WHEREAS public health is a provincial responsibility, and emergency medical services (EMS) and ambulance response are the authority of Alberta Heath Services (AHS) and its contractors; and

WHEREAS AHS centralized and assumed responsibility for EMS from municipalities and at that time promised no degradation of EMS services in rural communities; and

WHEREAS many municipalities operate a fire service utilizing volunteer firefighters or paid on-call firefighters who participate in the Medical First Response program but are not trained paramedics; and

WHEREAS these volunteers often  serve as first responders in the absence or delay of Emergency Medical Technicians and paramedics within their service area; and

WHEREAS AHS has, through its ambulance and paramedic processes and policies, significantly reduced the services provided to rural Alberta; and

WHEREAS as a result, ambulance personnel are not always available to attend as first responders thereby leaving that responsibility to the volunteer firefighters; and

WHEREAS many volunteer firefighters are experiencing an increasing level of stress or burnout and reduced capacity to respond  because of these additional duties; and

WHEREAS many jurisdictions, due to unbudgeted rising costs, may need to contemplate reducing service levels to no longer respond to medical assist calls, even though it places its own residents in further jeopardy;

THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta advocate to the Government of Alberta to compensate municipalities that operate a fire service with volunteers or employees that are qualified as Medical First Responders in instances when those volunteers or employees respond to emergencies due to the absence or delay of provincial emergency medical technicians and paramedics in their service area.

Ambulance services have deteriorated considerably in the past several years. Specifically, this year (to date) our firefighters have been first on scene for medical assist calls 23 times and in 15 of them the wait time exceeded 20 minutes before an ambulance arrived. During that period, responding firefighters are often placed in a compromising position. If this continues, we fear that we may lose excellent personnel and, equally troubling, will have serious difficulty recruiting new members.

RMA has no active resolutions directly related to this issue.

Alberta Health Services

Thank you for your letter of November 29, 2022 outlining some of the recent Resolutions from the RMA’s Fall Session.

I appreciate you sharing the concerns that many of your members have regarding the provision of health services. Alberta Health Services strives to ensure that all Albertans have access to high quality health care in a timely fashion.

The Resolutions in question however fall more within the realm of government policy direction in Health and Advanced Education. I understand that these resolutions have also been provided to the Government of Alberta and I anticipate that they will respond to you directly.

Alberta Health

As background, in Alberta, the EMT designation is no longer used by the Alberta College of Paramedics or in provincial legislation. The EMT designation has been replaced by the primary care paramedic (PCP) designation. The other two designations for regulated members of the Alberta College of Paramedics are emergency medical responder (EMR) and advanced care paramedic (ACP), with EMR as the entry-level qualification, PCP as the middle qualification, and ACP as the highest qualification.

Alberta’s government understands that the ongoing strain on emergency medical services (EMS) has had a major impact on medical first responders, and we sincerely value the partnership we have with municipalities that provide this important service.

Under the Alberta Medical First Response (MFR) Program, administered by Alberta Health Services (AHS), MFR agencies made up of municipal fire-rescue services may join AHS’ MFR Program and respond to requests from AHS EMS dispatch to provide MFR services prior to the arrival of EMS. This voluntary agreement also allows MFR agencies to choose which types of EMS events they wish to respond to.

As MFR services are an optional responsibility for Alberta municipalities that are part of a public safety role, Alberta Health does not provide direct funding to MFR agencies to cover operational costs. However, the department does cover the cost of some training, equipment and supports, including the development and administration of provincial medical control protocols for medical first responders.

As you are aware due to your involvement with the Alberta EMS Provincial Advisory Committee (AEPAC), I was provided with a number of recommendations regarding the important role of medical first responders in assisting EMS to provide emergency health care to Albertans. These recommendations also speak to supports, including funding.

In his role as Parliamentary Secretary for EMS Reform, R.J. Sigurdson, MLA, Highwood, and former AEPAC co-chair, will be leading efforts to develop an implementation plan for AEPAC’s recommendations, while keeping a strong focus on Premier Smith’s direction to reduce EMS response times and wait times for EMS crews in hospital emergency departments. Both are significant factors in increased time on task and ongoing pressures on medical first responders in Alberta.

It is important to note that the implementation of initial recommendations from AEPAC included pilot projects involving MFR agencies and an exemption permitting EMRs to work on emergency ambulances. Budget 2022 includes $64 million in funding for EMS. This is in addition to $600 million that was added to Alberta Health’s operating expenses budget in 2022/2023, growing to $1.8 billion by 2024/2025.

The Government of Alberta response does not acknowledge the increased need to fund MFR agencies, specifically in rural areas. While participation in the Alberta Medical First Responder Program may provide funding to municipalities for some training and related costs, this resolution is seeking funding support for situations in which rural municipal first responders are required to provide services beyond their formal scope due to a lack of provincial EMS resources in the area. Currently, the province is essentially downloading the responsibility of responding to some emergencies and accidents onto rural municipal first responders. This not only carries increased costs for municipalities, but also places municipal first responders, many of whom are volunteers, into front line response roles that they may not be comfortable with taking on. In 2022, the Government of Alberta accepted the final report of the Alberta EMS Provincial Advisory Committee (AEPAC). Among the 53 recommendations in the report were several related to broadening and standardizing the role of MFRs in responding to emergencies. While this approach has merit, there is a concerning lack of detail as to if or how municipalities will be supported to upgrade their MFR capabilities or for the costs of responding to emergencies.

In Fall 2023, Alberta Health announced a massive restructuring of Alberta Health Services. The restructuring includes a focus on improving EMS response times and improving patient flow and continuity of care. The primary focus for AHS going forward will be acute care. RMA is cautiously optimistic that the new AHS structure will assist in parts of the recommendations within this resolution to be further implemented.

As the response does not indicate a willingness to compensate municipalities for events when they provide services beyond their scope, RMA assigns this a status of Intent Not Met.