Red Cross Rescuer Awards

The Manitoba Division of the Canadian Red Cross held their annual Rescuer Award presentations ceremony today at the Portage Ave office in Winnipeg. The Rescuer Awards are presented to non-professional rescuers or off-duty first responders who have assisted in a rescue attempt or provided help in an emergency situation. Awards were presented to eight Manitobans on November 1st to mark the first day of CPR month.

The Paramedic Association of Manitoba has become one of the largest Red Cross Authorized Providers in the province. More than 70 PAM members currently teach under our AP umbrella. As a result of that relationship I was asked to deliver the opening remarks at today's event and assist with the presentation of the Rescuer Awards.

It was an honour to have been asked to participate in this event, and while I expected to hear some remarkable stories about rescue attempts and by-stander first aid, I underestimated the emotional content of the day. Not only were the award recipients on hand to be acknowledged, but so too were many of the victim's family members...some of whom had lost loved ones in these incidents.

The father of an 18 year old driver killed in a vehicle rollover near Austin, Manitoba in April was on hand to convey his appreciation publicly to Dr. Jon Gerrard, Gerrard's wife Naomi and retired nurse Carolyn Stuart. These three individuals were first on scene at the accident and performed CPR and scene control while awaiting the arrival of emergency services.

In March of 2007 a middle-aged father of two young boys collapsed at home while talking on the phone. The boys called 911 and with the direction and help of the dispatcher performed CPR on their father until paramedics arrived. I'm not sure of the age of these young men, but I would estimate them to be about 8 and 11 years old. Their mother spoke briefly to the crowd of about 60 people gathered to observe the presentations, and I doubt there was a dry eye in the room.

As paramedics, most if not all of us have seen the efforts of relatives, friends and by-standers to help prior to or after we arrive on scene. The Rescuer Awards are an excellent opportunity to pay tribute to individuals that have gone "above and beyond", whether the outcome is successful or not. The awards also give public attention to the importance of first aid and CPR training. But even more importantly, they provide an excellent vehicle to allow those most affected by the emergency to acknowledge these individuals for their efforts.

The next time you come across a remarkable example of someone going out of their way to help at your scene, let us know. PAM is currently working on a recognition and awards program...but we'll continue to support the Red Cross Rescuer Awards as well.

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.

PCP Program at Red River College

On Monday, September 24th Manitoba's Minister of Health delivered some very exciting news from the Notre Dame campus of Red River College. The provincial government has decided to fund Red River to develop and deliver a Primary Care Paramedic program in Manitoba.

This announcement follows months of speculation regarding the direction that our provincial government planned to take to assist with an education program for EMS in Manitoba. Just a few short days ago I had speculated that this news might be delivered, but in all honesty I certainly didn't expect it quite so quickly.

In very simple terms the announced partnership means the government will provide RRC with funding to develop a 12 month Primary Care Paramedic program. The course should begin in September of 2008, and will most likely be delivered in two rural sites as well as the RRC campus each year. Initial enrollment will be limited to 40 students a year.

The reason this announcement means so much is quite simple. Paramedicine will now be taught in a health sciences faculty at a post secondary institution...something PAM has been advocating for years. Not only does it make sense to teach paramedics in an environment that already has a successful nursing program among it's list of health curriculum, the very fact that paramedics will graduate from this environment adds credibility and respect for both the graduate and the profession.

There are most certainly many details yet to be uncovered, and I hope to have that opportunity as soon as I return from the East coast (yes...I'm holidaying in Nova Scotia!). The student numbers are low to start and we won't see a graduate until at least June of 2009. But it's a "giant leap" in the right direction. I applaud our provincial government for their decision to support the Red River initiaitive...I know it was both complicated and difficult to do.

Education Decision Close?

