Provincial President Update

August 3, 2021
Provincial News

Dear Members,

Provincial President Member Update 

As we come to the close of the BC Day long weekend, I know you are all still under incredible pressure. Despite recent measures we saw similar delays and pressures on you all, continuing the frustration and anger which is real and justified.  You have all faced incredible impacts for far too long and need immediate help for the experiences personally and as a profession.

We know that after the last year and a half of facing COVID we are now seeing provincial restrictions relaxed with the restart plan.  BCEHS is experiencing significant increases in call demand, continued out of service (OOS) and staffing shortfalls across BC. This demand has escalated even higher through the heat dome/heatwave tragedy, interface wildfires across BC, and the tragic losses in Lytton.  All of this is in addition to the demand of the ongoing six-year overdose emergency, which is the new baseline post-COVID for accessing paramedic and dispatch services in BC.

After months of sounding the alarm on the state of our service we saw things come to a head following the tragic heat dome emergency in late June, with media, the public, paramedics and dispatchers, pleading for help. We were all desperate for action; our members, our patients, and the public needed intervention by those responsible for providing Ambulance Services to the citizens of BC. We urgently needed acknowledgment, accountability, and action and the result was immediate meetings and working with the President and CEO of PHSA and the Ministry of Health (MOH) to address immediate, short- and longer-term actions to ensure we can provide timely access to Emergency Health Services to the citizens of BC. 

As you know we have been providing solutions going back over one year to BCEHS and PHSA with no meaningful action or change. With ongoing public, media, member pressure, and through calls for urgent action, on top of our solution-based approaches and following our submission here we reached the joint document which was submitted to the MOH here. This along with other briefing documents and supporting information set the stage for Minister Dix’s announcement on July 14, 2021 (background, news release and actions) and our update here. Within the announcements the Minister of Health specifically directed BCEHS to focus on two specific goals:

  • Provide timely and exceptional service to British Columbians when and where they need ambulance services
  • Be an outstanding Employer in supporting the wellness of call, dispatch, and paramedic staff

To support BCEHS to achieve these goals the Minister of Health announced several actions, and in the two weeks since we have been working diligently with the MOH, Chief Ambulance Officer Leanne Heppell, New Board Chair Jim Chu, and I/COO Neil Lilley to work through many of the details for implementation and action flowing from the ongoing issues, various recommendations/agreements, and announcements. In parallel we have been working and assisting BCEHS with immediate measures to address the emergent staffing shortages in all areas of the province, and emergency preparedness challenges we are and continue to face in the province with wildfires, heat emergencies, summer recreation/weekend, air quality, employee wellness, and increased call volume and service demands (memo here). While we push for implementation of change, we are working tirelessly with the new BCEHS leadership to bridge the wellness, staffing and operational pressures in every area of our service

The announcements further outlined a series of immediate actions to bolster and strengthen ambulance operations with a focus on increasing the capacity of dispatch and paramedics to respond quickly to urgent patient calls for service. You saw Leanne Heppell announce Friday July 30, 2021, the posting of the 85 Paramedic Positions and 30 new dispatch positions. We know this is merely a drop in the bucket for needs in Metro and Urban, and it does not address the shortages in many areas/locations across the province. We are working through the remaining parts of the announcement and there is much more needed both short and long term as outlined in the Minister’s announcement to meet the current and increased demands, and evidence-based action to achieve the benchmarks to reach the highest acuity of calls in 8 minutes and 59 seconds or less in the 90th percentile. The evidence is clear and the year-to-year growth in volume of calls, increased unit hour utilization (UHU), reduction in stations has trended response times upward.  The Minister’s acknowledgment and commitment to address this long term is key to the change needed. Key to achieving these goals are the recommendations outlined by the Union in our 51 recommendations of July 5th, the joint letter of agreement of July 8, 2021 to the MOH, and the which commits to environmental scan of UHU, this is intended to lead and guide the Minister’s direction of:

“Finally, the Minister of Health has asked the new Board Chair, working with the BCEHS Board and Chief Ambulance Officer, management and staff, to create a refreshed vision and go-forward strategy for the BC Ambulance Service and bring this back to the Health Minister for consideration of additional actions for 2022/23 forward.”

In addition to the forgoing, I will provide an expanded update on some of the key issues as follows:

BCEHS Governance

The appointment of a new chair and reconstituted board of BCEHS that is to solely focus on ambulance services and its staff, accountable directly to the Minister of Health focused on getting meaningful results linked to the two goals. The Board Chair and Minister have been providing regular updates to me on the status of remaining board appointments and he advised me yesterday he expects the board to be announced this coming week.

The appointment of a new Senior Executive VP as the Chief Ambulance Officer reporting to the BCEHS board and a member of the Senior Executive team of PHSA. The Chief Ambulance Officer who is solely focused on providing Senior Executive leadership for the BC Ambulance Service and the achievement of the two goals working collaboratively with the BC Ambulance senior management team, ambulance paramedics, and the ambulance Union leadership. Leanne has been very hands on since her appointment and many of you have seen her presence and leadership on the frontlines already. We have been working hard to address the actions, changes, agreed to actions and needed actions with accountable and critical timelines for the many items before us. This week will continue to see more details and actions.

