I thought with some of the developments in paramedicine recently that I would take this opportunity to highlight some of the work that the Paramedic Association of Canada has been up to over the past 18 months.

It is with great regret and sadness that I was sent a copy of a letter to practitioners in Alberta from the president of the Alberta College of Paramedics regarding a surprising decision by the College to pull away from their affiliation as a Chapter of the Paramedic Association of Canada.

The Paramedic Association of Canada has enjoyed a very productive and fruitful relationship with all of our Chapters over the past number of years. It is important to understand that having a truly national organization that is represented by Chapters from Coast to Coast is of the utmost importance to our Association. This is important because of the truly national scope of some of the work that is being done in this profession; whether that be keeping ahead of the ever-changing competencies and scope of practice for the profession, or by keeping up-to-date with requirements for inter-provincial reciprocity, or simply by ensuring that practitioners from across this country have the best tools available to maintain competence, which will ensure for the protection of the public.

Up until 2006, the Paramedic Association of Canada’s focus was more directed towards membership services and lobby efforts and less focused on issues that would be of a regulatory nature, such as ongoing competence and protection of the public. This was well identified by a number of the regulatory Chapters as being a barrier to continued involvement with PAC. The Board of Directors and Executive heard this message loud and clear and began to take steps to address this with launch of a new strategic plan “2006-2008”. While this complete paradigm shift was endorsed, it was also identified as a huge and complex undertaking which wouldn’t happen overnight.

In September 2007, following my election as President, I spoke publicly about the importance of moving, at an accelerated pace, with these important changes in philosophy. During this time it was also noted by some Chapters that there was a bit of unhappiness with PAC’s progress and that they were considering dissolving their relationship with us. In March 2008, members of the executive of the Paramedic Association of Canada met with these Chapters, where frank discussions on the future relationships took place.

I would like to summarize the activities that the Paramedic Association of Canada has undertaken during the last 18 months to move the Association forward in this renewed strategic direction:

1. During the course of late 2007 and 2008 a number of meetings were held to renew the National Occupational Competency Profile, a function necessary by any regulatory body to define educational requirements. Representatives from a number of Chapters attended all of those meetings as a voting committee member;

2. In May of 2008 both the Executive Director and I met with a number of Chapters at their annual general meetings and presented our changing direction to the membership;

3. In late May 2008, the Paramedic Association of Canada hired Ms. Donna Lefurgy as the part-time Registrar to lead the potential development of a National Examination and Registry;

4. In June 2008, at our AGM in Victoria I spoke to both the BOD and the AGM about the need to accelerate the changes. As well there were bylaw changes introduced to begin to separate some of the non-regulatory functions away from PAC;

5. In late November 2008 a committee of the executive and some Chapters of the Association met in Winnipeg and began the process of updating and renewing the Strategic and Business Plan to ensure that it was consistent with our new direction. This work is being finalized by staff and will be presented to the Board of Directors for ratification;

6. In early December 2008 our Executive Director attended the meeting on labour mobility for provincial paramedic regulators to provide some historical significance and offer our support in meeting this goal. The work to date and the ongoing changes to the strategic direction of the Association were discussed at this meeting as well;

7. In late December the Paramedic Association of Canada sought an initial validation from practitioners on the updates and renewal of the Competency Profile Project. The information on accessing the validation survey, available in both French and English, was sent to all Chapters;

8. During the course of the last 18 months I have updated practitioners though the Canadian Emergency News and on our website at least four different times on this important change of direction.

As you can see by this information, a substantial amount of work and development has been undertaken and more is planned to continue to position the Paramedic Association of Canada where we have been told and where we strongly believe we need to be.

It is only by continued collaboration with Colleges and Association Chapters across this great county that we will be able to succeed in meeting these goals.

I would be more than happy to talk to any practitioner that would be interested about this or any other issue. I can be reached by e-mail at chris.hood@paramedic.ca.

Yours in EMS

Chris Hood, President

February 10, 2009

By Darren Sandbeck and Howard Snodgrass

Alberta Health Services

On May 29, 2008 Alberta Health and Wellness Minister Ron Liepert announced a fundamental shift in the way ground ambulance services will be governed, funded and administered in the province. From its traditional background as a municipal service, EMS will be transitioned into an essential component of the health care system.