In June of 2001 Manitoba Health signed a Memorandum of Understanding with the Manitoba Emergency Services College (MESC) in Brandon to deliver EMR and EMT programs regionally. This MOU provided the Brandon College with significant funding to ensure that the educational needs of EMS in rural Manitoba were met. In simple terms, the agreement called for MESC to facilitate 10 EMT courses annually based on regional requirements. The memorandum expired in 2006, and for a number of reasons, including concerns expressed by the EMS Directors, it was not renewed. Alternatives have been explored for some time now, including government support to assist Red River College with the development of a Primary Care Paramedic program.

The Paramedic Association of Manitoba has long been advocating the need for a more professional education model for paramedicine in our province.Our desire to be recognized and respected as health professionals is met with certain challenges as a result of the educational processes used in the past.To validate our 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. Paramedics should be educated in an environment that promotes portability of credentials to or from other health care roles. It has been strongly recommended by Canada’s leading experts in emergency medical services that future paramedic’s be educated in an environment similar to other front-line health care practitioners such as physicians and nurses. Many Canadian jurisdictions now require diploma and degree programs for graduates to obtain licensure. Having a recognized post secondary educational institution deliver a paramedic program within a health sciences faculty would go a long way toward answering those critics who suggest paramedics aren't really health practitioners. It would also add credibility to our call for self-regulation!

The Paramedic Association of Manitoba has been supporting Red River's proposal to develop and deliver PCP education in our province. We've met on numerous occasions with representatives from the RRC Health Sciences faculty and officials from Manitoba Health to promote this concept. I'm confident that our arguments have been heard, and hopeful that Department officials have been able to convince their political bosses of the many benefits associated with moving in this direction. Based on responses to my many requests for information over the past few weeks, I'm somewhat optimistic that we may hear an announcement regarding this issue once the Legislature reconvenes early next week. Stay tuned...

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.

Ontario Closer to Paramedic Self-Regulation?

Late last week the Ontario Paramedic Association (OPA) issued a press release in response to a letter from Ontario's Health Minister to the provincial Health Professions Regulatory Advisory Council (HPRAC). HPRAC provides policy advice to the Ontario Health Minister on matters related to the regulation of health professions in that province, including advise on whether or not health professions should be regulated and amendments to the Regulated Health Professions Act.

In his correspondence, Ontario Health Minister Smitherman asked HPRAC to "advise whether paramedics and emergency medical attendants should be regulated under the Health Professions Act, and if so, what would be the appropriate scope of practice, controlled acts and titles authorized to the profession." The Health Professions Act provides direction for regulating health professions in Ontario, including the responsibilities of each professional regulatory college.

Although the reply time frame associated with this request is unclear, and may well take the better part of a year to obtain, the fact that Ontario's Health Minister has raised this issue with his advisory council has bolstered the spirits of the OPA. In the press release issued by OPA President Mary Osinga the Minister's request is applauded and called a "bold step forward for Ontario's Paramedics". If Ontario moves in the direction of paramedic self-regulation they will join the ranks of a number of other Canadian jurisdictions that have recognized the importance of such a move...Alberta, Saskatchewan, Nova Scotia and New Brunswick.

The Manitoba Government is currently reviewing the legislation of it's health professions. The Health Professions Regulatory Reform Initiative (HPRRI) is currently studying "umbrella legislation" options that would replace existing regulatory Acts in our province. I anticipate this umbrella legislation will define health professions and outline a common framework for all regulatory Colleges to follow in regard to administrative practices and complaint and discplinary processes. As such the Paramedic Association considers it imperative that we work to ensure our profession is recognized as a health profession within this legislation to set the stage for paramedic self-regulation in Manitoba.

PAM had requested to participate in the review initiative with Manitoba's other regulated health professions, however we were denied any official status in the process because we are not a regulatory body. But we were assured that we'd be kept abreast of it's progress, and just this week I received correspondence stating that both regulated and non-regulated professions should have access to a discussion paper on this subject in the near future. If need be we too will be asking our Health Minister to ensure paramedics are recognized as health professionals. Hopefully Manitoba will also find itself one step closer to paramedic self regulation through this process.

