+ RMA Rural Municipalities
of Alberta

Resolution 3-23F

Minimum Standards for Adequate Ambulance Services in Rural Alberta

Date:
November 8, 2023
Expiry Date:
December 1, 2026
Active Status:
Active
Sponsors:
MD of Taber
District:
1 - Foothills-Little Bow
Year:
2023
Convention:
Fall
Category:
Emergency Services
Status:
Intent Not Met
Vote Results:
Carried
Preamble:

WHEREAS the Government of Alberta maintains responsibility for delivering emergency medical services (EMS); and

WHEREAS all Albertans deserve the same level of service and access to ambulance services; and

WHEREAS Alberta Health Services (AHS) has established varied target EMS response times, including 12 minutes for metro and urban areas, 15 minutes for communities with more than 3,000 residents, 40 minutes for rural communities under 3,000 residents, and 90 minutes for remote communities; and

WHEREAS rural Alberta communities, located outside urban areas and with populations fewer than 3,000, do not receive direct ambulance resources, including both personnel and equipment, under AHS service delivery, and

WHEREAS this lack of direct resources presents a significant risk of inadequate service provision; and

WHEREAS rural Alberta communities, outside of urban areas with populations less than 3,000, and that rely on volunteer services, face unique challenges in meeting minimum requirements and commitments essential to medical response; and

WHEREAS rural Alberta communities, outside of urban areas with populations less than 3,000, and that rely on volunteer services, find that ongoing training requirements and related costs become a significant impediment to retaining volunteers; and

WHEREAS the response time target for a life-threatening event is eight minutes for 50 percent of calls and 12 minutes for 90 percent of calls;

Operative Clause:

THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta advocate that the Government of Alberta and Alberta Health Services ensure every area of Alberta has available ambulances with qualified emergency personnel, capable of providing response times that ensure lifesaving measures.

Member Background:

Municipalities in rural Alberta rely on the Government of Alberta to provide adequate emergency medical services for the health and safety of our residents, in a way that promotes and supports the growth and stability of our province and our local communities.

Providing adequate service involves understanding the needs of each unique community and knowing the interconnectivity between surrounding communities to ensure a stable and sustainable service remains available for our residents.  There are communities throughout southern Alberta, such as the Town of Vauxhall and Village of Foremost, served by volunteer ambulance service.  These examples represent combined urban and surrounding rural populations that are just under the Alberta Health Services (AHS) rural 3,000 population category and are challenged with trying to maintain adequate ambulance service with success being linked to retaining essential volunteers.  Volunteers in today’s ambulance service struggle to maintain minimum standards that surround training and increasing demands related to volunteer services.

There is an important role for AHS to play in the provisioning of ambulance service in rural communities that includes supplying equipment, personnel, training, and systems that can support acceptable services delivery province wide.

According to the AHS mandate,1 the Regional Health Authorities Act (RHAA)2 charges AHS with responsibility to:

  • promote and protect the health of the population in Alberta and work toward the prevention of disease and injury;
  • assess on an ongoing basis the health needs of Albertans;
  • determine priorities in the provision of health services in Alberta and allocate resources accordingly;
  • ensure that reasonable access to quality health services is provided in and through Alberta;
  • promote the provision of health services in a manner that is responsive to the needs of individuals and communities and supports the integration of services and facilities in Alberta.

Communities throughout Alberta, large or small, are made up of residents that look to the province in support of their health and safety, and even more so in the event of an emergency.  The Government of Alberta has made many improvements over the years, with the exception of committing to provide reliable direct ambulance service to our smaller communities and surrounding areas.  These communities are primarily rural and appear to have somewhat fallen between the categories.  A review of rural and remote services is needed to identify these gaps in service and ensure that adequate resources and systems are put into in place to support communities now and into the future.

References:

1 Government of Alberta (2010). Alberta Health Services – Mandate and Roles https://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-mandate-roles.pdf

2   Government of Alberta (2022). Regional Health Authorities Act, RSA 2000, c. R-10 (RHAA)

RMA Background:

1-21F: Emergency Medical Services Capacity and Service Delivery in Rural Alberta

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.

Click here to view the full resolution.

6-22S: Responsiveness of Service Delivery by Quasi-independent Agencies in Alberta

THEREFORE, BE IT RESOLVED that the Rural Municipalities of Alberta request that the Government of Alberta review the continued use of unelected, quasi-independent agencies for the administration and delivery of essential public services, with the results of the review published for public examination.

Click here to view the full resolution.

Government Response:

Alberta Health Services

AHS has spent the past year putting into action our EMS Operating Plan which focuses a number of initiatives with a goal of getting more ambulances with qualified emergency personnel on the road. Additionally, addressing this goal will help improve EMS response times in the community, reduce EMS hospital time, and reduce the utilization of rural ambulances in metro centres, returning the ambulance back to the community a quickly as possible.

