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1 Focused 2008 / 2009 o n d e l i v e r i n g c a r e Focused 2008 / 2009 British Columbia Ambulance Service 1

2 Table of Contents Overview Provincial Profile Regional Profile Vision, Mission and Goals Services Dispatch Services Transfer Services Specialty Services Medical Programs Community Awards Programs Achievements Achieving Our Goals Statistics Provincial Response Volumes Fleet and Facilities Human Resources BCAS Budget British Columbia Ambulance Service Focused 2008 / 2009

3 Overview Provincial Profile Created in 1974, the British Columbia Ambulance Service (BCAS) operates under the authority of the Emergency and Health Services Commission and is tasked with the provision of public ambulance service across the Province. Today BCAS is the largest provider of emergency medical services in Canada and one of the largest in North America. BCAS serves over 4.3 million British Columbians and responds to calls for service across six health authorities covering 929,730 square kilometres. In 2008/2009 BCAS paramedics responded to 516,547 events by ground and 8,356 by air. BCAS employs 3,983 individuals who are dedicated to providing timely and high quality emergency medical services. BCAS paramedics and dispatchers deliver front line patient care, with support services staff including Communications, Finance, Human Resources, Information Management/Technology, Labour Relations, Medical Programs, Organizational Health and Safety and Policy and Planning personnel working to support paramedic efforts and ensure BCAS continues to deliver high quality care. BCAS operates 187 stations, 480 ambulances, 47 support vehicles and nine dedicated ambulance aircraft. Focused 2008 / 2009 British Columbia Ambulance Service 3

4 Overview Focused on delivering province wide care Prince George Kamloops Vancouver Victoria 4 British Columbia Ambulance Service Focused 2008 / 2009

5 Overview Regional Profile Northern Region BCAS Northern Region covers 606,300 square kilometres, almost two-thirds of B.C., and is bordered by the Northwest and Yukon Territories to the north, and the B.C. Interior to the south, and Alberta to the east, and Alaska and the Pacific Ocean to the west. The Northern Region includes 35 ambulance stations and is also home to the BCAS Northern Region Administrative Office located in Prince George. Interior Region BCAS Interior Region also serves a large geographic area, which ranges from densely populated to scarcely populated areas. The Interior Region covers 214,700 square kilometres, from Williams Lake to the U.S. border and from Anahim Lake in the Chilcotin to the Alberta border. The Interior Region includes 62 ambulance stations and is also home to the Interior and Northern Region Dispatch / Communications Centre, and BCAS Interior Region Administrative Office located in Kamloops. Lower Mainland Region BCAS Lower Mainland Region is characterized by communities with high population densities. The region serves the 604 area code, covering 71,020 square kilometres, and stretches from the USA border, east to Manning Park and North to Boston Bar. The region also serves the Howe Sound corridor to Pemberton and the Sunshine Coast. The Lower Mainland Region includes 45 ambulance stations and is also home to the Lower Mainland Region Dispatch / Communications Centre and BCAS Lower Mainland Region Administrative Office, located in Vancouver. Vancouver Island Region BCAS Vancouver Island Region serves the residents of Vancouver Island as well as the Gulf and Discovery Islands. Serving an area of 56,680 square kilometres, the Vancouver Island Region includes 44 ambulance stations and is also home to the Vancouver Island Region and Provincial Air Ambulance Dispatch / Communication Centres as well as BCAS Vancouver Island Region Administrative Office and BCAS Provincial Headquarters, located in Victoria. Provincial Programs BCAS fifth operational area, Provincial Programs, crosses all of the geographical regions. Within Provincial Programs are four speciality program areas: Provincial Scheduling, the Emergency Management Office, Fleet Operations and Airevac and Critical Care Transport. Focused 2008 / 2009 British Columbia Ambulance Service 5

6 Overview On a day to day basis we are focused on achieving a higher level of patient care excellence that meets the needs of communities across the province. 6 British Columbia Ambulance Service Focused 2008 / 2009

