The province’s ambulance response problems go far beyond spiking emergency calls, says a new report from the Parkland Institute.
“The current crisis was not simply the result of increased call volumes due to the pandemic,” says medical sociologist Michael Corman, whose report calls that a simplistic view. “The pandemic just exposed the weak foundation of a system that has been teetering on the edge for some time.”
Alberta Health Services has in the past frequently cited higher-than-normal volumes of seriously ill patients, the continued impact of COVID-19, and increased staff absences due to illness as contributing to the pressure on EMS and the health-care system in general.
Corman says paramedics point to the erosion of key work processes central to being a competent paramedic as among the problems.
“This was in large part brought on by a system that focused exclusively on efficiency, on the idea of ‘doing more with less’,” says Corman.
At the same time, some of the policies and practices adopted resulted in a lowering of standards and a toxic work environment that made providing good care nearly impossible, the report says.
Corman is the author of “Lights and Sirens: The Critical Condition of EMS in Alberta” a report issued by the Parkland Institute on Tuesday. The 69-page report based on interviews with 29 people, including 27 paramedics, examines the current crisis facing paramedics in the province.
In a news conference on Wednesday, Health Sciences Association of Alberta (HSAA) president Mike Parker said the report validates what the organization representing 30,000 health professionals has been saying for some time.
“We are concerned about the over-simplification of the crisis in health care and these proposed solutions,” he said.
HSAA wants to see response times measured “call to door” to better reflect the patient experience. AHS calculates response times when an ambulance was dispatched. But that does not account for the time the call for help was in the queue, sometimes for hours, said Parker.
The association also wants to see numbers released on unfilled shifts and dropped ambulances (ambulances that did not have the staff to operate).
He called on the government to show proof that working conditions are improving. “Decreased injury rates would be a good start.”
While the province says it has added 19 new ambulances, there is not enough staff to run them, he said. “We do not have enough paramedics and emergency communications officers to staff the shifts are already funded.”
The level of serious injuries is at an unacceptable level he said, adding 28 per cent of EMS workers suffered a serious injury last year.
“Under-staffing and unsustainable workloads are creating the conditions where EMS workers are at high risk of psychological and physical injury.”
Parked called on AHS to improve working conditions to keep the paramedics now on staff and actively recruit additional help. He also said call volumes need to be reduced by tackling the opioid crisis through harm reduction services, “instead of a misguided abstinence-only approach.”
Paramedic burnout has led to a spike in the amount of times they have called in sick, says the report.
According to the report, in the 2022 fiscal year, there were 264,806 hours of sick time logged by EMS staff, up from 222,519 a year earlier and 192,626 in 2020.
In Central Zone, sick time soared 88 per cent to 22,645 hours in 2022 from 12,024 hours the year before.
“Sick time in 2022 represents a loss of over 22,000 12-hour paramedic shifts,” says Corman. Recent Workers’ Compensation Board stats also point to an “alarming increase” in disabling injuries among paramedics in the province.
Corman drafted a set of 15 recommendations that address much-needed EMS-specific changes but also changes more geared toward “upstream medicine” and the social determinants of health.
“EMS doesn’t happen in a vacuum,” says Corman. Elements of the healthcare system such as home and community care, long-term care, and physician services all impact the need for EMS.
The EMS-specific changes proposed include, among others, developing an evidence-based plan to determine the resources needed; changing the data collection strategies that are used to inform the development of policies and system design; and making the non-traditional role of community paramedics a mainstay in Alberta.
Another key recommendation is to address the source of paramedic burnout through the adoption of the principles of a trauma-informed environment that centres on the mental and physical health of employees.