OPA News Release - Ontario Paramedic Self-Regulation being considered by HPRAC

Health Professions Regulatory Reform Initiative (HPRRI)

Staff Shortage Spells Ambulance Outages

In the month of August, Springfield Ambulance (Oakbank) was out of service for almost 200 hours due to a lack of staff. A service that still relies heavily on staff to take on-call hours during nights and weekends, Springfield is finding it more and more difficult to ensure it's ambulance is available 24/7. They are not alone in that situation...ambulances across the province are taken out of service daily because of staffing problems...and that includes ambulances with paid staff around the clock.

Before the September long weekend, CBC radio and television news contacted the Paramedic Association of Manitoba about concerns related to ambulance staffing in the Springfield area. When asked about the prevalence of the problem, I suggested that we had heard reports similar to that in question from many services across the province. Since doing the CBC interview, we have confirmed ambulance outages occurred due to staff shortages in at least 14 different services for various periods of time over the Labor Day Weekend in Manitoba.

Staffing models vary dramatically from region to region. Some regions have opted to try and staff units on a full-time basis 24/7. Others rely on staff to take some on-call hours outside of their regular working hours to maintain service. Some will pay overtime to staff cars...others won't. Some regions have restricted their hiring to a minimum Technician-Paramedic level, some will hire anyone with an EMS Provider License. Undoubtedly the inconsistent staffing models from region to region have some bearing on whether or not units are taken out of service from time to time.

But I think the real problem runs much deeper than whether or not a region will pay to staff a unit in-house or rely on paramedics to be available on-call. I'm sure many regions have been reluctant to even consider changes to staffing models until government provides more clear direction regarding the future of EMS in Manitoba. Many EMS stakeholders, including the Paramedic Association of Manitoba, worked for more than 2 1/2 years to develop an EMS Framework document for consideration by senior government...that work has yet to be formally approved. Another committee, which also included representation by PAM, spent countless hours considering educational criteria for EMS programs looking to meet Manitoba Health's licensing requirements. Outside of the rumor mill, no final decisions have been made in this area that we are aware of. And government support for a paramedic education program that was expected to begin at Red River College almost one year ago has yet to be confirmed...and may well be in jeopardy.

My fear is that the staffing crunch we're beginning to see will only get worse if government continues to drag their heals on these very important issues. We are almost two years behind in educating paramedics that would normally staff many of our rural services. High school graduates looking toward EMS as a career are oftentimes leaving the province to pursue education in other jurisdictions...regions of the country that offer certificate or diploma programs in paramedicine and more definite career opportunities once they graduate. Our politicians need to make some very difficult and important decisions in the immediate future that allow us to be proactive and work toward improved system delivery...if not, the reactive decisions they will be forced to make will hurt Manitobans a whole lot more.

CBC TV NEWS - Aug 30, 2007

Has the Blogger/Author Died?

That's a question that's appeared in the subject line of many emails sent my way lately. So I'm here to say...I'M BACK!

I apologize for the lack of content in my blog over the past four months. It really doesn't seem like four months has passed since the provincial election was called and I last posted on this site, and as I think back over the course of that time I really can't justify, even to myself, why I haven't been able to find time to write. Having said that though, I have to admit that my frustration level has been over the top on more than a few occasions these past few months, and I found it difficult to communicate anything constructive. In fact, quite honestly I began to question whether or not "it was worth it" anymore.

Midway through the provincial election campaign, PAM released a White Paper on EMS in Manitoba. This document, entitled Emergency Medical Services - Manitoba's Quiet Crisis, makes a number of recommendations designed to improve ambulance and paramedic services throughout the province. There's nothing earth-shattering in the paper...in fact it's simply a more formal collection of the very recommendations we've been making to Government for the past five years. If you haven't already read PAM's White Paper you can download it from our web site by clicking here.

