Annual Report 2011/12 - BCEHS · 2015. 3. 31. · 6 EHSC Annual Report 2011/12 BC Bedline (BCBL) is a 24/7 provincial service that works with hospital physicians to ensure the timely

1 EHSC Annual Report 2011/12

AnnuAl RepoRt 2011/12

Emergency and Health Services Commission

Message from the EHSC President and PHSA President and CEO

We are pleased that 2011/12 was a year of success that can be credited to the closer alignment of the Emergency

and Health Services Commission (EHSC) and its operating entities – the BC Ambulance Service (BCAS), BC Bedline,

and Trauma Services BC with the Provincial Health Services Authority (PHSA) and the provincial health care sys-

tem. Together, we joined our services on a strategic and operational level to enhance pre-hospital care for British

Columbians.

We will continue to closely align EHSC with the health sector to actively pursue opportunities for innovation and

improved patient care.

We can be proud of a number of initiatives that have benefitted from our partnership including improved trauma

bypass protocols and new station facilities for BCAS, increased transparency and accountability to the public

via the Patient Care Quality Office, and more rigorous financial reporting and evaluation tools to enable better

decision making. We are advancing the paramedic profession through the Resuscitation Outcomes Consortium

research to develop best practices for care. The EHSC is also making great progress in its efforts to create a system

for seamless inter-facility patient transfers across British Columbia. One other highlight includes the Quality and

Patient Safety team’s Patient Safety Huddles, which are further developing our culture of learning.

Together, we will continue to thrive and support change that further integrates EHSC into PHSA and the health

sector. By tapping into PHSA’s insight, resources and talent, the list of successful initiatives will continue to grow.

We look forward to a bright future together as we stand committed to providing the best possible pre-hospital

care to help our communities be healthy and safe.

MESSAgE fROM THE ExECuTivE

Lynda CranstonPHSA President and CEO

Michael MacDougallEHSC President

The three agencies under the Emergency and Health

Services Commission (EHSC), BC Bedline, Trauma

Services BC, and BC Ambulance Service, provide both

pre-hospital emergency services and inter-facility

patient transfer coordination and transport services.

The EHSC, established in 1974, carries out its legislat-

ed mandate in accordance with the Emergency and

Health Services Act. in April 2011, the EHSC success-

fully transitioned to the Provincial Health Services

Authority (PHSA).

As outlined in the Organization Chart, a number

of program areas and corporate services are direct

components of the EHSC, including: Medical Pro-

grams; Quality, Safety, Risk Management and Accredi-

tation; Communications; finance; Human Resources;

and information Management.

EHSC OvERviEW

EHSC Annual Report 2011/124

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ContentsBC Bedline

Trauma Services BC

BC Ambulance Service

A Year in Transition

Burns Lake Mill Explosion

Quality, Safety, Risk Management and Accreditation Program

EHSC Patient Care Quality Office

eAmbulance

facility and Station improvements

Organizational Challenges

Budget

BCAS Services

BCAS Stations

Program Overview and Highlights

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07

10

12

14

15

18

23

25

26

27

30

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36

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36


BC Bedline (BCBL) is a 24/7 provincial service that

works with hospital physicians to ensure the timely

transfer of acute care patients to another hospital with

a higher level of care by:

• facilitating physician-to-physician conference calls;

• coordinating calls between physicians and

specialist services;

• facilitating air or ground ambulance transport in

partnership with BCAS;

• arranging transfer of patients back to their

community hospitals; and

• coordinating interprovincial and international

transfers when required.

in 2011, BCBL facilitated 22,800 patient transfers; call

volume has risen every year and doubled since 2005.

Twenty call takers, nine support staff, four supervisors

and one executive director coordinate the province-

wide inter-facility patient system. BCBL coordinates the

transfers and works closely with the Patient Transport

Coordination Centre with BC Ambulance Service to

arrange transportation for the patient.

EHSC is building on the success of BCBL by establishing

the provincial Patient Transfer Network (PTN) to

strengthen coordination and collaboration with

physicians and health authorities across the province.

This is a key provincial initiative that will improve care

and system benefits by establishing a ‘one-stop-shop’

for all patient transfer coordination in B.C.

under the PTN, transfers for high level, critical care

patients will be overseen and coordinated 24 hours a

day under the supervision of a critical care specialist.

The network will enable physicians in the health

authorities to speak directly to a physician or critical

care nurse at the network who will then directly

coordinate the transfer planning and transportation

including air ambulance support if required. Currently,

health authorities contact BCBL for most high acuity

patient transfers and alternate service providers for

low acuity transfers. The PTN will be the lead agency to

coordinate patient transfers for all acuity levels.

The PTN will reduce duplication and ensure better

coordination of patient transfer planning to ensure

appropriate care across regions and the province.

improving transfers of patients is another important

component of increasing the quality of care for British

Columbians. The PTN will begin operations in 2013.

“Over the past year we have worked closely with the

health authorities, BC Ambulance Service and other

partners to plan for the Patient Transfer Network. Our

goal is better coordination of services and improved

communication between health professionals to ensure

patients throughout B.C. receive the appropriate care

at the appropriate facility in a more timely and efficient

way.”

Kathy Steegstra, Executive Director, BC Bedline

BC Bedline


Trauma Services BC (TSBC) is the newest service within

EHSC.

in february 2012, the BC Trauma Advisory Committee

transitioned from a long-standing working group to an

agency under the EHSC and PHSA.

