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Opinion: What do you expect when you call 9-1-1?
By Michael Hurley
When British Columbians call 9-1-1 to seek emergency medical assistance, they do so because they are experiencing a situation that requires an immediate response beyond their own capabilities. Firefighters, as the first responders in BC, are generally first on-scene and provide medical and scene management support until paramedics are able to respond.
Last fall BC Emergency Health Services (BCEHS) made changes to how it allocates its resources by having ambulances respond to certain medical calls in a “routine or non-priority” manner as opposed to previous designation of “emergency or lights and sirens”. The BC Ambulance Service (BCAS) argued these changes contained in the Resource Allocation Plan (RAP) were necessary to improve response times for those patients with the most urgent medical needs.
At the BCPFFA, we’re calling this move what it really is: the Ambulance Service’s scramble, as directed by the BCEHS, to manage a shortage of available ambulances and paramedics. The BCPFFA is strongly opposed to these changes and supports the call for more ambulances and paramedics.
As any emergency worker can tell you, once a call is downgraded to non-priority from emergency, the timeline to get to the incident changes. Our members have seen a number of cases where patients in distress (heavy bleeding, head injuries, spinal injuries and loss of consciousness) are being considered non-priority, leading to increasingly longer response times by ambulances, which we find simply unacceptable.
Since these changes were quietly implemented last fall, firefighters across the province are noticing much longer wait times for paramedics to arrive at an incident. In an increasing number of cases the wait for an ambulance can be between 40 and 50 minutes longer than before the protocol changes. Is this what you expect when you call 9-1-1?
One of the biggest obstacles professional firefighters encounter in serving the needs of their communities is the inability for simultaneous dispatch, where 9-1-1 operators can send what the system views as an appropriate level of response. Fire is dispatched only when certain criterion is met or after it’s determined that an ambulance is unavailable to respond as required. Critical minutes are lost in this process, and timely on-scene assessment and patient care is being compromised.
In our view, operators should be sending on-duty trained firefighters to determine the level of patient care needed and granting them the authority to upgrade or downgrade the level of response required by ambulance. No matter how skilled 9-1-1 operators are, only trained responders on scene can effectively prioritize patient care for the best possible results.
In Canada, the standards for emergency medical response are less than nine minutes in nine out of ten calls, or in the 90th percentile. BCAS chooses to report only average response times, which in our view is not a true reflection of how emergency responses should be disclosed.
The North American standards are much higher, at four to six minutes for most medical emergent calls. BCEHS targets 12 minutes, and meets that goal 52 percent of the time for the highest priority calls. Prior to the recent RAP changes, first responders attended 35 percent of medical calls. If the recent RAP changes are fully implemented, first responders will respond to approximately 25 percent of medical calls.
By changing its response to 74 of 868 call types, including downgrading 39 to non-priority, BCEHS is condoning a delayed response to the emergent needs of your community. Is this acceptable to you and your loved ones when emergency medical care is required?
We are urging the government through the BCEHS to return the medical response to what the Cain Report in 1989 envisioned of an ambulance service, which was a layered response, with firefighters being simultaneously dispatched to medical emergencies within their community’s jurisdiction. Wait times are becoming dangerously long and putting undue stress on those in need of immediate care.
British Columbia’s population growth and the aging Baby Boomer generation make it essential that this discussion, along with an informed and integrated systemic response to these challenges, shape the future of the emergency services system. BCPFFA wants to work with all stakeholders to ensure that British Columbians receive the care and attention required when they call 9-1-1 – and we’re not confident they’re getting it today.
If you need to call 9-1-1 for yourself or someone else in need, how long are you prepared to wait for assistance? Are you okay with the system deciding that you don’t have a real emergency?
Professional firefighters on duty in your community are committed to responding to your emergency when called upon and providing you with the service that you deserve.
Michael Hurley is president of the British Columbia Professional Fire Fighters Association (BCPFFA)