A recent swell in violence-related emergency medical response incidents in Winnipeg has renewed debate about whether or not paramedics should be issued body armour in the interest of personal protection and safety. The need for this type of equipment and any decision related to mandatory use of body armour is a discussion I'll leave to the health and safety experts and labour organizations within the profession. But comments made by City Councillor Gord Steeves related to this topic leave me shaking my head.
When questioned about the need for body armour by a local Winnipeg TV news reporter, Councillor Steeves smirkingly replied that it would be hard to rationalize the need for this type of protection for paramedics working "outside the urban core". As the Chair of Winnipeg's Standing Committee on Protection and Community Services, it appears Councillor Steeves is either suggesting violence doesn't occur outside of the downtown core, or he has limited knowledge about status management and dispatch of EMS resources within his jurisdiction.
The fact that paramedics responding to incidents in an urban core are more likely to encounter violence-related calls is one I would not argue. BUT, apparently not well understood by the Councillor is the fact that EMS resources are not and should not be limited to geographical boundaries. They are regularly and routinely sent to where they are needed, regardless of where they are stationed. Any paramedic in Winnipeg could respond to a call in the downtown core, just as any paramedic working in a rural environment could be dispatched to bordering areas. That's how any well coordinated and efficient EMS service is managed.
In fairness to Councillor Steeves, however, local politicians shouldn't be expected to be experts in the management of health care services and resources. Another argument for Manitoba to consider a provincial EMS model.
Wednesday, August 12, 2009
Saturday, July 04, 2009
PAM Recognizes Achievements
At the first annual Manitoba EMS Awards Gala held in May at the Winnipeg Convention Centre, the Paramedic Association of Manitoba presented two recognition awards.
Our Media Recognition Award was presented to Ms. Gabrielle Giroday of the Winnipeg Free Press for her very considerate and compassionate reporting in a story entitled "Paramedics duty to family remembered".
And Ernie McLean was given the 2009 Paramedic Association of Manitoba Outstanding Achievement Award for his contribution to Manitoba EMS. Ernie first joined the Winnipeg Ambulance Service in June of 1975, and has represented paramedics in both labour and professional capacities over the years on many fronts.
Congratulations to both award recipients!
Our Media Recognition Award was presented to Ms. Gabrielle Giroday of the Winnipeg Free Press for her very considerate and compassionate reporting in a story entitled "Paramedics duty to family remembered".
And Ernie McLean was given the 2009 Paramedic Association of Manitoba Outstanding Achievement Award for his contribution to Manitoba EMS. Ernie first joined the Winnipeg Ambulance Service in June of 1975, and has represented paramedics in both labour and professional capacities over the years on many fronts.
Congratulations to both award recipients!
Investing in Paramedics
Governments and Regional Health Authorities appear to be holding the line on spending. Manitoba's emergency medical services system isn't likely to see any additional funding in 2009/10. No surprise really, in light of our current economic climate. But as the demand for health care continues to rise, can we afford to sit back and wait for an upturn in our economy? Or is now the time to consider investing in health care...in changes that could ultimately improve service and may even reduce costs in some areas?
For a number of years, paramedics in Nova Scotia (Long and Brier Island) and Ontario (Beausoleil First Nation on Lake Huron’s Christian Island) have had "expanded roles" within their respective community health care systems. These programs involve paramedics providing primary health-care and prevention services in addition to handling their normal emergency call volume. They visit patients in their homes and provide routine services ranging from checking vital signs and general patient assessment to administering flu shots and assessing medication compliance. They conduct home assessments to detect fall hazards and other dangers. By developing collaborative relationships with local home-health services, they have also begun to perform home wound care, draw blood to ensure people who require routine blood work actually have it done, and assist with medication administration.
Health care models that incorporate paramedics in expanded practice roles have proven successful. Programs such as these have significantly reduced hospitalizations, visits to physician offices and emergency departments, and residents’ travel times and costs. In one such example, an elderly couple was transported by ambulance six times in six months, although none of those transports resulted in a hospital admission. Following the commencement of daily visits by local paramedics, they haven't been transported once.
Paramedics have also seen their roles expanded in larger urban centers. Cities such as Ottawa and Edmonton have used paramedics to assist with patient care and treatment in crowded emergency rooms. Paramedics in Saskatoon have been used to assist in the provision of mobile health services in neighborhood communities, targeting children, the elderly, immigrants and individuals with chronic disease. And examples of community paramedicine have captured the attention of rural health leaders in other Canadian jurisdictions as well. Most recently, the role of Renfrew County paramedics has been expanded to include home visits and community patient assessments.
Expanded roles for paramedics increases accessibility of health services and has a positive impact on community health. It can reduce the demand on our emergency room facilities and resources. It seems promising for filling the widening health-care gaps in rural and remote communities. And it can reduces costs to our health care system and the public. Even in difficult financial times, it would be a very wise investment.
For a number of years, paramedics in Nova Scotia (Long and Brier Island) and Ontario (Beausoleil First Nation on Lake Huron’s Christian Island) have had "expanded roles" within their respective community health care systems. These programs involve paramedics providing primary health-care and prevention services in addition to handling their normal emergency call volume. They visit patients in their homes and provide routine services ranging from checking vital signs and general patient assessment to administering flu shots and assessing medication compliance. They conduct home assessments to detect fall hazards and other dangers. By developing collaborative relationships with local home-health services, they have also begun to perform home wound care, draw blood to ensure people who require routine blood work actually have it done, and assist with medication administration.
