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911: Why Calgary opposes the EMS dispatch change

Two-thirds of multi-agency call times in the Foothills region are at least a minute over the prescribed 90 seconds for answering and dispatching immediate medical services.

Nearly half are more than double the recommended 90 seconds.

Suzanne Oel, Foothills County Reeve and chair of the Foothills Regional Emergency Services Commission (FRESC), said it’s a direct result of the EMS dispatch split. Theirs began back in 2009.     

“I guess ever since that point, we’ve had a lower service level,” Oel told LiveWire Calgary.

Oel is backing Calgary’s battle against the province’s decision to fully consolidated EMS dispatch within Alberta Health Services. They’ve been waging a public campaign to reverse the decision for more than three years.

Calgary, Lethbridge, Red Deer and Wood Buffalo are some of the remaining pieces for the full consolidation of EMS dispatch. Last week, Mayor Naheed Nenshi went to Edmonton, along with representatives from the other municipalities, to lobby Alberta Health Minister Tyler Shandro.

“Today’s meeting was a good opportunity for us to detail to Minister Shandro why we believe that 911 dispatch should be operated at a municipal level,” said Mayor Nenshi.

“The local knowledge and integration with fire services, who are first on the scene to deliver life-saving care in 50 per cent of cases, cannot be overlooked if safety outcomes are the number one priority. It is now up to the Minister to make his determination with the facts in front of him.”

The province is reviewing the EMS dispatch information from this meeting. Calgary will hold a special meeting of council Sept. 28 to address the issue.

The Foothills numbers

Oel said emergency organizations adhere to the National Fire Protection Association (NFPA) Standard 1221.

It states: “Processing times for emergency calls requiring emergency medical dispatch questions and pre-arrival medical instructions is 90 seconds 90 percent of the time.”

When they launched a media blitz back in 2017, they were only reaching that benchmark four per cent of the time. Today, three years later, it’s achieved in six per cent of calls.

Oel estimated that 50 to 55 per cent of calls in their area required multi-agency response.

FRESC diagram of what they say happens in 911 calls. COURTESY FRESC

She said under new Public Safety Access Point (PSAP = 911 call centre) standards, calls are supposed to be answered in 15 seconds, 95 per cent of the time. Then it’s to be transferred to ambulance, fire or police within 60 seconds 99 per cent of the time.

The total call-to-response time in these cases is targeted for 90 seconds.

Recent data from FRESC shows that in these calls, 65.18 per cent are at two minutes and 30 seconds (2:30).  Just over 47 per cent are three minutes. Oel said that quite often they reach five minutes to complete that chain of response.

“If you ever guessed how long 90 seconds is, let’s just hold your breath, or watch your loved one hold their breath in an emergency,” she said.

Calgary 911 call response

Magni Magnuson, Acting Commander for Calgary 911, said there are tens of thousands of calls annually that require a combination of emergency services.

He’d make the same case as Oel: If you break out the EMS dispatch, you lose the immediate access to police, fire, ambulance dispatch under one roof.

“The proposed non-integrated model basically requires us to transfer the call outside of the four walls in Calgary 911 centre, which increases the risk of information or call loss, resulting in unnecessary delays.”

Magnuson said with three AHS calls centres across Alberta, there’s a lack of local knowledge.

“Their call takers might not be as well versed in local geography, and then able to pinpoint, say, landmarks that would be known to our call takers here in Calgary, but they would not to someone in Peace River,” he said.

 “So, some of that local knowledge will be lost.”

Recent diagram tweeted out by Calgary Mayor Naheed Nenshi. TWITTER

The anatomy of (two) 911 calls:

Call comes into Calgary 911, and the operator asks if it’s for police, fire or EMS.

The call is immediately directed to that emergency service.

From there, Magnuson said a “very structured protocol of questions” is asked to determine the priority of the response. That gets sent to dispatchers who then dispatch the appropriate emergency resources – police, fire and EMS.

“In today’s environment, we have our folks side-by side, and we have a situational awareness, we have leads that are monitoring what’s going on,” he said.

He gave the example of a call coming in as a medical emergency, but through the questioning they find that it was the result of a physical assault. Police could be dispatched simultaneously.

With the EMS dispatch outside of the local 911 call centre, a similar call would look something like this:

The call comes into Calgary 911, and the operator asks if it’s for police, fire or EMS.

Caller says they need an ambulance. 

That call gets transferred to an AHS EMS dispatch centre where the additional questions would be asked. 

Should it be determined that police response is needed, that call would be transferred back to Calgary 911. From there, the dispatch of additional resources is done.

Alberta Health says EMS respond quicker in Edmonton… slightly

Since Edmonton switched, they’ve seen improved EMS response times, according to Steve Buick, press secretary for Health Minister Tyler Shandro.

“I believe that the way the system works is that the 911 dispatchers already, in effect, press a button to transfer a call to EMS, they transfer it to a city EMS dispatcher,” Buick said.

