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.
Wednesday, September 26, 2007
Wednesday, September 19, 2007
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
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...
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,
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...
Tuesday, September 18, 2007
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.
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.
Wednesday, September 12, 2007
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)
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)
Saturday, September 08, 2007
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
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
Wednesday, September 05, 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:)
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:)
Saturday, April 21, 2007
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.
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.
Thursday, April 19, 2007
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.
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.
Tuesday, April 17, 2007
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.
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.
Wednesday, April 04, 2007
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.
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.
Tuesday, April 03, 2007
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.
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.
Monday, April 02, 2007
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...?
Friday, March 16, 2007
PAC to Hire Registrar
The Paramedic Association of Canada (PAC) has over 14,000 members from coast to coast. Founded in 1988 as the Canadian Society for Ambulance Personnel (CSAP), PAC represents prehospital practitioners on a national level to promote quality care and development of our profession in the public interest.
Probably best known for authoring the National Occupational Competency Profile (NOCP) for paramedicine, PAC works diligently to represent paramedics on numerous federal initiatives and committees. PAC is currently undertaking a major review of the NOCP, working with regulators and the Federal Labor Mobility Coordinator Group on issues related to inter-provincial reciprocity, considering options for accreditation of EMR education programs, and has identified development of a national examination and registry as priorities within the organization's business plan. And today PAC takes a big step toward fulfilling their very ambitious agenda...they're hiring a Registrar.
The Executive, committee chairs and membership are to be commended for all that PAC has accomplished for our profession and our patients. But the "next steps" would never be realized if we continued to rely solely on volunteers to keep a national association alive.
The posting for this .5 to .75 EFT Registrar position is available on the PAC web site. I anticipate we should see this position filled before we meet in Winnipeg for the 2007 PAC AGM on June 2nd.
Probably best known for authoring the National Occupational Competency Profile (NOCP) for paramedicine, PAC works diligently to represent paramedics on numerous federal initiatives and committees. PAC is currently undertaking a major review of the NOCP, working with regulators and the Federal Labor Mobility Coordinator Group on issues related to inter-provincial reciprocity, considering options for accreditation of EMR education programs, and has identified development of a national examination and registry as priorities within the organization's business plan. And today PAC takes a big step toward fulfilling their very ambitious agenda...they're hiring a Registrar.
The Executive, committee chairs and membership are to be commended for all that PAC has accomplished for our profession and our patients. But the "next steps" would never be realized if we continued to rely solely on volunteers to keep a national association alive.
The posting for this .5 to .75 EFT Registrar position is available on the PAC web site. I anticipate we should see this position filled before we meet in Winnipeg for the 2007 PAC AGM on June 2nd.
Thursday, March 08, 2007
Right Care - Right Practitioner - Right Place
Dr. Mark Taylor, deputy head for the Department of Surgery at the University of Manitoba, made some very interesting statements in his commentary (Huge amount can be done to fix health care) published March 6th in the Winnipeg Free Press. The entire article can be viewed by clicking here.
One comment made by Dr. Taylor that's sure to raise eyebrows in the medical community..."Our health care system has largely evolved for the best interest of the practitioners". It's hard to deny that many of the road blocks placed in the way of change within our health system are a result of "protectionist attitudes" that have existed in the health care community forever. Although there seems to be more acceptance within professional realms to share responsibilities and scopes of practice, it's still too often an uphill battle when looking at ways to better utilize various health practitioners in non-traditional roles.
And in part it's this reluctance to think outside of the traditional medical model that stands in the way of doing what Dr. Taylor rightly suggests needs to be done if we want to address many of our health care woes. He goes on in his commentary to say "We need to reorganize our systems of care provision to ensure the patient gets the right care by the right practitioner in the right place".
