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.