Ambulance reforms pledged to shrink waits

New plan to hire more paramedics, treat more minor calls without a ride to hospital

B.C. is adding eight ambulances and 34 paramedics in the Lower Mainland as a first step as the government promises major reforms to improve substandard emergency response times.

The new action plan unveiled Friday by B.C. Emergency Health Services calls for big changes to how minor emergency calls are handled – more on-the-spot treatment by paramedics or even medical advice by phone is likely rather than the standard practice of an ambulance ride to hospital.

“There are still too many patients waiting too long for an ambulance who need one and there are too many patients receiving an ambulance and a transport to an ED (emergency department) that don’t require it,” BCEHS executive vice-president Linda Lupini said.

Accompanying the plan is an independent review that found it takes an average of 10 minutes and 24 seconds for ambulances to reach life-threatening calls in the Lower Mainland and Greater Victoria.

A new target of under nine minutes for 75 per cent of those critical calls is being adopted, in line with international standards.

And the review warns population growth and aging will drive up call volumes six per cent a year and push ambulance response times up to more than 15 minutes by 2020 if no improvements are made.

The eight extra ambulance that are being deployed include three in Surrey, two in Langley, two in Abbotsford and one on the North Shore. Extra paramedics have also been added in the Tri Cities.

But Lupini said that is just an immediate stop gap to relieve pressure, with much more improvement required through a combination of more resources and innovation.

Without changes in procedure, she estimated, up to 30 more ambulances would be required by 2020 and at least 10 single responder vehicles.

While more money is being requested, much of the planned reforms focus on other methods to speed up ambulance response times to critical calls and to cancel or redirect ambulance transport for less urgent calls that can be handled differently.

Lupini said many of those calls “could be dealt with by physicians over the phone or a paramedic seeing and treating a patient without bringing a patient to an emergency room, because that’s what really ties up resources.”

The top reform priority is to reduce how long paramedics wait in hospital emergency departments to hand over incoming patients so they can get back on the road. Fraser Health hospitals are expected to be at the forefront of making the necessary ER reforms.

Faster dispatch and deployment times to get ambulances in service is another strategy.

The latest reform plan comes in the wake of ongoing complaints from municipalities and their fire departments of unacceptably long waits for ambulances to arrive and transport non-critical patients.

That was the result of a controversial restructuring of the B.C. Ambulance Service priority system that aimed to speed ambulances to life-threatening calls but often slowed it to others.

Surrey Fire Chief Len Garis said he’s optimistic about the changes.

“It should make it more of an efficient system,” he said.

Ambulance Paramedics of B.C. president Bronwyn Barter said the review confirms the service is “extremely understaffed” and argued more immediate staff increases are required.

But she said there are “a lot of positives” in the report, including the acknowledgement of the need for more resources and the move to reduce delays at hospitals, which consume 17,000 paramedic hours a year in urban areas.

NDP heath critic Judy Darcy said the government should have acted sooner in light of years of public outcry.

She predicted the plan will leave many people “still falling through the cracks” – and they may include those less acute cases where a decision is made they don’t need an ambulance response.

“The devil is going to be in the details,” Darcy said. “Triaging over the phone is a very different kettle of fish than triaging when someone presents at an emergency room.”

Transforming Emergency Health Services Action Plan

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