The minister’s statement set in motion a massive effort designed to facilitate the government’s direction: the Alberta Health Services EMS Transition Project. Over the past few months and into 2009 a growing core of experienced EMS professionals, consultants and health officials have been working cooperatively with operators and municipalities to meet the official transition deadline of April 1, 2009. While the changes being proposed are groundbreaking in many respects for some established EMS operators and municipalities, the overarching requirement to put aside past practices and forge new ways of doing business in the interests of all Albertans represents a new and exciting EMS partnership.

The Minister of Health and Wellness set the following parameters for the transfer of this responsibility:

• Municipalities will have a choice to continue to directly deliver the services under a contract with Alberta Health Services;

• Alberta Health and Wellness will define the overall system governance by setting provincial standards and performance measures; and

• The 2009-2010 EMS budget is $217 million (an increase of $27 million to cover transition costs and dispatch consolidation).

In addition, the Ministry of Alberta Health and Wellness has defined the following public policy principles for the delivery of emergency medical services:

• EMS must be responsive to rural and urban needs;

• EMS must be aligned with the delivery of health care;

• EMS must maintain a public safety role;

• EMS medical oversight must be active and consistent;

• EMS costs must be predictable and transparent; and

• Stewardship of EMS must be proportionate to funding contribution and be performance based.

Working in conjunction with the ministry, the new Alberta Health Services (AHS) health region, the largest health region in Canada, was charged with operational responsibility for EMS delivery and for running a transition process that will result in a coordinated, province-wide EMS system.

With its stated goal of creating more patient-focused care, the short-term operational aim of the EMS Transition Project is to maintain current levels of ground ambulance service delivery while increasing medical oversight, coordination and operational performance. It is an immense project, as service delivery contracts must be negotiated with more than 80 service providers across the province by the transition date of April 1, 2009. However, there is considerable expertise within the province to ensure a smooth transition.

Over the past four years, two Discovery Projects (Peace Country Health and Palliser Health Region) have already made the transition in operational governance from the municipalities to respective regional health authorities. The Peace Health Region has taken over a direct responsibility role for service delivery whereas the Palliser Health Region has a hybrid arrangement with some direct delivery and third party contracted services. The two leads of these projects, Darren Sandbeck and Howard Snodgrass, have been tasked with Co-leading the Transition Project.

The Transition Team utilizes existing health region representatives as regional leads during the initial phase of the project. The team also has representation from the Emergency Health Services branch of the Department of Alberta Health and Wellness and is subject to joint oversight from a steering committee on which AHW and AHS senior management at the ADM and COO levels are represented.

Dr. Hal Canham, the provincial EMS medical director, also sits on the steering committee and has appointed medical leads from each of the regions to form the Regional Medical Directors Council. In collaboration with the Transition Team, the council will provide clinical expertise regarding the transition and consolidation of EMS services, assisting all parties to ensure quality and access are improved and that at a minimum, no degradation of service occurs.

For most of July and August, meetings were held with providers and municipalities to explain the goals of the project, and to receive initial input concerning intentions to continue services on a short-term or long-term basis. The input gained led to the development of the business plan, which lays out a process for achieving the shift of governance, funding responsibility, increased medical oversight as well as laying out the basic operational structure for this to occur.

Following acceptance of the business plan by the minister in mid-September, the next phase of the project got underway—the consolidation of dispatch centres.

More than 30 dispatch centres with differing capabilities are being consolidated to a more workable number of nine—the number of existing health service areas. This number will decrease further as AHS adjusts service zones within the region and the actual viable responses to the RFP are evaluated.

To ensure continuity, the contracts were designed with a short-term goal of regional consolidation over the first three years, with further consolidation to follow as communications infrastructure improves and efficiencies are identified. As this edition of Canadian Emergency News goes to press, evaluation of the dispatch proposals is currently underway, with awarding of contracts expected before the end of the current year.

In mid-October, the Transition Team began a series of regional meetings aimed at explaining to municipalities and to the industry how the contracting process for the new province-wide EMS delivery system will function. It was important to communicate that a made-in-Alberta system would incorporate both direct delivery and contracted models.

Because of the Discovery Projects, direct delivery of EMS has been in place in two areas of the province since 2005. These are services where Alberta Health Services directly provides EMS services in a select community or area that includes:

• Direct employment of staff;

• Direct management of resources; and

• Establishment of detailed operating practices.

