Ambulance waits under fire at UBCM 

In Whistler and beyond, communities rally for ambulance response review at annual convention

click to enlarge FILE PHOTO - Big Concerns The Lower Mainland Local Government Association is using the UBCM conference in Whistler to highlight the negative impacts of long ambulance response times.
  • File Photo
  • Big Concerns The Lower Mainland Local Government Association is using the UBCM conference in Whistler to highlight the negative impacts of long ambulance response times.

On a summer Saturday evening, in the heart of Whistler Village, a man lay at the entrance to a busy restaurant, suffering seizures and fading in and out of consciousness for a full 40 minutes before BC Ambulance arrived on scene.

"He lost consciousness multiple times during that time," said RCMP Sgt. Rob Knapton, adding that police, who were flagged down to provide assistance, were on scene at 9:45 p.m. and paramedics arrived at 10:25 p.m.

It is not clear if this incident was called in as a Code 3 — a top priority, lights-and-siren response.

But concern is growing in Whistler, and beyond, about ambulance wait times, as evidenced by resolutions at the Union of British Columbia Municipalities (UBCM) conference this week, which will likely serve as a lightning rod for the issue province-wide.

The pressing question in this corner of B.C., which is becoming increasingly busier from one end of the corridor to the other, is whether the ambulance service is keeping up with growing demand? The Aug. 9 incident is not an isolated one.

At 3 a.m. on Saturday, July 5, it took BC Ambulance 14 minutes to respond to a cyclist struck by a taxi in the village; he had a broken femur, two broken eye sockets, and bleeding on the brain as local firefighters waited anxiously by his side, rendered almost ineffectual by law.

This call came into ambulance dispatch at 2:33 a.m. Paramedics arrived at 2:47 a.m. The station is less than one kilometre away.

The 14-minute wait is almost double the eight-minute city standard elsewhere for urgent calls.

"Other ambulances in the area were assigned to other calls," said Kelsie Carwithen, manager of media relations with BC Emergency Health Services and BC Ambulance Service via email.

Further down the road in Squamish, Sue Lawther was walking her son's dogs on a rainy May evening on a residential road in the Highlands. She fell on the cement and broke her femur. Her yells alerted the neighbours, who called an ambulance.

"It was pouring rain. It was freezing cold," said Lawther, who lives in Whistler. "It was 22 minutes before the ambulance got there."

She was taken to Squamish General Hospital where she had to spend the night because there was no ambulance available to transport her to the city where she needed surgery.

"It was an incredible wake up call (about) the services that I took for granted because I lived in Canada, and thought that we had these services," said Lawther. " I don't think I would have anticipated waiting for 22 minutes in the pouring rain in the dark relying on my neighbours to try and get me through those 22 minutes before an ambulance came. I would have anticipated that help would have arrived much sooner.

"It was an eye-opener for everybody that it took so long for the ambulance to arrive."

Said Whistler Mayor Nancy Wilhelm-Morden's upon hearing of the incidents: "It's just not acceptable."

She's not alone in her concerns.

These same stories are playing out in communities across B.C., particularly in the last year after sweeping changes to ambulance responses.

It appears, however, to be coming to a head in Whistler at the upcoming UBCM convention (Sept. 22-26).

Several resolutions at UBCM this year are calling for change.

B.C. communities, large and small, urban and rural, are calling for the government to review its one-year-old Resource Allocation Plan (RAP) that has changed the way ambulances respond to calls, essentially downgrading Code 3 calls, "lights and sirens" calls to Code 2 for a full 39 types of calls. The change was implemented in part to help ambulances respond faster to the most urgent calls.

A third-party review of the RAP changes found that they are consistent with contemporary best practices nationally and internationally.

"The methodology has a strong foundation in robust clinical evidence of the actual medical needs of British Columbia's EMS patients, and is superior to the processes used in many major EMS systems," said Alan Craig in his external review report.

The reality on the ground, however, is reports of longer wait times for everyone else.

The fallout lands on the firefighters who rush to the scene to help, but cannot transport a patient.

The Lower Mainland Local Government Association Executive (LMLGA), which includes 33 local governments from Pemberton to Hope, including Whistler, is using UBCM to highlight the negative impact on response time and patient safety and is calling for the province to "develop an effective, well integrated, patient-centred emergency response service for our citizens provided by fire and rescue service and BC Ambulance Service working together."

Councillor Chuck Puchmayr, of New Westminster, is the president of the LMLGA executive.

He calls the government's roll out of the resource allocation plan "a red herring."

"They delays aren't because ambulances are moving at Code 2," said Puchmayr. "The delays are because there are just not enough paramedics."

He said there are even cases where people are calling taxis, or using alternative transportation, to get to the hospital.

Last winter in Whistler, firefighters responded to a call after an American tourist fell down several steps in the village, blowing out his knee, and suffering lacerations to his face.

After 35 minutes waiting for an ambulance, the visitor's family put their father into their own car and drove him to the health care centre.

Puchmayr calls these incidents "deplorable."

"We want them (the government) to come clean and just admit that they have a shortage of paramedics, and they have a backlog in emergency wards and that's why they're not able to dispatch ambulances," said Puchmayr. "It has nothing to do with whether to go on lights and sirens or not. It has everything to do with the fact that they just do not have the paramedics to go to the calls, and as a government they're obligated to do that."

The District of Squamish is spearheading its own resolution on the issue. It is highlighting that "the delayed response leaves an expectation that first responders will attend patients until the British Columbia Ambulance service arrives, which downloads an additional cost for pre-hospital medical care to the community."

Squamish is asking that the UBCM work with the province to develop a funding mechanism that will compensate local governments providing pre-hospital medical assistance through the first-responder program for the additional costs of delayed response by BCAS.

Squamish Mayor Rob Kirkham said the ambulance situation is something that Squamish has been experiencing for a while, particularly with the upgraded highway through town.

"It's one more downloading from other levels of government to us in delaying their response times," he said. "What ends up (happening), of course, is we're left picking up the slack with our firefighters having to be on site, and be on site for longer periods of time and therefore not being available for other concerns that come up in our community."

It has a rippling effect he said — more resources, more volunteers, more recruitment campaigns, more training.

"All of that comes at the expense of the District of Squamish."

Kirkham could not say just how much it has cost the DOS this past year.

"I'm delighted to hear about it (coming up on the UBCM agenda)," said Lawther, who praised the professionalism and the care from the paramedics who did help her.

Last year in Whistler, the average response time to urgent calls was 13.37 minutes. BCAS responded to 739 urgent calls.

During the ski season, there is an average 303 emergencies and transfers per month from Whistler. During July and August that drops to 219 per month with the shoulder seasons averaging 138 per month.

During the five-month period from Oct. 2012 to March 2013, an ambulance based in Pemberton performed calls in the Whistler area (including transfers to the city), an average of 21 times per month, and from Squamish in that time period, an average of five times per month.

The current configuration during the day is one full-time unit and one on-call unit. At night, there is one crew on standby in the station and one on-call crew.

"Call volumes and trends are reviewed on a regular basis," said Carwithen.

But with the resort breaking room night records month after month, there is escalating concern that there are not enough paramedics to serve the area, and that wait times are deepening.

"It really does seem like unilateral decisions have been made by the province without consultation and they're having a downloading effect on urban communities and are putting rural communities at risk," said Wilhelm-Morden. "The ambulance service is just calling out for a review."

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