Health care models that incorporate paramedics in expanded practice roles have proven successful. Programs such as these have significantly reduced hospitalizations, visits to physician offices and emergency departments, and residents’ travel times and costs. In one such example, an elderly couple was transported by ambulance six times in six months, although none of those transports resulted in a hospital admission. Following the commencement of daily visits by local paramedics, they haven't been transported once.
Paramedics have also seen their roles expanded in larger urban centers. Cities such as Ottawa and Edmonton have used paramedics to assist with patient care and treatment in crowded emergency rooms. Paramedics in Saskatoon have been used to assist in the provision of mobile health services in neighborhood communities, targeting children, the elderly, immigrants and individuals with chronic disease. And examples of community paramedicine have captured the attention of rural health leaders in other Canadian jurisdictions as well. Most recently, the role of Renfrew County paramedics has been expanded to include home visits and community patient assessments.
Expanded roles for paramedics increases accessibility of health services and has a positive impact on community health. It can reduce the demand on our emergency room facilities and resources. It seems promising for filling the widening health-care gaps in rural and remote communities. And it can reduces costs to our health care system and the public. Even in difficult financial times, it would be a very wise investment.
Wednesday, June 03, 2009
Regulated Health Professions Act
The Manitoba Government has introduced umbrella health legislation designed to replace existing statutes currently governing the 21 self-regulating health professions in Manitoba. Bill 18, The Regulated Health Professions Act received first reading in the Legislature on April 16th, and was referred to Committee this week.
Bill 18 is similar in nature to legislation currently in place in other provinces across Canada. Alberta, British Columbia and Ontario all have umbrella legislation in place...Manitoba is following suit. The Regulated Health Professions Act will standardize many of the regulatory functions governing existing health professions...the make-up of the College's Councils, reporting processes, investigation and discipline procedures, registration practices and public access to information. It also introduces the concept of Reserved Acts, establishes an Regulated Health Professions Advisory Committee and outlines the application process for new health professions to seek self-regulation.
It appears that Opposition parties are in favor of the general principles contained in this legislation and all existing regulators have been consulted throughout the legislation reform initiative. I'm expecting the Bill to return to the Legislature and be passed in rather short order.
Bill 18 is similar in nature to legislation currently in place in other provinces across Canada. Alberta, British Columbia and Ontario all have umbrella legislation in place...Manitoba is following suit. The Regulated Health Professions Act will standardize many of the regulatory functions governing existing health professions...the make-up of the College's Councils, reporting processes, investigation and discipline procedures, registration practices and public access to information. It also introduces the concept of Reserved Acts, establishes an Regulated Health Professions Advisory Committee and outlines the application process for new health professions to seek self-regulation.
It appears that Opposition parties are in favor of the general principles contained in this legislation and all existing regulators have been consulted throughout the legislation reform initiative. I'm expecting the Bill to return to the Legislature and be passed in rather short order.
Sunday, May 17, 2009
Manitoba EMS - "Not a Healthy System"
Today's story in the Winnipeg Free Press (Not a healthy system) paints a fairly accurate picture of EMS in rural Manitoba.
A close look at the story can uncover some technical errors, but that's to be expected in any article of this depth written by someone not firmly entrenched in the profession. Overall the reporter has identified the challenges facing Manitoba's emergency medical services system.
As insightful as the article itself is, take some time to look at the statistical data that is provided on the Free Press web site. Chute times, call volumes, responses times, staffing models...it's by far the most indepth review of EMS in Manitoba that I have ever seen published for all to view.
I've had some Paramedics suggest to me that this story puts a negative light on rural practitioners. In my mind, nothing could be further from the truth. It identifies system deficiencies, and as paramedics wanting to provide the best level of emergency medical care to our patients we can, I can't see the negative.
A close look at the story can uncover some technical errors, but that's to be expected in any article of this depth written by someone not firmly entrenched in the profession. Overall the reporter has identified the challenges facing Manitoba's emergency medical services system.
As insightful as the article itself is, take some time to look at the statistical data that is provided on the Free Press web site. Chute times, call volumes, responses times, staffing models...it's by far the most indepth review of EMS in Manitoba that I have ever seen published for all to view.
I've had some Paramedics suggest to me that this story puts a negative light on rural practitioners. In my mind, nothing could be further from the truth. It identifies system deficiencies, and as paramedics wanting to provide the best level of emergency medical care to our patients we can, I can't see the negative.
Monday, March 30, 2009
Blood Testing Approaches Final Hurdle
In June of last year “The Testing of Bodily Fluids and Disclosure Act” was passed by the Manitoba Legislature. This legislation would allow a mandatory blood testing order to be sought any time emergency services personnel experience a significant exposure to body fluids when rendering emergency care or first aid.
Although this legislation received Royal Assent on June 12th, 2008, it did not come into force immediately. Government officials have been working on the regulations that accompany the Act, and recently consulted stakeholders for final input. In addition to the draft regulations, PAM was asked to comment on a “fact sheet” regarding exposure to blood pathogens and the workings of the blood testing application process. The Paramedic Association of Manitoba had recommended to the Health Minister that such information be made available when the legislation takes effect.
PAM has reviewed the draft documents and recommended a couple of minor revisions for consideration. I’m anticipating this legislation will come into effect in the coming months. As soon as an effective date has been proclaimed we will post the details and all appropriate information on our web site.
Although this legislation received Royal Assent on June 12th, 2008, it did not come into force immediately. Government officials have been working on the regulations that accompany the Act, and recently consulted stakeholders for final input. In addition to the draft regulations, PAM was asked to comment on a “fact sheet” regarding exposure to blood pathogens and the workings of the blood testing application process. The Paramedic Association of Manitoba had recommended to the Health Minister that such information be made available when the legislation takes effect.