Having pre-established direct delivery systems in these two large geographical areas has been found to provide significant flexibility in offering an alternative approach to the contract model.

Yet consistent with the minister’s direction to offer communities the option of devolving EMS to the health sector or to retain existing EMS resources on a contract basis, a contracted service delivery model is also available. This model is representative of the model presently employed throughout the province and ensures no gap or degradation of service.

Alberta municipalities have a long history of providing excellent EMS coverage within their own boundaries, and occasionally beyond. As the achievement of a more coordinated, borderless and seamless EMS system is the overriding intent of the transition process, it is recognized that these first agreements must solidify existing levels of service delivery as well as reflect traditional coverage areas as a starting point in the ongoing transition process.

As snowfalls are becoming a fact of winter life throughout the province, Alberta Health Services contract discussions teams are crisscrossing Alberta’s landscape to attend frequent meetings designed to reach individual provider service agreements.

As the date for EMS transition to officially come under the health umbrella is fixed, the Transition Team recognizes the concept that operational changes must be phased in accordance with existing methods of doing business. This is especially true for municipalities operating integrated fire and EMS services.

With the two-year duration plus the possibility of two one-year extensions, the contracts have been designed to promote flexibility in the proposed contractual EMS partnership. This will allow sufficient time to fully understand how services are provided in each community and what improvements can be made. This contract duration also allows sufficient time for Alberta Health Services to examine and determine how to best provide services in the future within an integrated health care system.

At the same time, the new agreements are clear in their intent to provide EMS service delivery that is resource-driven and not confined by artificial boundaries. They introduce system status management (SSM) methodology, which is widely accepted in the industry as a best practice.

This system attempts to ensure that the right ambulance at the right time is deployed to the right location, in a timely manner. While the SSM name is new to some of the smaller providers in Alberta, the concepts of mutual aid and assistance in both EMS and fire environments have had a long history in the province. Recognition of traditional coverage areas is a key starting factor in the ongoing contract discussions. The adjustment of these coverage areas will only occur following dialogue between AHS and service providers. Any change will be based on the overall premise of providing improved patient care.

In summary, while we are not there quite yet, we feel that the objective of the EMS Transition Project--the achievement of major reforms to EMS governance and funding models, with no gaps or degradation in the levels of current service, is almost within our grasp. With the continuing atmosphere of cooperation between all parties we feel confident that as April 1, 2009 comes and goes, the prehospital care and transportation of Alberta patients will enter a new era of more effective and coordinated care within the health care system. And if all goes according to plan, the change will occur seamlessly and blend in with the excellent standards of EMS care that Albertans have become accustomed to.

About the authors:

Darren Sandbeck is currently the Director, Regional EMS and Emergency Preparedness for the Peace Country Health Region of Alberta Health Services. He is a former Executive Director of Foothills Regional Emergency Services Commission. Darren holds a Master of Arts degree in Leadership from Royal Roads University and remains a registered Paramedic.

Howard Snodgrass is currently the Regional Manager of Emergency Medical Services for the Palliser Region of Alberta Health Services. Howard has served in many change-management and service integration roles in his career as an EMS leader in Alberta. Harold holds a Master of Arts degree in Leadership from Royal Roads University and remains a registered Paramedic.

January 09, 2009

By Lynn Klein

In the early years of EMS communication centres--or more correctly, answering services--they were often housed in private homes, service stations, funeral homes and various other professional or semi-professional venues. All involved in these early centres made their best attempts to deliver the necessary resources to the calling party.

In the past two decades, programs such as Advanced Medical Priority Dispatch, Power Phone, Criteria Based Dispatching, CritiCall and other types of communication education have dramatically improved the communication aspect of the public safety profession. I have heard it stated that if one was disabled, dysfunctional, disinterested, decertified or disgruntled, then they could simply be a dispatcher.

In the past, it was not uncommon to use a communication centre as a training ground for new hires, or for people who could no longer work in the field due to illness or injury. I suspect this scenario still exists in far too many organizations. In some jurisdictions, field medics secure a position in the centre, and then return to a field paramedic position after a requisite amount of time in the communication centre. This type of process more often leads to turn over just as the individual is becoming a very good communications specialist.

Is the communications aspect of the EMS profession vital?

