WHEREAS the Government of Alberta took responsibility for the delivery of emergency medical services (EMS) as it was a provincial health responsibility; and
WHEREAS at the time EMS transitioned from a municipal responsibility to a provincial responsibility the Government of Alberta committed to maintaining service levels; and
WHEREAS even prior to the COVID-19 pandemic the capacity of the provincial EMS system had not increased adequately to meet escalating needs; and
WHEREAS this capacity issue has been exacerbated, both directly and indirectly, by the COVID-19 pandemic; and
WHEREAS the number of “code reds”, where no ambulances are available in a community or in larger geographical areas of the province, is increasing; and
WHEREAS the health and safety of citizens continues to be a priority for municipalities; and
WHEREAS municipalities continue to frequently support the provincial health care system by providing medical first response through fire departments; and
WHEREAS there has been a recent upward trend in fire service wait times due to the increased length of time it takes for EMS to arrive on scene in municipalities that provide medical first response; and
WHEREAS a lack of EMS capacity is compromising timely access to emergency healthcare for all Albertans, and particuarly those in rural areas;
THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta request the Government of Alberta to immediately consult with municipalities to develop a plan to make urgently needed improvements to the capacity, delivery, and performance of the emergency medical services system.
When the Government of Alberta transitioned EMS service from a municipal responsibility to a provincial responsibility there was a commitment to maintaining service levels. However, as populations have grown, and demand for EMS has increased, a historical lag in corresponding capacity has created intense pressure on the emergency care system.
Provision of emergency health care in rural communities has significant, unique challenges, including low population densities and large geographic areas. Large geographic areas inherently result in longer EMS transport times, making EMS response times even more critical where timely care is critical, and delays may result in compromising patient care and safety.
The borderless provincial delivery model utilizes system status management, where resources are shared across jurisdictions, and deployed where statistical probabilities project they will be required. Therefore, when resources are exhausted in major urban centres resources are drawn from surrounding communities. While attempts are made to provide cross coverage, lack of capacity frequently results in large areas lacking adequate EMS resources and facing longer response times.
In rural areas, the repositioning of resources to more densely populated urban areas amplify response time issues where large geographic areas already create challenges. The full benefit of a provincial model can only be realized when resources are adequate to provide timely response and performance for all Albertans.
The transition to a provincial EMS system has also impacted municipalities, who support emergency medical care by providing medical first response. Impacts include an increasing need for municipal fire services to provide medical first response due to a lack of EMS presence, which can result in increased stress on firefighters responding to medical incidents and increased costs.
Though a provincial EMS dashboard has been recently established to measure EMS performance, up to date information is challenging to access. Transparent reporting regarding performance indicators, in which municipalities do not have to use of freedom of information requests to access data for their communities, is key to trust in the emergency care system. Analysis of this data will assist in determining impacts of decisions on patient safety and quality of care.
EMS service levels have become an urgent, even critical issue with potential life and death consequences. Every citizen experiencing a medical crisis across Alberta is impacted, as the time of EMS response increases, the survival rate of patients decreases. Service delivery improvements will require an innovative multidimensional strategy. Timely access to emergency care has both direct health benefits and broader community benefits. These include attracting new residents, stimulating economic growth, and ultimately supporting viability and contributing to the sustainability of rural communities.
14-19F: Provincial Funding for Regional Air Ambulance
THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta request that the Government of Alberta provide funds to locally- and regionally-operated emergency response air ambulance services at the same ratio as Shock Trauma Air Rescue Society (STARS) funding;
FURTHER BE IT RESOLVED that the Government of Alberta commissions an independent review, which includes engagement with the public, industry stakeholders and municipalities acoss Alberta, of the helicopter emergency medical services system in Alberta.
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On January 24, 2022, the Minister of Health announced the establishment of an Alberta Provincial EMS Advisory Committee with the goal to provide immediate and long-term recommendations that will inform a new provincial EMS service plan. It was further announced that AHS Emergency Medical Services is taking immediate action with a 10-point plan to address the unprecedented pressure on the EMS system. The plan is made up of 10 initiatives designed to help reduce demands on existing resources, to increase availability of ambulances and to plan for the future.
