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Review backs B.C.'s ambulance priority shift

Ambulance response times have been a controversial topic since a major change in call priority that took effect in November. - Fle
Ambulance response times have been a controversial topic since a major change in call priority that took effect in November.
— image credit: Fle

An external review has endorsed B.C.'s contentious reallocation of ambulance service in favour of the most urgent cases.

Lower Mainland cities, fire departments and their unions have denounced the changes introduced in November, saying dozens of categories of calls have been downgraded to slower responses, resulting in extreme waits of more than an hour in some cases.

Ambulances now head to many of the downgraded calls without the lights and sirens they used in the past, a change that's expected to reduce the risk of crashes with other motorists.

B.C. Emergency Health Services contends the longer waits have averaged just 10 minutes slower in the Lower Mainland, but have enabled slightly faster ambulance responses to critical emergencies where extra seconds can save lives.

The report by Alan Craig, the retired deputy chief of Toronto Emergency Services, says the BCEHS Resource Allocation Plan takes a "careful and prudent approach" based on actual medical evidence that matches global best practices and is "superior" to the priority systems used in many major jurisdictions.

It agrees the lights-and-siren response carries serious risk to both paramedics and the public and should be limited to just the most urgent incidents.

It also says the public needs to better understand that very few patients from 911 calls need to be rushed to hospital.

The science of emergency medicine is rapidly evolving, Craig's report says, overturning key assumptions over the past decade.

Short response times, with fire department first responders further shortening them, are no longer considered worthwhile in virtually all cases, he said.

The report says emergency doctors now agree that short response times improve patient outcomes in less than one per cent of cases – just ones involving cardiac arrest and patients unable to breathe.

"Not surprisingly, the magnitude of contemporary changes in emergency medicine may conflict with the expectations and the culture of some paramedics, some first responders and some members of the public," it says.

BCEHS insists its changes have improved not hurt overall patient outcomes.

While the provincial government department maintains the ambulance response changes are not about saving money, the external review suggests there is a link.

Craig's report said the public should also understand that "fixed response times for other than the most critical incidents are a major driver of EMS system costs, particularly as demand for service continues to rise."

In a conference call Friday with reporters, Craig said cost should never be an issue with critical care, but added it may not be cost-effective to mandate speedy response times to routine non-urgent calls.

"We want to put the money where it's needed – critical calls – not an overly strict, non-medical response to minor calls."

He gave the example of an elderly senior who wakes up with severe back pain and needs to go to hospital emergency via ambulance.

Requiring the ambulance to arrive in eight minutes when that patient may then wait several hours in emergency because of their low-priority condition is not  good use of public money, Craig said.

Bronwyn Barter, president of the Ambulance Paramedics of B.C., said she believes the changes are aimed at at least containing the ambulance service budget.

"This is a money issue and a resource issue," Barter said. "The call volume has been increasing in the province and the resources have remained the same. We do view this as a tactic to do more with less."

The union head said front-line paramedics believe too many calls are now downgraded from code 3 with lights-and-siren to routine.

"We don't think it's appropriate to rob Peter to pay Paul," she said. "The amount of time people are waiting with a fractured hip or after a fall – it's not appropriate that they're waiting that long."

Surrey Fire Chief Len Garis was critical of the external review, saying Craig's work guided the development of the BCEHS Resource Allocation Plan and he can't be considered an independent, unbiased expert.

He cited the Surrey fire department's own independent analysis, conducted by University of the Fraser Valley professor Martha Dow, which found a doubling in wait times in Surrey for lower priority calls.

"The wait times have gotten extremely long," Garis said, adding some patients' condition can deteriorate as a result.

"I'm concerned for the public and I'm concerned for the people who have fallen through the cracks."

BCEHS has urged fire first responders to follow the plan's recommendation that they not attend numerous types of low priority calls where they will end up waiting longer for ambulances to arrive.

But the service's Dr. William Dick said each city council will have to decide if they want to provide a different level of service than what the plan has determined is medically necessary.

 

 

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