A recent editorial by the provincial fire fighters union president makes several claims about the provincial pre-hospital health care system that require clarification so readers can have a balanced perspective.
Sooke News Mirror, July 23, 2014, page 8, “What do you expect when you call 9-1-1?
To ensure that both ambulance and first responder (fire department) resources are dispatched appropriately, and the public isn’t at risk from emergency vehicles driving at high speeds unnecessarily, BC Emergency Health Services (BCEHS) undertook its fifth review of its Resource Allocation Plan (RAP) in 2013. The RAP outlines which resource(s) to assign to each medical call received and how they should respond – lights and siren or routine.
Our evidence-based review found that there is no clinical benefit for patients to have first responders dispatched for several of the call types that they currently attend. A formal consensus among EMS physicians is that only patients in cardiac or respiratory arrest, or those having total airway obstruction, benefit from a rapid ambulance response. An ambulance is still sent to every call in B.C., however, they are responding without lights and siren more often.
Ambulance dispatchers assess the patient’s condition over the phone and prioritize every call for service – people with life-threatening conditions get the fastest response with the highest trained paramedics available. When appropriate, dispatchers notify first responders that there is a patient that would benefit from having fire fighters provide first aid as soon as possible. This notification occurs in seconds, not minutes as stated. First responders remain able to upgrade the call if they have concerns about the ambulance response.
With these changes, ambulances are getting to critically ill or injured patients faster and those with non-life threatening conditions have been waiting only a few minutes more on average. An EMS expert reviewed the process used to update the RAP and found that the methodology was consistent with contemporary best practices nationally and internationally, used robust clinical evidence, and is superior to the processes used in many major EMS systems.
BCEHS continues to monitor the RAP changes – which have only been implemented for ambulances so far, not first responders – on a system-wide basis and review individual calls when the response was questioned. To date there have been no negative clinical patient outcomes attributed to the RAP changes.
BCEHS greatly values the role of first responders and will continue to work on strengthening this partnership using medical evidence and facts to enhance care and service for patients.
William Dick, MD, MSc, FRCPC
Vice President, Medical Programs