Ambulance services are going to change in Alberta after a report found issues in its delivery. The Minister of Alberta Health and Wellness, which is now Alberta Health, directed the Health Quality Council of Alberta (HQCA) in February 2012 to review how emergency medical services (EMS) operates. There are 343 pages in the report showing five areas issues were found and five recommendations to deal with them.
The findings:
Alberta Health Services (AHS) took over responsibility of managing EMS in 2009 and services were restructured to have a more centralized system. This gave standardized practices for patients. The problem was a lack of understanding of the area.
When EMS was consolidated so was the EMS dispatch system but the transition was put on hold because of concerns raised by some EMS stakeholders. The result is a patchwork of dispatch centres including three AHS call centres — one being contracted — with different standards.
Some systems include fire and EMS. Usually the fire chief in that area decides on deployment of both fire crews and paramedics. The report states one of the challenges is that services are not meeting AHS standards and separating the costs of both services is difficult.
One size does not fit all. Many participants of the study felt this way about service delivery in different areas; urban, rural and remote areas have different needs.
The review was unable to show limitations in EMS delivery as information is not reliable. A standard data system is not used, which gives a wide variability of data. Users of the system such as municipalities and patients have limited information.
Ponoka’s director of protective services, Ted Dillon, was reluctant to discuss the report as he is unsure how recommendations will be implemented. Police, fire and EMS work together in an incident and he does not how the three will communicate with each other. “We are the safety system.”
Ponoka’s EMS and fire receive dispatches from a call centre in Rocky Mountain House and this could have an effect on costs for the town. The Rocky dispatch centre might not operate based on HQCA recommendations.
Elisabeth Ballermann, president of the Health Sciences Association of Alberta, said there are areas the report failed to address in a press release.
“EMS is the ‘canary in the mineshaft’ of health care. The problems in EMS are often symptoms of problems elsewhere in the system. The shortages of long-term care and acute-care beds in Alberta mean our emergency crews are stuck in hospital emergency rooms for hours because there are no staff to take over the care of the patients and no beds to which patients can be admitted,” said Ballermann.
Recommendations and required actions:
The Government of Alberta should implement standards for the Public Safety Answering Point System (911) and also analyze an appropriate number of call centres.
There should be two EMS dispatch centres under AHS for a reliable system. Within that change management plan should be used to assist in the transition. Public safety agencies should also have a structure where they can communicate and transfer information with each other easily.
Different areas such as urban, rural and remote should have their own definitions of service and training. Ambulance locations that allow for the most efficient care and transfer of patients should be planned. For hospital or inter-facility transfers a system is needed to determine what resources should be used.
A single source of EMS data for Alberta Health and AHS is needed. Data should be linked with other healthcare databases. This will help AHS identify important service information. A quality and safety management that will help with planning and performance.
Since the report was released the Alberta government has announced it will implement the recommendations with a submitted plan by March 31. Health minister Fred Horne said in a press release some patients were not getting EMS service. “That’s why I asked the HQCA to review the system, top to bottom, and why we will begin acting on its recommendations immediately to improve ground ambulance service across the province.”
Guardian Ambulance has the contract for AHS in Ponoka but representatives would not comment.