The purpose of the new agency is to increase the

quality of trauma care in B.C. by integrating trauma

services throughout the province. TSBS will improve

trauma care by maximizing efficiencies and sharing

best practices throughout the provincial health care

system.

Our vision is to provide a high performing,

comprehensive, integrated, and inclusive trauma

system for B.C.

TSBC will develop a coordinated inclusive network

of trauma services across the province that not

only integrates with health authority services while

partnering with BCBL, EHSC Medical Programs, PHSA

Mobile Medical unit as well as transportation services

offered by BCAS.

“We are a small team with a very big responsibility – to

work with health authorities and trauma specialists to

improve trauma care through better integration across

British Columbia. Trauma is the leading cause of death in

the first four decades of life, therefore improving trauma

services in B.C. is an important part of the overall health

care system.”

Catherine Jones, Executive Director,

Trauma Services BC

Trauma Services BCes




for 38 years, the core business of BC Ambulance

Service has been providing patients across British

Columbia with the highest quality emergency medical

services possible. BCAS has evolved and responded to

the changing needs of healthcare since its inception

in 1974. Pioneers of BCAS, Dr. Peter Ransford and Mr.

Carson Smith, instilled a culture of high quality patient

care and operational efficiency that is alive and thriv-

ing to this day.

under the purview of the EHSC, BCAS provides ambu-

lance service and inter-hospital transfer services for

patients requiring a higher level of care. BCAS is proud

to serve as the largest provider of emergency medi-

cal services in Canada and one of the largest in North

America. BCAS responds to the needs of 4.4 million

British Columbians and attends calls for service across

six health authorities covering almost one million

square kilometres.

BCAS employs 4,017 individuals – 3,668 paramedic and

dispatch staff, 200 support staff and 149 management

staff. BCAS operates from 184 ambulance stations and

three dispatch centres. in 2011/12, BCAS paramedics

responded by ground to 486,138 events – 394,069 pre-

hospital (9-1-1) events, and 92,069 inter-facility patient

transfers. BCAS has a fleet of 559 vehicles, including 497

ambulances and 62 support vehicles. BCAS also has a

fleet of ten dedicated ambulance aircraft that trans-

ported 7,732 patients in 2011/12. in August 2011, BCAS

added a dedicated air ambulance helicopter to serve

the interior, based in Kamloops.

“BC Ambulance Service is undergoing a period of tremen-

dous change following our closer alignment with the

health care system in British Columbia. I’m proud of our

organization’s renewed focus on patient care and on our

staff; we are continually looking at ways to better serve

our communities and support our front line personnel.

There were many successes in 2011/12 as well as opportu-

nities for us to learn and improve our service. Many of our

staff go above and beyond the call of duty to provide the

best care possible for patients, support their colleagues,

and proudly play their part in the BC Ambulance Service.”

Les fisher, Chief Operating Officer, BCAS

BC Ambulance Service


BCAS employs

4,017 individuals3,668 paramedics200 support staff149 managersBCAS operates from184 ambulance stations3 dispatch centres


in March 2010, the Province of British Columbia

announced that the Emergency and Health Services

Commission (EHSC), including BCAS, would transfer

to become an administrative responsibility of

the Provincial Health Services Authority (PHSA).

Strengthening the relationship between the health

authorities and EHSC will increase innovation in pre-‐

hospital care and enhance the role of paramedics in

the health care system, particularly in rural and remote

communities. in 2011/12, the majority of corporate

services completed the transition.

BCAS Operations Restructuring

in an effort to improve pre-hospital patient care, BCAS

undertook a comprehensive, six-month review of

service delivery throughout the province between

August 2011 and february 2012. While examining

BCAS’s five different organizational regions, the review

found operational and administrative differences and

duplication of effort and resources.

in March 2012, BCAS Operations was reorganized

to provide a more standard, consistent provincial

approach to patient care while still respecting local

needs. The new structure is aimed at eliminating

duplicated efforts and focusing resources on

patient care and service delivery. The new structure

emphasizes similarities in service delivery rather than

being structured strictly according to geographic

boundaries. The purpose of the organizational changes

is to focus energy and resources where it matters most:

patient care.

Patient Care and Service Improvement Initiatives

2011/12 was a year of considerable growth:

• in August 2011, BCAS added a fourth dedicated

helicopter and critical care team to the air

ambulance fleet. Based in Kamloops, the service

transitioned from being provided on a semi-

dedicated basis to a permanent basis following

a competitive bidding process to secure the

contracted aircraft.

• BCAS’s Critical Care Transport Program was

expanded through the addition of a new ground

bases in Langley and Nanaimo. The new teams

primarily transport patients with life-threatening

conditions who require constant monitoring and

support from local hospitals to major medical

centers.

• BCAS implemented the Early fixed-Wing

Activation Program in the Northwest whereby

paramedics can ‘reserve’ an air ambulance airplane

based on their on-scene assessment of the patient.

Previously, a physician would need to access the

patient in hospital and then call an air ambulance.

A Year of Transition


This new process will reduce the time it takes to

get a critically ill or injured patient to a higher level

of care; the program will be expanded throughout

the north in 2012/13.

