Rural EMS is on Life Support
May 08, 2015
The following op-ed piece appeared in the April 29, 2015 edition of the Winnipeg Free Press:
Manitobans know in times of crisis, it often takes longer for responders to reach remote northern communities with emergency medical care than it would in Winnipeg.
They may be less aware response times are also unacceptably long in larger rural Manitoba communities to the south, as well.
This scenario, coupled with the fact emergency room closures are becoming more common in more locations in rural Manitoba, has raised fears among rural residents about the level of care they receive in an emergency.
It was this scenario that prompted paramedics to call for a review of the emergency medical services (EMS) system in Manitoba. It was hoped the EMS Review, which was finally released two years ago, would generate a road map to fix emergency medical services in rural Manitoba, but paramedics are still waiting for any meaningful action on the majority of those recommendations.
An overarching recommendation in the EMS Review was to hire more than 400 paramedics to improve quality of services and reduce response times and provide a safe level of care.
However, a great many Manitoba paramedics are continuing to leave their communities for Winnipeg or other provinces where wages are better and working hours are shorter and more predictable. Manitoba is also not graduating enough paramedics to take the places of those that leave, meaning the ambulances that are needed in rural communities are increasingly unavailable and out of service due to staffing shortages.
Provincial guidelines mandate ambulance response times are not to exceed 30 minutes 90 per cent of the time. Rural ambulances fail to meet those guidelines far too often because ambulances are increasingly being used for hospital transfers and are out of their communities (leaving a shortage of ambulances available for emergency calls), and the fact that there aren't enough paramedics to provide care.
With the number of emergency rooms closures we have seen, it would have been beneficial to see the number of highly trained advanced care paramedics (ACP) in rural Manitoba increase. This was also a recommendation in the EMS Review.
An ACP's advanced scope of practice would help fill the gap of medical skills available to rural patients. But there still seems to be very little urgency on the part of Manitoba Health to move quickly on either recruiting or graduating advanced care paramedics to work in rural Manitoba.
It is not a stretch to say rural paramedics are dangerously overworked and overtired. Some work shifts lasting days at a time without rest. While on call, they rest when they can while a hand-held radio crackles nearby in case a call comes in.
In this fatigued state, they are asked to make medical assessments in high pressure situations, then barrel, lights and sirens, down Manitoba highways at 120 km/h, often with critical patients. No one wants to see a line-of-duty death due to fatigue.
Rural paramedics do have a choice, of sorts. They can either work double shifts or on-call in their fatigued state, or they can choose to actually get needed rest on their off hours.
If they don't take the extra work that comes with a short-staffed service, their community goes without emergency medical coverage. So the pregnant woman in Ashern, and the baby in distress in Hamiota, and the injured farmer in Winnipegosis wait upwards of an hour or more for life-sustaining care to arrive.
The STARS helicopter was meant to be a panacea for rural health care. It hasn't worked out that way. STARS does not attend many calls because of its specialized format. Its location in Winnipeg means it can't fly to many remote or rural communities fast enough (and without refuelling because it's a small chopper), and a host of other reasons. The indisputable fact is ground ambulances get to the vast majority of medical calls faster than STARS.
Lifeflight is Manitoba's fixed-wing air ambulance. It provides coverage for the entire province of Manitoba but has runway limitations. The majority of its missions are in the far north providing airlift to the most critically injured or ill patients. When it is available to fly in the South it is put into service to bring patients to Winnipeg.
The vast majority of Manitobans that need EMS will never need either Lifeflight or STARS. Of the hundreds of calls EMS responds to each day, it is likely Lifeflight would transport two patients a day. STARS would transport about that many per week. These are necessary elements in our EMS network, but ground ambulance with trained paramedics continues to be the back bone of the system.
These challenges weigh heavily on those who provide emergency medical care in rural and remote communities, and certainly weigh heavily on people who live there. Solutions have been identified but require a commitment to improve rural health care and implement the recommendations of the EMS Review.
Manitobans deserve no less.
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