EMS and Regionalization - Does it Work?

Ten years after the introduction of Regional Health Authorities in Manitoba, the provincial government has called for a review of the RHA system. The Regional Health Authority External Review Committee has been mandated to examine current RHA practices and recommend strategies for improvements in the future. Their report to the Ministers of Health and Healthy Living is to be completed by December of this year.

Without doubt Manitoba's emergency medical services system has seen both growth and opportunity over the past half dozen years. Some will argue that system improvements are a direct result of regional health authorities assuming responsibility for service delivery. But that perception may have more to do with the coincidence of timing than reality. While our rural system has evolved from primarily volunteer based in the 1990s to employee based today, the drive toward such change was more reactive to crisis than proactive management by the RHAs. Advancements in practitioner education and training have been driven in large part by the profession in response to increased demands placed on us by rising call volumes, longer transports and system needs. Improved communication, dispatch, and vehicle initiatives fall outside the responsibility of any single RHA, and in fact were conceptualized prior to the 1997/98 regionalization of our health care system.

Over the past decade and a half, many provinces have adopted a regional model for health care delivery. This strategy is said to be chosen in an effort to contain escalating costs, enhance public participation in decision-making, and improve planning, integration and accountability. Some critics, however, suggest government uses this authority strategy more to deflect criticism and avoid having to make tough choices as service expectations exceed existing capacities. It's also very interesting to note that not all health services are delegated to regional health authorities. Here in Manitoba a number of health services are excluded from RHA responsibility, including Pharmacare, Oncology, CancerCare Manitoba, many northern Nursing stations, fee-for-service physician services and others.
To my knowledge, only Manitoba, Saskatchewan and Quebec have opted to include ambulance services as health services administered by Regional Health Authorities. Other jurisdictions have chosen more centralized governance structures for EMS, perhaps recognizing that incidents and transports often don't align themselves with borders and boundaries. So what prompted our government to include ambulance and paramedic services in the list of regional responsibilities and was that the best decision to make?

The current Manitoba authority model has eleven RHAs, each with a very distinct and differing approach to the delivery of emergency medical services within their boundaries. The result is that Manitoba's EMS system is fragmented, not well coordinated, lacks efficiencies and accountabilities and has widely varying levels of performance across the province. The reality is that level of service and quality of care is dependant on a patient's location. And unfortunately, in our current model the system managers tasked with making EMS work aren't given the authority to make change.

Should EMS be administered by eleven regional health authorities, or would there be benefit to a more centralized management system? I'd suggest that with an RHA review currently underway, now is a very appropriate time to field this concept. Whether centralization meant public, corporate or a combination of the two, I can't help but think that such an entity would result in a more efficient and consistent level of prehospital care.