• The Primary Response unit (PRu) concept was

adopted in the Lower Mainland on a permanent

basis following several trials throughout the

area. PRus are a non-transport capable response

unit that is staffed by a single advanced care

paramedic. PRus enable BCAS to provide a higher

level of paramedic care to more people, helping to

ensure we get the right care, to the right patient at

the right time.

• BCAS paramedics are now embedded within the

vancouver Police Department’s integrated Tactical

Safety unit (iTSu) to support patient care at large

public events. To reach a patient in distress in the

midst of a crowd, the iTSu works its way through

the attendees, locates the patient and forms a

protected, safe workspace around the paramedic

and patient. The unit is based on similar teams

in the uK that respond to public safety incidents

following football games.

• BCAS’s extensive fleet operations experience and

robust maintenance program has been expanded

to include other areas of the provincial health care

system. BCAS is now managing fleet services for

Northern Health and PHSA and is assisting other

Canadian EMS systems in developing similar fleet

management programs. BCAS’s provincial service

delivery model and diverse operating conditions,

enables ambulances to move throughout the

system so each vehicle is utilized to its fullest

extent.

• in greater victoria, the location of ambulance

calls has changed over time and the current

stand-alone station model wasn’t providing the

flexibility required to best serve the region. in

2013, paramedics will be deployed from a large

central station and satellite locations throughout

the region; the smaller stations can be more easily

relocated to respond to changing demand and

provide the fastest response for patients.

• The EHSC Billing department has been working

diligently over the past number of years to

decrease the time a patient receives ambulance

service to when the invoice arrives in the mail.

in 2012/13, the EHSC surpassed our service

targets and will have 55 per cent of our invoices

distributed within in 10 days and 90 per cent

billable within 30 days.


The EHSC was put to the test on January 20, 2012,

following an explosion at Babine forest Products

sawmill, just outside of Burns Lake, on a night with

some of the worst weather the area had seen all winter.

Paramedics quickly responded in ambulances based

in Burns Lake, Southside, fraser Lake, vanderhoof,

Smithers, and Houston.

BCAS established on site command and triage and

patients were swiftly transported to the local hospital.

BC Bedline and air ambulance support via the Critical

Care Transport Program were also drawn into the event

to transport injured patients to higher levels of care at

facilities throughout the province.

The response was truly a team effort due to the vast

number of personnel involved: the paramedics across

the North who responded and maintained service in

all communities; the dispatchers in all centres and BC

Bedline call takers who coordinated the response and

provided support in addition to the normal workload;

the critical care paramedic crews who responded by

both ground and air to provide their expertise; and the

managers who responded and coordinated resources.

Large scale incidents require an integrated response

and meticulous coordination with many other

agencies. As the incident unfolded, BCAS and BC

Bedline worked in partnership with Northern Health,

vancouver Coastal Health Authority and others to

ensure patients got the care they needed in a timely

manner.

Burns Lake Mill Explosion


Quality, Safety, Risk Management and Accreditation ProgramM

The EHSC Quality, Safety, Risk Management and

Accreditation program (QSRMA) supports and guides

the provision of the best care possible by facilitating

patient-centered improvement projects, reviewing

patient safety events and coordinating systems-level

changes to the pre-hospital care system. The QSRMA

team works closely with all programs and the EHSC

Executive, ensuring patient safety is at the forefront of

organizational decision-making. QSRMA focuses on

building a culture of safety.

in 2011, QSRMA began paramedic Patient Safety

Huddles - short, frequent informal forums for staff to

talk about calls – to raise awareness of patient safety

issues. The huddles offer a transparent and blame-free

opportunity for staff to share ideas and incorporate

reporting of patient safety issues into daily work.

The QSRMA program awards staff with ‘Q Pins’ for

embracing and promoting patient safety huddles,

having a positive impact on patient safety, eliminating

risks to patients by reporting near misses or “good

catches” and by advocating for patients.

QSRMA collaborates with the Patient Care Quality

Office which provides a clear, consistent, timely and

transparent process for patients and various healthcare

partners to register compliments and complaints

about patient care.

The Risk Management Program works with EHSC

leaders to identify and assess risks, develop and

monitor mitigation strategies and manage pre-hospital

event-related litigation activities include working with

legal counsel and the BC Coroners Service. QSRMA

also leads the EHSC in the strategic goal of achieving

accredited status through Accreditation Canada.




As part of its closer integration with the healthcare

sector, the EHSC announced that as of April 1, 2011

the PHSA Patient Care Quality Office (PCQO) would

expand to include the EHSC. The EHSC PCQO operates

in keeping with the legislative requirements of the

Patient Care Quality Review Board Act and the related

ministerial directives. The PCQO ensures care quality

complaints are managed consistently, responded to in

a timely fashion and accounted for transparently.

Between July 1, 2011 and June 30, 2012, the EHSC

PCQO processed and responded to 160 compliments,

231 complaints and 1,312 requests for information or

questions.

The PCQO supports service improvements through

feedback from patients and helps EHSC agencies

achieve its mission to provide safe, reliable and

efficient care. in addition to care quality complaints,

compliments and requests for information, and by

leveraging the PCQO’s expertise and centralized

system, patient safety events are now reported

through the EHSC PCQO toll-free line. Events are

triaged by the patient care quality officers and sent to

the most appropriate handler via the Patient Safety

Learning System (PSLS).

