Paramedics Recognized in Memorial Legislation

Bill 17 - The Firefighters, Peace Officers and Workers Memorial Foundations Act passed second reading in the Manitoba Legislature on October 15th, thereby sending it to Committee for review. The legislation would permit the three named occupational groups to establish memorial foundations to raise funds for the construction and maintenance of memorials that pay tribute to colleagues killed in the line of duty. When a bill passes second reading it is sent to Committee for review, and this particular bill was on the agenda of the Social and Economic Development Committee last evening (Monday, Oct 29).

Individuals and organizations are given opportunity to speak to the proposed legislation during the committee meeting. On behalf of the Paramedic Association of Manitoba I spoke to Bill 17 and the need to ensure Paramedics were properly recognized in this Act. My presentation can be viewed here.

Following our presentation I was asked a number of questions regarding our suggested amendment to this Act. Our recommendation to committee was that one memorial recognizing all three essential emergency services (Police, Fire, EMS) would be appropriate, but in the event that this option was not acceptable the legislation needed to be amended and sent back to the House ensuring Paramedics had equal opportunity to develop a memorial to pay tribute to those killed in line of duty deaths. The Minister responsible for Bill 17, the Honourable Ron Lemieux, assured us that he would be submitting an amendment that would address a separate Paramedic memorial.

As debate on this particular bill unfolded it became clear that Minister Lemieux would not entertain a change in the name and/or main intent of Bill 17. In other words, clause 2 of the legislation would remain intact and the Act would automatically establish memorial foundations for the three named groups...Firefighters, Peace Officers and Other Workers and no others. However, the Minister did add the following to the proposed legislation..."The Lieutenant Governor in Council may, by regulation, establish one or more memorial foundations to promote the memory of Paramedics and other specified groups of workers who have died in the workplace."

Although reluctant to include the word "paramedics" in this amendment, the Minister has given us, in my view, equal opportunity to establish a memorial specific to our profession. The fact that this wording was used is a direct result of the efforts of paramedics across this province to be heard on this very important issue, and I commend everyone who contacted their MLA and Government to voice displeasure with the original legislation. I also think the fact that we had paramedics in the audience listening to my presentation and watching the subsequent proceedings as our elected officials debated this legislation in committee had a very positive effect on the outcome.

The amended Act will now be sent back to the House for third and final reading. I anticipate this will happen quite quickly, and the Act will be proclaimed with little or no delay.

CRNM Health Professions Legislation Review

The Manitoba Government is moving forward with plans to develop umbrella legislation that would encompass all current self-regulated health professions in the province. Simply put the new legislation would create a single Act replacing the 20 existing pieces of legislation governing Manitoba's self-regulating health professions, and each profession would then have a regulation specific to their practice. The rationale for this is two-fold. Not only has it become a bureaucratic nightmare to try and maintain 20 separate Acts, all of which require full legislative process (reading of bills in the Legislature as well as debate and committee time) any time an amendment is needed, but public expectation for health professions has changed dramatically since much of the current legislation was implemented, making it necessary to review many of the current practices associated with professional regulation.

I had an opportunity yesterday to sit in on an information session delivered by the Registrar for the College of Registered Nurses of Manitoba to nursing staff and senior RHA administration in Steinbach. I thought it would be an opportunity not only to ensure that I understood the review process currently underway, but also to gauge the mood of current regulators as the process continues to unfold.

According to the CRNM presentation, we do have a fairly good understanding of what to expect when new umbrella legislation is introduced. We anticipated that the framework for this legislation would be very similar to that of the BC model adopted within the past couple of years, and it appears that is the case. Legislation from other Canadian and international jurisdictions will also be considered during the review as outlined on the Health Professions Review web site, as well as taking into consideration current best practices from within existing Manitoba laws. The umbrella legislation will outline common administrative practices, including board structures, reporting requirements and investigation and disciplinary processes. It will also clearly define the requirements and process to be followed when a "new" health profession requests self-regulatory status. Regulations will then be approved by Government to define the specifics associated with each professional College. The benefit here is that regulations can be added or amended much more easily that an Act that requires full legislative process.

During the course of this presentation there was brief reference to anticipated time-lines for new legislation, although CRNM does expect these may be somewhat optimistic as a result of the spring election. Originally Government had indicated they hoped to bring this legislation forward in the Spring of 2008 and begin to roll it out late fall of that same year. Once umbrella legislation is in place the larger Colleges (Nurses, Physicians, Pharmacists) will be the first to have revised regulations in place. Other health professions will follow throughout 2009.

When we were first advised of Government plans to consolidate all health professions under umbrella legislation I wondered how existing Colleges would react. It would appear, based on the presentation I saw yesterday, that all health professions have embraced the opportunity to participate in the review process and will work collaboratively to make this work. In my view that's good news for our profession...the sooner the review process is completed the sooner the moratorium on applying for self-regulation will be lifted and we'll be able to move forward in that regard.