“Instead, they’ll push a button then it’ll go to the AHS EMS dispatcher and I believe the integrated systems are still free to dispatch fire, regardless, so there’s no delay in dispatching fire if the service chooses to dispatch fire first.”

Buick also pointed to a recent letter, obtained by LiveWire Calgary, from Darren Sandbeck, the Senior Provincial Director and Chief Paramedic for Alberta Health Services, to the City of Calgary.

AHS Letter to City of Calgary by Darren Krause on Scribd

In it, among other things, it said that Medical First Response (MFR) calls are already processed with a Computer Assisted Dispatch (CAD) program that communicates directly with Calgary Fire.

“There is no transferring of the caller and callers do not need to ‘tell their story multiple times,’” Sandbeck wrote.

He also said that AHS already handled between seven and 30 per cent of EMS call volume from these remaining municipal centres. He cited the recent June 13 hailstorm as an example of when Calgary’s 911 system was overwhelmed with calls.

“What actually happened that day, and happens with other significant weather and natural events, is that the Calgary 911 system became quickly overwhelmed and stopped processing EMS 911 calls, simply transferring them to our Southern Communications Center to manage those EMS calls that were occurring at the time,” Sandbeck wrote.

Call transfer times

Alberta Health cited Edmonton as a place where EMS response times have improved slightly.

But response times (from call to EMS arrival on scene) are different from the first response call times. Response times include the “chute” time (from notification to being en route). Then it adds “travel” time – from en route to arrival at the scene.

We contacted Edmonton Fire Rescue Services and Edmonton Police to find out if they’d tracked data on their MFR call times since EMS dispatch was taken over in that city in 2010.

Edmonton Fire said they don’t have data on the impact of the change. Edmonton police declined to comment on another jurisdiction.

Oel said there are no AHS benchmark times to have those calls directed back to other emergency services. She said that’s a problem.

“They (AHS) keep their own stats, which are in their own world, and we have no ability to have,” said Oel.

“So, there’s no standards at that point.”

AHS said EMS calls vary significantly so they don’t benchmark time to dispatch medical first responders.

“When calls are received that always require a medical first responder (MFR) in addition to EMS, such as a motor vehicle collision, an MFR is requested immediately before the caller is interrogated,” an email response from AHS read.

“Most often a caller is asked a series of protocol questions that help dispatchers determine the most appropriate resources to be dispatched.”

The email went on to describe certain situations where dispatch might happen after a couple of protocol questions. In some cases, a medical first response isn’t needed until an EMS crew arrives on scene and determines a need.

Diagram of response from the 2018 HCQA report. HCQA REPORT

The 2018 Health Quality Council of Alberta report on ground ambulance service delivery covers the dispatch/EMS consolidation extensively (pages 35 – 77). It said “no conclusions could be drawn regarding the effect of the transition of EMS operations from municipalities to AHS because of the poor quality and limited historical data.”

Cash savings with consolidation

According to Buick, AHS pays the City of Calgary $6 million annually to dispatch AHS ambulances.

He said the change isn’t about the money. When all is said and done – people hired, trained, housed – the province will save $3 million.

“We’re making the change because it’s how the system was intended to work and how it does work in 60 per cent of the province,” he said.

“But it’s fair to point out that the City does not want to lose $6 million in revenue.”

When asked about the impact on jobs and funding, Magnuson said they’re concerned about any job loss at the city.

“Our biggest driver here is making sure that we provide the best service possible to the citizens of Calgary, and that we ensure that our responders have the best information to be safe at the work that they do,” he said.

In his information to council, Mayor Nenshi said 45 City of Calgary employees would lose jobs. AHS would hire 25 people to handle the calls, he said.

Time is critical

Oel pointed out that the Foothills 911 tagline is “There 1st when seconds count.”

“What’s the time element issue? It’s that transferring between agencies… because everybody has to process the call the way they’re mandated to process the call,” she said.

“That means you enter various pieces of information, which takes time before you make the call to get your agency responding.”

They have the data to back up their case.  Oel said the process is both intricate and complex.

She recognized they have unique challenges in being mostly rural. The area they cover stretches from Calgary’s south boundary down to Fort Macleod. It goes east to the County of Newell and southwest to Crowsnest Pass.

But they have some larger urban centres like Okotoks and High River, so they understand those aspects, too.

They have logged cases where the problems have threatened the lives of citizens.

As a result, they’re still fighting for a reversal of the consolidation. Oel is hoping Calgary, Red Deer, Lethbridge and Wood Buffalo get a reprieve. It’s leverage for them to go back to the province.

She said they’re ready to take the service back. Oel said the provincial dispatch service is duplication. The space, the people, the software – it’s already available in these areas.

But, what it comes down to is time. Life saving time. That’s why they continue to fight, she said.

“We have been honest for years, and we haven’t stopped because it’s so important,” Oel said.

“We’re talking about people’s lives and level of service that has degraded and hasn’t improved.”

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