More emphasis needs to be placed on ensuring patients entering our health care system, especially many of those currently seen in over-crowded hospital emergency rooms, are directed to more appropriate health facilities and treatment options whenever suitable. We can't continue to believe we can "buy our way out" of the increasing strain placed on our current health care system by throwing money in the form of bonuses or incentives at our practitioners. A seniors population that has doubled in the past 20 years is forecast to double again in the next 15. Hospitals and emergency rooms are no longer viable in every community. Urgent care and community facilities need to better utilize alternative existing health care options, including nurse practitioners, physician assistants, pharmacists, therapists and paramedics. As Dr. Taylor suggests, there are ways to fix our health care system. It's time our community leaders, politicians and health administrators stopped fear-mongering whenever change in health care delivery is contemplated.
One comment made by Dr. Taylor that's sure to raise eyebrows in the medical community..."Our health care system has largely evolved for the best interest of the practitioners". It's hard to deny that many of the road blocks placed in the way of change within our health system are a result of "protectionist attitudes" that have existed in the health care community forever. Although there seems to be more acceptance within professional realms to share responsibilities and scopes of practice, it's still too often an uphill battle when looking at ways to better utilize various health practitioners in non-traditional roles.
And in part it's this reluctance to think outside of the traditional medical model that stands in the way of doing what Dr. Taylor rightly suggests needs to be done if we want to address many of our health care woes. He goes on in his commentary to say "We need to reorganize our systems of care provision to ensure the patient gets the right care by the right practitioner in the right place".
More emphasis needs to be placed on ensuring patients entering our health care system, especially many of those currently seen in over-crowded hospital emergency rooms, are directed to more appropriate health facilities and treatment options whenever suitable. We can't continue to believe we can "buy our way out" of the increasing strain placed on our current health care system by throwing money in the form of bonuses or incentives at our practitioners. A seniors population that has doubled in the past 20 years is forecast to double again in the next 15. Hospitals and emergency rooms are no longer viable in every community. Urgent care and community facilities need to better utilize alternative existing health care options, including nurse practitioners, physician assistants, pharmacists, therapists and paramedics. As Dr. Taylor suggests, there are ways to fix our health care system. It's time our community leaders, politicians and health administrators stopped fear-mongering whenever change in health care delivery is contemplated.
Wednesday, March 07, 2007
Manitoba EMS Education in Peril
The future of paramedicine as a recognized health profession in this province is dependent on a model of education that is both CMA accredited and professionally accepted within the health care community. All other health professions demand diploma or degree programs for entry to practice. The announcement last year that Manitoba Health was working with Red River College to develop a PCP program for delivery beginning in September of 2007 was very welcome news, as it opened the door to a more professionally respected education program. Today that concept appears to be in jeopardy.
Red River College was promised provincial funding for program development to replace the expired rural PCP education agreement with MESC. They indicated to Manitoba Health that final approval had to be in place by January 1st of this year in order to be ready for a September 2007 course start date. Well, that date has come and gone, and Treasury Board has yet to approve the money needed for the agreement to move forward. In fact, if Red River College doesn't receive funding approval within the next month, they'll miss the next possible course start date of January '08. The education agreement between the Manitoba Emergency Services College in Brandon and Manitoba Health expired in June of 2006. Unless RRC is able to deliver a PCP course this fall, we won't see an education program provide course graduates, at least in rural Manitoba, for a full three years. With most regions struggling to keep their heads above water staffing wise, that's a hit that many services may not be able to handle.
But what's even more alarming is that the delay caused by the government inaction in this matter may jeopardize the possibility of having a PCP diploma or degree program offered in Manitoba altogether. Not surprisingly, RRC is both frustrated and discouraged by the lack of funding approval for a project that less than a year ago seemed to be a very high priority. Rumors that Winnipeg Fire Paramedic Service may be in the process of developing their own program for public offering may be another nail in the coffin of a post-secondary paramedic education program. While I appreciate the level of expertise that WFPS would bring to EMS education in the province, unless it is done in partnership with a College or University it unfortunately won't meet the expectations of the health care community, and as such does nothing to promote paramedicine as a recognized health profession.
The Manitoba Government prides itself in EMS system improvements made over the course of the past 7 years. Unfortunately, education, which is the very cornerstone around which the whole system revolves, may fallen by the wayside.
