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A moral obligation

Sea to Sky ambulance service continues to face severe staffing challenges.

On Aug.14, an 84-year-old man in the Village of Ashcroft died of a heart attack while waiting for an ambulance, the second time in the span of a month that has happened in the small Interior village downstream from Kamloops Lake. This despite the fact the ambulance station was just metres away from where he collapsed, and the local hospital less than a kilometre away. 

The town’s paramedics were out on triage—meaning they were covering for a neighbouring area—roughly a 30-minute drive away. While Ashcroft has a hospital, it’s not uncommon for the emergency room to be closed on weekends due to doctor shortages. 

The resident’s death sent shockwaves across the province, raising the alarm once again on an emergency care system that is badly in need of repair.

In areas like the Sea to Sky, which has seen rapid population growth in recent years, the problem takes on an extra air of urgency: paramedic staffing has not kept pace with the growth in the general population, leading to mental health issues among paramedics, burnout, and a dangerous lack of ambulance coverage in many communities.

SURGING IN THE SEA TO SKY

Pemberton, Whistler and the surrounding Sea to Sky region are experiencing their own challenges accessing paramedics and ambulance services. 

So far in 2022, thanks in part to a rapidly rebounding tourism sector, the number of calls to the ambulance service has surged in Whistler and the corridor, on track to pass pre-pandemic numbers. 

According to British Columbia Emergency Health Services (BCEHS), paramedics in the Sea to Sky corridor responded to 3,280 patient events from Jan. 1 to Aug. 21. By community, the Pemberton area had 357 patient events, Squamish had 1,186, Whistler had 1,350 and Lions Bay had 387. 

The total number of BCEHS patient events in the Sea to Sky for all of 2021 was 4,568: Pemberton (607), Squamish (1,781), Whistler (1,537) and Lions Bay (643).

Province-wide, the volume of BCEHS calls typically increases annually by six per cent, with this number rising farther in faster-growing regions like the Sea to Sky, according to Troy Clifford, president of Ambulance Paramedics of BC, the union representing more than 4,500 paramedics and emergency dispatchers across the province. 

In the Sea to Sky, ambulance service has become increasingly stretched thin, with rising numbers of calls and transfers to the Lower Mainland, on top of existing on-call staffing challenges 

On some days, there is just one ambulance serving the entire corridor, from D’arcy to Lions Bay—a stretch of nearly 170 kilometres that takes more than two hours to drive, end to end.

“There’s been many days and nights recently where there’s been one designated car in each of the four Sea to Sky communities—so Lions Bay, Squamish, Whistler and Pemberton. If three of them are doing transfers down to the city, that leaves one car in the whole Sea to Sky,” says Pemberton paramedic and unit chief Kelly Budway. 

Budway notes the current health-care situation in Whistler and Pemberton has contributed to some of the issues facing ambulance service, as local medical facilities can’t commonly keep patients overnight, requiring transfers to the city. 

“Whistler and Pemberton have health-care centres that are not open 24 hours. They have on-call coverage at night. So they’re always available to you, but can’t keep patients overnight,” she explains.  

“If anyone comes in at any point during the day or night, that patient eventually has to go out, and if they’re discharged, that’s great, but if they have to go to higher care or even the same level of care, they have to be transported to the city. So that takes our resources out of the community.” 

In the event of a Code 3 “lights-and-sirens” call, “if we are the closest car to it, then we would be responding, and sometimes that could be anywhere,” Budway adds. 

“If we’re the only car in the Sea to Sky and there’s a car accident in Lions Bay, then we’re responding Code 3 an hour-and-a-half down the highway, and there is potential for that, and it happens.”

 DANGER DAYS

The problem is not new. Last summer, Sea to Sky paramedics spoke out against what they called “dangerous” staffing levels in the corridor.

“The staffing levels for the corridor have dropped to dangerous levels. Squamish is short 34 ambulances for July, Whistler is short 14, Pemberton is short 73 ambulances and has 140 unstaffed shifts. This would not be a problem if the B.C. Government would finally admit that no one wants to work for $2/hr [the rate for rural paramedics when they’re waiting for a call],” one paramedic told Pique at the time. 

And staffing shortages in one region can have a cascading effect on others. Due to staffing shortages in the Lower Mainland or in more rural locales like Lillooet, Sea to Sky paramedics can end up responding to numerous calls outside of their region, resulting in either no ambulance service in the Sea to Sky or substantially delayed service. 

