A recent online survey of 150 paramedics and EMTs in Edmonton by their union, the Health Sciences Association of Alberta, exposed widespread issues with low morale and a lack of resources that could jeopardize patient safety. Among the findings:
- 86 percent of respondents said that during their previous four shifts, they had experienced a lack of resources, including no ambulances available for emergency calls, called a “red alert.”
- 72 percent said they could not meet their response-time targets three or more times during those shifts.
- 72 percent had calls that took more than one hour for them to respond to, with some EMS personnel reporting experiencing that as many as four times during their previous four shifts.
The survey, released in January, was conducted in an effort to get to the bottom of reports from Edmonton paramedics and EMTs about a lack of resources, says Kim Adonyi, communications officer for the Health Sciences Association of Alberta.
In 2009, control of Edmonton EMS was taken away from the city and turned over to a provincial authority, Alberta Health Services. “Because Alberta Health Services deals with the entire province’s health care workers, certain elements of EMS have fallen through the cracks,” Adonyi says. “One of the complaints is that the population of the city is getting larger, but the resources for EMS have not.”
According to the executive summary, respondents reported that, “The emergency ambulance service in the Edmonton metro zone is completely inadequate as it is and the vast majority of our respondents have raised their concerns to the attention of Alberta Health Services’ management but to no avail. We shouldn’t be surprised then that two-thirds of our respondents are seriously considering seeking employment elsewhere.”
Since the survey was released, Alberta Health Services has created a joint commission to investigate EMS workers’ claims and announced plans to hire more than 30 additional EMTs and paramedics and add stations and ambulances. The union is conducting a similar survey among all EMS workers throughout the province.
Sue Conroy, senior vice president for emergency medical services for the health authority, told the Edmonton Journal that she takes staff concerns seriously. Median response time in Edmonton is eight minutes, up from the 2009–2010 fiscal year, when it was seven minutes. “It shows we’ve got some challenges,” she said.
The Health Sciences Association of Alberta represents more than 2,350 EMS workers.
AHA Clarifies Dispatcher-Assisted CPR Guidelines
The American Heart Association issued a scientific statement in January reaffirming the importance of dispatcher-assisted CPR and clarifying specifically what dispatchers should advise. The four recommendations include:
- Dispatchers should “formally and systematically” question callers to determine if someone is in cardiac arrest, and if so, tell callers how to administer CPR immediately.
- Dispatchers should confidently and assertively give hands-only CPR instructions for adults who have had a cardiac arrest not caused by asphyxia (as in drowning).
- The performance of individual dispatchers should be measured by reviewing a given call’s audio recording.
- Dispatchers’ performance measurements should be part of a quality assurance program involving EMS and hospitals.
Although the 2010 resuscitation guidelines recommended that dispatchers guide bystanders in starting CPR, the new scientific statement emphasizes the importance of measuring dispatchers’ and EMS performance.
Ontario Study Finds Firefighters not Needed on Most Medical Calls
Firefighters have a role to play at only about 2 percent of medical calls, according to a study commissioned by an association that represents more than 50 EMS agencies in Ontario, Canada.
In Ontario, firefighters are dispatched to calls that involve potentially life-threatening emergencies, such as respiratory distress, cardiac arrest or trauma. It’s up to dispatchers to decide if the call warrants both firefighter response and paramedics, or just paramedics, according to Jim Price, executive director of the Association of Municipal Emergency Medical Services of Ontario (AMEMSO), which represents 50 regions throughout the province that provide EMS.
Recently, firefighters have been making the case that they should go on more medical calls, he explains. “Whether it was a trial balloon or not, fire has come forward saying, ‘We’re not busy. We’re right on the street corner. Why don’t you send us?’” Price says. “What we’re saying is, ‘That costs money every time you roll that truck. If there is a chance you may do some good when you go, then great, go to every medical call. But when there is a situation that doesn’t need you, it doesn’t make a lot of sense.’”
To get an “objective, arm’s length” tally of the calls that firefighters made a difference on, AMEMSO hired a consulting firm to conduct an evidence-based study, Price says. The report found that except on the 2 percent of calls involving cardiac arrest, paramedics could have handled the situation without firefighters present. “If someone is damn near dead or soon to be, there is an opportunity for fire to make a difference,” he says.
In Ontario, entry-level paramedics have two years of education and must complete licensing exams; advance level paramedics have additional training. Except in instances where firefighters can get there first and make a difference with AEDs or oxygen, “it’s illogical to send the larger vehicles into these situations,” Price says.
According to the study, the discussion about resource allocation has been largely driven by firefighters: “Stakeholders in Ontario’s pre-hospital emergency medical community are engaged in an increasingly public dialogue around how best to safeguard system response times, and improve patient care outcomes … To date, the Fire community has largely defined the tone and content of the public dialogue.”
Fewer Kids Hospitalized for Drowning
EMS agencies involved in drowning prevention efforts should pat themselves on the back. The rates of children hospitalized for drowning dropped by nearly half between 1993 and 2008, research shows.
Researchers from Johns Hopkins Center for Injury Research and Policy and the Arkansas Children’s Hospital Injury Prevention Center analyzed an inpatient hospital database and found that rates of pediatric hospitalizations associated with drownings fell from 4.7 hospitalizations per 100,000 kids to 2.4 per 100,000 during the 16-year period, a 49 percent decline nationwide.
Still, there’s more drowning prevention work to be done. Nearly 1,100 children aged 1 to 19 drown each year, making it the second leading cause of unintentional injury death in this age group, according to the study. For every pediatric drowning death, another two children are hospitalized after nonfatal drowning injuries. Boys are more likely to drown than girls. The study is in the February issue of Pediatrics.