“Improved public safety communications has become an issue of national concern. Improving communications systems has been identified as one of 14 categories proposed for continued development by the National Highway Traffic Safety Administration's EMS Agenda for the Future.” That is part of opening statement from California EMS Communications Plan final draft September 2000.

EMS communications has been aptly compared with the nervous system in higher organisms. “Through the communications system, messages of varying complexity are transmitted to other components of an EMS system such as rescue or ambulance services, hospital emergency departments, to affect their responses to emergency situations. During the emergency period, the responses may be augmented or altered in accordance with new information transmitted via the communications systems.” That is an excerpt from the EMS communications plan by the State of New Jersey Department of Health and Senior Services Office of Emergency Medical Services. (Revised edition, July 2006, Page 1, opening statement.)

I find it interesting that such importance is placed on this vital link and yet in so many agencies, we fail to qualify and retain communication specialists. While some EMS organizations have done a good job in attracting and retaining communications personnel, there is much room for improvement.

Over the years I have attended many seminars and conferences. I have often heard presenters speak about their EMS agencies in terms of our paramedics and dispatchers. It almost sounds as if these are separate components of the same system when in fact they are, and should be, part of the same team. In some systems, the term dispatcher is replaced by EMS Communication Specialist, which I believe more correctly defines the roles and responsibilities this individual must perform. One reason I believe people have not been willing to remain in these roles is historically those who staff a communication centre have not been compensated at pay rate equal to field colleagues.

“Although salary is only part of the reason people choose a career in public safety communications, wages do affect employee satisfaction and have an impact on tenure. Other factors to consider when examining your organization’s salaries include benefits and the cost of living in your area.” 

That is an excerpt from a public safety communications 2006 salary survey, What EMS Communications Centre Personnel Earn.

Suggestions for attracting and retaining communications personnel

Successful organizations should have:

1. Pride in one’s agency: All communication personnel should be in uniform and wear the uniform of the organization they represent. This uniform, plus the cost to maintain it, should be supplied by the service. Civilian attire does not give the personnel working in the centre a sense of belonging. Proper ID cards and badges should also be issued.

2. Defined break periods. All communication personnel should be given time off the floor to relax.

3. Shift patterns that reduce the amount of time the communication personnel are on shift. Fatigue, especially on a long night shift, is very common. The concept of longer shifts to secure more time off must seriously be examined to reduce the stress and sick time often related to longer shifts.

4. An exercise area. Because communication centres are sedentary atmospheres, personnel should be encouraged to be fit. This promotes mental acuity, reduces stress and leads to less health related issues and time off work.

5. An incentive program. A points system could be established where communications personnel may earn points by volunteering at public displays, seminars and conferences, teaching CPR and AED classes, acting as CIS peer debriefers, or working on special projects. These points could be redeemed for such items as a trip to an EMS conference, agency items such as t-shirts or mugs or special items of uniform dress such as a mess kit or dress uniform (if this is not part of normal uniform issue).

6. A “walk in our shoes” program, in which personnel either within the organization or from a public safety program who may be considering a career in EMS communications are invited into the communication centre. These individuals would spend one entire rotation to give them a true feeling of the skills and demands required for the position. This is not a process in which a person simply plugs in with a communications officer for a few hours but for the entire block, including nights.

7. Communications specialists who are attracted by design, not by default. These vital and complex centres should not be used as a general venue to accommodate personnel who have been injured and may no longer be able to work in their former capacity. Many collective agreements have duty to accommodate language, however the communication centre should not be the first consideration in this relocation.

8. A strong and responsible bargaining unit. Fair and decent treatment of EMS employees is ensured and protected by a collective agreement between the employer and the employees. All members of the communication centre at some point in their career would be well advised to serve in a union position, so they may better understand the great value such organizations have played in past, present and will play future development of their profession.

9. Communications personnel with a minimum emergency medical responder certification if they are responsible for EMS resource deployment. Or they should be current or former paramedics so they understand the medical terminology used by field personnel and other health care professionals.

10. All communications personnel should be provided with a complete geographic tour of the areas they will be responsible for. Digital mapping, GPS, AVL are all great tools when they work, but are no replacement for a working knowledge of the response area. They should also know how to read a paper map when these electronic information systems fail, or the centre has to be evacuated to a location where the normal operational technology may be compromised.