Reaction to the White Paper released by PAM has been quite positive. Some of the recommendations made in our paper formed the basis for the PC campaign during the provincial election...paramedic self-regulation and an expanded role for paramedics in our health care system. Many are supported by arguments made in a White Paper released earlier in the year by the EMS Chiefs of Canada. In off-record discussions, many of our Regional EMS Managers support most if not all of the concepts included within our recommendations. Yet little or no gain has been made in many of the areas addressed within that document, and that forms the basis of my recent frustrations.

The only funding increases seen by Manitoba's EMS system over the past few years have been in reaction to crisis. The long anticipated announcement that Red River College would begin offering a one year certificate program in paramedicine still hasn't been made, and I suggest may in fact be in serious jeopardy. Despite assurances that PAM would have opportunity to participate in the Health Professions Regulatory Reform Initiative (HPRRI), little or no information has been forthcoming in this area. Service delivery and the level of patient care provided by paramedics across the province is still very inconsistent. And to add insult to injury, it has been suggested that PAM did little more than summarize work done by the long awaited (and still unreleased) EMS Framework Project and call it our own.

Hence frustration has overwhelmed me at times lately. But after careful thought and consideration, I've come to this conclusion. Political interference is a very real problem when it comes to reforming EMS in Manitoba. Respectfully I suggest that those within Emergency Services on Ellice Ave get it, the Department of Health gets it, senior bureaucrats and administrators within Health get it...I think even the Minister of Health and at least a handful of other Cabinet Ministers "get it". Unfortunately the politicians at the top don't get it, and continue to stonewall much of the work done by those others I mentioned to make much needed improvement a reality. Now that I better understand the problem...I'm not nearly so frustrated:)

Doer Calls a Provincial Election

Premier Gary Doer put an end to speculation last evening by calling a provincial election that sees Manitobans go to the polls on Tuesday, May 22nd. I for one am looking forward to the next four weeks.

I suppose a downside to the election call is the fact that two bills in which the Paramedic Association of Manitoba had specific interest will most likely die on the order paper. Bill 22 was intended to establish memorials to honor fire fighters, peace officers and workers killed on the job. Bill 209 attempted to establish guidelines that would permit mandatory blood testing anytime someone lending aid to another person suffered a significant exposure to bodily fluids. But the fact that these bills will not proceed is not all bad. Regardless which party forms the next government, these issues have drawn attention and to a certain extent support on both sides. The opportunity should exist to have both reintroduced...and any necessary changes can be lobbied for ahead of time. That opens the door to a better outcome for paramedics in both areas.

One initiative that did not reach completion prior to the election call was the much anticipated approval for funding to establish a paramedic education program at Red River College. And that does concern me. The EMS network has expected Red River to be ready to begin PCP program delivery in September of this year, but because the provincial government dragged their heels on approval, that date cannot be met. The next window of opportunity for course commencement is January 2008. But unless Treasury Board procedure allows for consideration of matters when the legislature has been dissolved, and I doubt that it does, it may be unlikely that funding for any education initiatives will be dealt with until June at the very earliest. That could have a very negative impact on much needed paramedic resources, particularly in rural Manitoba.

But one benefit that an election campaign does bring with it is the opportunity to bring issues and concerns forward to all candidates, regardless of their status or accessibility in the previous government. Ex-ministers, back-benchers, up and coming MLAs and party leaders will all hit the campaign trail over the course of the next four weeks, and that provides paramedics across the province an excellent chance to ask them for their position on any number of issues. It allows each and every one of us to ask those seeking re-election to defend their actions over the past four years, and to tell us where they stand on issues that we hope to bring forth in the next four.

The Paramedic Association of Manitoba will be preparing statements and questions for all candidates. Funding, service delivery and education will be priorities as we challenge candidates from all parties for their position on matters related to emergency medical services and emergency health care. In a fashion very similar to the one PAM used during the last federal election, we will provide any candidate feedback we receive to our membership.

I encourage everyone involved in emergency medical service in this province to take advantage of the opportunity Premier Doer has given us to ask some very tough questions.