AHS is taking action to:

  • EMS Return to Service initiative (45-minute offload target): As of March 16, 2023 EMS has been working collaboratively with our emergency department and hospital teams to return EMS crews to service within 45 minutes. This is measured from the time of arrival at the hospital until the ambulance and crew are available for the next event. This initiative decreases hospital time and increases community coverage and has a direct impact on decreasing response times.
  • Metro Response Plans: Metro response plans were created and implemented, These plans are designed to keep suburban/rural resources in their home community and prevent resources from being pulled into the metro environments. If a suburban/rural ambulance is the closest resource to a high acuity event they may still need to be used.
  • 911 to 811 Pathway (Health Link/Secondary triage): EMS 911 has partnered with Health Link to provide a pathway for secondary triage of lower acuity patients. The RN at Health Link triages the patient to determine if healthcare advice or other services are a better pathway than an EMS response. This helps to preserve EMS capacity for higher acuity events and supports qualified emergency personnel being available for their community.
  • Non-Clinical Transport: When a patient has been discharged from hospital or is headed to an appointment and has no acute care requirements, hospital staff are engaging and using other modes of transport to move patients, such as family, taxi, or community resource. This leaves resources in community to respond to events.
  • Ground Ambulance Regulation (GAR) variance: EMS has requested and was granted a 3-year GAR variance for the use of Emergency Medical Responders (EMR) in all of Alberta. The use of EMRs allows more practitioners to enter the system and supports our community workforce needs.
  • Fatigue Management/Hours of Work (HoW) Project: AHS continues to review communities to determine staff fatigue and address the issues identified through improvements in shifts, scheduling, additional staff, and resources.
  • Hiring, Recruitment and Retention: EMS has hired a program lead for recruitment, retention, and development with a focus on provincial strategies to improve current workforce challenges. EMS Operations is working to centralize and standardize the hiring practices across the province to speed up the process and ensure all staff are onboarded and supported as quickly as possible.

Regarding communities served by volunteer ambulance service – AHS is engaged in meaningful discussions with rural volunteer services involved. AHS acknowledges the important role that volunteers play in the provision of ambulance services, yet we understand the increasing strain on them to meet evolving standards and demands. AHS is actively assisting communities such as Foremost with more sustainable staffing options. and we continue to explore options to support more sustainable and robust direct delivery services by transition communities like Vauxhall from a volunteer service to a direct delivery core flex model.

This strategic shift aligns with our commitment to promoting and protecting the health of the population of rural Alberta, as outlined in the AHS mandate and the Regional Health Authorities Act (RHAA). We recognize the need for a comprehensive approach that encompasses equipment, personnel, training, and systems to ensure acceptable service delivery province-wide.

Alberta Health

Our government has made a strong commitment to improve emergency medical services (EMS) response times in the province. This includes strengthening rural EMS coverage and boosting recruitment and retention of the front-line EMS workforce. Our Health Care Action Plan (HCAP) prioritizes four areas of improvement: decreasing emergency department wait times, improving ambulance response times, reducing surgical wait times and empowering front-line workers to deliver health care.

As highlighted in my mandate letter from Premier Smith, we are working to improve EMS response times across the province and ensure implementation of the recommendations stemming from the Alberta EMS Provincial Advisory Committee (AEPAC) and the Alberta EMS Dispatch Review. To that end, I have established a new Alberta EMS Standing Committee, comprised of front-line paramedics, Alberta Municipalities and the RMA, Indigenous representatives, and other key community partners. Over the next three years, this committee, chaired by the Registrar of Emergency Health Services (EHS) with Alberta Health, will provide advice on all aspects of the system, including air ambulance, dispatch, ground ambulance and medical first response. Its work includes reporting to me on implementation of the recommendations from the AEPAC and the Alberta EMS Dispatch Review. I am pleased that RMA will participate on the new standing committee, and I look forward to learning of its progress in improving EMS in the province.

Further, I have directed Alberta Health Services (AHS) to co-ordinate all strategic priorities regarding EMS operations with Alberta Health’s Registrar of EHS. The province will set clear provincial performance indicators, operational standards and mandatory reporting requirements for EMS. These standards will apply to all service providers, including AHS, and address service provision in rural and remote areas of the province. The goal is to make sure Alberta has a high performing EMS system that is reliable, accountable, and follows best clinical practices. As you may know, we are also refocusing the health care system to ensure Albertans receive the best care within a single, fully integrated, high-functioning system. A new Acute Care

organization will be created to focus on specialized areas with patient-centred care. This organization will oversee the delivery of EMS, hospital care, urgent care centres, cancer care, clinical operations and surgeries. It will work to further reduce EMS response times and enhance access to care across the province.

Development:

The outlined actions provided by Alberta Health Services to improve EMS show a promising outlook on the future of healthcare services throughout the province. RMA appreciates the work that is being done to enhance EMS and looks forward to the implementation of these enhancements of service. It is promising to see Alberta Health acknowledge and prioritize the initiatives of the AEPAC report and RMA remains cautiously optimistic about the future changes to the healthcare system in the province.

Providing adequate service involves understanding the needs of each unique community and knowing the interconnectivity between surrounding communities to ensure a stable and sustainable service remains available for residents. Blanket solutions do not ensure that every area of the province receives equitable care.

It is essential that Alberta Health creates a solution that ensures every area of Alberta has available ambulances with qualified emergency personnel, capable of providing response times that ensure lifesaving measures. Although the response from Alberta Health acknowledges the unique needs of EMS in rural and remote areas, there is no clear plan or funding to ensure that there are accessible services available to residents living in rural and remote areas.

RMA assigns this resolution as Intent Not Met and will continue to advocate for the asks of this resolution.

Provincial Ministries:
Health
Provincial Boards and Organizations:
Alberta Health Services
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