Time to rethink 90% on-time target for ambulances, MLAs told

The government company that oversees ambulance services in New Brunswick says its 90 per cent on-time target is increasingly difficult to achieve and it's time to look at new ways to measure performance.

Craig Dalton, the CEO of EM/ANB Inc., previously known as Ambulance New Brunswick, told MLAs that the service hasn't been able to meet performance standards across the province since 2016.

The system of shifting ambulances to areas with the highest demand — and often leaving rural areas without adequate coverage — is increasingly untenable, he said during a meeting of the legislature's public accounts committee.

"We know that the dynamic deployment model, as I've said, does not work under this level of stress and strain," he said.

The province's contract with Medavie Health Services New Brunswick Inc., a private company which provides the ambulance service, is overseen by EM/ANB.

WATCH | 'Void of any help': Rethinking ambulance targets:

Why New Brunswick’s ambulance service may adopt new performance targets

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Strain on system means current model ‘does not work,’ officials told MLAs during a Public Accounts meeting in Fredericton.

Dalton is both EM/ANB's CEO and the chief operating officer for Medavie Health Services.

He told reporters the 90 per cent on-time performance standard — which earns Medavie performance payments when met — should no longer be the sole measurement.

"We should probably ask ourselves whether response time is the right standard to consider," he said.

"Should we be talking about the quality of care provided? Should we be talking about patient outcomes?"

Asked whether that meant dropping the 90 per cent target altogether, Dalton said "we should probably look at a broader set of outcomes."

But he acknowledged it would be difficult to assess whether a patient's outcome could be attributed to the care they received from ambulance paramedics and not from hospital doctors and nurses.

"I didn't say it was easy at all. It's a challenging question to ponder: What are you trying to achieve just beyond getting there within a certain period of time?"

Carleton-Victoria Progressive Conservative MLA Margaret Johnson said the dynamic deployment system has failed communities in her riding, including Tobique Valley, which last year saw an ambulance stationed there redeployed to Campbellton, 200 kilometres away.

"It's leaving little towns and little villages void of any help," she said.

A redeployment like the one to Campbellton means there's no way someone in Tobique Valley would see an ambulance within the target time, Johnson said.

"Ninety per cent sounds like a wonderful figure, if you're there 90 per cent of the time. But it's just not happening. We're not seeing evidence that that figure is happening," she said.

The contract with Medavie requires the company to respond to 90 per cent of calls within target times — nine minutes in urban areas and 22 minutes in rural areas.

But under the agreement, rural response times are averaged into broader regional numbers that include a far greater number of on-time responses in urban areas, meaning there's no incentive to improve the rural times.

That was the conclusion of a 2020 report by New Brunswick's auditor general.

The PC government and EM/ANB talked about renegotiating the contract, and Dalton said Wednesday discussions are continuing, but so far there's been no change.

"We're absolutely intent on continuing that process," he said.

On Tuesday, the Union of Municipalities of New Brunswick, the Paramedic Association of New Brunswick and the New Brunswick Association of Fire Chiefs issued a joint call for changes to the dynamic deployment system.

They said the upcoming 2027 expiry and potential renewal of the contract is the perfect time to make changes.

The shifting of ambulances out of communities often leaves it to firefighters, including many volunteers, to respond to medical emergencies they're not trained for.

Scott Poupart, president of the fire chiefs' association, said the "unsustainable demands" were putting too much pressure on firefighters. 

Dalton acknowledged the problem.

"What they've shared is another validation of the level of stress that our system is under right now," he told reporters.

He told the committee that EM/ANB is looking at "a number of initiatives" including single response units, a pilot project in which a single paramedic — rather than the standard team of two — responds to lower priority calls.