MEDICAL RESPONSE:
PROPOSALS FOR BETTER CARE
Manitoba Government and General Employees’ Union
Local 911 - Paramedics of Winnipeg
Standing Committee on Protection and Community Services
December 5, 2013
Local 911
Medical Response: Proposals for Better Care
Standing Committee on Protection and Community Services
December 5, 2013
Thank you very much. My name is Chris Broughton, and I am the President of Paramedics of
Winnipeg, MGEU Local 911. I am pleased to have this opportunity to present our perspective on
the medical response portion of the 2014 City Budget.
As you know, Local 911 represents the men and women who deliver life-saving emergency
medical services to the people of Winnipeg. We are proud of the care and service we provide,
and we are dedicated to improving patient outcomes and delivering the best, most efficient
service we possibly can. This is at the heart of our presentation today: we believe we have a
series of suggestions that can help improve timely medical transport while improving patient
care. We hope you will consider them in this budget year and in future years.
Budget 2014
We recognize that budgets require a balance between delivering services with the
ability to finance those services. We note that the budget for medical responses is 4.7%
higher than in 2013 before transfers to capital are considered (mostly as a result of the
addition of 11 new dispatch positions). We also note that there were 7,200 more
ambulance dispatches between 2010 and 2012. However, it is unclear to us whether
savings as a result of the more aggressive vacancy management proposals are reflected
in these budget numbers.
While we recognize WFPS is excluded from the mandatory reduced work week
provisions we are concerned that some of our community partners may not be available
when their help is needed in an emergency during the Christmas week. We do not
believe these measures will promote the safety and care of the Winnipeggers who
depend on our services. We urge councilors to reconsider these proposals.
Obstacles to better emergency response and care
For many, Emergency Room (ER) visits by ambulance are the easiest pathway to medical
care. Seniors, those without a family doctor and those who have not yet acquired all the
skills to navigate a complex health system often contact 911 at the first sign of trouble.
This results in the dispatch of fire-based first responders and then most often an
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ambulance. In 2012 57,892 ambulance transfers to hospitals occurred. Current data
suggests that only 12.56%, or 7270, of those transfers were critical.
Often patients are sent to hospital ERs even when another form of care might be more
appropriate. Our members report, for example, that often ambulances are dispatched
when people lose track of their medications and feel unwell as a result – current
protocols recommend such persons be taken to the ER. Because these patients are
triaged as less urgent by ER staff offloading time is lengthened and the ambulance is
unavailable for service until the offload is complete.
Based on recent Transfer of Care Availability Study at the Health Sciences Centre (HSC)
Emergency Department (over a 32 day period in January and February, 2013) the
average time for transfer of care from EMS to hospital staff was 61 minutes. Every
unnecessary transport takes an ambulance off the road for an hour. Eliminating just
1,500 unnecessary medical transports (2.5% of the 2012 level) would ensure 1,500 more
hours of availability and help maintain quick responses to serious -- almost one
additional crew for a year.
Winnipeg Fire and Paramedic Services data clearly shows that the more ambulances
available the faster the response time. When available ambulances drop from 20 to 10
mean response times decline by almost 1 minute and 40 seconds – a critical period of
time in potentially critical situations. (Source: WFPS 2010 data) It makes sense to us to
reduce the number of times ambulances unnecessarily transport to ERs in order to
maintain the best possible response times when advanced lifesaving care is needed.
Four Proposals to Reduce Unnecessary ER Transports
Community Paramedicine: Councillors here today are well aware of the tremendous
success achieved by stationing paramedics at the Main Street Project. In the first 5
months Main Street Project paramedics saw 8,000 patients, out of which only 161 were
sent to an emergency room -- a big drop of approximately 60% from the 400 patients
sent to ER in the previous time period.
WFPS and WRHA initiated the EPIC program where two paramedics provide medical
assistance, when needed, to residents of two inner-city personal care homes and the
Salvation Army building and the top 40 common callers to the 911 system. Often
frequent callers have chronic medical conditions or mental health issues. Having
paramedics visit them when required, do a medical assessment and connect them to
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community health resources, reduces their dependence on ambulances and emergency
rooms. This approach is working in other jurisdictions.
We have attached some additional information on Community Paramedicine in the
attachments to this presentation.
As the data accompanying the 2014 Budget clearly shows community paramedicine at
the Main Street Project is a success – an increase of 10,000 patient contacts between
2010 and 2012. The results of the EPIC program show similar results.
Based on impressive numbers of reduced emergency calls and transports to ERs the
EPIC program is renewed for another year. It seems clear that a program of expanded
community paramedicine should be developed and implemented on a priority basis,
city-wide, to further reduce pressures on emergency medical transport.
Intelligent Destination: Strong intelligent destination protocols need to be implemented
to help unclog ERs in Winnipeg. Sometimes it makes more sense to send a sprained
ankle to the Misericordia Urgent Care Centre, the Pan Am Clinic or Quick Care clinics and
other resources such as walk-in clinics. Every time a patient is redirected from an ER to
more appropriate care more ambulances are available to meet the needs of the most
critical calls.