All health authorities in B.C. each have PCQOs and

each are represented at a provincial table whose

membership includes the Ministry of Health and

the leads for the Patient Care Quality Review Board

Secretariat. EHSC is represented by PHSA Patient Care

Quality Offices’ Director.

EHSC Patient Care Quality Office


Medical Programs provides the medical input,

education and oversight to guide paramedics in the

provision of quality patient care. Medical Programs

integrates four major functions: physician oversight,

quality improvement, clinical education and research.

By integrating all functions, Medical Programs strives

to provide the best support possible to paramedics

to enable them to provide excellent patient care.

Through Medical Programs, EHSC encourages a

culture of continuous learning and improvement that

emphasizes a commitment to patient care and safety

as well as support for paramedics.

EHSC Treatment Guidelines

The EHSC Treatment guidelines (Tgs) are the medical

resource documents that guide paramedic treatment

in the province of BC. Tgs are a combination of best

practice and evidenced-based medicine designed to

support paramedics in making informed decisions in

the field.

As scope of practice increases, the Tgs represent an

innovative way of thinking, using a principles based

approach, to guide paramedics in their decisions

providing the best, most appropriate care for

their patients. The Tg philosophy is based on the

fundamental principle that patients will be transported

to hospital and treated if necessary. it also is expected

that pre-hospital care occurs within a framework of

medical oversight and that there is an open dialogue

between the clinical leaders in our organization and

paramedics.

in 2011/12, the Tgs underwent a complete

reformatting in an effort improve navigability and

usability for paramedics and several new protocols

were added. The first public iteration was produced

and published on www.bcas.ca. Medical Programs also

worked to make the Tgs available as a web application

for mobile devices setting the stage for

www.BCTg.bcas.ca to be completed.

Clinical Education

in 2011/12, the EHSC Clinical Education department

developed and delivered a number of courses to

enhance paramedic practice in British Columbia:

• Domestic violence Recognition for Paramedics

course, developed for Toronto EMS by Sunnybrook

Hospital, was provided to BCAS paramedics.

The online course focused on best approaches

specifically for paramedics as they come upon a

potential domestic violence situation.

• A new course was created to inform paramedics

about changes to legislation regarding advanced

care directives and patient’s rights related to

confidentiality and informed consent. This course

uses ambulance call scenarios to discuss the

policies and practices that support professional

paramedic practice and comply with the recent

Medical Programs M


changes including patient privacy, rights of refusal,

protecting children and vulnerable adults and

patients in custody.

The department also completed the first phase of the

paramedic profiling project which will help support

recruitment and ongoing training. The initial phase

focused on identifying key attributes of successful

paramedics at the PCP and ACP license levels. Better

understanding of these attributes will contribute to

improving paramedic selection as well as focusing

paramedic education.

Clinical Education also adopted a core competency

education model for paramedics that address the basic,

life-threatening incidents faced by paramedics in the

field: trauma, pediatric emergencies, cardiopulmonary

arrest and airway emergencies. These ‘four Pillars’ of

maintenance of competency education are addressed

through delivery of internationally-recognized

certification courses. Three of the four courses, Cardio

Pulmonary Resuscitation, Pediatric Emergencies for

Pre-Hospital Professionals, and Airway interventions

and Management in Emergencies, were delivered

previously.

in 2010/11, Clinical Education completed procurement

of the fourth and final course, international Trauma Life

Support (iTLS) and initiated the process to become a

Chapter of the iTLS, a global organization dedicated

to preventing death and disability from trauma

through education and emergency trauma care. iTLS

is accepted internationally as the standard training

course for pre-hospital trauma. These four courses

represent the global standard in emergency pre-

hospital care and provide certification upon successful

completion.

The EHSC courses will rotate every two years ensuring

the maintenance of an accepted standard of care

for these major life threatening challenges faced by

paramedics in the field.

Clinical Education also initiated a pilot program to

explore the use of simulations in rural education

programs. This program focused on small group

simulations coupled with physician feedback and

discussion. As a result of this program, an ongoing

simulation strategy is being created. Developed

by ACP paramedics for ACP paramedics, with the

participation of physicians as instructors and mentors

and ACP simulator operators, advanced care simulation

continuing education sessions were held in the ACP

centres across B.C.

Resuscitation Outcomes Consortium

The Resuscitation Outcomes Consortium (ROC) is a

clinical trial network focusing on research in the area

of pre-hospital cardiopulmonary arrest and severe

traumatic injury. Other EMS agencies from across

North America are working with ROC to complete

clinical trials for pre-hospital cardiopulmonary arrest

and severe traumatic injury. ROC is the first large-scale

effort to conduct clinical trials that focus on the very

early delivery of interventions by EMS teams to better

optimize patient survival.

The ROC office provides BCAS with the infrastructure

and project support for clinical trials and other outcome-

oriented research that will rapidly lead to evidence-

based change to enhance clinical practice. Together,

BCAS and the ROC office are conducting clinical trials

that focus on the very early delivery of interventions by

EMS teams to better optimize patient survival.

in 2011/12, the EHSC was involved in two clinical trials.