7 Overview Vision, Mission and Goals Our Vision: to be the Leader in the provision of emergency medical care Our Mission BCAS strives to provide timely and high quality emergency medical services by, caring for and about its patients and staff, providing creative solutions for changing health care needs and collaborating with its partners in the health care system and community. Our Goals Goal 1: Provide innovative and effective quality patient care Goal 2: Strengthen partnerships to provide effective and efficient patient care Goal 3: Use our resources for effective, efficient and appropriate patient care Goal 4: Ensure a healthy, safe and supportive workplace Our goal is to ensure that patients receive the right care, by the right provider, at the right time. Delivering on this goal requires a focused approach involving paramedics, dispatchers, and management. Today paramedics provide much more than just ambulance transportation to hospital. BCAS continues to be focused on the opportunities within the health care system for BCAS to strengthen and provide expanded health services. Resources are in a constant state of demand while supply is limited. This is an operating reality that requires BCAS to be focused on improving its ability to effectively use operating funds and prioritize areas of capital investment. BCAS employees are essential to its success. BCAS must continue to be focused on recruiting exceptional individuals, to provide continuing education, and to offer a safe and supportive workplace. Focused 2008 / 2009 British Columbia Ambulance Service 7

8 Service Service Providing high quality public ambulance service requires us to apply our resources, technology and expertise in a way that is efficient, effective and focused on providing care that patients can count on. 8 British Columbia Ambulance Service Focused 2008 / 2009

9 Service Dispatch BCAS knows that the people who call us need our help. Making sure we deliver that help begins with BCAS Emergency Medical Call Takers (EMCTs) and Emergency Medical Dispatchers (EMDs) in BCAS Dispatch/ Communication Centres. Directing Basic Life Support (BLS) and Advanced Life Support (ALS) ambulances, as well as air ambulances when needed, these dedicated professionals gather critical information from the caller and use internationally recognized protocols to assess incoming calls and dispatch the appropriate resources. BCAS EMCTs and EMDs also work with emergency physicians who are on call to consult over the phone and assist in complicated triage processes to ensure patients receive the right care in the right time. They also communicate with First Responders, Search and Rescue and Police to ensure the right people and resources are also on scene. BCAS operates four Dispatch/Communications Centres; three Regional Centres based in Kamloops, Vancouver and Victoria, from which ambulances are deployed, and one Provincial Air Ambulance Coordination Centre located in Victoria, which manages all responses requiring air ambulance transport. These fast-paced call Centres operate 24 hours a day, seven days a week. Lower Mainland Dispatch Communications Centre Dispatches ambulances to over 30 communities in some of the province s most densely populated areas On average, responds to 1,100 calls and inter-facility transfer requests on a daily basis Vancouver Island Dispatch Communications Centre Dispatches ground based ambulance resources to all of Vancouver Island, Powell River and the surrounding Gulf Islands On average, receives to calls a day Interior / Northern Region Dispatch / Communications Centre One of the largest geographical Dispatch/ Communications Centres in North America, the Centre is responsible for dispatching ambulances in 98 communities throughout interior and northern BC Handle an average of calls a day Provincial Air Ambulance Coordination Center Responsible for coordinating and providing air and ground Critical Care Transport and non-critical air transports Transports are primarily coordinated within the province but can be inter-provincial or international Focused 2008 / 2009 British Columbia Ambulance Service 9

10 Service Services Basic Life Support The most common ambulance service provided by BCAS is Basic Life Support (BLS). BLS paramedic crews provide care for medical emergencies or traumatic injuries. Examples include the provision of high quality CPR and the use of Automatic External Defibrillators; the administration of medications for pain, heart attack, difficulty breathing or severe allergic reaction; and the treatment of wounds and fractures. Emergency Medical Responders (EMRs) and Primary Care Paramedics (PCPs) provide this service. Working as an EMR is an entry-level, community focused position that is ideal for people who live and work in a rural or remote area and have a desire to make a difference. BCAS employs EMRs on an on-call, part-time basis. The majority of paramedics working across B.C. are PCPs. They work in both full time and part time positions in rural and larger communities. Becoming a PCP requires approximately 12 weeks of training plus a preceptorship period, after which paramedics can continue to build on their skills by obtaining endorsements for additional practices such as IV administration and entubation. Advanced Life Support When more advanced care is required, BLS paramedic crews can be assisted by BCAS Advanced Life Support (ALS) paramedic crews. ALS ambulances are staffed by Advanced Care Paramedics (ACPs) who receive additional training which enables them to perform more advanced emergency care procedures including cardiac monitoring, advanced airway maintenance, and drug administration. BCAS employs full-time ALS crews in Victoria, Nanaimo, Vancouver, Abbotsford, Chilliwack, New Westminster, Surrey, North Vancouver, Richmond, Kelowna, Kamloops, Prince George and Trail. 10 British Columbia Ambulance Service Focused 2008 / 2009

