The local ambulance system has faced problems for years, says one former St. Paul paramedic, who, like several others, is hopeful about a proposed model in which Alberta Health Services would take over delivery of the system next year.
“I’m optimistic – it can’t get any worse,” says the paramedic, noting he worked in St. Paul for 12 years and still keeps in touch with local people. Issues such as shifts, losing experienced paramedics, wages and morale have been problems in St. Paul for years, but he notes, “It’s not just St. Paul, it’s everybody.”
“The whole province, that made the system, made their bed and now have to deal with it,” he said, adding unless the government changes its direction on pre-hospital care and health care, nothing will change.
Paramedics themselves are not to blame for problems in the delivery of ambulance services, St. Paul’s mayor noted at the Town of St. Paul’s Dec. 8 council meeting.
“They’re caught up in a system. The system is failing us,” Mayor Glenn Andersen said.
Town and County of St. Paul officials both used to sit on the ambulance society board to run local ambulance services, but the town stepped away within the last couple of years.
“We’ve seen the writing on the wall,” Coun. Norm Noel said of town’s decision to step away.
At one point in time, paramedics worked in the area and the borders of the County of St. Paul. Over time, a more centralized model came into place, and ambulances dispatched from St. Paul to other locations such as Edmonton could be called away to deal with emergencies if they were the closest to such scene calls. The town did not want to be responsible for covering deficits without any say on the centralized dispatching causing such cost overruns, Noel said.
Now, the County of St. Paul has also decided to divest its interests in delivery of local ambulance services, as of March 31, 2015.
County of St. Paul Coun. Cliff Martin, who is chair of the ambulance society, says the county didn’t feel it was fair to ask its residents to pick up deficits from running the ambulance service when the town and its residents were not doing so.
But the problems the society has faced in staffing the ambulance unit have steadily grown, he said.
“We tried everything to do that,” he said of addressing staff shortages and recruiting people to the area. “We provided free housing, we provided signing bonuses. The competition was too tough.”
The ambulance society instead tried to bring people to work in St. Paul over shifts so they didn’t have to relocate to the area but that was also a challenge.
“It’s more lucrative to work closer to where you live - it’s also more lucrative to work in industry,” Martin noted, adding it is hard to compete with urban centres and the oilfield.
Town and County of St. Paul have both reviewed two options for ambulance care going forward. One would involve private delivery of services, while the other would involve an AHS direct delivery model, with AHS handling staffing and ambulances.
St. Paul Fire Chief Trevor Kotowich was in attendance to talk to town council at its Dec. 8 meeting about these options, saying AHS was recommending a direct delivery model, which he also supported.
“I think this is really positive,” he said. While private delivery would be another option, he felt that businesses’ focus had to be on making money. “This isn’t the case here.”
Instead, AHS is suggesting it would keep the same model of having one Advanced Life Support unit, and two Basic Life Support units in St. Paul. AHS is also suggesting that province-wide, it is seeing the need for a full-time non-ambulatory transfer (NAT) unit. The NAT unit would involve one or two trained practitioners using a minivan or suburban-type vehicle to help deliver people to the city for appointments, instead of tying up the time of more highly trained professionals.
“That would take a lot of pressure of ambulances transferring people just for appointments,” said Martin, adding that would mean cost savings as well.
The St. Paul ambulance unit would likely not focus on hiring and keeping local staff, but instead people from other locations would travel to do shifts in St. Paul before heading back home. But Kotowich and Martin both believe staffing shortages would be addressed by moving to the new model.
“Our casual pool is probably about 20 something. They probably have something like 2,000 to draw from,” said Martin of AHS. “You haven’t got the opportunity they have. A standalone system in a regional system just doesn’t work any more.”
When ambulance EMS units are not available, it puts “unwanted and unnecessary pressure” on the fire department, which is only supposed to assist ambulance personnel on scene calls, Kotowich said. “But we’re finding ourselves getting there 10, 15, 20 minutes before the ambulance and that’s not right.”
However, at the town council meeting, Noel expressed some reservations about AHS direct delivery, saying, “I see this working in an ideal world, but I don’t see this working in our world.”
Andersen felt the idea of a “direct delivery” model needed more explanation, and council decided to direct its administration to find out more about what it involved before making its decision.
However, Martin said the County has decided to provide the letter of support for the change. “We came to that conclusion, why are we fighting something that could be better?”
Both he and Kotowich believe that it would be a smooth transition to a direct delivery system from AHS, with Kotowich adding, “The end users should see absolutely no difference in how the ambulance service is running.”
He thinks there have been improvements in the system already, and says, “Do I feel we’re on the right track now? You bet.”