This governance model is a clearly a step in the right direction to re-establish our structure and governance as a standalone service and profession and will allow for leadership and oversight that reflects our unique dual role within health and public safety and meet the expectations of our patients and the public.

30 Dispatchers

“The Ministry of Health will make available budget resources and direct BCEHS to hire an additional 30 full-time dispatchers.” These positions were posted this past Friday and there will be seven assigned to each Victoria, Kamloops and 16 in Vancouver. The parties have been working hard to agree to recommendations to support dispatch staffing. Please see the attached Letter of Agreement to relax the probation and lock-in language for EMCT/EMD’s.  This will support increasing dispatch capacity [view LOA].

85 Paramedics 

“The Ministry of Health will make available budget resources and direct BCEHS to hire 85 Full-time paramedics for Metro/Large Urban regions beyond hiring already planned for 2020/21 focused on reducing wait times for purple and red events.” These positions were posted this past Friday as well, although we had hoped to discuss where these positions were being placed the BCEHS assigned them as outlined in the memo. There are a number of impacts of filling so many positions at once and we have been working to support and anticipate addressing as needed.

22 pre-hospital SOC stations 1 to 24/7 ALPHA

“The Ministry of Health will direct BCEHS to bring forward an assessment, recommendations, and an action plan to the Minister by the end of September on the conversion of up to 22 pre-hospital SOC stations 1to 24/7 ALPHA stations to enhance ambulance coverage for these communities. The plan will set out timelines and prioritization for the conversion starting with six communities October 1 and with completion of all recommended conversions by June 30, 2022.” 

1 Burns Lake, Vanderhoof, Fernie, Kimberley, Golden, Revelstoke, Fort St James, Ashcroft, Princeton, Keremeos, Bowser, Pemberton, Sicamous, Lillooet, Peachland, Chetwynd, Houston, Cumberland, Barriere, Fort Nelson, Clearwater, Port McNeil.

We know this announcement has created uncertainty and many questions, we do understand the impacts of this and are close to finalizing further details of the timelines for the implementation of the new Full-time 24/7 Alpha staffing to the above communities which will be replacing the previously announced and posted SOC model. We also know a transition agreement will need to be reached for Vancouver Island prototype stations which were already rolled out. We anticipate having more details on this in the coming week.

Hospital Handoff Delays

“The Ministry of Health will direct health authorities to provide additional and appropriate staff available to receive and care for patients before they can be formally admitted to the Emergency Department, to reduce hand-over times for paramedics and get paramedics and ambulances back on the road to respond to patient calls.”

We are awaiting an update from BCEHS and MOH of the details and will report as soon as we have specifics.

22 New Ambulances

“The Ministry of Health will provide funding and direct BCEHS to purchase an additional 22 ambulances for the Metro Vancouver/Fraser regions.”

We have been advised these units are in the process of being ordered and added to the fleet.

Employee Wellness

“The Ministry of Health will work with BCEHS and the Union leadership to take immediate action to better support employee wellness. The Ministry of Health will provide funding to contract a team of mental health and wellness professionals to work directly with dispatch staff and paramedics to address chronic stress, fatigue and to support wellness among staff (including access to trauma informed therapy).” 

The parties have agreed to a joint working group to implement this. The Union, led by Bob Parkinson and Warren Leeder, has been finalizing a briefing paper and action plan for implementation. Much of this work has been down through many years of work and included in the following documents [CSA standards, 5RF, MH statement, GAP analysis].

EMALB

“The Minister is directing the Emergency Medical Assistants Management Licensing Board (EMALB) to provide recommendations by September 6 to the Minister for scope of practice changes that will allow firefighters to use an expanded diagnostic skill set to allow for more effective patient assessments for timely information updates for incoming paramedics and the use of expanded skill sets for immediate mitigation of life-threatening medical scenarios in advance of the arrival of paramedics. This will provide the basis for consultation with municipalities and BCEHS on the implementation of Collaboration Agreements in response of the respective service to calls. In addition, there will be a return to the pre-COVID-19 pandemic first responder dispatching practices for 9-1-1 which will also alleviate operational pressures caused by the sharp increase in 911 call volumes.”

BCEHS Vision and go-forward strategy.

With respect to the forgoing announcement surrounding the role of our first responder, the provincial regulator (EMALB) is being tasked to review and make recommendations back to the ministry by September. APBC, led by Vice President Dave Deines, we will be providing a submission to the EMALB on the issues outlined. We know this announcement has not been received well however we are optimistic and confident that with our extensive experience in other Canadian Paramedic jurisdictions, and here in BC, that evidence- based, best practices will be incorporated into those recommendations [letter here].

