Accredited PCP Bridging

With the announcement earlier this year that the Manitoba Emergency Services College would no longer be offering a rural PCP bridging program, many practitioners have been left wondering how best to pursue completion of Canadian Medical Association (CMA) accredited education to bridge to the PCP level. While this bridge education is not necessarily required to apply for licensing as a Technician-Paramedic in Manitoba ("grandfathering from EMT to Tech-P can be granted under specific conditions), there is significant benefit to obtaining education in a health profession that has that CMA "seal of approval" known as accreditation. Many employers and regulators, not only in Manitoba but across the country, require completion of CMA accredited education as a prerequisite to employment or licensure.

The rural PCP bridging program was accredited by the CMA as a partnership between the Manitoba Emergency Services College in Brandon and the Winnipeg Fire Paramedic Service. It recognized four regional delivery sites...Brandon, Interlake, South Eastman and Parkland. As such, it may be feasible that an agreement could be reached between interested regional health authorities and WFPS to deliver a rural bridging program for practitioners interested in pursuing a CMA accredited program. At the very least, the accreditation certainly allows WFPS to continue delivering this education in Winnipeg until the CMA expiry date in 2009.

I had some very preliminary discussions with WFPS around this concept yesterday. PAM will continue to pursue the possibility of working with various RHAs and WFPS to see if an agreement can be reached to deliver rural PCP bridging programs for interested regions and practitioners. I'm hopeful that this possibility might become a reality in the new year.

Farewell to Chief Shoemaker

On behalf of the Paramedic Association of Manitoba, Jodi and I attended the farewell reception for WFPS Chief Wes Shoemaker and his wife Lori. The event was held last evening at the Fairmont Hotel in Winnipeg. A handful of Winnipeg City councillors were in attendance, as were many other civic and government officials. Mayor Sam Katz made a very brief appearance. Representatives from all three WFPS employee unions (PPAW, UFFW and WFPSOA) were also present to bid Wes and Lori farewell.

As you probably have already heard, Wes has accepted an Associate Deputy Minister's position with the B.C. Government, and begins work in Victoria early next week. The City has named Jim Brennan as the interim WFPS Chief, and is expected to begin looking for a full time replacement early in the new year.

2006 Annual General Meeting

The Paramedic Association of Manitoba held it's 2006 AGM in Winnipeg at the Polo Park CanadInns on Saturday, November 25th. The agenda included Board presentations of Association activities over the past year and the election of two Board members to replace outgoing members having completed three year terms.

The attendance at this year's meeting was disappointing. We were unable to convene the meeting as scheduled due to the low number of voting members present...in accordance with Association Bylaws the meeting had to be reconvened after a 15 minute break with those in attendance forming the quorum.

Agenda items included Board reports on Association activities over the past year, including a review of the annual financial report (P&L and Balance Sheet). Two Board of Directors positions were up for election, and both Jodi Possia and Stuart Cuddy were re-elected to these positions by acclamation.

The annual Chairman's Report included an outline of Association priorities for 2007 as I see them:

• Continued emphasis on increasing membership numbers...
• PAM now has an agreement with Manitoba Health Emergency Services that allows them to forward practitioner names, addresses and email information in accordance with an indication of approval on licensing application and renewal forms.
• Clear identification of PAM as a professional association versus a labour organization...
• We need to ensure that any misconceptions that PAM is a "union" are clarified. Our success at achieving self-regulatory status is dependant on our ability to be seen as an organization that acts in the best interest of our patients and the public in general.
• Continued efforts at achieving self-regulation...
• This includes extensive consultation with all other stakeholders such as government, employers, unions, other health professions, and in particular EMS practitioners across the province.

There is considerable work to be done as we enter into a new year. Significant gains have been made by PAM in regard to solidifying our position as a key stakeholder in Manitoba EMS. Our success in maintaining and improving that position rests on our ability to be viewed as a true "professional organization".

PAM Meets With Health Minister

Jodi and I met with Health Minister Theresa Oswald on Tuesday, November 21st. This was our first official meeting with Minister Oswald since her appointment to the Health portfolio in late September. The Deputy Minister of Health, Arlene Wilgosh, was also present.

We used this opportunity primarily to introduce the Paramedic Association of Manitoba to the Minister. We outlined our role as a professional association and advised Minister Oswald of our intent to continue in efforts to pursue self-regulatory status for our profession. Other topics of discussion included the status of the EMS Framework and potential benefits associated with a more centralized management of all Manitoba ambulance and paramedic resources.