Budway notes an instance just last month when a Pemberton crew had to respond to a major car accident in Lillooet.

“One of our crews went up and ended up transporting the patient to Kamloops, to their major trauma centre, and then they overnighted it in Kamloops,” she says. “That leaves our car out of the community for 24 hours.”

Clifford, the union president, says the best practice is to ensure those on-call paramedics made it back to their homebase as quickly as possible, “but it’s so short-staffed in the city, and we’re so under-resourced, that they get drawn into emergency calls there and it’s really hard to get out.” 

The current on-call model, which pays rural paramedics a paltry $2 an hour while on standby, is a major barrier to recruiting and retaining qualified staff. 

“The biggest challenge [for the Sea to Sky] is the same thing that’s going on across the province … and that’s the part-time, on-call model,” Clifford says. 

“The biggest problem we have is our ability to recruit into the profession because of that precarious wages and benefits model. We know the full-time model works, and we need additional full-time resources in the Sea to Sky corridor, which would help us ensure that we have adequate coverage. 

“Most of our on-call people have other jobs, and we’ve depleted those resources [to the point] that they just aren’t available to back-fill shifts or staff those additional ambulances.”

The added stress put on the system from a lack of staff has led to worsening mental health among B.C. paramedics, as post-traumatic stress disorder (PTSD) has become more frequent in the profession. 

“The psychological and mental health injuries are higher than ever. Thirty per cent of our members are either in treatment or off with psychological workplace injuries, and those are WorkSafeBC’s numbers,” Clifford says. 

“The injuries are coming as a result of insufficient resources, and the delays and the pressure on paramedics to go to back-to-back calls is causing more fatigue and stress.”  

The stress has been evident to Budway, who says she feels a moral obligation to work extra hours.

“When you’re living and working in your own community, you feel obligated to keep the car staffed, but at the same time, you need to have a work-life balance,” she says. 

“You need that time to decompress, de-stress, spend time with your family and your loved ones, and do things outside of work. But if a car goes down, you know that if something happens to one of your family members, there’s no one left to respond. So it is a big moral obligation there.”  

FINDING SOLUTIONS

Liberal MLA for the Sea to Sky Jordan Sturdy has a unique insight into ambulance issues in the corridor, having previously served as a paramedic for 25 years.

“What this corridor needs are some dedicated, additional resources. It needs another car in Squamish and another in Whistler, and certainly, you could do it seasonally, if need be,” he says.    

“Despite the growth in the corridor since just the last census—we are averaging 20-per-cent growth—there are no more resources here in Pemberton or the corridor.” 

Sturdy believes the changes made to the BC Ambulance Service under the NDP government have only shifted around positions instead of increasing the actual number of ambulances in the region. 

“There are no more on-call cars in the corridor, and you’ll hear Minister Adrian Dix talk about hiring [more] paramedics in the Sea to Sky … but all they did was shift their positions. They did not increase the number of cars. They did not increase the number of paramedics,” he adds.  

For its part, BCEHS says the Sea to Sky has seen more resources invested into the region of late, with more on the way. 

“With the Ministry of Health, BCEHS has made significant improvements to paramedic staffing, including in the Sea to Sky corridor,” BCEHS communications officer Cindy Leong said in an emailed statement. 

A planned shift to a scheduled on-call model in Pemberton was scrapped last summer after a small outcry, and replaced with a full-time, 24/7 “alpha” model.

The alpha model was implemented last fall, “which saw the addition of nine full-time paramedic positions,” Leong notes.  

“As part of the Rural, Remote, First Nations and Indigenous COVID-19 Response Framework (RRIF), three ambulances were added, one each in Squamish, Whistler and Pemberton, and in addition, two temporary advanced care paramedic positions were added to the Whistler station to serve the Sea to Sky area.

“Recognizing the great work these advanced care paramedics have contributed to the Sea to Sky area, these two advanced care paramedic positions were made permanent in June 2022, and they help support primary care paramedics in the region.”

The investments have contributed to a “more stable staffing situation” in the corridor, Leong says, adding that BCEHS continues to actively recruit across the province and throughout the Sea to Sky corridor.

For more information about potential careers at BCEHS, check out: bcehs.ca/joinus.