PAM has reviewed the draft documents and recommended a couple of minor revisions for consideration. I’m anticipating this legislation will come into effect in the coming months. As soon as an effective date has been proclaimed we will post the details and all appropriate information on our web site.
Sunday, March 29, 2009
Budget 2009
Last week Manitoba Finance Minister Greg Selinger unveiled the province's budget for 2009. Not surprisingly...no new funding initiatives for emergency medical services.
Mr. Selinger did announce $4 million dollars would be directed toward emergency services in the City of Winnipeg, but this funding is aimed at offsetting the City's decreased financial commitment to EMS. Historically Winnipeg has covered 25% of the cost for ambulance service in the city, while the province picked up 25% and the patient paid the remainnig 50%. Winnipeg has decreased their contribution to approxiamtely 14%, so as a result, despite the funding contained in this budget, no additional money will find it's way into providing ambulance services in the city.
Budget 2009 also included a commitment to "add new ambulances to the provincial fleet". At first glance this may sound promising, however in reality these new units are required to simply replace a number of aging fleet vehicles already in operation.
We're facing difficult economic times, so the fact that Budget 2009 outlined a very modest 1.8% in expenditures should come as no surprise. One third of Government departments were in fact asked to either hold the line or decrease spending. But at a time where health care expenses continue to rise, and the Conference Board of Canada suggests that the manner in which we spend halthcare dollars far outweighs the benefit of simply adding more money to the system, investing in our emergency medical services should be viewed as a wise investment.
In jurisdictions across Canada and internationally, investing in paramedic services has had positive effects on the health care system. Paramedics are treating patients in the community and utilizing non-emergent options such as physican offices, clinics and urgent care facilites to reduce the strain on over-taxed emergency rooms. Timely interventions in respiratory, cardiac and neurological emergency care have been shown to dramatically improve patient outcomes, and have the potential to lessen the finacial burden on both health and social services. Now more than ever, is the time to think "outside the box" and invest in our emergency medical services. Investment made today in service delivery strategies, paramedic education, recruitment and retention and EMS research will have positive long-term financial effects.
Mr. Selinger did announce $4 million dollars would be directed toward emergency services in the City of Winnipeg, but this funding is aimed at offsetting the City's decreased financial commitment to EMS. Historically Winnipeg has covered 25% of the cost for ambulance service in the city, while the province picked up 25% and the patient paid the remainnig 50%. Winnipeg has decreased their contribution to approxiamtely 14%, so as a result, despite the funding contained in this budget, no additional money will find it's way into providing ambulance services in the city.
Budget 2009 also included a commitment to "add new ambulances to the provincial fleet". At first glance this may sound promising, however in reality these new units are required to simply replace a number of aging fleet vehicles already in operation.
We're facing difficult economic times, so the fact that Budget 2009 outlined a very modest 1.8% in expenditures should come as no surprise. One third of Government departments were in fact asked to either hold the line or decrease spending. But at a time where health care expenses continue to rise, and the Conference Board of Canada suggests that the manner in which we spend halthcare dollars far outweighs the benefit of simply adding more money to the system, investing in our emergency medical services should be viewed as a wise investment.
In jurisdictions across Canada and internationally, investing in paramedic services has had positive effects on the health care system. Paramedics are treating patients in the community and utilizing non-emergent options such as physican offices, clinics and urgent care facilites to reduce the strain on over-taxed emergency rooms. Timely interventions in respiratory, cardiac and neurological emergency care have been shown to dramatically improve patient outcomes, and have the potential to lessen the finacial burden on both health and social services. Now more than ever, is the time to think "outside the box" and invest in our emergency medical services. Investment made today in service delivery strategies, paramedic education, recruitment and retention and EMS research will have positive long-term financial effects.
Friday, January 23, 2009
Leave Paramedicine to the Pros
Here's a link to a very interesting editorial written by the International President of the IAFF. I was dumbfounded when I read it. This is written by the same individual who has, for years now, been telling his membership that embracing EMS with open arms is their only chance of surviving financial cutbacks and maintaining job security in the years to come. Am I missing something here?
I'm not being critical of Paramedics working in a fire-based environment. The modes by which paramedical services can be delivered are various, and continue to expand across our country, especially in jurisdictions where self-regulation has been achieved. But how hypocritical is it to suggest that his fire-fighters are capable of looking at expanding their "tools of the trade", but no one else seems to be. He may have a valid concern within his editorial, but his arguments are blatantly hypocritical!
Paramedics are health care professionals. Put them in any environment you like. But let them practice health care, and don't expect them to be masters of many trades. Leave paramedicine to the pros!
I'm not being critical of Paramedics working in a fire-based environment. The modes by which paramedical services can be delivered are various, and continue to expand across our country, especially in jurisdictions where self-regulation has been achieved. But how hypocritical is it to suggest that his fire-fighters are capable of looking at expanding their "tools of the trade", but no one else seems to be. He may have a valid concern within his editorial, but his arguments are blatantly hypocritical!
Paramedics are health care professionals. Put them in any environment you like. But let them practice health care, and don't expect them to be masters of many trades. Leave paramedicine to the pros!
Friday, May 16, 2008
Manitoba Paramedics Recognized for Exemplary Service
Paramedics from across the province were congratulated yesterday by Lieutenant-Governor John Harvard for their many years of exemplary service in the field of Emergency Medical Services.Manitoba's EMS Medal Awards Committee approved 19 nominations this year for receipt of the EMS Exemplary Service Medal. The Honours Medals were presented to twelve of these recipients, with
family and colleagues present, during a formal ceremony hosted by the Lieutenant-Governor at Government House in Winnipeg. The Emergency Medical Services Exemplary Service Medal is the newest member of the Canadian Exemplary Service Honours system designed to recognize those men and women who have dedicated themselves to preserving Canada’s public safety through long and outstanding service. The EMS Honours are reserved for professionals in the provision of pre-hospital emergency medical services who have performed their duties for a minimum of 20 years in an exemplary manner, characterized by good conduct, industry and efficiency.