11 Service Transfer Services Patient Transfers BCAS also coordinates and completes patient transfers. In 2008/09, inter-facility patient transfers made up 28 per cent of all BCAS transports in B.C. All patient transfers requiring an ambulance and paramedic resources are managed through BCAS' Communications/Dispatch Centres, who assign ground ambulances to patient transfer requests from health care facilities. BCAS has a small number of dedicated ground ambulance transfer vehicles available for patient transfers, but also utilizes emergency fleet ambulances, to transfer patients between health care facilities. A number of private patient transfer operators also provide non-medical patient transfers under contract with Health Authorities. These non-medical transfers are restricted to stable patients who do not require the skills of a paramedic during transport. Focused 2008 / 2009 British Columbia Ambulance Service 11

12 Service Specialty Services From the time a call for help is placed to 9-1-1, to treatment at the scene and transport to hospital BCAS is focused on providing patients with the right care, in the right time, and by the right care provider. In some cases this may mean specialty paramedic services. Air Ambulance BCAS Air Ambulance program provides the critical transportation linkages between accident scenes, hospitals and referral centres across the province for patients requiring more specialized care then available in the local community. Operating from three flight centers located in Vancouver, Kelowna and Prince George, the Air Ambulance Program employs a total of 6 dedicated fixed wing planes (2 turboprops and 1 jet based in Vancouver, 2 turboprops based in Kelowna and 1 turboprop based in Prince George), and 3 dedicated helicopters (2 based in Vancouver and 1 based in Prince Rupert). BCAS also employs approximately 40 charter carriers throughout B.C. The BCAS Air Ambulance program employs highly skilled, specially trained emergency medical personnel including ACPs specializing in Adult Critical Care, known as Critical Care Paramedics (CCPs) and Child and Maternal Critical Care, known as Infant Transport Team (ITT) paramedics. Critical Care Transport Critical Care Transport (CCT) Team paramedics provide highly-specialized care and long-distance transport between health facilities for critically ill or injured patients. The first ground based CCT Team was established in Kamloops, B.C. and operates in the Thompson, Cariboo and Shuswap areas. A second dedicated CCT team was formed in the east Kootenay Boundary area and currently operates out of Trail B.C. This team was formed as a joint venture with the Interior Health Authority, and is comprised up of highly skilled critical care paramedics paired with critical care nurses. 12 British Columbia Ambulance Service Focused 2008 / 2009

13 Service Specialty Services Infant Transport Team BCAS has specialized teams that work with paediatric, neo-natal and highrisk obstetrics patients, while en-route to specialized care units in hospitals throughout B.C., the Yukon Territories, other parts of Canada and the United States if necessary. All paramedics serving on the Infant Transport Team (ITT) complete a specific training program focused on providing care to children, where they learn advanced skills such as intubation and the use of a wide variety of monitors, ventilators, IV pumps and medications. In addition, ITT paramedics liaise with specialist physicians who provide support and guidance One of only two paramedic units of its kind in the world, the ITT was formed by BCAS in 1976 to provide expert care and transport to patients under 16 years old that require a higher level of care. Special Operations In addition to providing emergency medical and non-emergency transport services, BCAS also offers contracted paramedic services at major public and international events, professional sporting events, movie sets and community fairs. As part of this service, BCAS deploys paramedics on bicycles at major public events where crowds can limit access and speed of response for normal ambulance vehicles. This special operations unit was first implemented in Victoria in BCAS was one of the first North American Emergency Medical Services agencies to organize and deploy paramedics on bicycles. BCAS bike squads currently operate in Vancouver, Victoria, and Kamloops, as well as their neighboring communities when required. Focused 2008 / 2009 British Columbia Ambulance Service 13

