In April 2006, the NB provincial government announced a plan to evolve the nearly 40 separate EMS service operators in the province into a single province-wide operation, similar to a change already in place in both Nova Scotia and Prince Edward Island. The key focus for this was to ensure safe and consistent ambulance service to all residents by:
- establishing performance response standards;
- utilizing a dynamic ambulance deployment system;
- ensuring consistent clinical standards province-wide;
- implementing recruitment and enhanced training strategies;
- development of a centralized medical communications management centre;
- coordinating all non-emergency transfer services; and
- expanding and standardizing fleet vehicles and equipment.
The benefits of managing an ambulance system province-wide are outlined in PAM's White Paper, Emergency Medical Services - Manitoba's Quiet Crisis. Many of the goals outlined by the New Brunswick Health Minister to ensure more consistent pre-hospital care in that province are already in place here in Manitoba, albeit to limited and restrictive extent. Our provincial fleet vehicle program has provided a level of standardization and improved ambulance equipment. We have a medical communications centre capable of dynamic system deployment and coordinating inter-facility transfers...but efforts to phase the MTCC into full operation have been met with operational and administrative challenges as a direct result of regional differences in those areas. The Manitoba Emergency Services Medical Advisory Committee (MESMAC) has legislative responsibility to develop and oversee clinical standards across the province, but Medical Directors in each region often dictate differing skill-sets and treatment policies with resulting inconsistencies. New (2006) legislation has increased the minimum training requirements for personnel licensing, but some regions still have great difficulties recruiting and retaining staff. Although a significant amount of government funding has been introduced over the past five years to improve EMS training in the province (Primary Health Transition Funding and the Red River PCP Program), each region still differs dramatically in their training levels and strategies. Add to this the regional disparities in staffing models and deployment practices, and there's little wonder as to why we have yet to develop any standardized response times.
There have been significant advances in our EMS system over the past decade as evidenced by much of what I outlined above. We have a provincial dispatch centre, a fleet vehicle program, enhanced communications, improved legislation and less reliance on "volunteers" to staff our system. But many opportunities to further improve the emergency and pre-hospital care we provide to Manitobans are hindered by the fact that we have eleven Regional Health Authorities and close to thirty licensed land ambulance operators. Each RHA has its own
Many Canadian provinces have opted for some form of a provincial ambulance and paramedic service. British Columbia has a single service owned, operated and managed by the provincial government. Nova Scotia, PEI and now New Brunswick have all now opted for province-wide service models owned more or less by the government but managed by a contractor. Alberta is considering a system that would see funding for ambulance service administered by a centralized board with regional representation that would oversee operations to improve care and consistency across the province.
Here in Manitoba we have an RHA "umbrella organization" (Regional Health Authorities of Manitoba - RHAM) that might be well positioned to ensure continued regional involvement in a more consistent province-wide delivery system. The task of moving to a province-wide delivery model would most certainly be met with both labor and logistical challenges. But there are far more benefits associated with moving in this direction than there are reasons not to, for our profession, our careers and most importantly our patients.
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