11. Encouragement of continuing education. Communications personnel must constantly keep current on new trends in their field just as field medics must keep current in their discipline. Inevitably there will be change.

12. Annual field orientation. All communication personnel should spend at least two shifts per year in the field to understand the issues of their colleagues. Conversely field personnel should spend at least two shifts per year in the communications centre so they may better understand the issues and challenges experienced by communications personnel.

13. Promotion of personal development. Communications personnel should invest in themselves by reading articles in professional journals, taking courses offered by their organization, belonging to professional associations such as the Association of Public-Safety Communications Officials, National Emergency Number Association, or the EMS Chiefs of Canada. They should also attend seminars and conferences using their own money as a personal investment, and shouldn’t always expect the agency to pay the way.

14. Wages and benefits for communications personnel that are not any less than those of their colleagues in the field. Some organizations are better than others in achieving this standard of equality.

15. A national or provincial medal for communications personnel. While there is a National Emergency Services Exemplary Services Medal for those who have served for 20 years of which 10 years were in a capacity of “risk” there is no such medal for those who serve in our many communication centres. This is an oversight that needs to be corrected. In fact, communications personnel are the first line personnel in any call. The dedication and level of expertise employed by communications personnel play a vital role on all calls, and such commitment should not go unnoticed and unrewarded in our country.

The aforementioned are only some of my thoughts and suggestions. Not all will agree. One startling fact is we are not attracting and retaining career communications personnel, and this is a global trend. In a profession that is in constant change mode to meet our demanding health care needs we will either innovate or evaporate.

About the author:

Mr. Lynn B Klein is in his 41st year in the EMS profession. Over his career, Lynn has been a field paramedic, paramedic educator, a superintendent responsible for media and pubic education, and still works part time in the communication centre of a public sector EMS system. Lynn has been a speaker at local, national and international conferences and is a recipient of the Canadian Emergency Medical Services Exemplary Service Medal.

January 09, 2009

As the production team for Survivorman arrives at the airport, ready to be flown to some far away place to produce another show, the scene is often the following: I’m edgy, the stills photographer is busy trying to get us a better deal, the camera man is excited, but trying to deal with a ton of equipment in pelican cases. And then there’s Barry, the paramedic (nicknamed Baramedic)--calm, cool, collected and well organized due to his fanatical obsession with getting to every airport five hours early for any flight.

At some point along the way, the networks that broadcast Survivorman were convinced by insurance companies and lawyers--after the extremely unfortunate death of Steve Irwin--that I needed to have an official risk assessment done for the show. That is, for the locations I venture into spending seven days alone surviving off the land.

The whole concept was a tough one for me to swallow, because giving risk assessments is exactly what I do. So I found myself sending information off to some agency based in New Zealand, so they could tell me whether or not I would be safe in Colorado or South Africa. All the answers for each and every location came back as I had expected. So my production team and I ignored them all, because they were ignorant of the realities and mostly paranoid. There was however, one recommendation for the series overall that I was happy to receive and it gave me the opportunity to have the network approve of putting it in the budget: Bring along a paramedic.

We couldn’t afford it before, but now the insurance companies were forcing the issue and I was glad to see it. If you haven’t seen the show, it goes something like this: I venture out to remote locations in various countries around the world. I am left alone to survive without food, with very little, if any, gear or water and no camera crew.

I have been able to travel down this path and make these kinds of films because my background is filled with many years of learning and teaching wilderness survival, along with working in film and television. I knocked off 11 such shows pretty much alone with no safety backup, which would have been a big problem if I had ever truly run into trouble.

Finding a paramedic for this kind of show wasn’t going to be easy. The person had to be willing to travel long distances and be away from home for up to three weeks at a time. Once on location, they had to be personable enough to be in close quarters with the rest of the team for long stretches of time. I may be off in the jungle trying to survive alone but my field producer, stills photographer, second unit camera person and paramedic would all be huddled together in a lodge, hotel, cabin or tent, depending on where we were for that show.

A number of organizations were contacted while we searched for paramedics, including the Professional Paramedic Association of Ottawa. We poured over resumes looking for someone with the right qualifications and experience. As we were getting closer to the first shoot--in fact, I was already on the way to the airport--we still hadn’t chosen our paramedic. One individual, an Ottawa paramedic named Barry Clark, seemed to come out of nowhere on the last day. We communicated with him a week or two earlier but had been caught up in sifting through all the other resumes. Then, with my bags already packed, Barry called up without having any indication from us that we would hire him and proceeded to fill us in on everything we would need to know to be safe in the Amazon jungle--my first location. We hired him on the spot.

