While local residents and members of Castlegar City Council are unhappy with the level of ambulance services in town, the provincial body that oversees those services — British Columbia Emergency Health Services (BCEHS) — says not to expect anything to change for at least a few more years.
The main concerns revolve around wait times, especially for patient transfers to another health care facility and the fact that staffing levels are higher in Trail and Nelson compared to Castlegar.
Both of these issues were brought up at a recent city council meeting by Coun. Sue Heaton-Sherstibitoff and Coun. Bruno Tassone. City representatives have made their desire for improved staffing levels and faster response times known to BCEHS on multiple occasions.
BCEHS West Kootenay representative Joe Puskaric explained how BCEHS operates.
“BCEHS responds to both 911 and patient transfer calls as quickly as we possibly can,” he said. “We send the closest available ambulance. We are a provincial service and can draw upon ambulances and paramedics from nearby communities as needed.”
But that system doesn’t seem to be working in Castlegar. The consensus is that the situation became more problematic after Castlegar lost its 24-hour emergency services in 2002 when the Castlegar Hospital became a health centre.
Puskaric acknowledged that the staffing models being used predate that time while at the same time defended the service BCEHS provides.
“Staffing reflects commitments to the full-time staff levels in these communities when the ambulance service began providing pre-hospital care back in the mid-1970s,” he said.
“Obviously things have changed over several years. We continuously look at different staffing models and what would be appropriate. People look at full-time versus part-time — at the end of the day — we provide coverage in this community 24 hours a day using two ambulances. So the coverage is still there.”
“We have more people, more base, our hospital was open 24 hours back then,” said Coun. Heaton-Sherstibitoff. “That formula is not working for our community, that’s the bottom line.”
Having two 24-hour ambulances doesn’t mean that those ambulances are staffed for all 24 hours. At times ambulance attendants are on call while waiting for an emergency call to come in.
Coun. Deb McIntosh clarified that they are not asking for better services, as she feels local ambulance attendants are doing a great job — it is increased services they want.
“We don’t want more than our share,” said McIntosh. “We all feel we need to advocate for increased ambulance service here.”
Staffing levels
According to BCEHS, Castlegar has two 24-hour ambulances, one full-time employee and 16 part-time or casual employees.
Trail, which has a 24-hour hospital emergency room, has two 24-hour ambulances, four full-time employees and 24 part-time or casual employees.
Nelson — which also has a 24-hour hospital emergency room — has two 24-hour ambulances plus one day-time ambulance, seven full-time employees and 20 part-time or casual employees.
When asked about increases in staffing or services for Castlegar, Puskaric repeatedly referred to the BCEHS Action Plan.
“We are in the process of evaluating and looking at numbers right now in each community — we call it the action plan. We’re looking at all the numbers in the community — full-time, part-time staff, call volume in each community.”
“Staffing and deployment of ambulance resources in all communities, in particular in remote and rural communities, are being carefully examined as part of our rollout of the BCEHS Action Plan,” said Puskaric.
Long wait for changes
When asked when we can expect this action plan to come into effect, Puskaric responded, “We are in the process of that right now, I can’t give you a time … But the action plan we are looking at is over the next two to three years. So we may see something sooner, we may not.”
That response does not satisfy Coun. Heaton-Sherstibitoff.
“We can’t wait another two to three years,” she said. “I’ve been a councillor for six years — this has been going on [all that time] … we have been bringing it up over and over. It is time we have a solution. We can’t afford to wait another two to three years for an action plan to come up.”
She also feels like the lack of BCEHS services is a burden on municipalities.
“It is downloading the issue on to municipalities,” said Heaton-Sherstibitoff. “When a call goes in to 911, our first-responders are the first ones on the scene and they have to stay there until the ambulance comes.”
Those first responders — such as the Castlegar Fire Department — are paid by the city.
In recent weeks, more than 20 local residents have approached Heaton-Shertibitoff with stories of extremely long ambulance wait times, some more than two hours.
“Our hospital is open eight to eight. The system in place in Castlegar is not working,” said Heaton-Shertstibitoff. “It is not working for patients who have to sit in the Castlegar Hospital after 8 p.m when it closes to be transferred to Trail.”
“It’s irresponsible that when you go to our hospital, that it is sometimes quicker for you to take whoever you brought to the hospital to Trail because you are going to have to wait three or four hours for an ambulance.”
