More often than not, people speak of problems, and offer no solutions. However, a recent visit from Dave Deines and Sherman Hillier, the provincial vice-presidents of Ambulance Paramedics BC (APBC) – CUPE 873 to council was full of the latter.
Deines says, “We made a promise to council at UBCM that we would come and visit and we are here. The reason we came before you today is to talk about ambulance issues in your community and rural BC. Everybody knows what’s happening right now, we are very aware with what is happening in terms of ambulance coverage.”
They explain this isn’t just a regional or provincial issue, it is national.
They were also accompanied by the Regional Representative, Richard Vollo. The three presented to council an alternative way to look at health care in the community, through paramedicine.
Hillier says, “This is something we have been working on for a period of time. In addition to being the VPs of the union, Ambulance and Paramedics is also the professional voice for paramedicine in BC. Further to that, Dave and I sit on the national committee for the Paramedic Association of Canada (PAC). PAC spent some time in Ottawa last November lobbying the federal government to support community care paramedicine. It’s a bit of a catch phrase. The idea is looking at different solutions for communities to try and bring stable paramedic jobs to communities, and to provide and enhance service for the residents of community. Essentially the concept and what has been working in some of the smaller communities back east, in Nova Scotia, P.E.I. and New Brunswick, is to enhancing the role of what a paramedic can do in the community and having a value added service for the paramedics you have.”
The idea is to recruit paramedics to small communities and offer them full-time employment. “If you build it they will come,” says Hillier explaining the current system prohibits anyone who is currently full-time from coming to Tumbler Ridge without reverting back to part-time. “If we could work together,” says Hillier, “There is a lineup of guys in Vancouver who are waiting to come.”
Currently in Tumbler Ridge there are four part-time ambulance members, and seven more recruits on their way, who run a 24-hour ambulance service. Tumbler Ridge is a ‘kilo’ station which means that the paramedics are only paid when they have an actual call-out. The rest of the time, they are paid $2/hour when they are on-call and carrying a pager. “That in itself is the problem with trying to keep ambulance services intact,” says Hillier continuing, “Some of the ideas would be to use those folks outside of hospital facilities, or inside hospital facilities to augment the staff who are in place. Other ways would be outreach, flu clinics, or post-op dressing changes, medications; those places where you have gaps. You have to identify that stuff on a case by case basis in each town. The problem with recruiting and maintaining paramedics in small towns throughout Canada is the stability of work.”
What the union is looking at in terms of solutions will be on a community by community basis.
The group would like to partner with northern communities and go forward to government and the health minister as a united front. “The upside for us,” says Hillier, “is we would provide stable jobs for our members and help treat patients. To us that’s the end goal. And hopefully take the burden off the health care system.”
Though this may be a brand new concept here in BC, nationally these collaborations between paramedics and the health care system have been working very well.
This whole concept started with Long and Brier Island, in Nova Scotia, and a small town by the name of Pugwash, a small community of 500 people that employs four full-time paramedics. “The baby-boomer aging at home population is growing,” explains Hillier continuing, “More and more, at-home therapy and antibiotics are being administered. In the community prior to the concept, they had to take two ferries to the health care facility, which was ridiculous because all they needed was an IV start, some antibiotics, some observation, follow-up and they went home.”
Other community focused programs have been put in place across Ontario as well.
“One dollar put into these types of systems, saves the health care system two dollars. That is the kind of thing we will approach government with,” says Deines. “We haven’t done it yet in BC, but I was just reading an article out of London. They are trying it in metropolitan areas because of the overload on the hospital systems and they are trying it in rural areas because they need solutions. What we are doing right now isn’t working and we know this,” he continues.
The other problem here in BC is the cost for training and payback for being a paramedic. Hiller explains, “Early when guys like Dave and I were recruited and trained as paramedics, you would come into the ambulance service and they would train you from zero to basic to primary care paramedic. The ambulance service got out of that business, it is now a fee for service, so to recruit someone into your community as a primary care paramedic, which is the national standard. As new recruit you would be required to go to the Justice Institute or some academy and pay an upwards of $10,000 bill for school and come back to your community to work for two dollars an hour. That is really the barrier.”
They explain the seven recruits coming to Tumbler Ridge will be at the emergency medical responder level of paramedic, which is not the national standard and not what they are promoting. We currently have two primary care paramedics, they explained.
“To go from a primary care paramedic to a community care paramedic there is not a huge amount of training. Paramedics in BC are highly trained and they go from primary care, IV therapy, and with some small augmented training we could easily move to enhanced care, ability to liaise with doctors over the phone and we do that today. If there is a cardiac arrest we talk with the doctor and decide whether to transfer the patient. Paramedics can also work at the health facility. If they are manning an ambulance 24 hours a day, they can be on the other side of the health facility able to provide care if need be,” says Hillier.
Though they haven’t had formal discussion with partner organizations yet, for example Northern Health, Hillier says, “It’s all in how you phrase what the job is that we believe we could be doing. No one is advocating we should take a nurse’s or health care professional’s job. What we are saying is we can augment those positions in the facility. This is one of the first lessons learned from the east coast. If we say, you have an emergency nurse on call 24-7, would it be beneficial to also have a paramedic there that could assess patients for you, and get things going? We know from medical professionals they will say yeah.”
Where things can get tricky is with funding streams. The APBC recently entered into a partnership with Northern Health, negotiating an ambulance-patient service that will go from Burns Lake, to Prince George. “What the issue was, is they had a number of patients going down to the cancer centre every day, and Northern Health identified a need to get these patients back and forth. It’s not a standard ambulance but it is staffed by paramedics who work out of Burns Lake, they hit different stops along the way. We had to get out of our policy agreement, think outside of the box and put our heads together,” says Hillier.
In the end, the program has been jointly funded by the two groups and will be going live in January. This collaboration created three full-time ambulance jobs in Burns Lake.
“Northern Health has now perked up and said, ‘This is interesting’,” says Hillier.
Here in Tumbler Ridge, some of our services could use some augmenting. Councillor Snyder says, “I can see this progressing as a complimentary service to what already exists. People that are here are doing a fantastic job, but they are very limited. When we have ambulance attendants come in from other towns and stay here in our station, that is saying there is some work here and those could be complimentary to the nurses who come in on-call.”
Hillier added that it costs the government one million dollars to run the 24-hour ambulance, and with the call volume Tumble Ridge gets, the government will not be looking to hire more paramedics for full-time positions.
Councillor McPherson says, “This is a problem that has come up 50 times and there has never been a solution presented until I’ve seen this. It is nice to see.”
Hillier explained in closing that in his 20 years in the profession, the situation has gotten worse. “We are trying to provide solutions we think would work. The beauty is it is tailored to a community’s specific needs. What you need in Tumbler Ridge, may be different from Logan Lake, but it is just a concept.”
With Tumbler Ridge being the first community they have met with, Council has asked for the APBC to go back and draft up a motion. They could potentially be using the same motion with all of the other communities involved. They spoke with more than 15 different communities about paramedicine at the UBCM. They are looking for a ‘Northern partnership of councils’ to go forward to government and initiate some positive change.