One of these trials compares the Continuous Chest

Compression (CCC) to 30:2 (compression to ventilation

ratio) CPR methods to determine which specific form

improves patient outcomes. if CCC CPR improves

survival compared to 30:2, then paramedics will be able

to follow a much simpler treatment. Paramedics in all

metropolitan areas are participating in this study.

for trauma patients, there are no valid and reliable

clinical indicators in the pre-hospital setting that help

identify which injured patients require rapid surgical

interventions or resuscitation. Bio Lactate in Shock

Trauma (BLAST) is a simple study intended to determine

if blood lactate readings taken in the pre-hospital

setting predict the need for in hospital interventions.

BLAST is the second clinical trial involving EHSC.

Data collected through the research partnership

between the ROC and EHSC has resulted in 11


publications in peer reviewed journals, including

publications in the New England Journal of Medicine.

EHSC investigators continue to be actively involved in

publishing research in top tier medical journals.

EHSC also partners with academics and graduate

students throughout British Columbia. During 2011/12,

seven such research partnerships were completed or

ongoing. These studies involved such diverse topics as

cardiovascular health risks associated with paramedic

occupational exposures, workplace stress and coping,

out of hospital midwifery practice, and studies of the

perceptions of patient safety among paramedics.

First Responder Program

first Responders (fRs) are an important part of pre-

hospital care in B.C.; they provide basic first aid such

as control of potentially fatal bleeding, CPR and

AED in conjunction with BCAS paramedics. in small

communities, volunteer fire fighters most often provide

fR services; in medium and large communities, career

fire fighters most often provide fR services for the

public. Participation in the fR program is voluntary.

The EHSC oversees the fR Program in British Columbia

and is responsible for ensuring all participants in

the program have signed consent agreements and

stay within the scope of practice of fRs. There are

approximately 6,500 fRs in B.C. and each holds an

Emergency Medical Assistant – first Responder (EMA-

fR) license issued by the provincial Emergency Medical

Assistants Licensing Board.



eAmbulance

The eAmbulance concept began with a vision in

2010 to create a ‘mobile communications unit’ by

incorporating updated medical technology supported

by a secure wireless network in ambulances and

stations throughout the province. The eAmbulance

system enables immediate and secure transmission

of dispatch information to paramedics enroute to a

call and patient care information from paramedics to

health authorities while enroute to hospital. There are

three essential components of the eAmbulance system.

In-Vehicle Gateway (IVG)

ivg provides secure mobile network connectivity that

can be used by multiple ambulance-based systems by

establishing:

• a secure Local Area Network (LAN) that connects

devices within and around an ambulance using

Ethernet or Wi-fi,

• a secure Wide Area Network (WAN) connectivity

to provincial networks using cellular network

technology while the ambulance is in motion,

• Wi-fi connectivity while the ambulance is at the

station, and

• gPS coordinates for dissemination to local and

remote devices.

ivg allows BCAS to utilize communications technology

that isn’t dependent on any one commercial cellular

carrier, uses multiple wireless and cellular technology

solutions and is scalable for easy readability on

mobile devices. ivg enables connections to a variety

of electronic devices including in-vehicle computers,

portable computer/tablet devices and medical devices

such as ECg monitors. ivg is being deployed in 2012/13

to support the MobileCAD and ePCR systems (below).

Mobile Computer Aided Dispatch (MobileCAD)

MobileCAD is a computer in the cab of BCAS

ambulances that connects with the CAD system in

all three BCAS dispatch centres. MobileCAD allows

paramedics in the ambulance to receive pre-hospital

event assignments and updates from dispatch and

send back status code updates to dispatch in real

time via a touch-screen computer. in addition to event

information, MobileCAD also provides paramedics

with maps and routing information. MobileCAD

communicates with the CAD via the ivg network.

Phase one of the Mobile CAD implementation

was complete in 2011/12 with installation in 258

ambulances.

implementation in remaining ambulances is planned

for 2012/13 and 2013/14.


Many benefits are already being realized from the

implementation of MobileCAD, such as:

• improved timeliness and quality of 9-1-1 event

information for both paramedics and dispatchers;

• improved presentation of event-related data;

• up-to-date map and routing information available

and;

• Reduced radio traffic – radio traffic in the Lower

Mainland has been reduced by 65 per cent.

ePCR

Electronic Patient Care Record (ePCR) system replaces

BCAS’s current paper-based electronic PCRs which are

completed following each call paramedics respond

to and scanned into the database at the ambulance

station. This is a significant step towards replacing

the manual Patient Care Report documentation and

beginning the electronic health record. Paramedics will

use 460 hand-held devices to complete and upload the

ePCRs remotely.

When the ePCR system is implemented in fall 2013,

paramedics will be able to collect and input data into

the ePCR system in real time and upload the patient’s

information for staff to use in the hospitals through

the provincial eHealth viewer. Each of BCAS’s 460

ePCR devices will be equipped with Bluetooth and

Wifi, camera, bar code reader, magnetic strip reader

for gathering driver licence and care card information

directly and a LifePak adapter enabling uploads of

patient defibrillator data. ePCR ambulance network

capability and safe stowage for ePCR will be installed

for use in ground and air ambulances by June 2013.

for ePCR, the benefits are patient-care focussed; when

implemented, sharing patient information between

health care providers and BCAS will be secure, seamless

and timely:

• Receiving hospitals will have up-to-date care

information, such as vital signs, medicines and

procedures administered when a patient handover

to emergency department occurs,

• BCAS will be able to accurately report on patient

care allowing trends to be identified and finding

opportunities to enhance patient care; and,

• Realize increased operational efficiency and

security due to less typing and no manual

scanning.

