By Erika Mathieu
Sunny South News
A growing trend in short staffing, ambulance downgrades, and removal of ambulances from scheduled shifts is, “absolutely a cause for concern,” according to Coaldale’s Fire Chief, Kevin McKeown, who also acts as the director of Protective Services and is an Advanced Care Paramedic.
“CDES, like many fire departments in Alberta, have a first-hand view of these issues daily as we are called upon to respond to more medical calls because ambulances are coming from greater distances while no local ambulances are available.”
Since mid-April, Coaldale’s EMS ambulances have been forced to downgrade from Advance Life Support to Basic Life Support on April 23, 24, and 27. On April 5, a Coaldale ambulance responded to Taber for an emergency event.
“We co-respond with EMS to all emergency life-threatening medical incidents; also, when an ambulance is greater than ten minutes away, our department responds as medical first response and provides care to the patient until the ambulance arrives. When there is no ambulance in Coaldale, and the fire department responds first, we track these as ‘Code Red’ events. Our stats show by the end of April 2022, we had already responded to 26 Code Red events in Coaldale compared to only six at this time in 2021.”
“Sadly, it has not been uncommon for an ambulance to be downgraded or out of service for other reasons. Over the last ten months, it seems this is occurring more frequently,” said Mckeown and added, “since the pandemic, downgrades in the level of service for AHS EMS ambulances in Coaldale have been increasing. Unfortunately, we have noticed that this trend is continuing to grow.”
As of May 3, the Health Sciences Association Of Alberta (HSAA) reported there to be 374 unfilled paramedic shifts in Alberta, a figure the HSAA said was rounded down. Emergency services departments province-wide are reporting unfilled shifts on a weekly basis in the hundreds, including a recent case on April 16 in Coaldale where two ambulances were dropped from the schedule altogether due to being short-staffed.
When an ambulance is downgraded from Advanced Life Support (ALS) to Basic Life Support (BLS) it means that there is no advanced care paramedic working on the ambulance. Instead, two primary care paramedics provide medical care for that shift. While primary care paramedics fill an essential role, according to a written statement from the HSAA, “the scope of practice for advanced care paramedics goes beyond what a primary care paramedic can provide. This includes but is not limited to intubation, cardioversion, cardiac pacing and a very large range of medication including those used in cardiac arrests.”
McKeown explained when someone in Coaldale is experiencing a medical emergency which requires ALS, and the ambulance closest to them has been downgraded to BLS, the next closest ambulance would be dispatched to that call. “More often than not, that ALS ambulance would be coming from Lethbridge,” said McKeown.
The impact these delays and code reds have on patients is well-researched. One study out of the UK found, “The most important predictive factors for survival (of patients who experienced cardiac arrest) were response time, initial presenting heart rhythm in ventricular fibrillation and whether the arrest was witnessed. The estimated effect of a one-minute reduction in response time was to improve the odds of survival by 24 per cent.”
In addition to this, in a community such as Coaldale, where residents have been left without a local urgent care centre since the start of the pandemic, the increasingly more frequent downgrading of ambulance services in town has a direct impact on, “the amount of time ambulances spend outside of our community,” said Mckeown.
“If Coaldale had an urgent care centre that could receive certain patients transported via EMS, it would help that ambulance get back into service quicker rather than having to transport every patient to the Chinook Regional Hospital ER,” said McKeown.
At a recent Coaldale council meeting, the issue of urgent care was brought up by Mayor van Rijn during a delegation from MLA Grant Hunter.
“The current situation is unsustainable, and the end result will be the loss of volunteer Emergency Services members that can no longer handle the increased workload backing up a poorly provincially operated ambulance service,” said Mayor Jack van Rijn in a statement last week.
The HSAA continues to ring the alarm on downgraded services, shortages in staffing, and long service times. In response to whether the HSAA’s reports can be reduced down to alarmist rhetoric, McKeown said the reports of downgrading and staffing shortages, “reveal the immense pressure on the EMS system in Alberta. This is not solely a Calgary or Edmonton problem anymore; we see ambulances being dropped all over the province. The COVID-19 pandemic exposed the system’s vulnerabilities and identified that resources had not kept pace with increasing demands for EMS services.”
Despite the rapid growth of the town of Coaldale and subsequent increased demand for services, the total number of ambulances has not increased in tandem with the municipality’s growth over the past decade. “When Coaldale and District Emergency Services operated the ambulance before AHS EMS took control in 2010, we had two ambulances. Fast forward twelve years, and AHS EMS is still running two ambulances in Coaldale despite rising call volumes and demand,” explained McKeown.
McKeown added there is a myriad of factors contributing to the ongoing challenges faced by EMS and first responders including, “EMS staffing shortages, ambulances ‘timing-out’ due to fatigue management, increasing local call volume, ER wait times, and Coaldale ambulances responding to calls in other communities all play a part in this problem,” he said.
As part of Coaldale’s recently adopted 2021-2025 strategic plan, public safety is outlined in the framework as one of six top priorities in the coming years. Mayor van Rijn said, “council takes the safety of our residents very seriously, and we are focusing our efforts on providing our emergency services with the resources to maintain the quality of care our residents expect and deserve. We are currently finding ourselves in a downward spiral when it comes to our ambulance service and as well, dealing with the closure of our Urgent Care Department.”
In addition to the strategic plan, van Rijn said council will meet with MLA Hunter this month to discuss the “unsustainable,” state of emergency medical services in Coaldale. Mayor van Rijn said council is well-aware of the implications these downgrades have on residents, “we as council will be discussing ambulance service and our urgent care department and how we can get the level of services back to where they must be.”