PAM Supports Winnipeg Harvest

A couple of months ago I was asked it would be possible for the Paramedic Association of Manitoba to help Winnipeg Harvest in their bid to set a new World Record for food collection in a 24 hour period. Event organizers wanted to have skilled first aid providers on site throughout the collection period...someone at Harvest knows an ex Deputy Minister of Health who knows me...and before I could say "self-regulation" we were involved.

Beginning at 17:00 on Saturday, October 20 and running straight through until 17:00 on the 21st, hundreds of volunteers assisted with the collection of non-perishable food items for Winnipeg Harvest. The 24 hour marathon event was set up at the Winnipeg Stadium, and organizers knew going into the weekend that they would need over 100 tons of food donations to beat the one-day food collection Guiness World Record set in Regina.

While the atmosphere throughout much of the weekend was both exciting and competitive (with the exception, perhaps, of the overnight hours that Mandy and I sat watch over), it would be difficult to argue the need to have had paramedics on hand. But all kidding aside, it was a terrific opportunity for PAM to participate in a great cause and support a very worthwhile charity. Event organizers treated us well and appreciated both our presence and support.

Special thanks to Bryan Leach, Stuart Cuddy, Amanda Baldwin, Lorne Harley and Tanya Cutting for volunteering to spend their weekend with me representing the Paramedic Association of Manitoba during Winnipeg Harvest's record breaking attempt. And thanks also to Central Region EMS Director Corene Debreuil for the use of an ambulance to help keep our volunteers both dry and warm.

Oh...and congratulations to Winnipeg Harvest. Maybe I forgot to mention that they collected more than enough food to set a new World Record.

Crisis Management

I received a call from CBC TV this afternoon..."would I consider doing another interview regarding service shutdowns and staffing problems...apparently Falcon Lake was having problems and would the recent hirings by Winnipeg EMS have much impact on rural staffing?"

As I mentioned a few blogs ago, the fact that Winnipeg has made employment offers to 16 rural Manitoba paramedics should be viewed as a boost for the profession and our EMS system. I have long argued that career progression is absolutely essential to recruitment in rural services. Without evidence that these opportunities are on the horizon, young students and potential paramedics look elsewhere for both education and employment.

What is frustrating, however, is the fact that we really don't have any resource plans in place to ensure that the loss of 16 paramedics from the rural setting won't cripple some ambulance services. Manitoba has 11 Regional Health Authorities with 11 different management structures and philosophies which results in 11 different EMS systems. And I'm not blaming any RHA manager or executive team for the disparities...they inherited a very fragmented system that had been severely underfunded for the better part of two decades. They had very little understanding of what EMS was or how it operated. For the most part they were facility and program administrators...they could see and feel what they were dealing with and plan appropriately. EMS didn't quite fit into that mold.

Manitoba Health initiated the EMS Framework Project in January 2004. Quite frankly, I was excited by the fact that the RHAs, government and other stakeholders recognized the disparities that existed within our EMS system and wanted to develop a blueprint to address future development. Included in the terms of reference for the work to be conducted by the Project Team (PAM had a seat on this committee, which would in turn make recommendations to a senior Steering Committee) was direction to "explore a range of potential EMS system models, including regional, provincial and hybrid models". Unfortunately that portion of the review became far too political and was never completed.

Without more centralized direction about staffing and service delivery, the disparities will continue to exist. Some regions, like SouthEast and Interlake which have primarily opted to staff services on a 24 hour basis, will fare better than others. But overall the system will be managed by reacting to crisis. It took great political will ten years ago in Nova Scotia to affect very positive change. I wonder what crisis needs to occur here at home before our decision makers will be prepared to take that plunge.

Education Announcement Welcome News

The recent announcement by Health Minister Theresa Oswald that the provincial government was partnering with Red River College to develop a Primary Care Paramedic education program was both welcome news and a pleasant “surprise”. I say welcome news because it moved paramedic education up to the “next level” here in Manitoba by way of it’s new relationship with a respected health sciences faculty in a post secondary educational facility. I call it a pleasant surprise because quite honestly I began to question whether or not this government was prepared to make what I think was a very difficult political decision to move in that direction.

This isn’t the first time that Red River College has considered offering an expanded education program for emergency medical services students. If my memory serves me correctly (and unfortunately that’s becoming somewhat of an issue of late), it was just 7 years ago that Manitoba Health attempted to sign an agreement with, at that time, Red River Community College, to deliver EMT and EMR education for ambulance services in Manitoba. Quite literally within moments of that agreement being signed word came down from senior government officials to abandon that direction and work toward a partnership with the Emergency Services College in Brandon. Despite country-wide trends to move toward a more professionally educated paramedic practitioner and similar recommendations from sources throughout the EMS and emergency, I was suspect that politics might drive us once again down that road.

The fact that Red River College has been awarded this opportunity should not be viewed in simple terms as criticism toward any past or existing EMS educational bodies in Manitoba. It is quite frankly so very much more than that, and in fact may well be one of the most significant moves toward improving not only our ambulance services but also the profession of paramedicine that this province has ever taken.

