginning of 2022, Bonnyville ambulances have been dropped from a scheduled shift and shutdown due to short staffing eight times, according to Health Sciences Association of Alberta (HSAA) EMS.
HSAA EMS is a trade union that represents over 27,000 paramedical technical and other healthcare-related employees in Alberta.
On Jan. 10 at 3:30 p.m., HSAA EMS placed the Bonnyville area on “Red Alert” after confirming there were “No Bonnyville EMS available to respond” to emergencies in the area.
Out of town pick ups
Another issue facing the region's emergency service’s fleet is that when a local ambulance is returning from a patient transfer, they can be rerouted to another emergency if they are the closest available ambulance – even if that happens to be within a major urban center.
"The dispatching center for AHS automatically dispatches the closest ambulance no matter where that ambulance was based from,” the fire chief explained.
He continued, “If all of our ambulances from Bonnyville are in Edmonton, and all the Cold Lake ambulances are transporting people from Cold Lake to Bonnyville or St. Paul, and someone has a heart attack in Bonnyville, they are going to dispatch the first available ambulance, which might be coming out of St. Paul or Vermilion. This is why we have seen some of the goofy stuff happening in southern Alberta with ambulances from Coaldale responding to emergency calls in in Calgary, while Calgary ambulances are responding to a heart attack patient in Airdrie.”
AHS 10-point plan
To address this mounting pressure on paramedic services, the EMS side of Alberta Health Services has started to rollout a 10-point plan.
Of the plan, five actions are already underway. This includes the hiring of more paramedics, which Alberta Health has reported to have increased by more than 200 employees over the last two years – a roughly nine per cent increase.
The health organization has also started launching pilot projects to manage non-emergency inter-facility transfers and has initiated an ‘hours of work’ project to help ease staff fatigue, which took roughly two years to study, compile and release data on, according to Heney.
AHS has also committed to stopping the automatic dispatch of ambulances to motor vehicle collisions where injuries are not reported, as well as transferring low priority calls to other agencies in consultation with EMS physicians.
In conjunction with these measures, AHS has also been monitoring and collecting data on Bonnyville ambulances along with other areas in the province that have been identified as systems under stress.
“Particularly, EMS systems put under stress due to patient transfers,” said Heney.
All the service providers selected for patient transfer monitoring are similar to Bonnyville EMS regarding the geographical distances from metro centers and the service area’s population base, he added.
Other measures the province has taken include increasing the provincial EMS budget, which now sits just over $14 million more than the 2019 budget.
In 2019, the provincial government spent $528 million on Ambulance Services, which includes ground ambulance, air ambulance, patient transport, and Emergency Medical Services (EMS) central dispatch. The government spent $542 million on Ambulance Services in 2021.
More recently, the province has developed a Provincial Emergency Medical Services Advisory Committee to provide immediate and long-term recommendations that will inform new provincial services plans.
Joe Gray, the operations manager for Cold Lake Ambulance Society sits on the newly established committee.
“I am proud to be a member of this advisory committee as we ensure a safe and high-quality EMS service across Alberta,” expressed Gray in a statement.
Additional actions slated to come for EMS services
The five actions of AHS’s 10-point plan that have not yet been realized include:
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The creation of a new integrated operations centre in Calgary that brings paramedic leads and hospital staff together to improve integration, movement of resources and flow of patients.
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Evaluations by an emergency communications officer to determine if an ambulance from “out of area” is the most appropriate ambulance to respond even if it may be closest to a 911 call.
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The implementation of a pilot project in Red Deer to manage the majority of patient transfers between facilities with dedicated transfer units with the goal of freeing up ambulances to handle emergency calls.
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Allowing ambulances to be reserved from assignments, instead of being automatically dispatched when a 911 call is received. This is to ensure more ambulances are available for critical patients.
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The development of a uniform strategic provincial service plan for EMS delivery in the province.