The award ceremony, emceed by Manitoba Committee Chair Troy Pauls, saw paramedics from Assiniboine, Parkland, Interlake, NEHA and Winnipeg RHAs recognized for exemplary service. Seven of this years recipients had actually received the Exemplary Service Medal previously, and this year were awarded an additional 10 year bar signifying 30 years of exemplary service in EMS.
To date, 105 EMS providers in Manitoba have been awarded the EMS Exemplary Service Medal. I was honoured to have been asked to participate in this years ceremony. Congratulations to all medal recipients!
For more information, visit the Manitoba EMS Exemplary Service Medal Web Site.
Wednesday, May 14, 2008
Manitoba Paramedic Honour Guard
On Tuesday, May 13th funeral services were held in Lac Du Bonnet for Paramedic Michael Motycka. Mike was killed in a work-related accident in his capacity as a scientist with Atomic Energy of Canada Limited, but was also employed on a casual basis with North Eastman Region as a casual Paramedic in his home community of Lac Du Bonnet.
In addition to his work with NEHA EMS, Motycka was also a volunteer fire fighter in Lac Du Bonnet. As a result of his commitment and dedication to community service, Mike's family requested the presence of uniformed emergency services personnel at the funeral, and also asked the Manitoba Paramedic Honour Guard to lead the funeral procession prior to the memorial service held at the Lac Du Bonnet Community Center.
Three members of the Manitoba Paramedic Honour Guard recently took part in the LODD funeral for a BC Paramedic who died while at work. Until the Motycka funeral, however, the Guard had not participated in any formal functions as a unit...but you certainly wouldn't have known that to be the case if you saw them in action in Lac Du Bonnet.
I can't begin to describe the pride I felt as I watched the Paramedic Honour Guard in operation. Not only were they professional and very well coordinated throughout their manouevers, their manner and conduct were truly exemplary. The effort and dedication that these individuals have given to bringing the Honour Guard to fruition in one short year is remarkable. They have proven their ability to be excellent ambassadors for our profession and our Province!The Manitoba Paramedic Honour Guard web site can be found at http://mphg.ca/
Thursday, May 08, 2008
Recognizing Dedication and Exemplary Service
With Emergency Medical Services Awareness Week just around the corner (May 18-24, 2008), it seems fitting that a number of Paramedics will be recognized for their long standing dedication to EMS at two events to be held later this month.
On May 15th, 19 Manitoba Paramedics will be presented with the Emergency Medical Services Exemplary Service Medal. The EMS Exemplary Service Medal is a member of the Canadian Honours system, and is awarded by the office of the Governor General to pre-hospital providers who have performed their duties in an exemplary manner, characterized by good conduct, industry and efficiency for at least twenty years . The Manitoba EMS Exemplary Service Medal Advisory Committee, chaired by Troy Pauls, reviews all nominations prior to sending them off to Ottawa for final approval. This years awards ceremony will once again take place at the residence of Lieutenant-Governor John Harvard, and is a very fitting kick-off to EMS Week in the province.
On Tuesday, May 20th, the Paramedic Association of Manitoba will unveil a new 20 year long-service lapel pin at a lunch reception to be held in the Manitoba Legislative Building. This pin is designed to recognize all active EMS personnel with at least twenty years experience for their many years of dedication and commitment to patient care. Close to 150 individuals have been asked to attend the reception to receive this lapel pin...those unable to attend this reception will receive their pin at a later date. The Honourable Theresa Oswald, Minister of Health, will bring greetings to those in attendance and participate in the pin presentations. For anyone interested in attending, the reception will begin at 11:45 a.m.
On May 15th, 19 Manitoba Paramedics will be presented with the Emergency Medical Services Exemplary Service Medal. The EMS Exemplary Service Medal is a member of the Canadian Honours system, and is awarded by the office of the Governor General to pre-hospital providers who have performed their duties in an exemplary manner, characterized by good conduct, industry and efficiency for at least twenty years . The Manitoba EMS Exemplary Service Medal Advisory Committee, chaired by Troy Pauls, reviews all nominations prior to sending them off to Ottawa for final approval. This years awards ceremony will once again take place at the residence of Lieutenant-Governor John Harvard, and is a very fitting kick-off to EMS Week in the province.
On Tuesday, May 20th, the Paramedic Association of Manitoba will unveil a new 20 year long-service lapel pin at a lunch reception to be held in the Manitoba Legislative Building. This pin is designed to recognize Monday, May 05, 2008
Blood Testing Challenged by HIV/AIDS Network
The Winnipeg Free Press (Sunday, May 5th) carried an article written by the senior policy analyst for the Canadian HIV/AIDS Legal Network calling for amendments to the blood testing bill currently before the Manitoba Legislature. Bill 18, The Testing of Bodily Fluids and Disclosure Act, would permit a blood testing order to be served upon a source individual in the event emergency personnel, Good Samaritans or victims of crime are exposed to another person's bodily fluids. The author of this article (Bill provides an illusory peace of mind) suggests the proposed legislation invades rights and privacy while providing no real benefit to those requesting the blood testing.