911 Calls Sent to the Right Service: Already the city is working with protocols that allow
911 to determine if a call is best handled by WFPS or if it is more appropriately
transferred to Health Links or some other service. We wholeheartedly support this
approach. We believe it will reduce unnecessary ambulance trips to Winnipeg ERs and
provide better care to those who need it, and ensure a better allocation of resources.
Stronger Community Education: Finally, we believe EMS trained staff can play a
stronger role in community education. One of the more frequent reasons for calls for
help are falls in the home. More often than not these calls are the result of residents’
having their feet go out from under them due to a loose carpet in a hallway, kitchen or
bathroom. We believe more education at the community level at schools, senior’s
homes and elsewhere can help reduce the number of slips and falls and in turn reduce
the pressure on our ERs as a result of easily preventable mishaps. Fewer trips to ERs
mean more EMS resources available when they are most needed. We are ready to help.
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Conclusion
Winnipeg has much to be proud of in how it serves its citizen requiring an emergency
medical response. But, data accompanying this preliminary budget shows that there
was an alarming fall off in citizen satisfaction with Winnipeg’s emergency response. We
concur with the notion that part of this concern may be driven by recent media
coverage of emergency room concerns. We see our proposals as incremental changes
that can have a positive impact on the service we provide and our clients’ satisfaction.
Like you we want to provide better, timelier and more effective emergency medical
response.
Thank you.
Attached Documents:
Appendix 1: Working in the Community: EPIC Stories
Appendix 2: Community Paramedicine, EMSCC Presentation, Standing
Committee on Health, December 2011
Appendix 1
Working in the Community: EPIC Stories
(The following are true life experiences from EPIC Staff)
Getting the Right Care -- Community Paramedicine is such a different role than the traditional
Paramedic role, as EMS providers we are trained to find the cause of a condition provide
emergent treatments as required and take the patient to the hospital, even though at times this
is not the appropriate outcome. The Community Paramedic role is a quite a different approach
and functions far beyond obtaining the patients past medical history, current medications and
allergies to investigating their current living conditions, family or community support and what
if any services they are linked to. Once the information is gathered the Community Paramedics
role is to work collaboratively with allied agencies to find a solution to their needs, link these
patients to the appropriate services and take a proactive approach to meet their needs rather
than waiting for the patient to access 911 when their illness becomes a crisis
The first patient I encountered in the EPIC role was an elderly lady who lived on her own in a
home that she had resided in for 40 years. This patient had home care services four times a day
to assist with meal prep and personal care. This patient existed in the living room of her home
in a recliner; she had mobility issues and did not move to far from the chair that she spent day
and night in. She did not have any close family members to assist her and the only social
interaction that she had was with the home care staff.
The first hurdle that I had to overcome in this role was actually showing up at her home and on
my own. Traditionally it is a 911 call that alerts paramedics to their patients and as EMS
providers “cold calls” are unusual and working alone took some getting used to. The patient
welcomed me in her home and appreciated the offer to assist with finding more support for
her. Following the visit and after gathering all of the information I connected with the home
care coordinator, a social worker and a family Physician that provided house calls in the area.
Over the span of a few weeks I regularly visited with the client, scheduled a joint assessment
with the home care coordinator to address concerns and arranged that the Physician attend to
review her medications. The home care coordinator arranged a GPAT assessment based on my
concerns and a few weeks later she was temporarily relocated to a PCH for respite.
I continued to regularly follow up with this lady while she was in the PCH and initially her goal
was to work with the staff on her mobility issue and she insisted on returning to her home.
While in the PCH she began to become involved in daily activities and she enjoyed interacting
with the other residents in the PCH. She continued to thrive in the PCH and she decided that
she was unable to return to her home and did not want to return to her isolated life. A few
weeks ago she was placed in a permanent PCH and I was able to meet with her again, she
appreciated all of the help asked that we continually visit her. She appears healthier and
happier and it was an honor to assist with improving her quality of life.
Appendix 1
Working with Other Health Professionals -- Home Care contacted me regarding a common
client, as they were concerned about her whereabouts and the strange people that were
residing in her apartment. The Client had been absent and missed 2 or three days worth of
home care visits (they administer meds 4x/day). I found she had been transported to the
hospital the night before after falling down a flight of stairs. When I went to check in with her
she had already left the hospital. She was not to be found at the Main Street Project or her
home.
However later in the day, an ambulance was dispatched to a bus around Main and Logan for a
female that fit my client's description. The paramedic crew phoned the EPIC cell and confirmed
that they did indeed have my client, and I me them at the scene.
When I arrived, the client was on a stretcher with neck pain. She had point tenderness and was
unable to turn her head to the right. The patient said she had been x-rayed but only her chest
and arm. This was confirmed through E-Chart and in discussion with our on call physician who
called the hospital to have the clients chart reviewed. Due to the reason for the previous night’s
fall and the ongoing tenderness to her cervical spine, we put a c-collar and transported her back
to the hospital.
Later on my days off my EPIC colleague contacted me to say our client had a c-2 fracture and
was getting a halo put on. She has since recovered and the Halo is off but she is still in a back
brace but doing well.
I see this as a success because even though she would have gone back to the hospital, the
needed care still might not have been given. But since we had physical evidence that she was
still injured and hadn't been properly x-rayed, (and probably the on call physician's influence at
the hospital), our client had a good outcome and will fully recover to the same physical state
she was in before her fall.
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