GUYSBOROUGH – After calls from provincial opposition parties, the paramedics union and the public, the Fitch Report on the state and best practices for the Emergency Health Services (EHS) was released on March 8.
The report was submitted to the government in Oct. of 2019 but not released until “Emergency Medical Care Inc. (the province’s EHS provider) contract negotiations were completed,” states a news release from Health and Wellness. That process is now complete and the report, with redactions, is available online.
The report makes 68 recommendations, of which the government says it will adopt 64. The report highlights several long-standing issues in the EHS system: off-load delay, non-productive time, response times and transfers.
The report states that significant time and money is spent in non-productive activities, “specifically waiting in hospitals to off-load patients in emergency departments.” Recommendations to address this issue include the provision of a designated team at hospitals to facilitate off-loading of patients.
While the Fitch Report states that, “on average, EMC (Emergency Medical Care) ambulances spend one-and-one-half hours off-loading patients for Category 1 calls,” times may vary widely. In an interview with CBC’s Information Morning on March 9, Michael Nickerson, the paramedics union CEO, said the longest off-load delay the organization had registered was 27 hours.
The Fitch Report also advises that off-load times could further be reduced by amending, “policies or adopt legislation, as needed, to allow patients to be treated in-home or transported to alternative treatment destinations, and/or with other transport modes.”
The EHS system can be compared to the human bodies it serves; if one part of the body is malfunctioning, it impacts the health of the whole person. Off-load delays impact response times to 911 calls and patient transfers. A recommendation that positively impacts one component in the system will have an impact on them all.
The Fitch Report cites patient transfers as a point in the system where resources should be reallocated and recommends that patient transfers be performed through alternate means: “Total transfers represent 47 per cent of all ambulance transports in 2018. Some 98 per cent of these transports require only basic life support (“BLS”) staffing and equipment. For that 98 per cent, a medical necessity policy and procedure could be developed so that many of these transports could be handled by other transportation modes such as multi-patient buses, wheelchair vans, or car services.”
This reallocation of resources and alternate means of patient transport would help resolve the EHS staffing shortage issue without the need to hire more staff, the report says. It could also increase system efficiency by freeing hospital beds, which reduces ED backlog, which reduces off-load time and increases response times to 911 calls. Ambulance response times are an issue that has come up time and time again in the province and at the Municipality of the District of Guysborough (MODG) council table.
One of the recommendations that the government is not considering at this time is the move to a civilian model for the EHS communication centre. The report states, “The salary costs at the EHS communications centre are approximately 50 per cent higher per hour than other comparable centres. Call takers at the EHS centre are paramedics, and as such have a higher salary structure than civilians. The International Academies of Emergency Dispatch (IAED), the organization that awards accreditation status to agencies, has found that civilians that utilize emergency medical dispatch protocols, generally perform better than paramedics as they are less likely to deviate from the protocols.”
When asked why this recommendation was not being immediately adopted, Health and Wellness Minister Zach Churchill told reporters at a technical briefing held on Monday (March 8), “That is one that we will look at over time and discuss that situation with the union that represents those staff. But there is no decision right now to move to a civilian model.”
The MODG has been calling for improvements to the EHS system for years and recently (Jan. 20) invited, for the third time, company representatives to council to answer council’s questions about the provision of service in the area; a meeting reported in this newspaper.
At that time, council was not satisfied with the company’s responses to questions about transfer and response times. This week, MODG Warden Vernon Pitts is more hopeful that positive changes will come in the provision of ambulance service in the area.
Pitts tells The Journal on March 9: “It’s good to see that they are going to implement some of the recommendations. I think it is phenomenal if they go down that road because too many times government, and it doesn’t matter what level of government, they go out and they consult, they get the information and they sit on it. It’s good to see the minister said they would be implementing these changes.”
Despite the hint of optimism, Pitts has concerns about the freshness of the information in the report as it was completed in 2019 before the pandemic arose, upending the world and impacting the way health care is provided in the province.
Pitts is also not satisfied with the amount of information redacted from the report. “I don’t think that’s proper. How can you be transparent if you turn around and you redact some of the statements? They could be key parts of the study,” he says.
“I am pleased that the province is moving forward with some of these changes. Our main concern is having someone to respond in time of an emergency,” says Pitts, adding that local medical first responders, such as trained fire department personnel could take a more active role in the emergency response system, which is a recommendation in the Fitch Report.
That being said, Pitts points out that medical first responders, who are mainly volunteers in rural areas, should be compensated, if they share the role of first response with EHS employees. “We pay EHS to do it. We should pay anyone else to do it … It would likely be a lesser rate of pay. We do have a large number of medical first responders with our various fire departments. In fact, I was one for 25 years,” says Pitts.
Pitts concludes by saying that the MODG would do anything they could to help implement the recommendations adopted by the province and included in the new EMC contract.