In making her argument against the Bill, Alison Symington makes reference to misinformation cited by emergency workers who have been exposed to bodily fluids, suggesting that education about the real dangers associated with blood borne pathogens is of greater importance than the option to request blood testing. Her remarks stem from comments made by media and the UFFW in support of this type of legislation, first suggesting that tuberclulosis would fit into the realm of diseases for which blood tests would be sought, and secondly for citing comments about exposed workers being unable to hug their children for fear of further disease transmission .
Legislation of this form pushes the balance between the individual who has been exposed and the source person from whom blood testing will be sought. While undoubtedly emotions run high following a potential exposure to blood borne disease sources, the importance of relating accurate and factual information when arguing in favor of blood testing cannot be overemphasized. The swiftness with which those in opposition to this legislation point to inaccurate statements and expectations can have damaging results to public and political support for this bill.
In making her argument against the Bill, Alison Symington makes reference to misinformation cited by emergency workers who have been exposed to bodily fluids, suggesting that education about the real dangers associated with blood borne pathogens is of greater importance than the option to request blood testing. Her remarks stem from comments made by media and the UFFW in support of this type of legislation, first suggesting that tuberclulosis would fit into the realm of diseases for which blood tests would be sought, and secondly for citing comments about exposed workers being unable to hug their children for fear of further disease transmission .
Legislation of this form pushes the balance between the individual who has been exposed and the source person from whom blood testing will be sought. While undoubtedly emotions run high following a potential exposure to blood borne disease sources, the importance of relating accurate and factual information when arguing in favor of blood testing cannot be overemphasized. The swiftness with which those in opposition to this legislation point to inaccurate statements and expectations can have damaging results to public and political support for this bill.
Thursday, May 01, 2008
WRHA Pilot Offers Opportunity
Earlier this week the Winnipeg Regional Health Authority and Winnipeg EMS announced a pilot project to help ease service problems associated with increasing offload delays at Winnipeg hospitals. The WRHA will provide funding to place paramedics in Emergency Departments to assume responsibility for patients until care can be transferred to ER personnel. This will allow transporting crews to transfer patient care to waiting paramedics stationed in hospital during peak periods, thus ensuring ambulances aren't tied up for prolonged periods of time as as result of ER backlogs.
In January 2004, then Minister of Health Dave Chomiak announced a formal review of the emergency care system in Winnipeg. The Emergency Care Task Force was mandated to review Winnipeg's ER system and make both short and long term recommendations for improving wait times and back logs associated with emergency rooms across the City. In correspondence sent to Minister Chomiak immediately following the Task Force announcement, the Paramedic Association of Manitoba outlined the benefits of integrating Paramedics into the health care system and better utilizing paramedics within emergency health care to address this issue. Among our recommendations at that time to ease system congestion and better utilize existing resources:
As our identity as health care practitioners more fully evolves and the credibility of the profession grows, the benefits associated with professional self-regulation strengthen. Paramedics licensed to practice under the umbrella of a regulatory college would be employable outside the realm of an ambulance service...they would hold a license not tied to a specific employer. Opportunities to practice paramedicine in environments such as clinical, industrial or research settings will improve career progression and longevity.
The use of Paramedics in Winnipeg emergency departments will not only offer system improvements and opportunity for professional growth, but also emphasizes the need for professional self-regulation sooner rather than later.
In January 2004, then Minister of Health Dave Chomiak announced a formal review of the emergency care system in Winnipeg. The Emergency Care Task Force was mandated to review Winnipeg's ER system and make both short and long term recommendations for improving wait times and back logs associated with emergency rooms across the City. In correspondence sent to Minister Chomiak immediately following the Task Force announcement, the Paramedic Association of Manitoba outlined the benefits of integrating Paramedics into the health care system and better utilizing paramedics within emergency health care to address this issue. Among our recommendations at that time to ease system congestion and better utilize existing resources:
- make use of Advanced and Critical Care Paramedics in emergency care facilities to assist with triage, patient re-evaluation and high workload efforts including resuscitative measures;
- enhance Paramedic treat and release capabilities, resulting in fewer ER admissions;
- enable Paramedics to refer or transport to Urgent Care and other health care facilities as appropriate to reduce ER patient loads.
As our identity as health care practitioners more fully evolves and the credibility of the profession grows, the benefits associated with professional self-regulation strengthen. Paramedics licensed to practice under the umbrella of a regulatory college would be employable outside the realm of an ambulance service...they would hold a license not tied to a specific employer. Opportunities to practice paramedicine in environments such as clinical, industrial or research settings will improve career progression and longevity.
The use of Paramedics in Winnipeg emergency departments will not only offer system improvements and opportunity for professional growth, but also emphasizes the need for professional self-regulation sooner rather than later.
Monday, January 14, 2008
Annual General Meeting Highlights
The 2007 Annual General Meeting of the Paramedic Association of Manitoba was held at the Fairmont Winnipeg this past weekend, and I'll be so bold as to suggest it may well be the most "successful" AGM in our Association's short history.
Typically the AGM is considered by many to be little more than a formality driven only by a Bylaw requirement to hold the meeting on an annual basis. To date our inaugural General Meeting held in Brandon (2001) was still the best attended. But this year the membership took full advantage of their ability to provide guidance and direction to the Executive on a number of issues.
The Board of Directors provided thorough updates on the various activities undertaken by PAM over the course of the past year. Membership numbers are up from 2006. PAM's Con-ed packages and On-line testing program are being used by paramedics in almost all regions for ARML purposes (with the exception of ARHA, Brandon and the Interlake), including Winnipeg dispatch and MTCC staff. The Manitoba Paramedic Honour Guard is in the final stages of preparation and is expected to be operational by early Spring. PAM has been an active participant in the development of the PCP Education Program requirements as recommended by the Program Advisory Committee. Members were updated on a number of local political and legislative initiatives, reviewed the status of issues which had been considered a priority going into 2007, were presented with an update of the latest Paramedic Association of Canada news and heard the Board's views on important matters heading into 2008.