Five initiatives outlined in the 10-point plan are already underway:
1. Hiring more paramedics
• Working to fill all openings quickly, and we are in conversations with the colleges about expanding these specialized paramedic training programs so there are more qualified candidates to hire.
2. Launching pilot projects to manage non-emergency inter-facility transfers
• Two pilot projects are underway, in each of the Calgary and North Zones, where patients who do not need urgent medical care are transported from hospitals to appointments, or back to care homes and residences by means other than ambulances.
3. Initiating an ‘Hours of Work’ project to help ease staff fatigue
• Project launched in November 2021, EMS is adjusting working hours, shifts, and scheduling at ambulance stations in highest need throughout the province to help to alleviate fatigue among staff.
4. Transferring low priority calls to other agencies in consultation with EMS physicians
• These calls are transferred to other agencies such as the Poison and Drug Information Service (PADIS) and processes are in development to transfer calls to Health Link 811 when appropriate, and in consultation with our EMS physicians in dispatch.
5. Stopping the automatic dispatch of ambulances to motor vehicle collisions that do not report injuries
• Previously, an ambulance would have been dispatched automatically and the crew would need to confirm there are no injuries. These calls are still responded to by police or fire as appropriate. EMS will always attend if injuries are subsequently identified.
In addition, work is underway on the following additional five initiatives:
6. Creating a new integrated operations centre in Calgary
• Bringing paramedic leads, zone and hospital staff together for improved integration between EMS and the hospital system, to improve overall patient movement throughout the system.
7. Evaluation by an emergency communications officer to determine if an ambulance from out of area, though it may be closest to a 911 call, is most appropriate to respond
• EMS will be implementing additional dispatching processes provincially, including evaluation by an emergency communications officer to determine if an ambulance from out of area, though it may be closest to a 911 call, is most appropriate to respond. This work is focused on getting ambulances back to their home communities as quickly as appropriate.
8. Implementing a pilot project in Red Deer
• This will manage most patient transfers between facilities with dedicated transfer units, freeing up ambulances to handle emergency calls.
9. Allowing ambulances to be pre-empted from assignments, instead of being automatically dispatched when a 911 call is received, to ensure more ambulances are available for critical patients
• This will allow EMS to divert ambulances to higher priority calls, when appropriate. This changes the way ambulances are assigned primarily in Calgary and Edmonton, and will assist with keeping ambulances in Suburban and Rural communities.
10. Developing a strategic 5-10 year provincial service plan for EMS delivery in the province.
The 10-step plan listed above is in addition to actions that have been undertaken over the past several months to increase EMS capacity and respond to the demand.
These include deploying supervisors to calls, delaying some non-urgent transfers, and working closely with hospital teams to ensure timely flow through our emergency departments. EMS has brought on additional staff and ambulances which includes the addition of 30 full time and 70 temporary full time paramedic positions across the province.
In early 2022, the Government of Alberta established the Alberta EMS Provincial Advisory Committee (AEPAC). AEPAC’s mandate was to explore system pressures that may contribute to service pressures, gaps and human resource/workforce challenges. This included focus on ground ambulance, air ambulance and dispatch, policies and procedures related to the delivery of EMS services, and identifying current and emerging issues that impact EMS delivery. RMA was represented on AEPAC by President Paul McLauchlin, who served as chair or vice chair for two cub-committees: EMS dispatch and air ambulance. The AEPAC delivered its final report to the Minister of Health in May 2022. The Minister later accepted all of the 53 recommendations in the report and tasked Alberta Health, Alberta Health Services, and related ministries and stakeholders (including municipalities) with implementing them.
In April 2023, Alberta Health Services released the Emergency Medical Services Operating Plan: April 1, 2023 – March 31, 2024. The operating plan heavily focuses on describing current progress and future plans in relation to implementing system improvements recommended from a variety of sources, including the AEPAC final report.
While the success of implementing the recommendations found in the AEPAC report is not yet known, the report has been approved by the Minister and is shaping the future operating priorities of AHS. This resolution is assigned a status of Accepted and RMA will continue monitoring implementation progress.