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Alberta to use private transport for non-critical patients to improve EMS response times

The Government of Alberta is promising improvements to response times from EMS, through the introduction of alternative-modes of transport for non-emergency calls.

Premiere Danielle Smith said that a pilot program which has diverted 15 per cent of calls, will free up to 70 transports per day across the province for ambulances.

“It allows our world class paramedics to do what they were trained to do, and even more importantly, lives will be saved because we have more ambulances available to respond to emergency calls from Albertans,” Premier Smith said.

The pilot program has already operating in Calgary, and additionally in Bonnyville, Valleyview, Athabasca, and St. Paul for the past six months.

Minister of Health Jason Copping said that the pilot freed up five more day-shift ambulances at the end of November, compared to September.

He said that they were looking at any options, including using non EMS vehicles and staff to transport medically-stable patients.

“We need more capacity to get patients out of emergency faster, and free up the staff for the next patient coming in with EMS—and some calls are still taking far too long, right across the province,” Minister Copping said.

Costs for the non-emergency transport service will be borne by patients. The province said they would be covering some costs for patients who are unable to afford to use the service.

“The normal process is actually to have individuals pay for non-medical transport, but that said, what’s critically important to us is that cost not be a barrier,” said Minister Copping.

The Alberta government said in a statement that that provincial guidelines will be introduced, and and that clinical staff and physicians would be able to decide if the service is able to use the transport service.

Parliamentary secretary for EMS reform RJ Sigurdson said that the non-emergency transportation came out of the AHS EMS committee’s review of services in the province.

Data has been showing rising response times, hospital waiting times for EMS staff

From Alberta Health Services’ data on monthly EMS activities, the response time for life-threatening events has been rising steadily since 2020. From that year, the median response time was approximately seven minutes, which has rose to more than 10 minutes starting in January 2022.

The 90th percentile response time, indicating the time which 90 per cent of calls are under, has also been rising. From approximately 11 minutes in 2020, to more than 20 minutes in 2022.

The time that EMS ambulances sit at hospitals has also been on the rise, with median times of just over an hour in 2020, to more than 80 minutes in 2022. The 90th percentile times have similarly risen, going from nearly two-hours in 2022, to more than three hours and 30 minutes in 2022.

Calgary Response Time for Life-Threatening Events. Source: Alberta Health Services Monthly Emergency Medical Services Activity Summary.
Calgary EMS Hospital Time. Source: Alberta Health Services Monthly Emergency Medical Services Activity Summary.

AHS administrator calls non-ambulance transfers ‘wonderful’

Minister Copping said that further announcements would be coming in 2023 regarding staffing.

Alberta Health Services administrator Dr. John Cowell said that the non-ambulance transfer program was an appealing way to improve EMS response times.

“One of the roles of the official administrator of course is to discover good ideas and accelerate them as fast as possible and this is one of those good ideas,” he said.

“When a an individual is fully assessed and waiting to return back home in an emergency department, they’re still occupying space in the pocket in the emergency department. We need to have a very flexible available system that you can get them home, whether it’s back in an urban setting, or even far distance into the rural areas.”

He said that the use of community shuttles and wheelchair accessible taxis would be among available options for patients, and put out a call to private organizations and companies to provide the services through AHS’ preferred vendor list. The province is currently operating very few of these vehicles.

“I believe it’s less than 10 of those actual vehicles that are owned and operated by Alberta Health Services, so now you can imagine there’s a huge push now to find contractors,” Cowell said.

“The potential once we do get the fleet up to an appropriate size is huge, because that’s what we’ve been describing, and that’s why we’ve committed to move it from a pilot and fast track it to a province-wide resource.”

The vehicles being described by the province are vehicles that can secure a stretcher, but won’t contain the extra medical supplies or equipment that are available for patient care in an ambulance.

Dr. Cowell said that AHS would be introducing new performance metrics to track the time from the call to when an ambulance arrives on scene.

“Most importantly, establishing key performance measures and targets that will let us know if these actions are actually making a positive difference. We now have the key measures determined on each of those priorities, and we’ll be announcing the targets early in the new year,” he said.

“The measure we’re going to use for EMS is the time from EMS dispatched to arrival at the scene. That’s what we’re calling the response time, and as I said, we have a measure now—it’s very accurate to know what that looks like, and whether in fact it’s improving with all of our interventions.”

It wasn’t clear from his statements on Wednesday how this would differ from the response time metric, which is already tracked and publicly disclosed by AHS.

Calgary Fire Department seeing increase in need to transport patients to hospital

Calgary Fire Department Chief Steve Dongworth, speaking to LiveWire Calgary on Monday as part of a year-end review of the Fire Department, highlighted the issues that service has faced during the growing EMS crisis.

“There was just a call yesterday, which was 70 minutes waiting for an ambulance—and I don’t say any of that to criticize the folks on the street with Alberta Health Services or EMS, they’re doing everything they can,” Dongworth said.

“We know that they’re great people, but the system has broken down a little bit to say the least.”

Chief Dongworth said that this year the department has transported approximately a dozen patients to hospital in firetrucks. Earlier this year in June when 3-year-old Tara Agarwal was transported to hospital by the Fire Department, officials said that was one of the first times the department had used the province’s emergency procedure to do so.

“Even though a fire truck isn’t really designed to do that, we’ve taken some patients to the hospital, and also in many more cases we followed a family vehicle to the hospital to make sure that if there is a condition worsens on the way to the hospital, we can provide help quickly. Often with one of our staff in the family vehicle,” he said.

Among the challenges that Chief Dongworth highlighted was the switch over from an integrated systems model to the single AHS dispatch centre.

“We continue to see challenges with that model, there’s no question,” Chief Dongworth said.

“We make Alberta Health Services aware where we see problematic calls in terms of the way the way they’ve been dispatched, and those kinds of things, but that’s ongoing and I suspect it will continue to be ongoing.”

The province had previous promised a review into EMS response times following a fatal dog attack in June, that would arrive in September. Minister Copping said that while a preliminary report had been prepared, AHS was reviewing it, and that it would made public in the new year.