During the course of our 40 minute meeting, the Minister assured us that EMS will continue to be a priority for her department. In terms of significant commitment, the Minister acknowledged and approved of our request to participate in discussions related to possible Health Professions Legislation and acknowledged the need to improve system efficiencies and consistency. She also indicated to us that she would be receiving a more detailed briefing on emergency medical services from her department staff in early December, following which she would initiate further consultation with our Association.

Operation Christmas Child a Great Success!

Hundreds of smiling and enthusiastic students loading close to 5000 gift-filled shoeboxes into 15 waiting ambulances, assisted (somewhat) by 30 plus paramedics...it was a sight to behold and an experience that I'm proud to have been a small part of!

This marked the fifth year that EMS in Manitoba has partnered with Operation Christmas Child. Five years ago, one ambulance collected gift boxes from one school. This year paramedics from six regions of the province visited 40 schools and collected about 5000 shoeboxes before converging to parade on the streets of Winnipeg...a sight that may well rival even this week's Grey Cup parade.

I want to congratulate everyone who took time to participate in this very worth while event. A very special thank-you to Meaghan Webb, who spent countless hours organizing and coordinating OCC right across the province. Thanks to Meaghan and paramedics from Assiniboine, Central, Interlake, North-East, South-East and Winnipeg regions, at least 5000 underprivileged kids living in some of the worst conditions imaginable will have a reason to smile this Christmas.

Operation Christmas Child Kicks-off!

Paramedics from 6 RHAs began collecting shoeboxes from local schools as Operation Christmas Child kicked off this morning. Off-duty medics from Interlake, Central, Assiniboine, South-East, North-East and Winnipeg regions began collecting gift-filled shoeboxes that will be distributed to less fortunate children around the world.

I had the pleasure of dropping in on two elementary schools near our EMS station...Domain and Sanford. Seventeen ambulances will visit 40 schools across the province today and tomorrow, and it's expected that we'll collect over 5000 shoeboxes for OCC this year.

A very special thanks to Meaghan Webb for her tireless effort coordinating this year's event. Thanks also to each and every participating medic for taking time out of their busy schedules to make this such a success, and to the regions...our employers...for their support in this very worthwhile venture.

Throne Speech Lacks Ongoing Commitment to EMS

I attended the Manitoba Legislature on Wednesday (November 15th) as a guest of the Health Minister's office to listen to the government Throne Speech. I have to admit that although I didn't expect any detailed announcements regarding emergency medical services, I had hoped to hear a commitment from the government to continue efforts to improve Manitoba's EMS system...unfortunately the only reference to EMS was in regard to the change in inter-facility transfer billing, a promise actually made in their 2005 Throne Speech.

The government stated that health care has been and will continue to be their top priority going into this legislative session. They spoke of investments made to establish world-class facilities in order to be more successful in recruiting and retaining health care professionals. They outlined previous and ongoing investments in training and education for nurses, physicians, LPNs, technologists and other specialists. But throughout, no mention was made of the need for similar investment in our emergency medical services system.

There was, however, one very significant promise made in the Throne Speech that carries with it a glimmer of hope and perhaps opportunity. The government has committed to an independent review of the regional health authority model. This, I think, is an excellent opportunity for the Paramedic Association of Manitoba to express concern over the inconsistencies of our regional EMS systems and the need for a more centralized management and oversight of EMS across the province. When the RHAs were empowered with the responsibility for health care provision in 1996, not all health components were shifted to the RHA model. Not everyone close to government believes EMS should have been moved into the regional model...this review opens the door to further investigating that decision and it's ramifications.

MPPA Ahead Of Its Time?

Some of you will remember the Manitoba Prehospital Professions Association (MPPA)...many of you may not. MPPA was the predecessor to PAM...it was our professional association through the 1980s and 90s. Not only did MPPA advocate for improvements in prehospital emergency care and self-regulation for paramedics, many of our colleagues involved with that association were also instrumental in establishing what we know today as the Paramedic Association of Canada.

The only fault the MPPA had was in its timing. Unfortunately it was an organization who's philosophies were decades ahead of what government and perhaps even the public was prepared to accept as possible at the time. Case in point was driven home by the announcement made by Health Minister Theresa Oswald when she indicated that costs for inter-facility transfers would no longer be billed to patients. The MPPA made that recommendation to the government's Emergency Services Task Force in January of 1993...yes...nineteen ninety-three!

Other recommendations made by the MPPA in that 1993 report include:

• Training for ambulance personnel should be done through qualified Educational facilities.

• All training programs should be CMA accredited.
  

• The contributions of the Provincial Government should be increased to bring Manitoba on par with the rest of Canada. (OK…maybe this hasn't happened yet!)

• Implementation of a provincial 9-1-1 system for ambulance, police, fire and poison control.

