Province reviewing Sask. ambulance services to improve standard of care

The Saskatchewan Health Authority is reviewing ambulance services across the province in an effort to improve services and standardize its "blended" public and private system.

Rod MacKenzie, the health authority's executive director of provincial services and community care, said the goal is to bring all ambulance services up to the industry standard of "advanced life support."

Some are still operating to the level of "basic life support." Differences between the two levels of service include what medications can be provided by the paramedic crew.

"We have some larger communities that are still in 'basic life support' and we know that we need to get them up to 'advanced life support,'" said MacKenzie.

You see a lot of advanced-care paramedics, for instance, in the cities and we need those advanced-care paramedics just as much or more in the rural areas.- Nelson Pompu, Swift Current EMS manager

"So the priority would be, how do we work with these larger communities to get them to that level?"

The authority is creating standardized contracts so that all ambulance services in the province will have to meet the same contractual obligations.

MacKenzie said the change will also involve supporting the services so they can meet the new standardized expectations.

He said the review should lead to savings for the health authority, but he does not expect any job losses as a result.

New contracts will outline response times

Last year's amalgamation of 12 health regions into one provincial authority presented an opportunity to look at the system, said MacKenzie. The review will be used to develop a five-year plan for EMS services in Saskatchewan.

"And they're quite happy with that as well, because there's been a lot of uncertainty in the past with the vagueness of the contract about what was the health authority's responsibility versus the private operator's responsibility," he said.

For example, existing contracts say a service needs to have an ambulance available 24-7, but do not specify what "available" means. 

New contracts will define "available" as having someone in the office eight hours per day, and being on-call for the remaining 16 hours, as well as outlining expected response times. 

Some Sask. services started with funeral homes

MacKenzie added that ambulance services in communities across Saskatchewan evolved independently into a mix of public and private.

Of the 105 ambulance services in Saskatchewan, about 50 are publicly owned. Another 50 are privately owned, and about five use a non-profit model. The health authority said the cost to patients is the same across the board.

Many privately run services were started by funeral homes or by local doctors around the 1930s and 1940s.

The ambulance service in Swift Current, which is privately run today, was among those started by the owner of a funeral home.

Al Siemens started an ambulance service because the existing service in the 1960s, run by the hospital, involved a nurse taking a taxi to the scene.  

Nelson Pompu, who manages the EMS service that evolved from Siemens's ambulance, is pleased the system is being reviewed.

Need to fund 'advanced' training, wages

He said services like his need funding to train paramedics to the "advanced" level, or to pay qualified paramedics at the level they require.

"You see a lot of advanced-care paramedics, for instance, in the cities and we need those advanced-care paramedics just as much or more in the rural areas, where your access to tertiary care is not as quick," said Pompu.

He said there are fewer of the advanced-care paramedics in the southern half of the province than in the north.

Although he said it is not common, he believes there are cases where patients receiving emergency care would not have been able to have certain medications because paramedics did not have the more advanced training.

He said some cardiac and pain medications can only be administered by paramedics with the advanced training.

"Would I say it happens? Sure it does," said Pompu.

"I think at points in time, yes, the patient would benefit. But to say it happens all the time, that would be an incorrect thing. Occasionally, yes."