Response times
Response times among Castlegar, Nelson and Trail are fairly consistent with each other for calls that came in through 911 during the last fiscal year. For “lights and sirens” calls the average Castlegar response time was 10 min. 17 sec., Nelson 10 min. 19 sec. and Trail 10 min. 45 sec.
Routine call response time averages were 11 min 34 sec for Castlegar, 12 min. for Nelson and 12 min. 7 sec. for Trail.
As these response times don’t correlate to the anecdotal reports and complaints being heard around town, the Castlegar News asked for further clarification of the numbers.
BCEHS explained that those response times relate to 911 calls — meaning that patient transfer calls are not included.
“With patient transfers from one hospital to another, the patient is already in the care of a doctor, and if that patient’s doctor thinks that he or she needs to go to another level of care then a request for a transfer by ambulance will be made through the BC Patient Transfer Network. Some transfers are done on an urgent basis, while others may involve patients who are being transferred for something important but non-urgent, such as a scheduled appointment,” said BCEHS director of corporate communications Lesley Pritchard.
Because some transfers are considered non-urgent such as for appointments and some involve situations out of the control of BCEHS, the organization says they don’t have statistics readily available on patient transfer wait times, so were unable to provide those to us.
Puskaric explained that calls are prioritized based on information given by the caller using a question-based logarithm that generates a call code, with life-threatening calls given first priority.
As calls come in, after consideration for the priority level, BCEHS sends the closest-available ambulance to the call. This may mean that an ambulance en-route to a lower priority call gets re-routed to a higher priority call. It also means that an ambulance based in Trail, but on the way back from a patient transfer call to another city, may get sent to a call in Castlegar if it is the closest-available ambulance.
That method of dispatch makes comparing the number of calls for each city somewhat difficult.
Calls to staff ratios
Castlegar ambulances responded to 967 emergency calls, Nelson responded to 1,374 calls and Trail 1,223 calls.
Patient transfer calls for Castlegar were 510, Nelson was 893 and Trail attended more than both those combined — 1,668.
But when you compare the number of calls each city responded to the number of full-time staff in that city, the contrast is stark.
Nelson had one full-time staff member per 323 calls and Trail had one full-time staff member per 722 calls. Castlegar had one full-time staff member per 1,477 calls.
Local staffing numbers show that the current system relies heavily on the on-call and part-time workers.
Puskaric says BCEHS is working on that too.
“BCEHS is currently working to stabilize staffing in rural and remote communities through a number of initiatives including community paramedicine, staffing changes to increase the number of regular and part-time positions and by recent changes in the pay structure for paramedics.”
Heaton-Sherstibitoff doesn’t plan on taking those answers from BCEHS and waiting patiently for change to happen someday.
“The problem is getting worse every year — they are not listening to the communities they serve,” she said.
In fact, BCEHS own action plan documentation states: “In recent years there has been an increasing demand for emergency patient care. Without changes, demand is projected to increase by 6.1 per cent annually.”
If that forecast holds true for Castlegar during the next three years, there will be 90 more calls next year, 186 more calls the following year and 287 more calls the third year compared to 2016/2017 numbers when all the while staffing and ambulance numbers remain the same.
“We need it now,” emphasized Heaton-Sherstibitoff. “The system is broken — fix it. To sit back and just talk and talk and talk and formulate an action plan is not working for our citizens.”
MLA Conroy responds
The two- to three-year timeframe doesn’t appeal to Kootenay West MLA and BC Minister of Children and Family Development Katrine Conroy either.
“From my perspective, that just doesn’t seem acceptable, we need to move it along quicker than that,” she said.
“I recognize the need to improve our rural ambulance services,” said Conroy. “It has been a longstanding issue of concern for me. It has been raised every year we were in opposition. We have 16 years of lack of service that we need to fix, which is frustrating. We are not going to be able to do it overnight, but we do need to look at it.”
She thinks the system needs to be changed not just for the patients, but for the paramedics as well.
“I don’t think it is working anywhere, especially in rural B.C. and the remote areas,” Conroy stated. “We know we need to invest in more paramedics, especially in rural B.C. and our region.”
Audit in progress
The Office of the Auditor General (OAG) is having a look at BCEHS practices.
According to the OAG website, the purpose of the audit is to determine “whether BCEHS has effectively managed access to ambulance and emergency health services across the province. The scope of this audit will include the provision of ambulance and emergency health services by BCEHS, and the organization’s collaboration with fire departments to coordinate access to emergency health services.”
Details of the audit are expected to be released in 2018.