• Establishment of a repeater network for communication between ambulances and hospitals in Manitoba.

• Establishment of a central dispatch centre for rural Manitoba to coordinate the movement of ambulances and the transfer of patients.

• Improved communication between rural ambulances and Winnipeg ambulances.

I'm encouraged by the fact that government has chosen to adopt so many of these recommendations over the course of the past few years...albeit much slower than we might have liked and some in a slightly different format that imagined almost fifteen years ago. I'm also encouraged by the fact that the Paramedic Association of Manitoba is now considered by government to be a valuable stakeholder in Manitoba's emergency medical services, as evidenced by the fact that we are now more regularly consulted and quoted on issues such as the inter-facility transfer decision. But I really think many of our successes today are a result of the hard work and tenacity of those who came before us. To every involved in MPPA...Thanks!

Province To Cover Inter-facility Transfer Costs

Manitoba's Minister of Health Theresa Oswald announced on Tuesday that the provincial government would begin covering costs associated with all inter-facility ambulance transfers effective immediately. The estimated cost for this service...$7 million annually.

The Paramedic Association of Manitoba has been arguing the need for consistency within our emergency medical services system. While this announcement doesn't afford any guarantee about the level of service or care that patients will receive, it does address a very serious inconsistency in terms of who pays for medical services that are not available in the community, often as a result of regional or provincial efforts to consolidate services in centers of excellence. In that light this announcement is most appropriate.

But on an even larger scale, perhaps it moves us closer to what we've been suggesting to government for some time now...a province-wide EMS system. If you consider that the provincial government purchases and maintains all ambulances, pays for a provincial communications network, foots the bill for most wage and benefit increases associated with collective bargaining, built and operates a provincial dispatch center and has now waded into the arena of patient billing...they have a fairly significant stake in paramedic services across the province. It only makes sense that if you own the resources, and you want to ensure maximum efficiency of those resources...you have to be able to control them as well.

New Health Professions Legislation

The provincial government is considering development of new "umbrella" health professions legislation. In a nutshell, this new legislation will would be an all-encompassing Act that would apply to any regulated health profession. It would identify generic requirements applicable to all self-regulating health professions including the application process for self-regulation and the rules regarding establishment, duties and responsibilities of a professional regulatory college. Each self-regulating health profession would then have its own regulation outlining it's Bylaws and "rules of operation" under this Act. A number of other Canadian provinces have similar legislation, including Ontario, Alberta and British Columbia.

The fact that Manitoba is considering such legislation has a significant implication on our profession. It very probably means that the government has placed a moratorium on any new self-regulating legislation until such time as this umbrella legislation is in place. In other words, any application for self-regulation made at this time would be placed on hold until the health professions act is developed. It's my understanding that preliminary discussions with existing self-regulatory professions regarding this umbrella legislation have begun...but that said we most likely won't see a new Act introduced prior to this time next year.

There are positives to this process, however. The fact that umbrella legislation regarding health professions will be somewhat generic and that each profession will have individual governing regulations is a plus from our stand point. Regulations require only Ministerial and caucus approval...they are not hostage to a vote in the legislature. Therefore, once health professions legislation is in place, and we make successful argument for paramedic self-regulation, the government of the day can be lobbied to approve the appropriate regulation. This tends to be a much easier process that having new legislation proclaimed.

There are currently 19 self-regulating health professions in Manitoba. The government has briefed each registrar on their desire to move in the direction of umbrella legislation. The Paramedic Association of Manitoba has indicated to the Health Minister's office that we would like to be included in this consultation process.

Consistent EMS Service Delivery

In May of this year the Paramedic Association of Manitoba presented all provincial MLAs with information regarding the consistency (rather lack thereof) of emergency medical services across the province. In the context of that presentation we outlined:

• Manitoba is comprised of eleven (11) Regional Health Authorities; each is very distinct in their approach to the delivery of Emergency Medical Services.
  
• Within the boundaries of the RHAs there are 37 different service operators. This governing model has contributed to an inconsistent and inefficient Emergency Medical Services System.
• Across Canada provincial governments are adopting more centralized EMS. Provinces such as Nova Scotis, British Columbia, Prince Edward Island and New Brunswick operate various forms of a "province-wide" EMS delivery model.

In an effort to promote more consistent and efficient pre-hospital emergency medical care, the Paramedic Association of Manitoba has recommended that Manitoba move toward a province-wide "over-sight" or management model for EMS. One suggestion we've made is that RHAM (Regional Health Authorities of Manitoba) be tasked with operational management of Manitoba's EMS resources.