14 Service Specialty Services Emergency Planning Disaster. It can strike anywhere, anytime. It takes many forms from earthquakes to floods and can build over days and weeks, or hit suddenly without warning. BCAS staff actively participate in emergency planning, mock disaster exercises and other joint training initiatives to ensure disaster preparedness and response capabilities are identified and deployed quickly and effectively when they are needed most. This is achieved through BCAS Emergency Management Office. BCAS provides provincial oversight and direction in the planning of multicasualty incidents, major emergency situations that involve multiple patients at one scene. This includes direction and advice regarding hazardous substances. BCAS Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) response team and Technical Advisors (TA) in conjunction with the Provincial Regional Dispatch Centers, provide a solid first line of defence in protecting the health and safety of BCAS personnel, as well as other responders, health facility staff, and the public against hazardous stubstances. TAs support operational staff by utilizing online resources, software programs, hazardous substance manuals, and field information to identify and research safety and response issues related to a hazardous substance release or potential release. 14 British Columbia Ambulance Service Focused 2008 / 2009

15 Service Medical Programs Medical Programs provides the medical oversight and input needed to guide paramedics in the provision of quality patient care. BCAS Medical Programs Division integrates four major functions: physician oversight, clinical performance management (quality improvement), clinical education and research. Paramedic practice is subject to direct and indirect medical oversight provided by physicians employed or contracted by BCAS. Medical guidance and direction is provided in real time from physicians contacted by phone in some instances, but principally by policies and protocols used to guide care given by paramedics in the field. Through its medical programs division BCAS is undertaking a fundamental change in the approach to patient care through the transition to new Treatment Guidelines, a combination of best practice and evidence-based medicine designed to better equip paramedics to make informed decisions in the field. BCAS supports the development of paramedics and the successful implementation of procedures and practices by developing curriculum and holding training courses. Through Clinical Performance Management, BCAS provides paramedics with timely and accurate information and feedback to ensure continuous improvement and patient safety. Clinical Performance Management provides a foundation for the development of medical guidelines, protocols and policy. Clinical Performance Management staff work closely with both regional training officers and physicians who provide medical oversight in with patient care issues and improving clinical performance. BCAS is committed to doing and using research findings to ensure we are meeting patient needs and desires in the most effective and efficient manner possible. Of note is BCAS participation in the Resuscitation Outcomes Consortium, which is focused on research in the area of pre-hospital treatment of cardiac arrest and severe traumatic injury. Focused 2008 / 2009 British Columbia Ambulance Service 15

16 Community Community As members of the community BCAS participates in community programs focused on improving the ability of community members to react in emergency situations. BCAS believes education in emergencies is an important part of patient care and the prevention of health emergencies. 16 British Columbia Ambulance Service Focused 2008 / 2009

17 Community Awards Support provided by quick thinking members of the public can often mean the difference between life and death for patients. Whether performing bystander CPR, providing critical information to dispatchers or assisting paramedics on scene, British Columbians are an important link in the health care system. To recognize the significant contributions made by citizens during medical emergencies, BCAS supports two community award programs: the Vital Link Award and the Good Samaritan Award. Vital Link Award The Vital Link Award is presented to citizens who are involved in saving a life through successful cardio-pulmonary resuscitation (CPR) efforts. Good Samaritan Award The Good Samaritan Award is presented to individuals who have provided unselfish and humanitarian assistance during a medical emergency. Award recipients are typically nominated by BCAS paramedics, EMDs or Supervisors who wish to express their appreciation for the exceptional assistance they received at the scene of a medical emergency. In addition to providing much deserved formal recognition to members of the public, the Community Awards program is also an excellent opportunity to educate the public about the positive impact bystander CPR and first aid can have on patient outcomes. It is BCAS hope that by recognizing contributions and re-enforcing the importance of bystander support, similar behaviour will be encouraged. In 2008/2009, 52 individuals in B.C. were recognized as contributing to the survival of a cardiac arrest victim with the presentation of the Vital Link Medal and 20 were presented with Good Samaritan Awards for the action they took to assist in an emergency. Focused 2008 / 2009 British Columbia Ambulance Service 17