Elections were held to fill three outgoing Executive positions, including two Directors and the Chair. I'm honored to have been re-elected to another three year term as Chairman of PAM, and also returning as Board members are Diane Findlay (IRHA) and Michelle Bessas (WEMS).
Members were asked to consider two Bylaw amendments at this year's AGM and approved both. The first change eliminates the requirement to elect two Board members from the EMR (Tech) member category and two from the Paramedic level category. Board members are now elected by majority vote from any of the current provincial EMS license categories. The second Bylaw change was only editorial in nature.
The Executive had notified the membership of a proposal to change the Full/Active registration fee from the existing $60.00 per year to $72.00 per year effective July 1st, 2008. When the motion was debated at the AGM, members decided that it should actually be raised too $80.00 annually to ensure the Association is able to grow and meet anticipated needs as we prepare to apply for self-regulation.
In addition to business set out by the Board for consideration, a number of resolutions were introduced by members at the AGM. The Association membership has provided the following direction to the Executive:
- Effective September 1, 2008, Con-Ed packages and On-Line testing should be available only to Paramedic Association of Manitoba registrants;
- Registration categories should be reviewed and amended as possible to allow "retired" EMS license holders full membership privileges and to develop a "student" category;
- Investigate a means to electronically telecast the AGM throughout the province in an effort to allow members to participate from sites outside of the host location.
Wednesday, January 09, 2008
One More Term?
The Annual General Meeting of the Paramedic Association of Manitoba is just days away, and among the items of business to be conducted at the January 12th meeting is the election of two Directors and the Chair. As my current term concludes, it marks the end of my seventh year as Chairman of the Association...and what many, including myself (and certainly my wife), expected would be my last.
In January 2001, a group of eight paramedics gathered in a meeting room at the Hotel Fort Garry, and with the help of the Paramedic Association of Canada formulated a plan to resurrect a pre-hospital professional association in Manitoba. Since that time, the face of emergency medical services in our province has undergone significant change, and PAM has been front and centre through much of that evolution. An increase in career opportunities, higher educational requirements for paramedics, improvements in continuing education, revised legislation, alignment with the National Occupational Competency Profiles, improved communication and dispatch systems, discussions around the concept of self-regulation...PAM has played a very important role in the betterment of emergency health care available to Manitobans today.
The establishment of a professional association for paramedics in Manitoba has served both our patients and our profession well. No doubt there have been frustrations along the way, and there is still much more to accomplish than what we've managed to achieve to date. But I think there is a greater willingness today than ever before, both politically and within the profession, to continue to strive for improvement, and that's exciting! As a result of that excitement I have decided to seek re-election as the Chairman of the Paramedic Association of Manitoba for one final term.
Now I need to go explain this decision to my wife :)
In January 2001, a group of eight paramedics gathered in a meeting room at the Hotel Fort Garry, and with the help of the Paramedic Association of Canada formulated a plan to resurrect a pre-hospital professional association in Manitoba. Since that time, the face of emergency medical services in our province has undergone significant change, and PAM has been front and centre through much of that evolution. An increase in career opportunities, higher educational requirements for paramedics, improvements in continuing education, revised legislation, alignment with the National Occupational Competency Profiles, improved communication and dispatch systems, discussions around the concept of self-regulation...PAM has played a very important role in the betterment of emergency health care available to Manitobans today.
The establishment of a professional association for paramedics in Manitoba has served both our patients and our profession well. No doubt there have been frustrations along the way, and there is still much more to accomplish than what we've managed to achieve to date. But I think there is a greater willingness today than ever before, both politically and within the profession, to continue to strive for improvement, and that's exciting! As a result of that excitement I have decided to seek re-election as the Chairman of the Paramedic Association of Manitoba for one final term.
Now I need to go explain this decision to my wife :)
Tuesday, December 18, 2007
New Brunswick Boasts Provincial Ambulance System
On December 16th New Brunswick EMS, a subsidiary of Medavie Blue Cross, assumed responsibility for management of operations for a new provincial ambulance service. It will manage the service on behalf of Ambulance New Brunswick, the public company responsible for providing land and air ambulance service throughout the province. This new system operates close to 130 land ambulances and employs over 730 paramedics.
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:
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 ownEMS management structure and is very distinct in their approach to the delivery of emergency medical services. It is in part this governing model that contributes to inconsistent Emergency Medical Services across our province.
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.
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.
Monday, December 17, 2007
PAM Annual General Meeting
As advertised on the Paramedic Association of Manitoba web site, PAM will hold it's Annual General Meeting on Saturday, January 12th, 2008. The meeting will be held at the Fairmont Hotel located at 2 Lombard Place in Winnipeg commencing at 13:00.
In addition to regular AGM agenda items (association reports and finances) there are three business matters to be conducted:
The Bylaw amendments proposed for discussion at the meeting are related to the make-up of the Board of Directors for the Association. The original Bylaws call for the Board to be comprised of two EMRs and two EMTs (Paramedic) or higher. Not only has wording associated with these license levels been changed in amended legislation (2006), but it has proven to be very difficult to elect the appropriate numbers from each category over the years. The proposed wording and rationale for this changes can be found using the web link below.
Membership fees for registration with the Paramedic Association of Manitoba have not changed since their introduction in 2001. Since that time the Paramedic Association of Canada has slightly increased member fees and the Benevolent Society has instituted a very modest member surcharge to ensure it's future viability. These costs and anticipated financial requirements associated with an application for self-regulation make it necessary to review our fee structure and propose a slight membership fee increase that would take effect on July 1, 2008 entering into the 2008/09 fiscal year.