implementation of all in-vehicle technology requires

coordination of many logistics including technology

installations, training of 3,600 staff and excellent

internal communication to ensure that the ambulance

service operations is not negatively impacted.


facility and Station improvements

The EHSC is in the midst of a multi-year strategy

to improve ambulance stations and other facilities

throughout the province. in 2011/12, the EHSC spent

$7.9 million on the following projects:

• undertaking maintenance and repair work,

heating, ventilation and air conditioning upgrades

and replacing of broken or worn-out furniture at

160 stations ($6.1 million); and

• constructing new stations in Winlaw, on Quadra,

Denman and Saltspring islands and significantly

renovating the Rutland station in Kelowna ($1.8

million).

in 2012/13, the EHSC facilities Department will be

focussed on:

• completing HvAC upgrades in the remaining

facilities;

• finding and constructing new facilities or

renovating existing facilities for stations in

Southside/grassy Plains, North vancouver,

Coquitlam, West Shore, fernie, Riondel, Bowser,

victoria, vancouver island and Kamloops dispatch

centres, vancouver administrative office, and

Saanichton provincial head office;

• planning for new stations in Richmond, Oceanside,

New Westminster and Burnaby; and

• sourcing district manager offices in areas

throughout the province.

BCAS is continuing a relatively new initiative of

utilizing modular structures for the construction of

new ambulance stations in a cost-effective approach to

providing quality crew quarters. A modular structure,

such as the one in Winlaw, is approximately one third

of the cost to construct versus the cost of a purpose-

built ambulance station such as one recently built

in Revelstoke. This ongoing commitment directly

impacts the patients who are served by BCAS and the

paramedics who provide this care on a daily basis.


Organizational Challenges

Problem STRATEGY

Increasing paramedic workload, particularly in the Lower Mainland

Strategic hiring practices, engaging community leaders and expanding paramedic roles in the community health

care system

Strategic hiring practices, public education about the important role of dispatchers within the pre-hospital system and engagement of social media, partnering with

local governments

Recruitment in remote communities

Recruitment in dispatch centres

There are several ongoing challenges that the EHSC and BCAS are working to address:


The 2011/12 budget for EHSC was $317 million.

Of this amount, the majority ($242 million) related to

BCAS as follows:

• Lower Mainland ground Operations: $77.9 million

• Other ground Operations: $88.8 million

• Provincial Programs: $73.4 million

• Service Delivery (Dispatch): $20.3 million

• BCAS estimated revenue recoveries from inter-

facility transfers at $21.8 million

Other major EHSC program budgets include:

• BC Bedline: $2.5 million

• Trauma Services BC: $2 million

• Medical Oversight and Clinical Education: $5.1

million

Budget




Ground Ambulance

BCAS responds to patients using two main types of

pre-hospital emergency medical service: Basic Life

Support (BLS) and Advanced Life Support (ALS). The

most common ambulance service provided by BCAS

is BLS; these paramedic crews are responsible for

providing care for medical emergencies and traumatic

injuries and are composed of Emergency Medical

Responders (EMRs) and Primary Care Paramedics

(PCPs). BCAS employs some EMRs on an on-call, part-

time basis but the majority of paramedics working

across B.C. are employed as PCPs - working in both

full-time and part-time positions in rural and larger

communities.

When more advanced care is required, BLS paramedic

crews can be supported by ALS paramedic crews. ALS

ambulances are staffed by Advanced Care Paramedics

(ACPs) who receive additional training which enables

them to perform more advanced emergency care

procedures and a higher level of patient care.

Service Delivery

BCAS’s Service Delivery program assesses, prioritizes

and coordinates ground ambulance responses from

three separate but integrated dispatch centres in

Kamloops, victoria and vancouver. Service Delivery

also incorporates dispatch training, development and

quality improvement areas. Together, the three centres

dispatched ground ambulances to 486,000 events in

2011/12 throughout the province.

When a request for service is received, Service Delivery

ensures that there is a timely, efficient and appropriate

response of ambulances, paramedics and other

resources to emergency calls. The centres are also

responsible for ensuring appropriate resources are

allocated and maintaining operational readiness for all

areas of B.C.

On April 11, 2012 the BCAS Patient Transport

Coordination Centre (PTCC) was established; prior to

this the three dispatch centres operated independently

when coordinating inter-facility patient transfers

and air coordination was managed by a Provincial

Air Ambulance Coordination Centre (PAACC) which

worked independently of the other dispatch centres

in managing air and critical care coordination for the

province.

The PTCC was created to allow a central coordination

centre to handle all requests, both ground and

air, for transfers. At the PTCC, each call taker’s

sole responsibility is coordinating inter-facility

patient transfers; the staff are able to fully focus

BCAS Services


on the complexities of coordinating inter-facility

transfers within the geographical challenges of B.C.

Consolidating this business area allows for focus and

efficiencies in inter-facility transfers while allowing the

ground ambulance 9-1-1 dispatchers to focus on the

critical pre-hospital emergency calls.