18 Community Programs ACT High School Program Cardiovascular disease is the second leading cause of death in B.C., accounting for more than one fifth of all deaths in the province. Research shows that a cardiac arrest victim is four times more likely to survive if CPR is administered by a bystander while paramedics are en-route to the scene. Students in B.C. are becoming well versed in this life saving skill, thanks to the High School CPR Program, an initiative aimed at establishing CPR training in every secondary school in BC by Made possible through a unique partnership between BCAS, the Advanced Coronary Treatment (ACT) Foundation (a national charitable organization dedicated to school-based CPR) and CUPE Union 873 (the union representing paramedics in B.C.) the program will leave a lasting legacy in B.C. schools, ensuring that Grade 9 and 10 students continue to benefit from this valuable training. The High School CPR Program has resulted in over 29,000 high school students in 156 secondary schools throughout B.C. being trained each year in CPR. 18 British Columbia Ambulance Service Focused 2008 / 2009

19 Community Programs P.A.R.T.Y. Program In partnership with local health care providers, BCAS is helping educate B.C. youth about how to stay safe through the P.A.R.T.Y. Program (Prevent Alcohol and Risk-Related Trauma in Youth), a one-day, in-hospital, injury awareness and prevention program designed to reduce death and injury due to alcohol, drug and risk-related behaviours. Open to youth ages 16 and older, the goal of P.A.R.T.Y. is to provide teens with life-saving information about trauma that will enable them to recognize potential injury-producing situations, make prevention-oriented choices and adopt behaviours that minimize unnecessary risk. Supporting the program are BCAS paramedics, who volunteer their time to lead P.A.R.T.Y sessions for Grade 10 students throughout the province. During these sessions, paramedics hold a mock-crash demonstration and describe in detail the process they go through when they attend a serious motor vehicle collision. Involving personnel and volunteers from Health Authorities, the RCMP, Auto plan brokers and ICBC, police, crash survivors, school districts and individual schools, this valuable public education initiative represents one of the ways BCAS paramedics continue to give back to their communities. Focused 2008 / 2009 British Columbia Ambulance Service 19

20 Achievements Achievements In 2008/09 BCAS built on current programs, introduced technologies and undertook initiatives that supported the achievement of BCAS goals. 20 British Columbia Ambulance Service Focused 2008 / 2009

21 Achievements Achieving Our Goals Goal 1: Provide Innovative and Effective Quality Patient Care Treatment Guidelines In 2008/09 BCAS undertook a fundamental change to patient care through a transition to new Treatment Guidelines, a combination of best practice and evidenced based medicine which are designed to better equip paramedics to make informed decisions in the field. The Treatment Guidelines represent an innovative way of thinking about how paramedics approach decisions to provide the most appropriate care for their patients. Automatic Vehicle Location Powerful, visual information on the location of incidents and ambulances is at the finger-tips of EMDs, thanks to the successful integration of Automated Vehicle Location (AVL) technology into the Lower Mainland Region Dispatch/ Communications Centre. EMDs are now provided with a real-time update of where resources are actually located. This will help BCAS respond to urgent events more effectively. CCT Ambulances BCAS introduced newly designed Critical Care Transport (CCT) specific ambulances to its fleet. These ambulances better support ground CCT teams in Trail and Kamloops in the transport of critically ill or injured patients over long distances. By designing a CCT specific ambulance BCAS is able to ensure that the needs of CCPs and their patients are met. The CCT ambulances were designed by BCAS personnel including CCPs, BCAS fleet and BCAS suppliers. Patient Care Information System Project BCAS completed its implementation of its Patient Care Information System (PCIS). Through this system, BCAS enhanced patient care information management. Now, both paramedics as well as quality improvement, ambulance billing, management, and other staff can all rapidly access patient care information. BCAS expects this improved access to patient care information to be translated into improvements that benefit both patients and paramedics. Focused 2008 / 2009 British Columbia Ambulance Service 21