Red River College was promised provincial funding for program development to replace the expired rural PCP education agreement with MESC. They indicated to Manitoba Health that final approval had to be in place by January 1st of this year in order to be ready for a September 2007 course start date. Well, that date has come and gone, and Treasury Board has yet to approve the money needed for the agreement to move forward. In fact, if Red River College doesn't receive funding approval within the next month, they'll miss the next possible course start date of January '08. The education agreement between the Manitoba Emergency Services College in Brandon and Manitoba Health expired in June of 2006. Unless RRC is able to deliver a PCP course this fall, we won't see an education program provide course graduates, at least in rural Manitoba, for a full three years. With most regions struggling to keep their heads above water staffing wise, that's a hit that many services may not be able to handle.
But what's even more alarming is that the delay caused by the government inaction in this matter may jeopardize the possibility of having a PCP diploma or degree program offered in Manitoba altogether. Not surprisingly, RRC is both frustrated and discouraged by the lack of funding approval for a project that less than a year ago seemed to be a very high priority. Rumors that Winnipeg Fire Paramedic Service may be in the process of developing their own program for public offering may be another nail in the coffin of a post-secondary paramedic education program. While I appreciate the level of expertise that WFPS would bring to EMS education in the province, unless it is done in partnership with a College or University it unfortunately won't meet the expectations of the health care community, and as such does nothing to promote paramedicine as a recognized health profession.
The Manitoba Government prides itself in EMS system improvements made over the course of the past 7 years. Unfortunately, education, which is the very cornerstone around which the whole system revolves, may fallen by the wayside.
Saturday, March 03, 2007
Emergency Room Crisis
An article in today's Winnipeg Free Press (Grace's ER in peril - March 3, 2007) once again speculates about a possible ER closure at the Grace hospital. Last year the province offered physicians $1,500.00 for every five shifts they covered at the Grace in an effort to offset a staffing shortage at the facility. Today that shortage remains, and it's not uncommon for patients to wait up to 10 hours to see a doctor. The government's solution as we move into 2007...cash incentives for physicians to pick up extra shifts. Am I missing something here?
Wait times in Winnipeg emergency rooms have been on the increase for years now. Not only are patients waiting longer to see physicians, but as you've undoubtedly experienced yourself, paramedics are often delayed far too long waiting to transfer care of their patients to hospital staff. In January of 2004 the provincial government undertook a formal review of the emergency care system in Winnipeg, and at that time we urged the Health Minister to encourage decision makers to "think outside the box" in efforts to find appropriate solutions to the problem. Among the recommendations we made at that time to help minimize ER problems:
As part of the effort to reduce the strain on Winnipeg ERs, Manitoba Health published an Emergency Room User Guide. In an effort to better educate the general public about proper emergency room use, they suggest there are certain conditions that are best dealt with "by a family doctor or local health clinic", and in fact recommend the use of Urgent Care facilities such as the Misericordia Health Centre and the Pan Am Minor Injury Clinic when appropriate. Yet paramedics are still required to transport to an emergency room.
In their white paper, the EMS Chiefs of Canada recommend that EMS become part of a "system" of health care that allows resources to be used more effectively and efficiently. They go on to say that it may "be clinically appropriate and beneficial to the health care system to assess, treat and release the patient or transfer them to another health care agency" (other than an emergency room). And yet provincial medical direction here in Manitoba refuses to consider the possibility of developing protocols to do just that.
Research suggests that only 10% of callers using 911 actually have a life threatening emergency. Many are in need of urgent or primary health care, and in fact could be dealt with through channels outside of the conventional emergency room. Innovative programs are underway in other Canadian jurisdictions to better integrate paramedics into the health care system and help minimize the increasing strain on emergency rooms and staff. Asking doctors, or for that matter any health professional, to pick up extra shifts is not the solution. We need to redefine the traditional model of pre-hospital emergency health care.
Money spent "bribing" practitioners to work longer and harder will only exacerbate the problem. Money spent on improving our EMS system can help address the real and increasing strain on our emergency facilities. Not only does it stand to reduce current pressures on our ER facilities and resources, but as pointed out in the EMS Chiefs white paper, "EMS high-level care can minimize time spent in the ICU, avoid additional complications and reduce the probability of on-going long term pressures on the health care system".