The PTCC has improved coordination between BCAS

and BC Bedline, improving operational efficiencies. in

the future, the Patient Transfer Network will be located

alongside the PTCC to further enhance the provincial

inter-facility patient transfer service and provide

improved support for the health care system and

patients. BCAS’s inter-facility patient transfer service

complements a number of other patient transfer

operations used by health authorities to provide non-

medical patient transfers for stable patients who do

not require the skills of a paramedic during transport.

Provincially, BCAS’s dispatch centres manage, on

average, three million telephone calls a year.


Statistics486,000 ground events throughout the province 394,000 pre-hospital (9-1-1) events92,000 inter-facility patient transfers


Pre-hospital events include all calls for pre-hospital care – both low acuity and high acuity – ‘lights and siren’ emergencies and ‘routine’ calls.

Approximately 1/3 of BCAS’s calls are high acuity lights and siren 9-1-1 calls, 1/3 are low acuity routine calls and 1/3 are inter-facility patient transfers.

Historical Provincial Event volumes


in 2011/12, BCAS operated from 184 ambulance

stations plus additional facilities:

• Provincial headquarters in victoria

• Three Dispatch Operations Centers (victoria,

vancouver and Kamloops)

• four Administrative Offices (victoria, vancouver,

Kamloops, and Prince george)

• 10 local offices for District Managers (Campbell

River, Castlegar, Chilliwack, Cranbrook, Dawson

Creek, Kelowna, Parksville, Smithers, Kelowna

airport and vancouver airport).

Station Designation

BCAS ambulance stations are classified as

metropolitan, urban, rural or remote. Station

classification is dependent on call volumes, geography,

remoteness, proximity to other ambulance stations and

health authority designation of facilities that are in the

area.

Thirty-six metropolitan stations are staffed 24 hours

per day by full-time paramedic crews.

Thirty-five urban stations are also staffed 24 hours

a day using a combination of full-time staff and

paramedics working standby shifts.

forty-eight rural stations are staffed using a stand-by

model, where paramedics are paid a reduced rate to

stand-by at the station ready to respond. When they

respond to a call, they are paid their full hourly wage

for three hours.

Sixty-five remote stations are staffed similar to

volunteer fire departments where paramedics are

called to respond by pager from the community.

When on-call, paramedics receive a stipend to be

available and their full hourly rate for four hours when

responding to a call.

BCAS Fleet

BCAS utilizes ground ambulances, supervisory support

vehicles and a fleet of gators and bicycles to respond

to events across B.C. in 2011/12, BCAS added 22 ground

ambulances to the fleet as medical support units for

major incident responses, gators for special event

response and training vehicles.

BCAS Stations



Critical Care Transport Program

BCAS utilizes Critical Care Transport (CCT) paramedics

to provide highly-specialized emergency care and

long-distance transport between health facilities for

critically ill or injured patients. BCAS is one of only

two ambulance services in Canada utilizing critical

care paramedics. The CCT Program in B.C. essentially

brings an intensive care unit to the patient and allows

physicians and nurses to remain in their local hospitals.

in this model, highly-trained paramedics with

specialized equipment and knowledge of the various

transport environments, provide safe, effective and

efficient patient transfer services. CCT paramedics

perform advanced medical interventions and work

with sophisticated monitoring and ventilation

equipment while enroute. The CCT program also relies

on the expertise of critical care (physician) transport

advisors for its functional medical oversight process.

Paramedics in BCAS’s CCT program work in

specially-configured ambulances and utilize six

dedicated airplanes, four helicopters and can call on

approximately 40 pre-qualified charter aircraft across

the province when required. Critical care paramedics

are deployed from air bases and stations in Prince

george, Richmond, Kelowna and Kamloops, Nanaimo,

Langley and vancouver; the team based in Langley

was added in 2012, the Nanaimo-based team was

added in 2011. Requests for fixed and rotary-wing air

ambulance, neonatal, maternal and paediatric transfer

services are processed through the Patient Transfer

Coordination Centre based in vancouver.

BCAS has two distinct protocols in place to ensure that

aircraft are deployed and available when required to

respond to a patient with an acute illness or injury.

Autolaunch is the simultaneous dispatch of both

ground and air ambulances for specific emergency

situations based on information provided from the

scene by 9-1-1 callers. This protocol helps ensure that

patients with life-threatening injuries are transported

to a trauma centre as quickly as possible.

The Early fixed-Wing Activation Program enables

responding paramedics at the scene to determine if

the patient may need to be airlifted to an acute care

hospital. They will activate the critical care transport

(CCT) paramedics and aircraft to begin preparing for

the emergency flight right away. Previously, only a

hospital physician would have been able to activate

the CCT team.

Program Overview and Highlights


Infant Transport Team

BCAS’s infant Transport Team (iTT) paramedics

provide emergency medical care to B.C. paediatric,

neo-natal and high-risk obstetrics patients while

en-route to specialized care units in hospitals.

Based at BC Children’s Hospital, these specialized

paramedics are required to complete a specific training

program focussing on providing care to children,

and the advanced skills specific to those patients.

iTT paramedics liaise with specialist physicians who

provide support and guidance.

Special Operations

in 1992, BCAS was one of the first North American

Emergency Medical Services agencies to organize

and deploy a Special Operations team of paramedics

on bicycles for major public events where crowds

can limit access and speed of response for normal

ambulance vehicles. The primary objective of BCAS’s

Special Operations is to provide rapid response care

through congested areas allowing paramedics to arrive

at the patient’s side faster than a traditional ambulance

vehicle.

