Ambulance Response Times Questioned

Burnaby Newsleader November 07 2013


November 12, 2013 at 1:04 PM


Stephen McLean was unloading a heavy box from his truck last Jan. 17 when he tripped, landing on his left knee in his back lane in South Burnaby.

"It didn't hurt but I could feel something was wrong," said McLean, 65.

Turns out, he'd broken his kneecap, landing just where the concrete of his garage meets the asphalt of the alleyway

He sat in the lane and called 911 on his cellphone, asking for an ambulance, then waited in the afternoon cold of winter.

And waited.

In the meantime he phoned 911 a few times more, called over a neighbour who was arriving home and eventually got hold of his son who came right over and called 911 a few times himself.

It was 70 minutes later by the time the ambulance arrived.

McLean couldn't say enough about how well the paramedics treated him, taking him to Burnaby Hospital where he eventually had surgery. But the wait still troubles him.

"I don't know if it had been a heart attack if it'd go faster," he said. "What some people told me is to ask for the fire department first."

In that case, there's little that firefighters could have done other that comfort him while he waited, said Coun. Colleen Jordan.

Still, it's such incidents that has Jordan concerned about B.C. Ambulance Service's (BCAS) response times in Burnaby and the possibility that firefighters are having to pick up the slack. She raised the issue after a recent Burnaby fire department quarterly report showed firefighters responded to significantly more medical calls compared to the same period last year.

Then last week came word that BCAS had changed its resource allocation plan (RAP), by downgrading the response to 70 medical conditions—instead of an ambulance being dispatched with lights and sirens, they'll be treated as a routine call.

The move "came as a total surprise" and Burnaby city hall and fire department were not consulted, said deputy city manager Chad Turpin at Monday's council meeting.

And if firefighters respond to such calls, they're required to stay with a patient until an ambulance arrives to take over, which means the firefighters aren't available for other calls, noted Coun. Paul McDonell, a retired firefighter. "What are you going to do if you have a fire?"

McDonell said he'd heard the move would "save [BCAS] 30 per cent on their budget, so follow the money."

"It's bad for injured and sick people as far as I can see, bad for fire service because it stacks up calls for fire service," said Jordan. "This is a horrible mess."

The move was not made as a cost savings measure but rather out of a concern for public safety, said Kelsie Carwithen, manager of media relations for BC Emergency Health Services, which is responsible for BCAS.

An ambulance will still respond to every call, Carwithen said by email. "This is simply a way to ensure that we are keeping the public, patients, paramedics safe by reducing the mode of the response – ie. code 3 response (driving fast) vs. routine (driving the speed limit).

"For example, there is a certain level of risk to the public when an emergency vehicle is driving code three through a busy intersection or stretch of highway … we don’t want to put the public at risk if code three is not necessary."

The RAP changes came after a routine review of 630,000 patient records and sets out the response to almost 900 different patient conditions.

When ambulance dispatchers ask questions about the patient, they input the answers into a computer program that spits out the type of response needed, explained Dr. William Dick, vice-president of medical programs for BC Emergency Health Services.

While Jordan cited the downgrading of response for a "suspected aortic aneurysm" as a cause for concern, Dick said that simply means such a patient "is stable, who doesn't look sick, and needs to get to the hospital but you don't need to race through traffic and have a motor vehicle crash or put bystanders in danger."

There are other stages of the condition that would merit a quicker response, he noted, and if the patient's condition changes the call-taker can always accelerate the BCAS response.

Built-in redundancies in the system means "we assume things are worse than they are" to be safe, he said.

"You will save time," he said of the difference in response. "But there is no evidence in the medical literature that saving a minute or two minutes on the vast majority of calls where we do save time makes any difference in the clinical outcome."

The types of calls where response was downgraded, "we've got really good evidence it's safe to do this."

As for firefighters responding to medical calls, Carwithen stressed that local governments decide what types of calls to respond to, with some municipalities choosing only to attend when getting there sooner can impact the patient's outcome while others respond to all calls they're notified of.

Firefighters are not trained to the same level as paramedics and mainly provide basic first aid and interventions. The RAP changes are expected to decrease by 35 per cent the number of medical calls firefighters attend.

The protocol for notifying first responders of medical calls will not be changed before consulting with them over the next month, she said.

As for McLean's long wait earlier this year, she said BCAS's records show an ambulance was assigned as soon as one was available.

"When Mr. McLean’s calls for assistance were received, all paramedics and ambulances in that area were all tasked with higher acuity events. This resulted in a response time that was outside of the average for calls of this nature."

However, if his symptoms had worsened, a higher level of response would have been provided.

"Because we are a provincial service, we can draw on ambulances from outlying areas to assist with call demand if needed."


Category: Public News