Again I ask...am I missing something here?
Wait times in Winnipeg emergency rooms have been on the increase for years now. Not only are patients waiting longer to see physicians, but as you've undoubtedly experienced yourself, paramedics are often delayed far too long waiting to transfer care of their patients to hospital staff. In January of 2004 the provincial government undertook a formal review of the emergency care system in Winnipeg, and at that time we urged the Health Minister to encourage decision makers to "think outside the box" in efforts to find appropriate solutions to the problem. Among the recommendations we made at that time to help minimize ER problems:
- increasing the number of Urgent Care facilities available and enabling paramedics to transport or refer patients to these facilities in lieu of an ER when appropriate;
- developing appropriate paramedic treat and release protocols, resulting in fewer ER admissions;
- utilizing Advanced Care (and in future Critical Care) Paramedics in emergency care facilities to assist with triage, patient re-evaluation and high workload efforts including resuscitative measures.
As part of the effort to reduce the strain on Winnipeg ERs, Manitoba Health published an Emergency Room User Guide. In an effort to better educate the general public about proper emergency room use, they suggest there are certain conditions that are best dealt with "by a family doctor or local health clinic", and in fact recommend the use of Urgent Care facilities such as the Misericordia Health Centre and the Pan Am Minor Injury Clinic when appropriate. Yet paramedics are still required to transport to an emergency room.
In their white paper, the EMS Chiefs of Canada recommend that EMS become part of a "system" of health care that allows resources to be used more effectively and efficiently. They go on to say that it may "be clinically appropriate and beneficial to the health care system to assess, treat and release the patient or transfer them to another health care agency" (other than an emergency room). And yet provincial medical direction here in Manitoba refuses to consider the possibility of developing protocols to do just that.
Research suggests that only 10% of callers using 911 actually have a life threatening emergency. Many are in need of urgent or primary health care, and in fact could be dealt with through channels outside of the conventional emergency room. Innovative programs are underway in other Canadian jurisdictions to better integrate paramedics into the health care system and help minimize the increasing strain on emergency rooms and staff. Asking doctors, or for that matter any health professional, to pick up extra shifts is not the solution. We need to redefine the traditional model of pre-hospital emergency health care.
Money spent "bribing" practitioners to work longer and harder will only exacerbate the problem. Money spent on improving our EMS system can help address the real and increasing strain on our emergency facilities. Not only does it stand to reduce current pressures on our ER facilities and resources, but as pointed out in the EMS Chiefs white paper, "EMS high-level care can minimize time spent in the ICU, avoid additional complications and reduce the probability of on-going long term pressures on the health care system".
Again I ask...am I missing something here?
Thursday, March 01, 2007
Another EMS Death
Media reports suggest that a paramedic student attending the Saskatchewan Institute of Applied Science and Technology (SIAST) was killed in a single vehicle accident in the Saskatoon area early this morning. It has been reported that the PCP student was on his way to a practicum shift with MD Ambulance when the accident occurred.
Unlikely to be considered a line of duty death, it still comes as a shock to lose another member of the Canadian EMS community. Just days ago Ontario paramedic Paul Patterson was killed in the line of duty while responding in a Rapid Response paramedic unit to a motor vehicle collision near Chatham, Ontario.
Five Canadian paramedics have died in the line of duty in the past ten months. Kim Weitzel and Shawn Currier were killed after responding to an emergency call at a decommissioned mine near Cranbrook, B.C. in May of 2006. Canadian Forces medics Corporal Andrew Eykelenboom and Glen Arnold died while serving our country in Afghanistan in August and September 2006 respectively. Thirty year old Paul Paterson was killed on February 25, 2007.
Twenty-one Canadian paramedics have been killed in the line of duty in only the last 11 years. It's a sobering thought to realize we have had that many deaths in our profession in such a short time.
Please...stay safe!
Unlikely to be considered a line of duty death, it still comes as a shock to lose another member of the Canadian EMS community. Just days ago Ontario paramedic Paul Patterson was killed in the line of duty while responding in a Rapid Response paramedic unit to a motor vehicle collision near Chatham, Ontario.
