By TERRY PUGH
The gaps in Saskatchewan’s emergency medical safety net – particularly delays in ambulance response times – need to be fixed.
That’s one point on which Warman elected officials and the organization representing the province’s professional paramedics agree.
But, they have different approaches to the problem.
Warman City Council would like to see the provincial government make changes to the legislation governing ambulance services in Saskatchewan that would allow trained municipal fire department first responders to transport patients to hospital in critical, time-sensitive situations when ambulances are not available. Under the current legislation, first responders can assess and treat patients at the scene, but they are not legally permitted to transport them.
Last month, Warman city councillors passed a resolution to that effect, and they’re hoping to gain support for the idea at the Saskatchewan Urban Municipalities Association (SUMA) convention next month in Regina.
But opening up the Ambulance Act may not be the best solution, according to the Paramedic Services Chiefs of Saskatchewan (PSCS), the organization representing 97% of Emergency Medical Services (EMS) providers in the province.
In a presentation to the Warman City Council meeting on Monday, February 23, PSCS President Jennifer Larre and PSCS Past-President Steve Skoworodko outlined several factors affecting access to timely EMS services across the province. Unless those underlying issues are addressed, the gaps in service will remain, according to PSCS officials.
“Opening the Ambulance Regulations Act alone will not achieve the desired outcomes for the citizens of Warman or Saskatchewan residents as a whole, unless the provincial government first commits to addressing the foundational issues currently affecting Ground EMS,” stated Skoworodko.
He cited some of the most pressing concerns PSCS is grappling with, including: rising call volumes, operational pressures, a critical shortage of paramedics province-wide, non-competitive wages compared to other emergency response personnel, and longer distances for ambulances to travel as a result of rural hospital closures.
He added that recruiting and retaining Ground EMS paramedics is also a major issue.
“We respectfully request your support in advocating for these necessary changes at the provincial level through SUMA,” said Skoworodko, adding that strengthening Ground EMS is key to ensuring timely access to emergency services.
“We believe there is a good strong system in the province – with part of the service being contracted and the other part being owned and operated by the Saskatchewan Health Authority,” he said. “But one of the biggest things we’re struggling with is a shortage of paramedics. There are over 200 vacancies in the province right now; and a big reason is the disparity in wages. It’s difficult to recruit and retain paramedics in Ground EMS because a lot of them move over to Fire services.”
Skoworodko also noted that the sharp rise in call volumes is impacting paramedic services in both large and small communities.
“Every ambulance service in the last ten years has seen a hundred per cent increase in call volumes,” he said. “I’m from Wakaw. Ten years ago we used to do 300 calls a year; now we’re doing over 1,000.”
Larre, who owns and operates a three-vehicle ambulance service in St. Walburg, said her company responds to over 2,500 calls annually.
“We’ve had a huge increase in calls,” said Larre. “The other factor that comes into play is that we have longer distances to travel. So instead of a 20-minute drive to a hospital, we’re on the road for over an hour transporting patients to hospitals in North Battleford and Lloydminster.”
Skoworodko said his organization wants to work with Warman and other municipalities to advocate for improved Ground EMS services. “One of the biggest concerns is the shortage of paramedics,” he said.
Warman Mayor Gary Philipchuk said during the February 23 city council meeting the information provided by PSCS is relevant and important. But, he noted, city councillors believe there is still a case to be made for reviewing and amending the Ambulance Act.
“What we have in our resolution to SUMA is the goal of expanding the scope of service,” said Philipchuk. “We had an incident at our skateboard park about six years ago where an individual had a shattered leg and was passing out from the pain, but no ambulance was coming.
“We had our first responders there, and they were doing what they could, but they could not legally drive the patient to the hospital, even though some of them are trained to be able to do that. So that was our moment when we really started pushing for more ambulance service in our area.
“We just thought, there’s a breakdown here; and over the years there have been other instances where people have had to wait a long time for an ambulance.”
Philipchuk said having Warman Fire Rescue first responders transport patients would only happen in circumstances where no ambulance is available.
“If that is the best option, then we want to be able to use it,” said Philipchuk. “We’re not saying it’s the go-to option, because we don’t want our first responders doing that all the time. But if that is the best option at that moment, we don’t want it to be illegal for that to happen.”
Skoworodko urged caution on the issue of ambulance delays, noting that a provincial government review of the EMS system in 2009 suggested that ambulance services which were not meeting performance standards specified in their contracts could have those contracts revoked. In response, ambulance contractors pointed out that the demands on their services were “out-pacing the resources that we’re funded for,” and the suggestion was dropped. Since 2009, he added, the gap between funding and ambulance resources has increased.
“The last increase for Ground EMS was in 2010,” said Skoworodko, adding Saskatchewan lags behind other provinces in per-capita funding for paramedic services.
“Saskatchewan is funded at $98 per capita,” he said. “Alberta is $154 per capita and Nova Scotia is $204 per capita. So we’re behind the times when it comes to funding Ground EMS. And, I think if there was money there to pay paramedics appropriately, and to retain them, we would be in a lot better position today.”
Warman City Councillor Marshall Seed said council appreciates the work that EMS paramedics do.
“It’s not an easy job by any stretch of the imagination,” said Seed. “But that being said, our priorities are the residents of Warman. In your documentation you state that the last consultations on EMS were in 2009. Since that time, our city has grown exponentially, and we’ve had many calls that were life-threatening and ambulances were delayed.
“Warman Fire Rescue are the ones that show up and take care of the patient on the ground,” Seed continued. “Our residents have clearly told us that the current ambulance service is not acceptable. We’re not trying to replace the EMS services. We have a high level of respect for what you do, but there is a massive gap that has not been filled since 2009. If Warman Fire Rescue is in a position to potentially fill that gap, whether on an interim or permanent basis, we have to do that. There is no other viable option.”
Skoworodko said PSCS is committed to solutions and is open to “approaching this issue from every direction,” adding he’s hopeful the conversation will continue. He noted PSCS will have representatives at the upcoming SUMA convention.
Warman Councillor Kevin Tooley said the city’s Ambulance Act resolution puts a spotlight on the issue and will encourage ongoing discussions.
“We’re looking for solutions,” said Tooley. “From our perspective, we have good resources that are part of our fire department, but the way things are right now, they’re fairly limited as far as what they can do.”