More ambulance-fire integration? B.C. officials poised to make announcement

Vancouver -

The shocking death toll and collapse of the ambulance system during British Columbia’s devastating heat dome appears to be spurring the province to make changes to how much medical support firefighters provide before paramedics arrive. 

CTV News Vancouver has been asking union leaders and government leadership whether a hybrid model or greater cooperation between the two could help with the 911 and ambulance crunch that’s seen increasingly high, sometimes record-breaking call volumes since the spring. 

They were careful with their wording, but confirmed discussions are underway, and hinted that there could be some changes to the scope of firefighters’ medical role coming soon in response to the Health Minister opening the door to those discussions in the weeks after the heat dome. 

"We're going to see a tighter partnership, there is some work that is going on now between this sort of tri-partnership meeting between the (health) ministry, fire and BCEHS,” said Leanne Heppell, chief ambulance officer for BC Emergency Health Services.

"We certainly are working closely and realizing that we want to make the most efficient use of all services to ensure we provide the timely care and access for our patients."

Former Surrey mayor Dianne Watts pointed out there have been discussions and panels and deliberations over the course of years, all pointing to a greater leveraging of fire halls and firefighters to support the ambulance service – perhaps even a hybrid fire-ambulance service like Winnipeg uses. 

“Several models from around the world have been looked at and the outcome and the recommendations are about an integrated service,” Watts said. “That’s not new. It’s the practicality on the ground getting there because you’ve got two unions … It’s a matter of political will because those recommendations from all those task forces, all the work that’s been done, all of the studies, all of the best practices. It’s already there.” 

THORNY FUNDING, JURISDICTIONAL, AND UNION ISSUES STALLING PROCESS

BC Emergency Health Services is funded by the province and manages paramedics, ambulances on the ground and air, and the dispatchers and specially-trained personnel who provide medical advice over the phone during 911 calls. It’s one of the only province-wide ambulance services in Canada. 

The province has dozens of fire departments, however, funded and managed by each municipality. With their greater numbers and ubiquitous fire halls, these departments have found that more than half of all their call-outs for medical support. 

"We've been advocating with government for years to have an increased role for firefighters,” said BC Professional Firefighters Association president Gord Ditchburn.

“It's not to take away from the work paramedics do by any means. The respect level we have for paramedics on the street it incredible … Firefighters have the ability to deliver naloxone and it makes a difference in a patient's life, so why can't we expand some of that to supporting prehospital care and our paramedics?” 

While Heppell’s comments suggested that some fire halls could soon double as ambulance stations and that there are discussions around “different models of care,” the paramedics union is opposed to the idea. 

“They don't want our job, we don't want their job," insisted Troy Clifford, president of Ambulance Paramedics and Dispatchers of B.C.

“That's being reviewed right now, but providing a duplication of services that goes on to municipal taxpayers is not what we need, nor expanding their roles so they can treat and transport. Fire departments are there for public safety, fire suppression and first response, and they fill that void very well.” 

TECHNOLOGICAL, SOCIETAL AND PATIENT NEEDS CHANGING

Fire departments have had to reconsider their role in communities over the years, with smoke detectors dramatically reducing residential and commercial structure fires. Now, most call themselves “fire rescue services,” because they’re more likely to attend car crashes and carry out technical rescues or provide urgent medical attention than they are to face flames.

While some departments may see a larger raw number of fire calls now than they did in decades past, the percentage of calls that are fire-related has decreased.

Similarly, paramedics are responding to more calls for overdoses and the so-called loneliness epidemic; their next call could just as easily be to pick up a senior who’s living alone and suffered a fall as it could be to treat a gunshot wound. Their mental health calls have also skyrocketed in recent years, and the increasing delays in service are having impacts on police who count on them to take patients to hospital. 

"Time that we spend waiting for an issue that's not necessarily a criminal issue or a public safety issue is time we can't be using to respond to people who are in need for other cases,” said Vancouver police Sgt. Steve Addison, explaining that officers will take people apprehended under the Mental Health Act to hospital in cage cars if the waits are extensive.

“It would be most appropriate for that person to be transported in an ambulance, however we understand that the system is stretched thin, so we do what we can to provide proper service to people in need.”

While sources tell CTV News the Health Minister is expected to make some sort of announcement about fire-ambulance cooperation in the coming weeks, Watts urged him to take bold and decisive action – even redesigning the entire pre-hospital care system.

“This is not a new issue and so putting a Band-Aid and trying to plug the hole in the dyke is not going to work,” she said, bluntly. “It has to change or the whole thing’s going to collapse.”

This is the fifth part of a CTV News Vancouver series examining British Columbia’s pre-hospital care system.

Part one: Not just a paramedic issue: What's behind 911 call delays in B.C.

Part two: B.C. family doctor shortage impacting 911 service and ambulance waits

Part three: B.C. paramedics understaffed by up to 40 per cent daily due to burnout, injuries, vacancies

Part four: 'We're taking action': B.C.'s new ambulance boss gives first interview