By Greg Nesteroff, Nelson Star
If you have a medical emergency in the Kootenays, it's best to be in Creston, judging by statistics from the BC Ambulance Service.
In 2012, Creston's average response time to Code 3 calls—requiring lights and sirens—was nine minutes and 20 seconds, less than Grand Forks (12:30) and faster than Cranbrook (10:01), Nelson (11:06), Castlegar (10:42), Trail (11:16) and less than half of Rossland’s response time (22:24).
However, all were slower than the nine-minute standard suggested by the U.S. Commission on Accreditation of Ambulance Services, a benchmark reached by only 10 communities in the province last year.
Creston also posted the fastest times in the region in 2010 and 2011. The slowest response times in West Kootenay/Boundary last year were in Christina Lake (27:05), Rock Creek (26:27), and Kaslo (24:05). The former two don't have ambulance stations, but the latter does.
The figures, obtained through a freedom of information request by former air ambulance pilot Hans Dysarsz (see related story), surprised rural Creston regional district director Larry Binks, a retired BC Ambulance administrator.
"Under 10 minutes is good," he said. "It comes down to staffing: if a station isn't staffed properly, response time is going to be poor. We recognize we live in rural areas and won't get the same response times [as in urban centres] but certainly deserve better than what is happening in some cases."
Creston achieved its response times despite only having one full-time paramedic and 13 part-timers. By comparison, Nelson has seven full-timers and 33 part-timers, Trail—which serves Rossland—has four full-timers and 27 part-timers, Castlegar one full-timer and 27 part-timers, and Grand Forks one full-timer and 14 part-timers. (Part time employees submit their availability and shifts are staffed accordingly.)
Binks, who worked for the ambulance service from 1974-2006, and Castlegar mayor Lawrence Chernoff have been advocating for improvements. Response times could be faster if all stations were manned full-time, he said, but attendants have to be adequately compensated, rather than a standby pittance.
Chernoff, who retired in 2006 after 29 years as a paramedic, suggested the service isn't as good as it used to be, and one reason is training.
"That's been identified as a key issue. In the past BC Ambulance trained you. Now you pay for it yourself. If you invest $5,000 and work in a small-volume station, you're never going to get that money back."
Chernoff and Binks met with BC Ambulance management last month at the Union of BC Municipalities conference, although Chernoff said previous talks were "frustrating ... It's moving too slow for us. We've met with probably everybody in BC Ambulance."
BC Ambulance spokeswoman Kelsie Carwithen said response times aren't determined solely by staffing—other factors include weather, terrain, roads, traffic, and geography. Reponses in rural and remote areas are generally longer due to the distances involved, she said.
Sixteen ambulances respond to calls in West Kootenay, including stations in Nelson, Castlegar, Trail, Kaslo, Fruitvale, New Denver, Riondel, Rossland, Salmo, and Winlaw. They aren't restricted to emergencies in their immediate area, so a Nelson-based ambulance might handle calls from Castlegar and Salmo.
Carwithen said the ambulance service constantly monitors call volumes and is committed to improving all response times, especially for the most urgent calls where speedy arrivals can affect patient outcomes.
"Despite increased call volume, overall response times for urgent events in the West Kootenay have remained consistent since 2011/12," she said. "Response times are extremely important, but the care and treatment paramedics provide when they arrive is equally important."
Carwithen also said the nine-minute standard is only a target that applies to urgent calls in metropolitan and urban areas — but one they do try to achieve.
"Response time figures are not based on the time it takes to have a trained emergency medical responder reach a patient; they only reflect the response time of paramedics," she said. "First responders can arrival on scene before paramedics and begin providing care."
Carwithen said the ambulance service is looking at ways of doing business differently and has already made several improvements including implementing an automated vehicle location system that lets dispatchers see where ambulances are in relation to the incident, and adopting computer-aided systems to maximize efficiency and better relay information to crews.
Average Code 3 Response Times
Communities with at least one "pre-hospital" event per week
Calls Avg Avg Avg
2012 2012 2011 2010
Balfour 39 25:18 30:05 26:14
Castlegar 466 10:42 11:35 11:44
Christina Lake 87 27:05 30:03 22:04
Cranbrook 1,049 10:01 9:32 10:06
Creston 313 9:20 9:17 10:10
Erickson 64 14:20 13:31 n/a
Fruitvale 157 19:31 19:43 20:46
Genelle 37 17:38 n/a n/a
Grand Forks 331 12:30 12:49 11:56
Greenwood 44 22:39 n/a n/a
Invermere 149 10:26 10:09 16:08
Kaslo 39 24:05 17:09 n/a
Kimberley 418 12:01 10:36 11:20
Midway 51 18:46 14:12 n/a
Nakusp 75 18:21 15:51 22:21
Nelson 567 11:06 10:46 10:12
Ootischenia 40 11:54 n/a n/a
Rock Creek 40 26:27 n/a 22:41
Robson n/a n/a 18:58 n/a
Rossland 134 22:24 22:40 23:08
Salmo 133 23:23 21:25 20:40
Sparwood 159 20:15 20:23 17:21
Trail 552 11:16 11:01 11:09
Warfield 56 13:52 13:11 13:05
• No data: New Denver, Silverton, Slocan, Montrose
• Slowest in 2012: Rogers Pass 51:41
• Fastest: Victoria 7:32
BC Ambulance critic promotes European-style system
Don’t tell Hans Dysarsz that BC has a first-class ambulance system.
The former air ambulance pilot and outspoken critic of the BC Ambulance Service says this province and much of Canada lags behind European nations in pre-hospital care.
“A true first-class system uses doctors in pre-hospital response. If you’re downtown Nelson and there’s a car crash with a doctor’s office around the corner [in Europe] those doctors would be paged at the same time as the ambulance. We don’t do that here.”
Further diminishing BC’s status, he says, is a lack of advanced life support paramedics. While Trail and Castlegar have such a crew, there isn’t one in Nelson.
“There is a misperception by politicians that pre-hospital care is too expensive and we can’t afford it,” Dysarsz says. “That is patently false. There is no medical reason for it and no financial reason for it. It’s cheaper to provide care sooner.”
He points to Switzerland and Germany as nations that long ago embraced different models which reduced mortality rates and saved money.
Dysarsz, who helped create Alberta’s STARS air ambulance service, advocates for what he calls “the five cent solution” — a nickel per day per year from each BC citizen to raise up to $84 million for a European-style system with more paramedics, advanced life-support paramedics, and helicopters in key locations. That money could come at least partly through finding efficiencies within the existing system, he said.
Dysarsz further suggests the ambulance service be broken into regions attached to individual health authorities and that municipalities who want to fund an additional layers of care be allowed to do so. He says paramedics would fare better under such a system in terms of pay and hours.
However, it will take a lot of people contacting their MLAs to make any of it happen, he added.
“We have an outdated system that’s deeply and highly dysfunctional. So many barriers are in place that have nothing to do with providing best medical care or best patient outcomes. That should be the absolute focus of all first-class ambulance systems.”
— Greg Nesteroff