Proposed Blood Samples Legislation

On November 30th, of last year Manitoba Conservative MLA Kelvin Goertzen (Steinbach) introduced a private members bill in the provincial legislature entitled "The Mandatory Testing of Bodily Substances Act" (Bill 209). A copy of the proposed legislation can be downloaded here. Simply put, this Act would permit a blood sample to be ordered for testing purposes if a crime victim, good samaritan, or anyone rendering care in an emergency situation came into contact with another persons bodily fluids.

At first glance it appears that Mr. Goertzen's bill is very similar to the first blood samples legislation passed by the Ontario government almost 5 years ago. That Act relied on the province's Medical Officer of Health to determine if a significant exposure to bodily fluids had in fact occurred and order a blood sample to be taken from the patient or source individual. So too does Bill 209. Other provinces (Nova Scotia, Saskatchewan and Alberta) have opted for the courts to make the decision and order blood testing. Both systems are deserving of further investigation.

Since passing their initial blood samples legislation, Ontario has amended it in an effort to speed up the process. Under the old Act, delays of up to 70 days could take place before the sampling was ordered. Under the new legislation that delay has been reduced to approximately 17 days.

Today, representatives from the Paramedic Association of Manitoba were invited to meet with staff from the Departments of Justice and Health to review Mr. Goertzen's bill and hear comparative comments about the other provinces that have similar legislation. It would appear that our provincial government has reconsidered their decision of 2005 not to proceed with blood samples legislation and are now prepared to move in that direction. PAM has been lobbying for this type of legislation for some time now.

On closer inspection we may find that Bill 209 needs some revisions to meet our expectations in terms of ease of process and access. It's also almost certain that this Bill will die on the floor of the legislature if an election is called in the next few days or weeks. But the fact that Mr. Goertzen has generated government interest by introducing this Bill bodes well for the future. If the NDP continue to govern, they most likely will want to take the initiative away from the Conservatives by amending this legislation or introducing their own. If the Conservatives form a government in the next while, it should be quite simple to convince them of the importance to move forward in light of who re-ignited this process just a few months ago. Either way, the future looks promising on this front.

Paramedics Disappointed With Memorial Legislation

Proposed legislation paying tribute to fallen fire fighters, peace offices and other "workers" has paramedics across Manitoba incensed. The Manitoba EMS Discussion Board has pages of comments from EMS professionals across the province expressing disappointment and anger over the announcement and the perceived exclusion of paramedics...and rightfully so.

In August of last year, the Honourable Gord Mackintosh, then Minister of Justice, announced plans for a memorial on the legislative grounds to honor "police officers, fire fighters and paramedics" killed in the line of duty. The Paramedic Association of Manitoba wrote to the Minister and suggested a member of the paramedic community be included in the planning committee as they worked toward completion of this project. In December we received a call from the Premier's Chief of Staff, Mr. Michael Balagus, requesting I meet with him to discuss our request.

On December 14th I met with Mr. Balagus and was was given an overview of a very preliminary proposal for the memorial project. At that time, all that was known was that the government planned to dedicate a limited amount of space on the legislative grounds to house the memorials, and that whatever design these tributes took would have to meet strict criteria. He expressed concern that other interest groups might come forward also asking for memorial space, and that they would be unable to accommodate multiple requests. He also assured me that no government funds would be available to build and maintain the memorials...that would be the responsibility of the group or groups involved.

I indicated to Balagus that we would be prepared to be recognized as a component of the emergency services family on a single memorial if both fire and police were so inclined. He indicated that the fire fighters would not even consider such a concept...that they wanted a distinct memorial dedicated only to fire LODDs. Mr. Balagus then suggested we might want to consider partnering with other organizations, such as the Manitoba Federation of Labour or the Winnipeg Labour Congress, to participate in the process.

Although partnering with organizations that predominately represent non-professionals might be seen as some individuals as inappropriate, it seemed fiscally responsible, so I spoke with both the MFL and WLC. I suggested that we would be open to discussing options that would see paramedics killed in the line of duty honored in a group memorial. But I indicated to both parties, and also to the provincial government, that it would need to be done in a fashion that would ensure paramedics were recognized distinctly and as professionals...perhaps a separate plague on a larger memorial. The door was open to further discussions...and the government assured me that we would be involved in further consultation.