Five Canadian paramedics have died in the line of duty in the past ten months. Kim Weitzel and Shawn Currier were killed after responding to an emergency call at a decommissioned mine near Cranbrook, B.C. in May of 2006. Canadian Forces medics Corporal Andrew Eykelenboom and Glen Arnold died while serving our country in Afghanistan in August and September 2006 respectively. Thirty year old Paul Paterson was killed on February 25, 2007.
Twenty-one Canadian paramedics have been killed in the line of duty in only the last 11 years. It's a sobering thought to realize we have had that many deaths in our profession in such a short time.
Please...stay safe!
Wednesday, February 28, 2007
CMA Accreditation vs "The Gap" vs Reciprocity
I was asked by a member that is currently enrolled in regional "gap" training (the difference between the EMT and PCP programs as identified by Manitoba Health) whether or not this education is accredited by the CMA. The simple answer...no. Although the Technician-Paramedic license is measured against the PCP competency profile, unless you complete an accredited full PCP or PCP bridging course, the fact that you are a Tech-P does not mean your education is accredited by the Canadian Medical Association.
I'm assuming that the reason some individuals are asking the question about accreditation is related to potential for employment in other EMS services (such as Winnipeg) or inter-provincial reciprocity. Two very different scenarios, as one relates to employment requirements and the other to recognition of qualifications in another jurisdiction.
In the case of employment requirements, such as applying to Winnipeg Fire Paramedic Service, the employer has every right to set minimum hiring standards. Winnipeg will not currently employ anyone who has not completed CMA accredited EMS education. So the reality is that a Technician-Paramedic in Manitoba that obtained their license by completing "gap" training will not be considered for employment. As I mentioned earlier, the "gap"training is not CMA accredited.
But inter-provincial reciprocity can be looked at somewhat differently. Most provinces have signed a document entitled Mutual Recognition Agreement (MRA) for Paramedics (available on the PAC web site...Agreement on Internal Trade pdf) Simply put, this agreement ensures that a paramedic authorized to practice in one Canadian jurisdiction will have his or her qualifications recognized in another jurisdiction. The scale used to measure these occupational qualifications is based on the NOCP. Because Manitoba has indicated that the Technician-Paramedic license they issue is based on the PCP competency profile, other Canadian jurisdictions should now recognize our Tech-P license as equivalent to PCP practice qualification. According to the MRA, your qualifications as a PCP should be recognized and only differences in occupational requirements (regional and local differences) should be tested by the regulator. This still does not, however, preclude other regulators or employers in other provinces from setting minimum requirements which may include completion of CMA accredited education.
All this said, it should be mentioned that the Paramedic Association of Manitoba supports the concept of CMA accreditation in EMS education. Accreditation is public recognition that an educational program has met national standards. The goal of CMA accreditation is to ensure that programs enable students to acquire the knowledge, skills and attitudes to function as competent health practitioners for the benefit of all Canadians. As an organization committed to achieving excellence in pre-hospital emergency care and our profession, it's important that we promote and expect accreditation of our EMS educational programs.
I'm assuming that the reason some individuals are asking the question about accreditation is related to potential for employment in other EMS services (such as Winnipeg) or inter-provincial reciprocity. Two very different scenarios, as one relates to employment requirements and the other to recognition of qualifications in another jurisdiction.
In the case of employment requirements, such as applying to Winnipeg Fire Paramedic Service, the employer has every right to set minimum hiring standards. Winnipeg will not currently employ anyone who has not completed CMA accredited EMS education. So the reality is that a Technician-Paramedic in Manitoba that obtained their license by completing "gap" training will not be considered for employment. As I mentioned earlier, the "gap"training is not CMA accredited.