The Paramedic Association of Manitoba is the professional association for EMS providers in our province. As members of the Association your input is valuable to the well-being of our patients and the profession. I encourage all members to attend the January 12th Annual General Meeting.
More information regarding the PAM AGM and business to be conducted at the meeting can be found using this link. I hope to see you at the Fairmont.
In addition to regular AGM agenda items (association reports and finances) there are three business matters to be conducted:
- the election of 2 Directors and a Chairman;
- voting on proposed Bylaw amendments;
- voting on proposed membership fee structure revisions.
The Bylaw amendments proposed for discussion at the meeting are related to the make-up of the Board of Directors for the Association. The original Bylaws call for the Board to be comprised of two EMRs and two EMTs (Paramedic) or higher. Not only has wording associated with these license levels been changed in amended legislation (2006), but it has proven to be very difficult to elect the appropriate numbers from each category over the years. The proposed wording and rationale for this changes can be found using the web link below.
Membership fees for registration with the Paramedic Association of Manitoba have not changed since their introduction in 2001. Since that time the Paramedic Association of Canada has slightly increased member fees and the Benevolent Society has instituted a very modest member surcharge to ensure it's future viability. These costs and anticipated financial requirements associated with an application for self-regulation make it necessary to review our fee structure and propose a slight membership fee increase that would take effect on July 1, 2008 entering into the 2008/09 fiscal year.
The Paramedic Association of Manitoba is the professional association for EMS providers in our province. As members of the Association your input is valuable to the well-being of our patients and the profession. I encourage all members to attend the January 12th Annual General Meeting.
More information regarding the PAM AGM and business to be conducted at the meeting can be found using this link. I hope to see you at the Fairmont.
Thursday, December 13, 2007
Proposed Federal Legislation to Protect Paramedics
On December 12, 2007 Liberal Member of Parliament Mario Silva introduced a Private Members Bill in the House of Commons to amend the Criminal Code of Canada. Bill C-495, An Act to amend the Criminal Code (emergency medical services workers) would make it an indictable offence to assault "an emergency medical services worker engaged in the execution of his or her duty".
Bill C-495 was introduced by Mr. Silva following an outcry from paramedics across the country. Earlier this year Silva proposed another Criminal Code amendment making it an offence to assault firefighters in the line of duty. The fact that the proposed bill did not also recognize the dangers faced by EMS personnel resulted in correspondence and calls not only to Mr. Silva's office and staff but to many other MPs as well. In a letter addressed to Canada's Paramedics, Silva (Opposition Critic for Labour Issues) indicated that he planned to draft legislation that would include paramedics in the same context as police and firefighters within the Criminal Code.
When this issue first came to light, staff from Silva's Ottawa office called to discuss the concerns raised by paramedics and apologize for the oversight of paramedics in the original draft. The error, they admitted, was due to a lack of understanding that paramedics were not necessarily included in the firefighter ranks. They immediately asked that we help them rectify this situation by providing a definition of paramedic that would be suitable for use in subsequent legislation. As Chairman of the Paramedic Association of Canada Board of Directors, I undertook to coordinate that effort.
Through consultation with various stakeholders, including the PAC Board and Chapter members as well as the EMS Chiefs of Canada, we arrived at the definition of emergency medical services worker that has been used in Bill C-495. The challenge was to make it narrow enough that it clearly represented practitioners associated with PAC and yet broad enough that it didn't exclude practitioners by restricting it to titles not recognized by some jurisdictions and was inclusive of practitioners working in many of the non-traditional EMS roles we are starting to see across the country. That process proved to be somewhat more difficult than originally anticipated, but was vital to moving forward with planning the proposed legislation.
Both PAM and PAC will continue to follow Bill C-495 in the coming weeks and months. You can read the proposed legislation and follow it's status on the Parliament of Canada web site.
Bill C-495 was introduced by Mr. Silva following an outcry from paramedics across the country. Earlier this year Silva proposed another Criminal Code amendment making it an offence to assault firefighters in the line of duty. The fact that the proposed bill did not also recognize the dangers faced by EMS personnel resulted in correspondence and calls not only to Mr. Silva's office and staff but to many other MPs as well. In a letter addressed to Canada's Paramedics, Silva (Opposition Critic for Labour Issues) indicated that he planned to draft legislation that would include paramedics in the same context as police and firefighters within the Criminal Code.
When this issue first came to light, staff from Silva's Ottawa office called to discuss the concerns raised by paramedics and apologize for the oversight of paramedics in the original draft. The error, they admitted, was due to a lack of understanding that paramedics were not necessarily included in the firefighter ranks. They immediately asked that we help them rectify this situation by providing a definition of paramedic that would be suitable for use in subsequent legislation. As Chairman of the Paramedic Association of Canada Board of Directors, I undertook to coordinate that effort.
Through consultation with various stakeholders, including the PAC Board and Chapter members as well as the EMS Chiefs of Canada, we arrived at the definition of emergency medical services worker that has been used in Bill C-495. The challenge was to make it narrow enough that it clearly represented practitioners associated with PAC and yet broad enough that it didn't exclude practitioners by restricting it to titles not recognized by some jurisdictions and was inclusive of practitioners working in many of the non-traditional EMS roles we are starting to see across the country. That process proved to be somewhat more difficult than originally anticipated, but was vital to moving forward with planning the proposed legislation.
Both PAM and PAC will continue to follow Bill C-495 in the coming weeks and months. You can read the proposed legislation and follow it's status on the Parliament of Canada web site.
