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Longer EMS waits leave B.C. patients at risk

An ambulance carrying an injured worker rescued by the coast guard leaves the Coast Guard Base Station Sea Island in Richmond, B.C., Thursday, March 22, 2007. New EMS protocols are under attack from critics who say they are resulting in significantly longer wait times for emergency service.


Changes to B.C. Ambulance Service protocols quietly introduced last fall have resulted in lengthy emergency response times and an increase in patient risk, according to Vancouver's fire chief.

John McKearney on Tuesday presented to city council a report on the impact of changes to BCAS's "resource allocation plan," implemented in late October. Chiefly, dozens of call types – including serious falls and some motor-vehicle injuries – have been downgraded from emergency to routine, resulting in response times to those calls being an average of 21 minutes slower, he said.

"Once they move from emergency to routine on these incidents … it changes the whole timeline to get to a call," Chief McKearney said in an interview after his presentation with city manager Penny Ballem.

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"My officers have given me numerous cases where the patient is in distress, the [call type] is routine and it has taken way beyond what is an appropriate level of service."

Chief McKearney's findings are specific to Vancouver, but he said the changes impact all municipal fire services in the province.

Further, the fire chief says the changes were implemented suddenly, with no prior consultation with fire services or the public.

"We woke up on the morning of the 29th of October and the calls started to come in from my officers that the ambulances aren't showing up to these calls," he said. "When we finally got informed – we got information from the Fire Chiefs Association [of B.C.] at about 10:30 a.m. – [we learned] the ambulance service had instituted this five hours before, at 5:30 a.m."

But William Dick, vice-president of medical programs at B.C. Emergency Health Services (BCEHS), the agency that oversees the BCAS, said the changes were made based on medical evidence and scientific data. In fact, BCEHS struck a committee of experts, including physicians, dispatchers, first responders and data analysts, and reviewed data from the past two years' worth of calls prior to making the changes, Dr. Dick said. Of 868 call types, a total of 74 were reclassified – 39 of which were downgraded from "lights and sirens" to routine. This has resulted in ambulances getting to the sickest patients an average of one minute faster provincially while reducing the amount of high-speed, "lights and sirens" driving they do, increasing public safety, Dr. Dick said. Lower priority patients are waiting an average of six minutes longer provincewide, he conceded.

"In the past, [these decisions have been made] with just anecdotal evidence, hearsay and best opinion, basically. This is the first time that we've used a scientifically valid, statistically rigorous way to actually look at these calls."

He stressed the changes are not about reducing costs, but rather using resources in a smarter way.

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Both Chief McKearney and Dr. Dick were unclear as to each other's data.

"I can't speak to his information," Dr. Dick said. "I just know that it certainly doesn't come close to matching ours and I think I have a really robust global overview of what's happening in the province and each municipality. I am absolutely confident in my data."

Chief McKearney included five case-study examples in his presentation. In one, a 65-year-old man fell, suffering a large laceration to his head. Vancouver Fire and Rescue Services (VFRS) attended and requested that dispatch upgrade the call to emergency; BCAS arrived 49 minutes later. In another, a 55-year-old man fell down two flights of stairs, suffering head trauma. VFRS attended and, after two calls for an urgent upgrade to emergency, BCAS arrived 40 minutes later.

Dr. Dick called the examples "extreme outlier cases."

After Chief McKearney's presentation on Tuesday, Vancouver city council voted to write a letter to B.C. Health Minister Terry Lake asking the province to review the matter.

Follow me on Twitter: @andreawoo

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