The misallocation of Nova Scotia ambulances

Once again Nova Scotia’s ambulance service is in the headlines. This time a widow is questioning whether the response time – which appears non-existent – contributed to her husband’s death.

Problems with our ambulance system are an on-going issue which health executives have consistently failed to resolve.

In the fourth quarter of 2011-12 the former Capital District Health Authority reported taking 144 minutes to off-load patients from ambulances instead of meeting the 20-minute provincial requirement. Capital Health promised then Health Minister Maureen MacDonald to improve performance by 10 percent per quarter. Capital Health’s self-imposed deadline gave them until September 2015 to meet the provincial requirement.

On March 21, 2019, when ambulance line-ups outside Halifax hospitals dominated the headlines I asked Minister Delorey who in his department monitored Capital Health’s progress and if the Halifax hospitals ever met their self-imposed targets. Neither the Minister or anyone in his department responded.

The Minister has called for a review of the circumstances which caused this recent death. But what is the point if no one is held accountable and nothing changes?

The availability of the emergency services is impaired by our misallocation of assets. A great percentage of the calls EHS ambulances and paramedic teams make are non-emergencies. EHS are operating an expensive taxi service, transporting patients between medical facilities as well as residents of nursing homes and long-term care facilities to and from hospital.

Patients moving between hospitals need the safety and security of medical expertise provided by paramedics. However, most long-term care residents don’t. They may need to go to hospital for a treatment, appointment, procedure or medical test, like an x-ray. These are necessary trips, but no more of a medical emergency than that of the person who drives themselves to hospital for similar reasons. The reason an ambulance is used is either due to physical impediment (like being bed-ridden or confined to a wheelchair which can’t fit in a regular vehicle), lack of alternative transportation or a fear of litigation.

The Department of Health and the NSHA seem populated with people fixated on ‘what if’ scenarios. What if the resident needs help while being transported? Well, what if there is a real medical emergency and there are no ambulances and paramedics available? That seems to have been the situation this week.

At a March meeting about changes to the Valley Regional Hospital’s ER in Kentville, I asked the ER manager how many patients arriving by ambulance are emergencies. He said, “Anecdotally – and I don’t want to be held to this number – 50 percent of ambulance deliveries are an emergency.”

That means 50 percent aren’t an emergency.

Nova Scotia has 180 ambulances based across the province. Terry Chapman, business manager for local 727 with the International Union of Operating Engineers, which represent paramedics, says the employer’s data shows 162 ambulances are available each day. According to data compiled by Andy Muise, Project Coordinator, EHS Ambulance Operations Management, the service received 182,452 calls in 2018. Of these, 72,933 calls, or 40 percent of volume, fell under their urgent-need/emergency call breakdown.

So the bulk of ambulance and paramedic time is devoted to medical transportation.

NSHA and the Department of Health will tell us that scheduling ambulances are a complicated operation. It may be, but where is the proof anyone has moved on the problem?

According to someone familiar with the ambulance industry, most of the world has one ambulance per 8,000 people. Nova Scotia, because of our geography, has one ambulance per 7,000 people. HOWEVER, my source says, “Unfortunately as our population ages more long term beds are required and the lack of these resources in the rural areas force more transfers toward Halifax and make the pile up worse.”

“The wait time to unload is not an ambulance problem. It is the result of not having any place for the patients in the hospital so they pile up in emergency causing a backlog.”

Those transfer pile ups are also growing at regional health centres, like Kentville, where the bulk of hospital patients seem to be waiting for alternative accommodation.

After the Kentville update on ER improvements an ER nurse, stopped in the parking lot to scream, “We’re working in chaos in EVERY shift! Why aren’t we using former hospitals in Berwick and Wolfville for bed space!?!”

Hers is a valid question. Those former hospitals are mostly occupied by government offices, like school boards, which could easily relocate to other buildings. We should do a quick inventory to identify all empty or underused provincial property to see what could wiftly be rehabbed into long-care facilities.

For example, the former Colchester Regional Hospital inTruro has been vacant for five years. A former minister told me the building has asbestos. Well, it had asbestos when it was a hospital. Government House had asbestos and we found $8 million to remove it and make necessary structural changes. Whether the former Truro hospital is to be sold or demolished, the asbestos will require an expensive removal and disposal process. Using the example set by buildings of similar square footage, like St. Pat’s High School in Halifax, the cost of demolition would be in excess of $3.5 million. How much could that go to making the building useful again? Why not bring it up to code and offer a sweetheart deal to a proven nursing home operator as an incentive to add 150 new long-term beds to inventory?

As for freeing up ambulances so they are ready for real emergencies, why not invest in local services like Kings Point-to-Point Transit, which services those with mobility issues. To mitigate liability and provide patient support, make an CNA or LPN available to travel on non-emergency transfers and supervise the hospital handover. That’s a cheaper alternative to using a paramedic team and ambulance.

My industry advisor says, “The problem we have is not the ambulances. In my view our problem is the management and structure. We should consider “farming out” the management to someone like the CEO of a corporation and apply basic business principles to the problem(s). Now we have a health system run by government using the only tool they know: throw more people and more money at the problem.”

All more money and people have done is buy time for those in charge. It’s time for new service-oriented thinkers, with clear performance targets to meet, to take charge.

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5 Responses to The misallocation of Nova Scotia ambulances

  1. John Whalley says:

    Excellent Article!

    I don’t think there was mention of Non Emergency Ambulance Service that I have seen in Halifax indicated by signage on the side of these vehicles. How is this managed?

    If I understand correctly. Nova Scotia Government Sets the criteria for what they want for ambulance services. All ground ambulance and air ambulance service in Nova Scotia is contracted by EHS to Emergency Medical Care Inc. (EMC), a subsidiary of Blue Cross Medavie Health Services. EHS is responsible for administering the contract for Nova Scotia’s pre-hospital emergency health services.

    Maybe a look at EMCs performance. Maybe time to look at other Ambulance Management Providers

    Retired Toronto Paramedic Operations & Communication Management Team Member

  2. buddyboy546 says:

    What a persuasive piece. We are fortunate to have the benefit of the writer’s knowledge and experience around health care to profile the problems and suggested solutions. The current government has amply demonstrated a lack of ability to address problems such as we currently have with health care. Other good examples are the non-ferry out of Yarmouth literally spending multi-millions with zero return and the massively expensive twinning of Highway 103 while other roads literally crumble away. The problem is with leadership; the solution will be change of leadership.

    Keep up the great work, Allan.

    • My focus is a change in health care leadership. I don’t think there is any political alternative. When the Tories were in we hoped that having a doctor premier would fix things and we came to disparage his government.

      When the NDP were in office we expected big things and compassion from them – that was a big failure. Hospital workers went on strike, albeit for about two hours in the middle of the night, but it threw off treatments, surgeries and the delivery of care for six months. The paramedics almost went on strike. Nurses were in a position to strike. As a family member for a serious needs patient, I found the NDP as bureaucratic and insufferable as any other government.

      The Advocates for the Care of the Elderly, ACE, wrote the NDP health minister that he was the worst minister in the history of the province! That was in a formal letter to him!

      We have expected too much from politicians and not enough from health care executives who guide the decisions politicians made and oversee the day-to-day operations.

  3. Bill Swan says:

    EHS is already “farmed out” to the private sector, where one would presume “basic business principles” are already in use. Evidently badly. http://www.emci.ca/Pages/home.aspx

    • I believe what the person who made that comment meant was to bring in outside experience and ideas. Health care executives simply keep shifting people with the same background and perspective between jobs. They have the same backgrounds, education and connections/relationships so think more of how they function than how the system functions to service those who need it.

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