But inter-provincial reciprocity can be looked at somewhat differently. Most provinces have signed a document entitled Mutual Recognition Agreement (MRA) for Paramedics (available on the PAC web site...Agreement on Internal Trade pdf) Simply put, this agreement ensures that a paramedic authorized to practice in one Canadian jurisdiction will have his or her qualifications recognized in another jurisdiction. The scale used to measure these occupational qualifications is based on the NOCP. Because Manitoba has indicated that the Technician-Paramedic license they issue is based on the PCP competency profile, other Canadian jurisdictions should now recognize our Tech-P license as equivalent to PCP practice qualification. According to the MRA, your qualifications as a PCP should be recognized and only differences in occupational requirements (regional and local differences) should be tested by the regulator. This still does not, however, preclude other regulators or employers in other provinces from setting minimum requirements which may include completion of CMA accredited education.
All this said, it should be mentioned that the Paramedic Association of Manitoba supports the concept of CMA accreditation in EMS education. Accreditation is public recognition that an educational program has met national standards. The goal of CMA accreditation is to ensure that programs enable students to acquire the knowledge, skills and attitudes to function as competent health practitioners for the benefit of all Canadians. As an organization committed to achieving excellence in pre-hospital emergency care and our profession, it's important that we promote and expect accreditation of our EMS educational programs.
Tuesday, February 27, 2007
Ontario Paramedic Line of Duty Death
A fifth Canadian paramedic has been killed in the line of duty since May of last year. Paul W. Patterson, a Primary Care Paramedic with Sun Parlour Emergency Services in Chatham, Ontario, died while responding to a motor vehicle collision on Sunday, February 25th. Paul was only 30 years old, and had graduated from Northern College of Applied Arts and Technology in 2001. Details regarding funeral arrangements and the accident that claimed Paul's life can be found on the Ontario Paramedic Association (OPA) web site.
Paul's death is a tragic reminder of the dangers faced by emergency medical services providers each and every day in our work to save the lives of others. Like all emergency services, we're often asked to assist others in times of poor weather and difficult conditions. It's especially difficult for those who knew and worked with Paul to have had to respond to the accident that claimed his life, and my thoughts are prayers are with those individuals as well as his family and friends.
The Paramedic Association of Manitoba has sent condolences to Sun Parlour EMS staff and management, and asked them to convey our sympathies to Paul's family. We will be represented at the line of duty death funeral planned for Friday, March 2nd in Strathroy, Ontario. Anyone planning to attend the funeral is asked to notify the OPA by email...that information can be found following the LODD notice on their web site.
PAM asks that paramedics wear LODD pins or black ribbons on their uniform in honor of Paul's memory. EMS services should also lower flags to half mast until the funeral has been held.
Details regarding the Canadian paramedic line of duty deaths that have occurred in the past year can be found in the press release issued by the Paramedic Association of Manitoba posted on our web site.
Stay safe everyone!
Paul's death is a tragic reminder of the dangers faced by emergency medical services providers each and every day in our work to save the lives of others. Like all emergency services, we're often asked to assist others in times of poor weather and difficult conditions. It's especially difficult for those who knew and worked with Paul to have had to respond to the accident that claimed his life, and my thoughts are prayers are with those individuals as well as his family and friends.
The Paramedic Association of Manitoba has sent condolences to Sun Parlour EMS staff and management, and asked them to convey our sympathies to Paul's family. We will be represented at the line of duty death funeral planned for Friday, March 2nd in Strathroy, Ontario. Anyone planning to attend the funeral is asked to notify the OPA by email...that information can be found following the LODD notice on their web site.
PAM asks that paramedics wear LODD pins or black ribbons on their uniform in honor of Paul's memory. EMS services should also lower flags to half mast until the funeral has been held.
Details regarding the Canadian paramedic line of duty deaths that have occurred in the past year can be found in the press release issued by the Paramedic Association of Manitoba posted on our web site.
Stay safe everyone!
Saturday, February 24, 2007
Province Funds New EMS Station
Earlier this week Premier Gary Doer announced funding to build and staff a new EMS facility within the Interlake Region. The absence of an ambulance in the areas of East and West St Paul have been a consistent topic of debate in the legislature's Question Period since the death of a prominent area resident nearly two years ago.