BCAS’s paramedic bike squads are also supplemented

by two gators purchased to support ambulance

coverage during peak crowd times. gators are

specialized all terrain vehicles that are used to

transport patients from on scene to the ambulance,

in situations where the ambulance is unable to reach

the patient due to ground conditions. The bike squad

and gators also provide contracted paramedic services

at major public and international events, professional

sporting events, movie sets and community fairs when

not otherwise needed.

Emergency Management

BCAS actively participates in emergency planning,

mock disaster exercises and other joint training

initiatives with other emergency management

organizations to ensure disaster preparedness and

response capabilities are identified and deployed

quickly and effectively when they are needed most.

To ensure paramedics are prepared to respond to

and recover from major emergencies, BCAS is a

strategic partner with the Province-wide Emergency

Management Office (EMO).

Based in vancouver, the EMO provides provincial

oversight and direction in the planning of multi-

casualty incidents, major emergency situations that

involve multiple patients at one scene. The team also

provides guidance in the areas of hazard recognition

and risk assessment by identifying and documenting

the hazards that pose the greatest threat at the

station, regional and provincial levels and developing

strategies to manage these risks. in addition, the EMO

provides direction and advice regarding major incident

support and hazardous substance and Chemical,

Biological, Radiological, Nuclear and Explosive

response.

Public Outreach

Vital Link and Good Samaritan Award Program

Support provided by quick-thinking members of the

public can often mean the difference between life

and death for patients. Whether performing bystander

CPR, providing critical information to dispatchers or

assisting paramedics on scene, British Columbians

are an important link in the health care system. To

recognize the significant contributions made by

citizens during medical emergencies, BCAS supports

two community award programs: the vital Link Award

and the good Samaritan Award. The vital Link Award

is presented to citizens who are involved in saving a

Air Ambulance Call Volume


life through successful cardio-pulmonary resuscitation

(CPR) efforts. The good Samaritan Award is presented

to individuals who have provided unselfish and

humanitarian assistance during a medical emergency.

it is BCAS’s hope that by recognizing contributions

and reinforcing the importance of bystander support,

similar behaviour will be encouraged.

ACT High School CPR Program

Cardiovascular disease is the second leading cause of

death in B.C., accounting for more than one-fifth of all

deaths in the province. Since 2005, BCAS has worked

in partnership with the ACT foundation to ensure that

students in B.C. are becoming well-versed in this life-

saving skill through the ACT High School CPR Program.

Through this partnership, over 40,000 high school

students in British Columbia receive training in CPR

each year. Research shows that a cardiac arrest victim is

four times more likely to survive if CPR is administered

by a bystander while paramedics are enroute to

the scene. With most out-of-hospital cardiac arrests

occurring at home, early recognition of a cardiac

emergency by a family member, early access to medical

help (calling 9-1-1) and early citizen CPR are critical to

saving lives.

P.A.R.T.Y. Program

Together with local partners, BCAS is helping to

educate B.C. youth about how to stay safe through the

P.A.R.T.Y. Program (Prevent Alcohol and Risk-Related

Trauma in Youth). P.A.R.T.Y. is a one-day, in-hospital,

injury awareness and prevention program designed

to reduce death and injury due to alcohol, drug and

risk-related behaviours. Open to students ages 16 and

older, participants follow the path of a trauma patient

from the time of injury until discharged from hospital.

During these sessions, paramedics hold a mock-crash

demonstration and describe in detail the process they

go through when they attend a serious motor vehicle

collision. The program is structured to bring them face

to face with the consequences of risky behaviour.


Community Support

Many paramedics throughout B.C. play prominent roles

in their communities by volunteering and fundraising

for many non-profit and charitable organizations,

participating in blood and food drives, travelling

to other countries for disaster relief support, 9/11

memorials and coaching sport teams.

Partnerships

Shuswap Lake – BCAS responds to many calls in the

summer due to the popularity of houseboats in the

summer. Working with the volunteer society, Coast

guard Auxiliary, Emergency Management BC and the

Columbia-Shuswap Regional District, BCAS is part of a

multi-agency partnership that greatly increases public

safety and emergency patient care.

Heavy urban Search and Rescue Teams – BCAS is

included in a vancouver-based team that locates

people entrapped following a disaster. HuSAR includes

search, medical and structural assessment capacity.

integrated Tactical Safety unit – Based in vancouver

and developed along England’s model of tending

to patients in a soccer riot, the vancouver Police

Department officers work their way through a crowded

event to form a line and create a safe workspace for

BCAS paramedics to attend to patients. Patients are

then rushed from the scene to a staging area that

ambulances and gators could access and then to

hospital.

Fees

BCAS fees are heavily subsidized for persons with

a valid BC Care Card and who are covered by the

provincial Medical Services Plan (MSP). The ambulance

service fee for MSP beneficiaries is $80. fees are not

an insured benefit under MSP or the Canada Health

Act. further information on ambulance fees in B.C. is

available at www.bcas.ca.


Trauma Services BCA program of the Provincial Health Services Authority

Annual Report 2011/12 - BCEHS · 2015. 3. 31. · 6 EHSC Annual Report 2011/12 BC Bedline (BCBL) is a 24/7 provincial service that works with hospital physicians to ensure the timely

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