At their annual covention held in Winnipeg last weekend, the Manitoba Federation of Labor addressed the concern of inconsistent emergency medical services by unanimously accepting the following:

• Be it resolved: the MFL lobby the provincial government to ensure EMS becomes a provincial program that provides consistent, uniform, quality patient care on an equal basis for all Manitobans.

Earlier in the year the Manitoba Young New Democrats passed a similar resolution at their annual meeting in Winnipeg. Concerned about varying levels of patient care from region to region, they uamimously passed:

• Be it resolved: that the Manitoba Government create a provincial authority that will govern pre-hospital care and will have provincially recognized standards of care, regardless of urban or rural environment.

Standardizing our emergency medical services and coordinating resources to ensure more effective and efficient utilization of paramedics only makes sense. Without cenralized management of all EMS services, responsible for coordinating operational activities and ensuring standardized medical oversight and consistency of care, little will change even with a provincial dispatch centre. Regions will continue to develop policy based only on the needs within their boundaries. There are strengths and weaknesses in every region today...let's learn from those and move forward in a coordinated effort to ensure our patients receive the level of care they deserve. It's good for our patients, and it will only serve to improve the system and the conditions in which we work.

Provincial Per-Capita EMS Funding

Here are the 2006/07 EMS per capita government funding estimates for each province as projected by the Canadian Institute for Health Information.

New Brunswick	$85.24
Nova Scotia	$74.41
British Columbia	$68.83
Ontario	$56.73
Alberta	$45.36
Saskatchewan	$41.24
Quebec	$39.22
Nfld/Labrador	$37.33
Manitoba	$35.82
Prince Edward Island	$34.45

Ten years ago Manitoba's annual per capita spending for EMS was only $13.21. The addition of a provincial communication system (Fleetnet), Fleet vehicle program, a provincial dispatch centre and improved staffing models in many rural areas has resulted in a significant increase in system funding.

Unfortunately administrators and government officials view this increase only in terms of additional expenses, without considering the benefits associated with the increase. When they purchase a new MRI machine in an effort to reduce wait lists, or increase funding to educate or hire more physicians or nurses, it's seen as a necessary and justifiable expense. Increasing EMS funding should be viewed in the same light...as another alternative to improving health care for Manitobans. Other Canadian jurisdictions have recognized the benefits of using paramedics to assist with emergency department backlogs, provide mobile health services and participate in non-traditional community health roles. Manitoba needs to follow suit.

Provisional EMS Provider License

The number of provisional EMS Provider Licences issued by Manitoba Health has been steadily increasing over the past year or two, and the way in which this policy is being used is of great concern to the Paramedic Association of Manitoba.

According to the MHES licensing manual, a provisional provider license may only be issued to personnel currently licensed in another province. Theoretically the purpose would be to allow a practitioner already licensed in another jurisdiction to seek employment in Manitoba and work until such time as they were able to take our provincial licensing exam. The provisional license is quite restrictive in that it really only allows that individual to drive the ambulance, and provide patient care only under the direct supervision of another paramedic.

For the past 18 months Manitoba Health has been granting provisional EMS licenses to anyone graduating from a CMA accredited program and hired by the Winnipeg Fire Paramedic Service while they await an opportunity to take the provincial licensing exam. Initially I had expressed concern to MHES about this practice, as it seemed to me that it contravened their existing policy on the use of these licenses. The explanation I received, however, was logical...these individuals graduated from an accredited program, and should not be unduly penalized for having to wait any extended period of time to take the exam. Other health professions practice in the same manner, allowing new graduates to work while waiting for their certification exam...why should we not consider the same opportunity for paramedics. At the same time, it was agreed that Manitoba needed to review this process and set reasonable standards to balance our graduates rights with public safety.

Unfortunately the issuance of provisional licenses has escalated, and I have real concern about how the process is being administered. On numerous occasions, provisional licenses have been issued, these individuals have subsequently taken and failed the provincial exam twice and the licenses are still in effect. While I respect and support the rights of new graduate's to seek employment, I question how the regulator can ensure public safety is not jeopardized when an individual that has twice failed a licensing exam is allowed to continue practicing under the cloak of a provisional license.

Our new Emergency Response and Stretcher Transportation Act allows any graduate of an approved EMS course to take the provincial licensing exam prior to seeking employment. There is no longer any need to issue provisional EMS Provider Licenses that remain in effect for an extended period of time. I have no problem with establishing a practice that is fair for the graduate...but our primary interest has to be public safety!

Annual General Meeting and Elections

Paramedic Association of Manitoba Board of Director nomination forms are now available on our web site. Two Board members will be elected to three year terms at our Annual General Meeting, which will be held on Saturday, November 25th at the CanadInns Polo Park beginning at 13:30.