Wednesday, December 12, 2007
When is Service Not Really Service?
Earlier this year I commented on an article that ran in a western Manitoba community newspaper suggesting legislative changes would make it difficult to recruit "volunteer ambulance attendants" (Ambulance Driver's Good Enough for Municipal Politicians). That same argument has surfaced once again...this time in the Interlake. A story that ran in the Interlake Spectator on December 7th was mirrored by CBC News yesterday...with municipal officials stating that elimination of the Ambulance Operator (AO) license could result in Riverton Ambulance Service having to close it's doors.
The emphasis that is placed on maintaining volunteer ambulance services in
Until the Emergency Medical Response and Stretcher Transportation Act and accompanying Regulations became law in April of 2006,
Access to our emergency medical services system should not be measured simply by how quickly an ambulance arrives at a residence, but rather how quickly the patient receives appropriate and definitive treatment for his or her health emergency. Those who place emphasis on immediate response times and volunteer service should be encouraged to utilize whatever resources might be available to them and seek to enhance the
Public policy regarding upgrading or changing an
We expect police car “drivers” to be police officers. We expect anyone driving a fire truck to be a firefighter. When we need emergency medical care, why don’t we expect an ambulance to be staffed by people able to provide that care? Anything less, I suggest, is a disservice.
Wednesday, December 05, 2007
RHA External Review Submission
In April of this year Health Minister Theresa Oswald appointed a three person panel to assess Manitoba's regional health authority system. The mandate given to the review committee was to examine and recommend strategies for improvement of the regional delivery model. A final report is expected to be delivered to the Ministers of Health and Healthy Living by years end.
The Regional Health Authorities Act legislation came into force in 1997. It sets out the conditions under which the RHAs are incorporated, and defines their duties and responsibilities for ensuring effective health planning and delivery. The decision to regionalize the operation and administration of health in Manitoba was a major change in the way that health care is planned and delivered.
While regional governance authorities were tasked with decision making related to most health planning and delivery, some core health services remained the primary responsibility of central agencies or Manitoba Health. The belief was, and I expect still is, that certain specialized health services could be more safely or efficiently administered centrally, and as such needed to remain outside of the regional governance model. Angiography, radiotherapy, some mental health services and Lifeflight air ambulance are all examples of health services that remained directly funded and administered provincially. Certain health facilities such as Addictions Foundation Manitoba and the Riverview Health Centre also operate outside of the regional health authority governance model.
Emergency health, including ground ambulance service, is identified as a core health service for which RHAs have been legislated direct responsibility. The decision to include EMS in the list of RHA services was probably given very little thought. I don't mean that to sound negative or critical...but the reality is that EMS was already void of central administration in that each municipal government had responsibility to ensure ambulance service availability. In the process of trying to de-centralize most other health services I doubt anyone gave much thought to centralizing EMS administration and delivery...that just wouldn't fit the mold under consideration at that time.
Today Manitoba has eleven regional health authorities and each is very distinct in their approach to the delivery of emergency medical services. As result, staffing models, alternatives to improve system efficiencies and even the level of care provided by paramedics across the province is very inconsistent. In an effort to assist the RHA External Review Committee with their examination of RHA operations and subsequent recommendations to Government, the Paramedic Association of Manitoba prepared a written submission for consideration. This report outlines current system challenges and recommends the committee consider the benefits of operating Emergency Medical Services within the context of a provincial model that includes regional input. It's an administrative model that has already proven very effective with many specialized health services, and one that EMS across this province would benefit from.
The PAM submission to the RHA review committee is available on our web site and can be found using this link - PAM Sumission to RHA External Review Committee.
The Regional Health Authorities Act legislation came into force in 1997. It sets out the conditions under which the RHAs are incorporated, and defines their duties and responsibilities for ensuring effective health planning and delivery. The decision to regionalize the operation and administration of health in Manitoba was a major change in the way that health care is planned and delivered.
While regional governance authorities were tasked with decision making related to most health planning and delivery, some core health services remained the primary responsibility of central agencies or Manitoba Health. The belief was, and I expect still is, that certain specialized health services could be more safely or efficiently administered centrally, and as such needed to remain outside of the regional governance model. Angiography, radiotherapy, some mental health services and Lifeflight air ambulance are all examples of health services that remained directly funded and administered provincially. Certain health facilities such as Addictions Foundation Manitoba and the Riverview Health Centre also operate outside of the regional health authority governance model.
Emergency health, including ground ambulance service, is identified as a core health service for which RHAs have been legislated direct responsibility. The decision to include EMS in the list of RHA services was probably given very little thought. I don't mean that to sound negative or critical...but the reality is that EMS was already void of central administration in that each municipal government had responsibility to ensure ambulance service availability. In the process of trying to de-centralize most other health services I doubt anyone gave much thought to centralizing EMS administration and delivery...that just wouldn't fit the mold under consideration at that time.
Today Manitoba has eleven regional health authorities and each is very distinct in their approach to the delivery of emergency medical services. As result, staffing models, alternatives to improve system efficiencies and even the level of care provided by paramedics across the province is very inconsistent. In an effort to assist the RHA External Review Committee with their examination of RHA operations and subsequent recommendations to Government, the Paramedic Association of Manitoba prepared a written submission for consideration. This report outlines current system challenges and recommends the committee consider the benefits of operating Emergency Medical Services within the context of a provincial model that includes regional input. It's an administrative model that has already proven very effective with many specialized health services, and one that EMS across this province would benefit from.
The PAM submission to the RHA review committee is available on our web site and can be found using this link - PAM Sumission to RHA External Review Committee.
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