Well, unfortunately we were not included in any consultation or discussion with government officials leading up to last week's announcement. Not only were meetings obviously held without inviting our profession, but absolutely no mention of paramedics was made in the government press release or at the press conference. Numerous calls and emails to the Premier's Chief of Staff over the last couple of days have gone unanswered. And the comments made by UFFW President Alex Forrest have only served to fuel the displeasure of paramedics across the province. It's no wonder people are disappointed.

If I were a betting man I'd guess a provincial election call could come as soon as the end of this week. If that's the case, anyone candidate knocking on your door should be encouraged to give you his or her opinion on why paramedics don't deserve the same respect paid to fire fighters and peace officers in Manitoba.

Budget 2007 Disappointing...But Not Unexpected

I was unable to attend the budget speech at the Manitoba Legislature today...I had to travel to Ottawa to attend meetings for PAC. Jodi Possia represented PAM in the legislative gallery, and I'm guessing that after the antics that took place before the budget was introduced (what should have been a 90 minute session lasted close to three hours) I should be happy Jodi agreed to attend!

Over the course of the past few years I have come to believe, rightly or wrongly, that what happens on Budget day really has nothing to do with setting government policy or direction for the upcoming year. Sure...there is a budget...and I expect that each government department is told how much money they can spend during the fiscal year. But for the most part, any major initiative outlined in the budget has already been announced in a much more public and politically acceptable venue. For example...before today's budget speech we already knew the government planned to build a new hospital in Selkirk, spend millions of dollars fixing provincial highways, put $3M into training and incentives for emergency physicians, add to medical diagnostic equipment outside of Winnipeg (and so on and so on)...because these initiatives had already all been announced. But still, every year as I sit down to listen to the Finance Minister outline government expenditures, I have that tingle of anticipation that suggests maybe this is the year. Maybe this year there will be an announcement that indicates a strong political will to invoke real change in EMS and health care in general. Wrong again.

I had hoped that funding for development of a PCP education program at Red River College would somehow be slipped into today's budget speech. I expected, at the very least, that there would be mention of the previously announced investment to build a new EMS facility is the St. Paul area, or that the government would continue with it's initiative to replace ambulances across the province on a six year cycle through the Fleet vehicle program. But unfortunately there was absolutely no mention of EMS in today's budget...not even within the context of further health care improvements.

And unfortunately (there's that word again) that's because there are still many within the political ranks, both provincial and municipal, that don't think paramedics belong in the health care arena. Putting more money into Manitoba's emergency medical services system is a divisive and contentious issue, regardless of how logical and necessary it may seem to us. If today's budget precedes a spring election call here in Manitoba, I would encourage you to ask the candidates running in your constituency where they stand on the issue of funding for EMS. There are elected officials out there who see the need for investment in pre-hospital initiatives and recognize the potential benefits associated with such change...they need to stand up and be heard. The others need to be educated.

PAM's reaction to the budget speech can be viewed on our web site.

Still No Money For EMS Education?

In June of 2006 the Memorandum of Understanding between Manitoba Health and the Manitoba Emergency Services College (Brandon) regarding EMS education expired. It was this MOU that outlined the expectations around EMS education programs (EMR and EMT) that were delivered by MESC in regions across the province. In lieu of re-negotiating this agreement with MESC, Manitoba Health began talks with Red River College in an effort to move PCP education into an accredited post secondary health faculty. It was good news for the profession, and government sources were optimistic that Red River would have a PCP course up and running by September, 2007. Unfortunately a delay in securing the necessary funding to develop the program has not only jeopardized that date, but perhaps the entire project.