I encourage all PAM members to attend this year's AGM.

Manitoba Ranks Lowest in EMS Expenditures

As I mentioned the other day, the Canadian Institute for Health Information (CIHI) has released their 2006/07 estimates for national health expenditures. According to the report Manitoba will spend approximately $3,284 per capita on health care this fiscal year, of which roughly $36 will go toward costs associated with ambulance service.

Following release of the report I contacted CIHI to request the data related to ambulance expenditures across the rest of Canada. This morning I received the Provincial and Territorial Government expenditures for the "ambulance" category dating back to 1974.

In reviewing this information, one thing is very evident...the Manitoba Government has increased EMS spending substantially over the past 13 years. In 1993/94 Manitoba spent only $10.3 million annually on EMS...the estimated expenditure for 2006/07 is $39.4 million. What's disappointing to note, however, is that only one province spends less per capita on EMS than Manitoba...P.E.I....but even they spend a greater percentage of their overall health care budget (1.2%) on ambulance service than we do. Manitoba ranks dead last amongst all ten provinces in that category.

The province that operates arguably the most successful emergency medical services system in the country, Nova Scotia, will spend close to $70.7 million dollars on ambulance service in the next fiscal year. That's a staggering $74.41 per capita...on the surface enough for many critics to suggest Manitoba could not consider such a model. But that would be very shallow thinking! While Nova Scotia spends approximately twice what Manitoba does annually on EMS, they actually spend less per capita overall on health care expenses. To me that suggests that the 2.5% of their annual health budget spent on emergency medical services has been offset by savings in other areas...something the Paramedic Association of Manitoba has been suggesting to Government for many years now.

Ambulance Services Account for Only 1.1% of Health Care Dollars

Last week the Canadian Institute for Health Information (CIHI) published their projections for 2006/07 provincial and territorial health care expenditures. Across Canada a staggering 35 cents of every dollar spent by Governments is spent on health care. According to CIHI, Manitoba ranks second only to Alberta in per capita spending in this area. Estimates suggest that Manitoba will spend almost $3,300 per person on health care expenses in this fiscal year. So where does that money go?

An editorial in the Winnipeg Free Press (Sat, Nov4) suggests in part that Manitoba is spending too much money trying to maintain too many hospitals. The CIHI estimates show that of the $3,300/capita spent on health care in Manitoba this year, costs associated with hospitals and other health institutions will gobble up over 57% ($1,890) of that money. Without doubt the closing of hospitals, whether it be in urban or rural settings, is a very unpopular political decision, but one has to ask whether or not that is money well spent.

Another very interesting, if not alarming, statistic is this...Manitoba will spend over $50 per capita on health care administration costs, while the money allocated for ambulance services in the province will amount to only $37 per resident, or 1.1% of the province's health care expenditures.

I don't suggest that there is a simple solution to curbing our rising health care costs. But our population is both growing and aging, and our expectations and demands are following suit. We can't continue to throw more and more money into our health care system thinking we'll "fix" the problem by simply hiring more doctors, nurses and other health professionals. We need to work collaboratively and think outside the box in an effort to reform health care delivery.

Among some of the many recommendations the Paramedic Association of Manitoba has made to Government in this area...Expanding scope of practice and fully integrating paramedics into health care to augment and improve current resources and programs...Using paramedics in emergency-care facilities to assist with triage, patient care and high workload efforts including resuscitative measures...Enhancing the use of appropriate paramedic treat and release protocols resulting in the need for fewer ER admissions...Increasing the number of Urgent Care facilities and enabling paramedics to transport or refer patients to appropriate health facilities in lieu of hospital ERs.

My reaction to the CIHI statistics has ranged from disbelief to disgust. How can anyone justify spending more money on health care administration than ambulance service? How does making decisions about health care outweigh ensuring Manitobans receive appropriate pre-hospital emergency care? Why doesn't the Government recognize that paramedics are a resource that would allow them to make difficult political decisions regarding hospital closures?

But the answer is simple...we're still not recognized as "health care professionals". As an association, when PAM talks about the benefits of using paramedics to augment health care delivery, the Government still fears our interests are somewhat self-serving. No doubt we've raised the bar within our profession...we've adopted national competencies for entry into practice, we expect our colleagues to adhere to professional ethics and conduct and we've promoted the need for higher educational and clinical standards for ourselves. But the reality is that we don't control those benchmarks, not do we have the ability to demand adherence through self-discipline. Until we become a self-regulated profession with the direct responsibility to protect the public interest, our goals will always been seen as self-serving.

