Rural medical coverage delayed for urban response amid shortages

By Sharon McLeay Times Contributor

All over the province, there are complaints about the Alberta Health Services (AHS) borderless roving deployment system for emergency calls and shortages of ambulances and paramedics. AHS promised when they took over the service in 2009 that service would be improved under their mandate, but 10 years later AHS still has no solutions to the reoccurring issues.
“It is an ongoing challenge and especially the further and further you get away from the bigger cities. We hear the same things further south, response times are not adequate and there are challenges of dispatching and getting the ambulance guided around our municipalities,” said Alberta Association of Municipal Districts and Counties (AAMDC) Al Kemmere in his address to Wheatland County council in February 2018.
Mike Harper, Union president of the Health Services Association Alberta (HSAA) agreed that change is needed regarding deployment and funding for front line services.
“The reason this happens is the metro areas are not staffed properly,” said Parker.
Borderless roving deployment often means rural units are called in to cover shortages in the cities, while other rural service areas are drawn on for coverage causing a domino effect of service shortages.
“Everyone is trying to fix this problem and they are talking to the managers who say there is no problem, or they are using statistics to flood the issue, when really the answer is to talk to the folks on the ground,” said Wheatland County Councillor Ben Armstrong. “It’s that whole pass-off system that allows them to be tied up … they are getting stuck at the hospital and can’t come back. The frontline staff can tell you what the issues are, but I’m not sure who is listening.”
It is a question of what AHS defines as coverage. Rural residents say current definitions and service methods are not acceptable. They are not happy when another county’s ambulance is put on standby for Wheatland County response.
There is a quality of service lost and stress added to attending crews, when ambulances are called to respond in unfamiliar areas. When crews respond on their home turf, they know many of the people and their reoccurring medical histories and they know the quirks of traffic and territory in the area that impede response. Some urban crews respond to rural calls and get lost, and rural crews responding in expanding urban territory is a challenge.
President Al Kemmere of the AAMDC said in the name of efficiency, they (AHS) are creating inefficiency,
The deployment system is an attempt to deal with shortages of crews and ambulances, and provide more coverage with less cost. Roving deployment began under the City of Calgary prior to 2009. It was modelled in the upgraded computerized dispatch program. The computer system, as in all businesses, cost a lot of money. Changes may not be technically possible and costs of making changes may be prohibitive.
The conflict between the expectations of the system and the reality of extenuating circumstances that surround each call were there from the beginning and have expanded, because the territory now encompasses regional zones.
Medical response delays can mean the difference between life and death, or worsened health outcomes. HSAA are aware of response issues, and emails and tweets from patients to HSAA are showing how issues are endangering patient care.
To cope with delayed response, AHS extended urban ambulance response targets from seven to 12 minutes in 2015. Rural targets were set at 15 minutes. But what happens when those rural delays become 30 to 45 minutes?
Wheatland County councillor Ben Armstrong said half hour response times are increasing for a number of the calls in rural areas.
Councillor Scott Klassen said it is also concerning that dispatch would not tell callers about delays. An anonymous twitter site AlbertaEms@StatusCodeRed has been set up to let the public know when there are limited resources for particular areas.
Rural fire crews also assist. They are tasked to hold the fort with CPR and first aid certifications, until paramedics or STARS can arrive on scene. Local ambulance crews are very thankful for firefighter coverage at times when they can’t be available.
“We absolutely rely on the fire departments because we cannot guarantee response times,” said WADEMSA manager Kevin Link.
Link could not discuss more of the issues due to a non-disclosure contract AHS has employees sign.
“The ones that are out there supplying the service that know the issues can’t talk to us, for fear of losing their jobs,” said Wheatland Councillor Ben Armstrong. “They are under gag orders and can’t talk to us. They are the ones that know what’s going on.”
HSAA president Parker said they advise their medics to abide by the non-disclosure terms to protect their members. Parker said to date there has been no disclosure cases regarding patient advocacy.
AHS Emergency Medical Services Chief Darren Sandbeck told media there would be no action taken when medics advocate for their patients
The seeming prioritization of urban calls has rural residents crying discrimination between urban and rural populations. They are taking offence that they pay the same taxes, but don’t get adequate service delivery. Residents wonder if cost cutting is done at the expense of patient care.
“What is our responsibility to the people of Alberta?” asked Parker.
HSAA says call statistics show a 36 per cent increase since 2009, staff hiring is lacking, and funding ratios haven’t improved for over five years. Parker said long-term budget constraints in Alberta have deteriorated the ability to provide adequate health care for Albertans. Parker is calling for more staff and more ambulances.
Each new ambulance, which needs eight medics to staff 24/7, and the accompanying maintenance and employee benefit costs are $1 million. Parker said it is costly, but support would have direct and tangible results for the public. He considered that an investigation and review of cost wastage in AHS could pinpoint needed funds to divert to front line services.