22 Achievements Achieving Our Goals Goal 2: Strengthen Partnerships to Provide Effective and Efficient Patient Care STEMI BCAS, in collaboration with Vancouver Coastal Health (VCH) and Providence Healthcare (PHC), initiated a new program to improve the outcomes of patients who have suffered from a time critical type of heart attack, ST Elevation Myocardial Infarction or STEMI. ALS paramedic crews working in the VCH region who suspect a patient is suffering from STEMI transmit 12 lead ECG data from the scene to the hospitals emergency department. The emergency physician confirms the STEMI and activates the angioplasty team while BCAS transports the patient directly to the receiving hospital. By taking STEMI patients directly to hospitals with catheterization labs, activating the hospital s angioplasty team and prepping the ER before the patient arrives, BCAS with VCH and PHC are saving time and heart muscle. ED DELAYS Health Authorities and BCAS have successfully implemented changes to reduce emergency department (ED) delays. The average provincial daily ED delay (after 30 minutes) has dropped by 38 per cent, from 81 hours per day in 2006, to 51 hours per day in 2008/09. This means ambulances are back on the road ready to respond quicker. 22 British Columbia Ambulance Service Focused 2008 / 2009

23 Achievements Achieving Our Goals Goal 3: Use our resources for effective, efficient and appropriate patient care NetCAD Patients in the Lower Mainland are benefiting from improved call assessment and triage; co-ordination with other first responder agencies; technologies such as AVL monitoring; and simplification of post-response analysis due to the implementation of the NetCAD project, a province-wide Computer Aided Dispatch (CAD) system that will link BCAS Communications Centres in Victoria, Vancouver and Kamloops on a common platform. Ambulances BCAS invested $2-million in 20 new full-time paramedic positions and three additional ambulances in the Lower Mainland to help BCAS manage increasing call volumes in Greater Vancouver Patient Transfer Budget BCAS realigned responsibility for patient transfers by transferring the $32 million budget for ground-based patient transfer work to the Health Authorities. BCAS continues to provide patient transfer services but Health Authorities are now charged an hourly fee for patient transfers or they can choose to use alternate service providers for patient transfers that do not require the skills of a paramedic. Resource Allocation Plan BCAS continues to make improvements to its Resource Allocation Plan (RAP) which is designed to help EMDs determine how pre-hospital calls can be handled to ensure that the right patients receive the right resource in the right time frame. Goal 4: Ensure a healthy, safe and supportive workplace Active Living Challenge BCAS promoted having a healthy and supportive workplace by creating an Active Living Challenge, a friendly six week competition designed to help employees increase their level of daily activity in any way they choose. Education A total of 82 PCPs and 23 ACPs received education bursaries through the Emergency Medical Assistant (EMA) Education Fund, an over $5 million dollar bursary program established by the Ministry of Health Services in September 2007 to support paramedic education. Since 2007, the EMA Education Fund has awarded $765,000 in bursary dollars to paramedic students across the province. Focused 2008 / 2009 British Columbia Ambulance Service 23

24 Statistics Statistics Keeping focused on the health of our patients and the health of our organization. 24 British Columbia Ambulance Service Focused 2008 / 2009

25 Statistics Provincial Response Volumes 2008 / 2009 Total Events by Region Lower Mainland (57.1%) Total: 516,547 Northern BC (6.0%) Vancouver Island (17.7%) Interior Region (19.1%) 2008 / 2009 Pre-Hospital Events (911) by Region Lower Mainland (57.2%) Total: 372,338 Northern BC (5.5%) Vancouver Island (19.3%) Interior Region (18.0%) 2008 / 2009 Patient Transfers by Region Lower Mainland (57.0%) Total: 144,209 Northern BC (7.4%) Vancouver Island (13.6%) Interior Region (21.9%) Focused 2008 / 2009 British Columbia Ambulance Service 25

26 Statistics Provincial Response Volumes Historical Provincial Event Volumes Pre-Hospital Events (911) Transfers Total Events From 2004/05 to 2008/09 demand for services has increased by 11 per cent. Pre-hospital events have increased by 11 per cent, from 334,278 to 372,338 and patient transfers have increased by 9 percent from 132,774 to 144,209. There have been ongoing discussions with health authorities to develop transfer management strategies for low acuity patients. Most Health Authorities now have contracts with alternate service providers (ASPs) to transport medically stable patients who do not require paramedic care. From 2004/05 to 2008/09 overall demand for service has increased by 11 per cent, but for the first time in a number of years BCAS has experienced a decrease in event volumes of 2 per cent in 2008/09. The most common emergency calls attended to by BCAS paramedics include falls/back injuries, traffic accidents, sick person (specific diagnosis), unknown problem (man down), breathing problems, chest pain and unconscious/fainting. 26 British Columbia Ambulance Service Focused 2008 / 2009

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