I'm mad as heck that only 1.1% of Manitoba's health care dollars are spent on pre-hospital emergency services. I think, and I know many others agree, that additional money spent on paramedic services can not only offset expenses in other categories of health spending, but ultimately improve the health of many Manitobans along the way. But I'm more convinced than ever that the way to get that message across to those responsible for writing the cheques starts with self-regulation.

EMS Exemplary Service Medal

The Emergency Medical Services Exemplary Service Medal recognizes professionals in the provision of prehospital EMS who have performed their duties in an exemplary manner. A new Manitoba website at www.esmmb.ca explains the history and purpose of the medal and outlines the process that must be followed to nominate someone for recognition in this category.

The EMS Exemplary Service Medal is a member of the Governor General's Medals of Honours family. While there is a component of the award that recognizes long service (nominees must have 20 years experience in EMS), the real purpose of this very prestigious Medal is to pay tribute to those who have displayed exemplary performance during their career. As a profession we should be encouraged by the fact that the Manitoba Awards Committee is striving to uphold the dignity of this award through its review process. The provincial committee reviews each nomination to ensure the behaviour being recognized as exemplary is exactly that...not simply 20 years of doing what's expected, but rather behaviour and accomplishments that we as professionals can be proud of and strive to emulate.

Unfortunately the evidence suggests that other professions treat this Medal as one that everyone in their line of work expects after 20 years of "employment". I hope we in EMS continue to view this Medal in the way it which it was intended...as recognition of truly exemplary service.

PAM to Meet With New Health Minister

Manitoba's new Minister of Health, Honourable Theresa Oswald, has asked to meet with representatives of the Paramedic Association of Manitoba on Tuesday, November 21st. This will be our first opportunity to meet with Minister Oswald since her appointment as Health Minister, and comes in response to a request we sent to the Minister's office shortly after she took office.

PAM Director Jodi Possia and I will take this opportunity to discuss a number of items with Minister Oswald, including self-regulation, the status of the EMS Framework Project and the need for more consistent and sustainable service delivery to position our pre-hospital system for future needs. Initiatives around education and professional integration will undoubtedly also be tabled for discussion.

PAM Working with Manitoba Public Insurance

The Paramedic Association of Manitoba has a number of goals that we are committed to as an organization, only a couple of which include:

• Raising public and political awareness about the role of Paramedics, and
  
• Being active in development and promotion of programs within the community that serve to reduce and/or prevent injury or illness.

In ongoing efforts to fulfill these objectives we have approached representatives of Manitoba Public Insurance with a plan to partner in the development of some safety and injury prevention announcements and messages. Our initial proposal is to work collaboratively with MPI on safety messages that can be placed on our web site and used as promotional materials by EMS services and ourselves at public events.

I'll be meeting with MPI later this week in hopes of working out an agreement that will be beneficial in assisting us to meet these objectives.

Membership Numbers Are Up!

Paramedic Association of Manitoba membership numbers are on the increase...a trend that will undoubtedly strengthen our ability to have meaningful discussions with decision makers at all levels of Government.

As of October 27th, PAM has 454 members...the highest number in our five year history. In October alone 13 new memberships were received...since July 1st (beginning of the 2006/07 membership year) we have 57 new registrations. I think this encouraging trend can be attributed to a number of things...our spring "road show" that saw PAM visit practitioners at 12 sites in 10 different regions across the province, the introduction of our on-line electronic registration and payment process, our attempts to improve communication at all levels, and, I dare say, increased awareness of Association activities as a result of discussions on the Manitoba EMS Discussion Board.

PAM has been very successful in gaining the attention of many key stakeholders within Manitoba's EMS "system". In our early days as a professional association we were rarely considered for inclusion on provincial or project committees, and had great difficulty even contacting Government officials to make our concerns known. While there's no doubt we still have a great deal of work to do, today they're calling us and asking for our input and opinion. That's a tribute to the work we've done and the respect we are starting to gain as an organization and a voice for the profession.

But...even though I'm encouraged by these new numbers, there are still too many practitioners out there who have not joined. Like it or not, numbers are important. Every time I meet with the Minister of Health...they ask. When we met with Hugh McFadyen (Opposition Leader)...he asked. A very successful meeting with Red River College ended with them asking how many members we had.

Practitioners need to be encouraged to be part of their professional association. PAM is about striving to promote excellence in pre-hospital emergency care and within our profession. Whether paramedics are working in Manitoba EMS full-time, part-time or as casual employees, most say they do it because their primary interest is the well-being of their community and the patients they care for. There are no good reasons for neglecting to be a member of your professional association...only excuses.

Further to...Firefighters Driving Ambulances

There's been considerable discussion since the announcement was made regarding a regulatory exemption allowing firefighters to drive ambulances in extenuating circumstances.