Don’t get me wrong…there have been other operational improvements made to Manitoba’s EMS system over the past few years. Job opportunities have expanded, vehicles and communications have been enhanced and a provincial dispatch center has been established. These have all, in some way, helped improve the service we provide. And without doubt there are details within this new partnership that have drawn concern…the limited student enrollment numbers and the September 2008 program start date among them.

But despite the aforementioned system improvements and agreement downfalls, I’m suggesting that moving paramedic education into the forum shared by all other allied health professions offers the most significant opportunity for development of both the system and the practitioner that we’ve seen to date here in Manitoba. Paramedics must be considered members of the health care delivery team. To validate that role and ensure credibility for graduates as they interact with other allied health professionals, Manitoba needs an education model for paramedics with strong affiliations to other health sciences programs. Education and credentialing similar to other health professions is absolutely necessary to achieve legitimacy of paramedics within the spectrum of health service providers. And paramedics now have an opportunity to be educated in an environment that promotes portability of credentials to or from other health care roles.

Despite any criticisms that may be directed at this most recent decision or concern that it may not meet the needs of those already working within our current system, it is very welcome news in my opinion.

Manitoba Staffing Critical

No doubt there will be lots of talk over the next few days about staff shortages affecting rural EMS services in Manitoba. The phone calls started today...by the end of the week there will most likely be a number of rural paramedics advising their managers that they have been offered employment with Winnipeg EMS.

In the big picture, this is a good thing. For many years WFPS refused to consider hiring paramedics who were not trained as firefighters. PAM has long argued that this practice served to have a detrimental effect on EMS in our province. Young Manitobans looking at paramedicine as a possible career option undoubtedly look at career progression when making decisions about where best to begin their education and employment. When Winnipeg was refusing to hire paramedics who wanted only to be paramedics, career progression was seen to be hampered by many throughout the province and that had a negative effect on both recruitment and, as a result, the long-term sustainability of our system as a whole.

But the Winnipeg hirings will open the door to criticism by some who see this option as "raiding" from already suffering rural services. The last time Winnipeg hired a large number of rural practitioners (5 or 6 years ago if my memory serves me) it drew bad press and serious criticism from many regions. WFPS was accused of stealing paramedics whose training had been paid for by rural employers. Winnipeg was blamed for "crippling" many services already struggling to keep ambulances on the road. The Winnipeg management was chastised by many, including government officials, for something that should have been recognized as good for the system and our profession.

I realize that services across the province are desperate for staff. And I know that many paramedics are both frustrated and tired as a result. But the Winnipeg hirings are a good thing. Anyone wanting to lay blame for problems these hirings might create should stand in front of a mirror.

Monuments Act Reintroduced

Late last week Infrastructure and Transportation Minister Ron Lemieux reintroduced legislation that would set up three foundations to create tributes in the memory of peace officers, firefighters and workers who have lost their lives on the job. The Firefighters, Peace Officers and Workers Memorial Foundations Act was originally introduced prior to the spring provincial election, and at that time was sharply criticized by paramedics across the province.

The legislation that was proposed by Minister Lemieux last week is the same legislation that was being considered before the May election. Undoubtedly that will draw the ire of many EMS providers, especially those who took time to contact their MLAs and Government to express frustration and anger over the "exclusion" of paramedics in this initiative.

While it's disappointing to see this bill reintroduced without change, it doesn't mean those who voiced concern in the spring weren't heard. In fact Mr. Lemieux was very conscious of the criticism lobbied toward previous efforts to enact this legislation. As a result, staff from the Minister's office called us 2 days before Lemieux rose in the Legislature to speak to this Bill last week, suggesting they wanted to give us a "head's up" in recognition of the condemnation the government had received earlier in the year.

It's likely the phone call was placed to allow the Minister and his government colleagues to deflect criticism they might encounter suggesting paramedics had not been consulted or informed of this initiative. But that said, Mr. Lemieux's assistant was accepting of my suggestion that paramedics needed to be included in future plans associated with the memorials and assured me that she would bring my concerns to the Minister's attention.

At the risk of being condemned by paramedics who spoke so honestly and passionately this past spring about being "left out" of this initiative, I respectfully offer the following for consideration:

1. The costs associated with the planning, design, construction and ongoing maintenance of each memorial will be very high...so much so that paramedics may not be well positioned to go it on our own.
2. If one can look past the title of "workers", I suspect there would be genuine interest from other parties to include paramedics in this process. As long as we have a voice, we have opportunity to ensure our expectations are heard and needs considered. What's most important is that our lost colleagues are not forgotten.
   
3. For the most part, this is a "big labour" initiative. I mean that with no disrespect, but simply to suggest that we encourage our EMS labour organizations to work with other unions to come to an acceptable outcome.

As the legislation moves forward we can focus our energies on fighting for a separate monument for paramedics or we work toward developing some alliances to ensure paramedics killed in the line of duty are remembered with the dignity and respect they so very much deserve. In my very humble opinion, option number one would likely make your head hurt.