Barry had to be clear on one important parameter: I had to be left alone. So safety checks would be verbal and by radio, which frustrates his better sense of safety to no end.

Barry has all of what I need to be the paramedic on a show like Survivorman: common sense; he doesn’t stress out or get flustered easily; and although his big size makes him stick out like a sore thumb, he still somehow manages to assimilate easily and in a wonderfully non-intrusive way with the local culture. The best part is that he gives me exactly what I need and want in a paramedic--an unyielding dedication to my personal safety. When my job as host and producer of the show has me sleeping on the ground in the Amazon jungle, Kalahari Desert, on the top of a mountain or in the middle of Pau Pa New Guinea, this is a good thing.

Preparing for the shoot doesn’t only mean grabbing his big red medic bag and packing his rain gear. He needs to know what all the potential dangers are to me and my team’s health and safety while on location. Diseases like yellow fever and malaria have to be considered. Anti-venom for numerous different snake species needs to be found. Are we dealing with neurotoxins or hemotoxins? Are we all going to suffer from foot fungus due to six hours of daily rain or are we going to be fried to a crisp in the desert sun?

Once on location, Barry kicks into gear discovering what infrastructure is available to us in the middle of the jungle, which is essentially none. When there is safety backup available in a given location, Barry lines up all the dominoes so if the worst should happen, he can start the process of hopefully saving my life. He is quite literally the only team member I don’t have to give information to in order to make the shoot happen. He knows what he needs to know or he finds it out. Then he tells me whether he is or isn’t comfortable with what will happen should we have an emergency.

For me, the fun part is giving him a run for his money. Of course the truth is, that I don’t ever want to lose life or limb for the sake of a TV show but the smartass in me likes to try to make Barry nervous. In reality of course, if all is going well and Barry is on the job, he should essentially be bored. I always say if I can bore Barry I’ve had a safe shoot.

A very unexpected and welcome side benefit to having Barry along has been experienced by outsiders. For some reason, shoot after shoot, we would all be fine. But then some accident would happen within the vicinity. Take the Amazon jungle, for example. It was somewhere around day four and I was hunkered down in the pouring rain trying to sift tiny crustaceans out of the mud in a little jungle stream. Huge spiders loomed inches above my head while I kept an eye out for more poisonous creatures than I care to remember. Suddenly I heard a loud boom. I had no idea what it was. A few days later, after I had survived my seven days, I was told of how a small plane had tried to land on the tiny grass airstrip in the middle of the jungle. It had crashed and Barry was there to provide basic life support to the pilot who was still alive after suffering a bilateral fractured radius and ulna as well as a chip fracture of T1 and T2 and a minor closed head injury.

On the very next shoot I spent a spooky night in the middle of lion territory listening to them growl while they took down and ate an antelope. I would learn later that on that day a Land Rover with six people flipped over on a steep road and it was Barry who was first on location to look after the multiple (some critical) injuries. In that instance, Barry showed another side of his skills that has come in handy over the last couple of years of shooting Survivorman—#8212;the part of him that is the caregiver. He is a great listener and is able to defuse a potentially volatile or panicky situation that would likely exacerbate the emergency department.

Perhaps the closest I have come to calling in Barry for an emergency was in the Kalahari. The temperatures reached 141ºordm;F in the sun and 101ºordm;F in the shade. All day, the only water I was able to drink was as hot as coffee. At night, huddled in the front seat of the Jeep, I noticed I was not cooling down. In fact, I seemed to be getting hotter. Everything about my condition was indicating heat stroke. I was nauseated, volume depleted, extremely hot and dizzy with a pounding headache and had trouble concentrating. I pulled out the two-way radio and hung it beside me vowing to call him in right away if I started to feel like I was going to lose consciousness. It took me five long hours of dabbing a damp bandana on my carotid arteries and wrists to slowly bring my temperature down. The only assurance I had that I would make it through this potentially deadly situation was the knowledge that I had a paramedic standing by, sleeping with his radio by his head. And knowing Barry, he was snoring loudly.

October 30, 2008