A memo circulated to all EMS Services in Manitoba clearly states that the use of firefighters to drive ambulances must be restricted to exceptional circumstances and is not to be used as a means of addressing operational challenges such as staffing. Manitoba Health also released a Treatment Guideline that very clearly defines the parameters around how this order may be used:

• Regions/Services must have a policy in place that limits use of the Order to occasions where:
• Both EMS crew members are required to actively provide care in response to a serious threat to life and/or limb, AND
• Additional EMS resources are not immediately available and cannot be dispatched to arrive in time to address the threat to life or limb.

• The Region/Service must file a written occurrence report with Manitoba Health within 5 days of the incident.

I’m very confident that the intent is only to give licensed EMS providers the legal ability to obtain appropriate assistance in extraordinary circumstances to act in the best interests of their patients. I would ask that members notify us any time they become aware of instances where firefighters are asked to drive an ambulance. PAM certainly plans to monitor this situation, and if we suspect this procedure is being abused in any way we will make our concerns known to Manitoba Health and the Minister.

As was appropriately pointed out to me by a colleague this morning….this can’t be viewed as a solution to resource problems that might exist in our EMS system. And I concur. We need to continue to lobby government for increased resources where needed and a more centralized management of those resources to ensure consistent, timely and appropriate care for all our patients!

Early Retirement for Paramedics

There seems to be renewed interest from paramedics across the province regarding early retirement benefits, and those discussions have generated some misconceptions about our "right" to this benefit.

In the spring of 2005, following extensive lobbying by the Paramedic Association of Canada and chapter members, the Federal Government revised the Income Tax Act. This Act outlines provisions related to maximum pension plan contributions and retirement benefits, and now includes paramedics in the definition of "Public Safety Occupations (PSO)". This designation recognizes the physical and mental limitations associated with increased age, and concedes that employees in these designated occupations continuing to work past a certain age might put public safety at risk. Including paramedics in the definition of Public Safety Occupation now allows us to negotiate increased pension plan contributions and unreduced early retirement benefits. Now it's up to us and the unions representing paramedics in this province to use this "right" to negotiate improved pension benefits and make early retirement a priority in contract negotiations.

The Ontario Government recently passed an amendment to provincial legislation related to municipal employees in that province (known as Bill C206 - Ontario Municipal Employees Retirement System Act). This legislation has been fraught with controversy as a result of wording that mandated the pension plan to "consider providing optional increases in pension benefits for members who are employed in the police and fire sectors". Paramedics in the province were mad because the Government did not include them in this statement, feeling they should have been included because of their designation within the PSO...other groups were upset that anyone was included in this capacity, arguing their occupations were as worthy as police and fire. While this legislation certainly doesn't preclude paramedics in that province from working to negotiate for early retirement, it probably makes it more difficult to obtain because the legislation doesn't require the municipal plan to consider it.

ARML Tests On-Line

The Paramedic Association of Manitoba has introduced an on-line testing process that can be used as a component of the Alternate Route to Maintenance of Licensure (ARML) program that is currently being utilized by many regions in the province.

PAM offers continuing education modules on our website that meet the academic Core Competency requirements of ARML, and 8 regions currently use these packages within their ARML programs. PAM now offers an on-line testing process to supplement these packages, and has offered this to all regions as an alternative to the existing written tests. Simply put, this would allow paramedics to review a con-ed package and take the associated test on-line at their convenience.

To date three regions have expressed an interest in using the on-line testing for this ARML year...Burntwood, Central and SouthEast. All three should be up and running within the next 2 months.

Third Winnipeg Mayoral Candidate Replies

Kaj Hasselriis is the third Winnipeg Mayoral candidate to respond to correspondence from the Paramedic Association of Manitoba asking that EMS be a priority following the October 25th civic election. If elected, Mr. Hasselriis says he'll meet with Winnipeg representatives of PAM. to investigate the amalgamation model. He goes on to say that "if it is not working for the betterment of all Winnipeggers, it will be changed".

Hasselriis is the third Mayoral candidate to respond to PAM's election correspondence. Sak Katz appears to defend the staus quo, while Marianne Cerilli has promised to work with all stakeholders to review the amalgamation concerns.

MESMAC Meeting

I attended the Manitoba Emergency Services Medical Advisory Committee (MESMAC) meeting on October 18th. Among the agenda items discussed:

• Approval of updated CPR and AED Treatment Guidleines
• Development of a protocol that would permit paramedics to rule out the need for c-spine immobilization based on recent studies (OPALS and NEXUS).
• Development of Obstetrical and Trauma protocols that allow paramedics in rural services transporting to a Winnipeg hospital to proceed to the most appropriate facility.
• Review of two equipment approval requests - King Air Airway (to replace Combitube) and Twinject (in lieu of EpiPen). Both were considered inappropriate for EMS use.
• Development of a protocol for removal of Taser darts.
• Review of Diphenhydramine dose as included in the Anaphylaxis protocol.
• Statement added to vehicle Operation ETG regarding appropriate cell phone use.