A month ago the Paramedic Association of Manitoba learned the government funding for the development of the PCP program at Red River has not yet been approved, and that the College was now unable to meet the projected start date of September 2007 (Manitoba EMS Education in Peril). We expressed our concern to Manitoba Health and the provincial government, encouraging them to move swiftly to ensure funding would be available as soon as possible to ensure RRC could meet their next projected program start date of January 2008. I had hoped that we might see funding for the PCP program announced in the upcoming provincial budget (Wednesday, April 4)...but my optimism is waining.

The provincial government has made an unprecedented number of funding announcements over the course of the past two months, all of which I expect will be formalized when the budget comes down. Just last week Health Minister Theresa Oswald announced a $3 million investment in emergency medicine education...none of which is earmarked for EMS. According to Oswald, $1.7M will be used to increase the number of training seats in emergency medicine at the University of Manitoba, and $1.3M will be directed toward incentive programs that encourage current doctors to fill vacant shifts in hospital ERs. In the Minister's words, "This proposal responds directly to their (emergency physicians) concerns (recruitment and retention of ER physicians) and will raise the profile of emergency medicine in Manitoba".

I can certainly appreciate the need to address the shortage of emergency physicians in Manitoba. But what about the need for paramedics in our EMS system? What about the need for an appropriate post secondary education program for paramedics in this province? What about a strategy to address the recruitment and retention of paramedics in our EMS system? These are concerns that we have expressed on many ocassions.

We'll be watching intently as Finance Minister Greg Sellinger unveils his provincial budget on April 4th to see if this government finally has a proposal that responds directly to our concerns.

Politics Mar the Edmonton Memorial Service

Diane Findlay and I traveled to Edmonton last week to attend the line of duty death memorial service for Alberta paramedic Michael Jolin. Jolin, 31 years old, was killed March 11th while at work, and leaves behind his wife and two young children. In his capacity as an EMT with HSE Integrated Ltd, which is a national safety services company, Michael was responsible for medical standby and treatment at an oilfield site near Fox Creek, Alberta.

Although particulars surrounding Jolin's death are still under investigation by Alberta Workplace Health and Safety, it has been confirmed that he was killed after being struck by a vehicle working in the area. According to early reports, he had stepped out of his mobile treatment center to assist a driver that that was backing a truck into the area when he was hit. Jolin was in uniform and on duty at the time of the incident.

I don't think it's any secret that the events surrounding Michael's accident called into question whether or not it should be considered a line of duty death. But the bottom line is...he was in uniform, on duty and at work when he died. While the circumstances that led to his death may not seem quite as "glamorous" as dying while rushing Code 4 to the scene of a serious medical or trauma incident, it still none the less equates to a paramedic dying in the line of duty...plain and simple. The Paramedic Association of Canada considered in a LODD; so too did the Benevolent Society, the Alberta College of Paramedics and the Paramedic Association of Manitoba.

So I have to admit that I was surprised by the small number of paramedics in attendance at the service in Edmonton on Saturday. Less than 100 uniformed emergency services personnel marched the kilometer or so in the memorial precession for Michael. There were EMS representatives from Nova Scotia, New Brunswick, Ontario, Manitoba, and British Columbia. At least 20 uniformed EMT students from NAIT marched with us, and the Honor Guard included representation from BC and Alberta. But all in all, knowing that Alberta has about 7500 licensed EMS practitioners, I thought attendance was poor to say the least.

I questioned memorial service organizers about the attendance, thinking perhaps a lack of communication or, ironically, the number of line of duty deaths over the past twelve months might have affected the numbers. I was shocked by what I heard! According to those I spoke with, many EMS Chiefs did not think this incident warranted consideration as a line of duty death, and as such did not support staff participation in the service. Apparently others within our ranks question the validity of considering industrial work such as Michael had undertaken to be "paramedic duty". A strange position to take, I think, based on the varying roles and responsibilities our profession has sought over the past decade or so. Internal politics very clearly at play.

I appreciate, and in fact invite debate within our ranks...no matter what the issue. But there's a time and a place for those who disagree to make their arguments heard...and the memorial service for a fallen colleague is not an appropriate time or place. If, as a profession we can't come together at times like this...?