In support of this submission APBC has been asked to provide the EMALB with a submission on what we believe are appropriate additions to scopes of practice for EMR – CCP’s.  If you have specific skills, procedures, therapies and/or medications that you would like to see included, please send to dave.deines@apbc.ca NO LATER THAN THIS FRIDAY August 6, 2021.  Several things to note – if any changes are made, it will most likely be done through a Ministerial order, so any structural changes to the regulation language are probably not going to happen, it will be simple additions to schedules 1 & 2.  Also any proposed additions need to be accompanied by supporting evidence and/or best practices.  Please also review the regulations to understand what is already current in scope.

BCEHS – Refreshed Vision and Strategy

“Finally, the Minister of Health has asked the new Board Chair, working with the BCEHS Board and Chief Ambulance Officer, management and staff, to create a refreshed vision and go-forward strategy for the BC Ambulance Service and bring this back to the Health Minister for consideration of additional actions for 2022/23 forward.”

This component should not be lost as it is key to the change and transformation required for our service and profession to meet the goal of providing timely and exceptional Paramedic and Medical Dispatch service to British Columbians when and where they need ambulance services and for BCEHS to become an outstanding Employer in supporting the wellness of call, dispatch, and paramedic staff.

We will be instrumental in this refreshed vision and strategy and work has begun to collaborate with the new BCEHS board and leadership to action this.

Over and above the work around implementation of the announcements from July 14th the Minister also acknowledged, recognized, and strongly supports the collaborative work of BCEHS and the Ambulance  Paramedics of BC Union leadership. He identified a range of areas to work collaboratively focused on employee wellness; operations, workload, and response times; recruitment and retention; building public confidence and understanding of ambulance services.

Again, in support the following documents and processes will be instrumental in achieving this:

Agreed items/ Further discussion items

Heat Dome – Review 

The Union has initiated professional and legal assistance and officially asked for standing in any formal or informal reviews following the tragic heat dome disaster in BC [letter here].

55/5 Surge Resources:

As you know In April 2020, BC announced and invested in 55 new ambulances and contracted five new air ambulances to support rural, remote, First Nation pre-hospital care with an additional 660 hours of paramedic coverage and an increase of 16 Advanced Care Paramedics being added across the province.

The five air resources have been established and the temporary surge resources are in place however they have not been established permanently. We also know that BCEHS has not been staffing all the resources and we have an agreement to determine and review the following:

  • Determine current locations/temporary locations
  • Extensions of LOA on Surge resources
  • Review temporary locations to optimize utilization while permanent plans and funding can be determined
  • Review of current locations with a lens on mitigation of rural/urban staffing and OOS demands and needs

Remote, Rural and Urban OOS and staffing

We know that the rollout of SOC to the Vancouver Island has significantly impacted many members personally as well as the staffing in some communities. We are seeing OOS never seen in those communities, and we are concerned that the dedicated members have not been appreciated or their commitments have not been truly valued by the service. The failure to address the true underlying issues has had the very impacts we warned BCEHS of. In addition, we are seeing similar patterns continuing across the rest of the province. As a Union, we are trying to address the impacts within the scope of the ratified and negotiated Collective Agreement and through lobby efforts and accountabilities built into the processes. There is no way of avoiding the reality of the need to address compensation in the Kilo model. Our sustainability, recruitment and retention ability are critically linked to this. Through our transition to Full-time and Regular positions this will help, however, many communities need more, and this is what we must address through acknowledgement and action and the renewed vision and strategy.

In addition, we know many large Urban/Rural communities, have seen significant reductions in staffing of high call volume Kilo units (more than 1000 calls annually). We believe the communities identified require additional full time ambulance coverage to address these shortages. 

With so much change it’s hard to keep up, we know it is very challenging to communicate and we are trying to do better. We all have a duty to squash rumours. I ask you all to be respectful and remember with this much well-needed transformation we need to ensure we work together. I see the recent changes as a path and structure to desperately get us to where we need to be as a service, profession, and Union. We have always known our essentialness and value as frontline public safety and health care professionals and to have the Minister stand up and acknowledge what we have faced, and his expectations cannot be undervalued. I feel there has never been a time in our history where we have been supported, recognized, or acknowledged more than now; however, in contrast we know it has also exposed our shortfalls and vulnerabilities as a service and we need to rebuild public and member confidence and trust in our service.

We know that transformation and change is difficult. We know the service delivery models being implemented were negotiated and ratified by the membership. However, the reality is only now coming to realization with real impacts for so many, this I know is very difficult for many. The reality is although we are making significant advancements right now many of the issues being suggested or asked for will in reality be subjects of negotiations going forward.

Despite it all, I am remaining optimistic that better times are ahead for us. With the work we are doing now and with impending announcements we will continue to see improvements for our profession and us all. I am so proud to serve each one of you as you continue to serve day in and day out while enduring incredible pressures both professionally and personally.

On behalf of the Provincial Executive Committee and Board please be kind, safe, caring, professional, and support each other. 

Be well,

Troy Clifford
Provincial President
Ambulance Paramedics & Emergency Dispatchers of BC
CUPE Local 873

Click HERE to view a PDF version of this 

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