PAM Meets With Opposition Leader

Earlier this month I had opportunity to meet with Hugh McFadyen, Manitoba PC Leader, to discuss issues related to emergency medical services in Manitoba. Mr. McFadyen and opposition Health Critic Myrna Driedger listened intently as we briefed them on concerns surrounding the Winnipeg fire/paramedic amalgamation, the need for more centralized management of Manitoba's EMS system and our pursuit of legislation for paramedic self-regulation.

Following the hour-long meeting, Mr. McFadyen assured us that his party would look to PAM for input on health issues as they prepare their platform for the next provincial election. He also indicated that he supported the concept of self-regulation and would be prepared to work with all stakeholders in our efforts to bring that to a successful conclusion.

Health Minister Allows Firefighters to "Drive" Ambulances

Health Minister Theresa Oswald has signed a Ministerial Exemption Order that will allow firefighters to drive ambulances in extraordinary circumstances.

The Emergency Response and Stretcher Transportation Act states that driving an ambulance responding to an emergency is retricted to licensed EMS providers only. Therefore, by law, firefighters who were not licensed as EMS providers could not drive an ambulance to the hospital even if requested to do so by the EMS crew. In certain situations, particularly in rural areas where additional EMS resources might take a long time to respond, there was concern about not being able to utilize all appropriate practitioners to provide patient care.

In an effort to address this concern, Minisiter Oswald signed the exemption that will allow both EMS practitioners to provide patient care enroute to the hospital when deemed necessary. The intent of this order is not to allow general policy to be adopted that permits firefighters to staff ambulances, but rather ensure there is flexibility for EMS crews to make that request when need be. As a result, firefighters with a Class 4 license (but not an EMS Provider License) are now permitted to drive an ambulance to the hospital if

• both EMS practitioners are required to provide care in an urgent and and serious threat to life or limb of one or more patients AND
  
• the crew staffing the ambulance asks the firefighter to drive it.

This Ministerial Exemption is in effect until December 31, 2006. At that time it will be reveiwed to ensure it has addressed the issue appropriately without creating additional concerns before being re-issued. I encourage you to bring any problems relating to this issue to our attention immediately.

Winnipeg Mayoral Candidates Differ on EMS

On Tuesday, October 17th the Paramedic Association of Manitoba contacted all four candidates seeking election as Winnipeg's next Mayor. In written correspondence to each candidate PAM sought assurances that the next Mayor would show leadership by stopping the current amalgamation strategy and asking all stakeholders, including the provincial Government, Manitoba Health and the Winnipeg Regional Health Authority, to work collectively in efforts to ensure a sustainable and effective EMS system for Winnipeg.

Incumbent Mayor Sam Katz replied to our request by outlining initiatives in the 2006 City budget aimed at improving Winnipeg's EMS services, including an additional ambulance and 12 new paramedic positions. Nowhere in his reply did he accept our recommendation to review the current strategy for amalgamation, nor did he acknowlege concerns related to ambulance shortages or staff retention issues.

Marianne Cerilli's response was much more encouraging. She acknowledged that Winnipeg's amalgmation was frought with problems and agreed that paramedics need to be more fully integrated into the health care system. In her reply she provided assurances that she would "reopen the (amalgamation) plan and reconsider the best approach to providing EMS for Winnipeg".

The correspondence received from both Katz and Cerilli is available for viewing on the PAM website at www.paramedicsofmanitoba.ca/initiatives/lobbying.asp. I encourage you to read them.

New PAM Blog

Communication has been an issue within our organization since our inception. Canadian Emergency News has proven to be an excellent vehicle to host a newsletter...unfortunately by the time you read it, the news is no longer new. We have worked diligently over the past year or so to improve our website; the time and effort has certainly paid off, but it's still a large area to search on a daily basis to see what the Association is doing. An electronic newsletter is in the works that will be emailed to members and EMS services regularly; undoubtedly it will provide information on a more timely basis that is possible through CEN. But I thought it would be beneficial to provide more immediate details on our activities to members and non-members alike...so we've started the Chairman's Blog.

I'll be making every effort to update this blog on a very regular basis. It's important that PAM members to be kept abreast of the day to day issues affecting our profession and our Association. If you have any comments or suggestions regarding my blog, please send me an e-mail and let me know.