WHEREAS the Government of Alberta, through Alberta Health Services, has taken over the responsibility for ensuring that proper provision of ground ambulance services and communication services are used in dispatching ambulances in Alberta; and
WHEREAS inter-facility patient transfers (IFPT) in rural Alberta account for a significant amount of time spent by EMS in a licensed ambulance; and
WHEREAS patients who are deemed to be clinically stable by a licensed clinical practitioner may be considered for a non-ambulance transport; and
WHEREAS the ultimate purpose is to develop a provincial Emergency Medical Service (EMS) system that is patient-centred, coordinated, and ensures the most effective use of available resources; and
WHEREAS the purpose is also to ensure effective coordination in responding to medical emergencies and providing patient transport within Alberta’s health system; and
WHEREAS it is not possible to take one service (ambulance) out of a rural community without serious impact to other services;
THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties request that Alberta Health Services provides an Emergency Medical Services (EMS) system that ensures appropriate coverage and response in all areas of the province; and
FURTHER BE IT RESOLVED that Alberta Health Services considers non-ambulance transportation (NAT) for clinically stable patients and considers reserving the use of ground ambulances for emergency events.
Emergency medical services should reflect the entire continuum of patient care, treatment, and transportation for patients outside of the hospital environment. Multiple providers and agencies may be required to ensure prompt response, effective treatment, and appropriate medical transportation for patients within a health care system, without additional costs to the patient.
Currently the provincial ambulance service has two critical roles: EMS pickup and delivery from an emergency incident, and IFT pickup and delivery for patient transfer or diagnosis. Private-for-profit (PfP) and not-for-profit (NfP) ambulance providers have co-existed in Alberta for more than 70 years. Most ambulance expenses for a patient are covered by private insurance. Costs for seniors and patients on inter-facility transfers (IFT) are covered by the Government of Alberta’s health care plan.
Blue Cross insurance rates for ambulance service are approximately $400.00 per emergency call. There are no readily available figures on the cost per call for IFT, as these costs are absorbed by the provincial health care plan.
Four factors predict a trend towards an increase in IFTs:
The Partnership for Rural EMS Direction (RED) was formed by municipal leaders, fire and dispatch staff and citizens concerned about the impact of transition on 911 call centres, coordinated dispatch and emergency response. A series of RED documents and research reports have been prepared and are included on the community first responder website at www.ruralcommunityresponders.com.
Information regarding Alberta Health Services’ actions based on the HQCA Review of Ground Emergency Medical Services in Alberta, January 2013 is as follows:
HQCA Required Actions:
Determine the resources required for Inter-Facility Transfers (IFT’s) that considers provider scope of practice, vehicle type and equipment based on patient need. Ministerial Directive D2-2013-2.2 – The implementation plan shall include options to limit the use of AHS EMS staff and contracted EMS resources for non-urgent Inter-Facility Transfers, including the use of external contractors to provide these services.
The HQCA Report can be accessed at:
Alberta Health Services Central Zone is waiting to release a “Request for Expression of Interest and Qualification” (RFEOIQ).
1-12S: Placement of Additional Radios in Ambulance Units
THEREFORE BE IT RESOLVED that the AAMDC request that the Province of Alberta address immediately, the lack of direct communication between fire, municipal services and ambulance to prevent lags in emergency response time during significant emergency events, by allowing the placement of additional radios in ambulance units.
DEVELOPMENTS: The Alberta First Responder Radio Communication System (AFRRCS) is currently under construction and will be completed in 2016. The system will provide two-way radio communication between emergency responders and will be available to municipal emergency responder agencies including fire, police and ambulance. Currently, the system will only provide oral communication to emergency with limited data capability. As AFRRCS will not be fully operational until 2016, this resolution remains Unsatisfactory. The AAMDC will continue to monitor the implementation of the AFRRCS and its ability to meet the needs of the AAMDC membership.
2-11F: Emergency 911 Dispatch
THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties (AAMDC) request the Province of Alberta to halt the transition of Ambulance Dispatch Centres and that the Standing Issues Committee undertake a joint review with Alberta Urban Municipalities Association to ensure that first responders, ambulance and fire remain as or be returned to one unified, efficient, dispatch to enhance communications while responding to emergencies in Alberta.
DEVELOPMENTS: The January 2013Health Quality Council of Alberta (HQCA) report on Alberta’s ground ambulance services, recommended that the consolidation of ambulance dispatch continue immediately. With the government’s acceptance of this recommendation, the reaction to this resolution is deemed Unsatisfactory. Dispatch consolidation had been limited until the release of the report and the AAMDC is disappointed in the renewed effort to consolidate. The Ministry of Health is currently reviewing the dispatch system. The AAMDC will continue to advocate for dispatch issues through its participation on the Medical First Response Advisory Panel, and the grass-roots Rural Community First Responders Working Group.
4-11F: Remote Location Emergency Response
THEREFORE BE IT RESOLVED that the AAMDC work with the provincial government to encourage commercial and industrial employers within the Province of Alberta to address and provide for emergency access at remote locations in their emergency response plans in accordance with current legislation.
DEVELOPMENTS: The AAMDC accepts the response of Alberta Human Services and Alberta Municipal Affairs as the Occupational Health and Safety Code requires employers to have emergency response plans in place that include procedures for rescue, evacuation and transport.
Health: Alberta Health Services (AHS) currently uses 20 non-ambulance transport vehicles throughout Alberta to transfer medically stable patients between health care facilities for specialist consultations, diagnostics and procedures. When medically appropriate, the Ministry of Health supports the use of such vehicles to allow for greater availability of ambulances for emergency calls.
Interest has been expressed to AHS from the municipal level regarding the status of a pilot project on increased use of non-ambulance transport in the AHS Central Zone. The issuing of a request for expressions of interest and qualifications is pending.
AHS has developed a provincial inter-facility transfer strategy that will include measures to limit the use of Emergency Medical Services staff for non-urgent, inter-facility transfers. Implementation of the strategy, which is pending approval, is expected to allow more resources to be devoted to emergency ambulance calls.
The AAMDC is encouraged by the steps taken to fulfill the intent of this resolution. At the AAMDC spring convention, the Government of Alberta released the Rural Health Services Review Final Report, which provides numerous recommendations related to rural health care service delivery, including emergency services. A commitment made by former Minister of Health Stephen Mandel was to ensure that ambulances that are transporting patients from a rural area to an urban centre return to their rural base as opposed to being diverted to another call in the urban centre. This, combined with the government response above, provides a satisfactory reponse to the second request made in the resolution.
However, the first request made in the resolution, that EMS coverage be adequate in all areas of the province, has not yet been achieved and the government response gives no indication of how this will be achieved. Many rural areas struggle with having approriate EMS coverage in their communities, which compromises safety as well as the ability of rural municipaltiies to attract and retain businesses and residents. The Ministry of Health’s 2015-18 Business Plan identified the need to “improve the effectiveness and efficiency of emergency and ambulance services” as a priority initiative. The AAMDC looks forward to the implementation of that initiative.
The AAMDC will continue to monitor all aspects of emergency services in rural Alberta and the recommendations made in the Rural Health Services Review Final Report. Until concrete action has been taken to ensure appropriate coverage and response in all areas of the province, this resolution will have a status of Accepted in Part.