I was invited by Health Minister Theresa Oswald to attend this announcement. I took advantage of the invitation and used the opportunity to meet very briefly with the Premier...something we've been trying to make happen for almost two years now. As an aside to the funding story, I was assured by Premier Doer that he would like to meet formally with us in the coming weeks.
The funding announced to build and operate this new EMS facility is quite substantial. The capital cost approved for erecting the station is close to $300,000.00, which by Manitoba Health standards should result in a two bay garage with modest living accommodations for staff. The promise to cover operating expenses at an annual cost of approximately $525,000.00 equates to 24-hour full time staffing of one ambulance. While the province has built a number of new EMS facilities over the course of the past 7 years, most have been replacement buildings. To my knowledge this is only the second "new" location adding to existing resources (Kinnesota Trails being the other). On the surface...a "good news" story for Manitoba EMS.
But in my mind this announcement also sounds a number of warning bells. Premier Doer suggested that lengthy response times (20 - 25 minutes) in the southern portion of the Interlake Region at least in part prompted this decision. It's a dangerous statement to make in light of the fact that Manitoba has yet to develop any response standards against which to measure our performance. While this announcement certainly acknowledges the need for system improvements, it does so by once again reacting to a very specific problem without addressing current system inconsistencies and inefficiencies that exist province-wide. And I dare say that staffing of this facility will be another interesting problem. Without exception all regions are teetering on the brink of experiencing paramedic shortages, compounded by the fact that the province is dragging it's heals on the funding approval needed for Red River College to have any chance of being ready to deliver PCP education this fall.
There's no doubt that the NDP government has made significant investments in our EMS system since first elected in 1999. Introduction of a Fleet vehicle program, a much improved communications system, development of the MTCC, substantial increases in regional funding to offset staffing costs, elimination of the interfacility-transfer cost to patients and announcements such as this new facility in the Interlake are all welcome indeed. But what has yet to be adopted by this government is a concrete plan that will improve Manitoba's emergency medical services system as a whole and ensure it's sustainability going into the future. Without that I fear we may simply be throwing more good money after bad.
I was invited by Health Minister Theresa Oswald to attend this announcement. I took advantage of the invitation and used the opportunity to meet very briefly with the Premier...something we've been trying to make happen for almost two years now. As an aside to the funding story, I was assured by Premier Doer that he would like to meet formally with us in the coming weeks.
The funding announced to build and operate this new EMS facility is quite substantial. The capital cost approved for erecting the station is close to $300,000.00, which by Manitoba Health standards should result in a two bay garage with modest living accommodations for staff. The promise to cover operating expenses at an annual cost of approximately $525,000.00 equates to 24-hour full time staffing of one ambulance. While the province has built a number of new EMS facilities over the course of the past 7 years, most have been replacement buildings. To my knowledge this is only the second "new" location adding to existing resources (Kinnesota Trails being the other). On the surface...a "good news" story for Manitoba EMS.
But in my mind this announcement also sounds a number of warning bells. Premier Doer suggested that lengthy response times (20 - 25 minutes) in the southern portion of the Interlake Region at least in part prompted this decision. It's a dangerous statement to make in light of the fact that Manitoba has yet to develop any response standards against which to measure our performance. While this announcement certainly acknowledges the need for system improvements, it does so by once again reacting to a very specific problem without addressing current system inconsistencies and inefficiencies that exist province-wide. And I dare say that staffing of this facility will be another interesting problem. Without exception all regions are teetering on the brink of experiencing paramedic shortages, compounded by the fact that the province is dragging it's heals on the funding approval needed for Red River College to have any chance of being ready to deliver PCP education this fall.
There's no doubt that the NDP government has made significant investments in our EMS system since first elected in 1999. Introduction of a Fleet vehicle program, a much improved communications system, development of the MTCC, substantial increases in regional funding to offset staffing costs, elimination of the interfacility-transfer cost to patients and announcements such as this new facility in the Interlake are all welcome indeed. But what has yet to be adopted by this government is a concrete plan that will improve Manitoba's emergency medical services system as a whole and ensure it's sustainability going into the future. Without that I fear we may simply be throwing more good money after bad.
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