Alberta Health Services (AHS) is working to improve Emergency Medical Services (EMS) response times and ensure Albertans needing emergency care, get that care. Improvement will be driven by innovative new approaches to delivering care, the addition of new resources, better use of existing resources, as well as support for existing EMS staff while seeking new workers to augment our team.
EMS/811 Shared Response is already helping patients get the care they need and reducing unnecessary ambulance responses. Launched mid-January, this new collaboration between EMS and Health Link 811 allows for the transfer of EMS callers who EMS assesses as low-acuity – or not experiencing a medical emergency that requires an ambulance - to Health Link 811 registered nurses for further triage, assessment and care. This collaboration provides better support for patients while allowing ambulances to remain in the community to respond to life-threatening emergencies, meaning faster emergency response times and better flow through the health system: two of AHS’ four key priorities. Since the launch in January 2023, more than 2050 EMS 911 callers were assessed as low acuity, transferred to 811, and helped by 811, keeping more ambulances available for higher acuity calls.
AHS has issued a Request for Expressions of Interest and Qualification (RFEOIQ) for transporting patients who do not require emergency care, between care facilities. By contracting third party partners to transport patients requiring care, between care facilities, patients receive the supports they need, and EMS ambulances are freed up to respond to emergencies. The RFEOIQ closed on March 9 and proponents’ responses are being evaluated.
EMS will be adding new ambulances to the streets again in 2023. 20 new ambulances are budgeted, 10 for Calgary and 10 for Edmonton. To staff these new ambulances, EMS will be hiring a total of 80 new paramedics. AHS is deploying these new ambulances to Calgary and Edmonton because these are the two areas of largest use and need. Adding ambulances here means less need to move ambulances from suburbs and rural areas, into the cities.
EMS also continues to have ongoing meetings with learning institutions regarding hiring of new graduates and potentially expanding future training capacity. AHS EMS is working collaboratively with HSAA to recruit staff for 56 converted temporary to regular full-time positions (throughout all Zones) as well as the additional 80 regular full-time positions to staff new ambulances in Edmonton and Calgary.
On March 15, 2023, AHS launched the EMS Return to Service initiative, which supports paramedics to hand the care of patients over to emergency department nurses within a 45-minute target, is now fully operational in all major hospitals across Alberta.
A recommendation that stems from the Alberta EMS Provincial Advisory Committee, the initiative reduces the time EMS crews spend in hospital waiting to transfer patients, and means more ambulances are on the road available to respond to emergencies.
This new provincial policy allows paramedics to return to service in the community faster, by moving patients who do not need observation to appropriate hospital waiting areas instead of automatically waiting with paramedics to be seen. While waiting, patients will be cared for by the ED/Urgent Care Centre (UCC) team, and a decision to assign a patient to the external waiting room will be based on patient stability and care needs. While still in its infancy, the EMS Return to Service initiative has resulted in a significant reduction in response times, has freed up more ambulances to complete scheduled inter-facility transfers, and helped to improve patient flow across the continuum of the healthcare system.
EMS has enacted new guidelines which allow paramedics to assess and treat a patient, without necessarily transporting to hospital. Patients are provided options for alternative care as well as referrals, if they do not need transport to a hospital or Urgent Care Centre.
This supports our emergency and acute care teams in suggesting non-ambulance alternative transport options to move patients who are medically stable, and ready to return home or to another care environments. This was announced in December 2022 and has been implemented for 2023.
A new inter-facility transfer program is putting 10 new ambulances on the road to support the transfer of stable patients between facilities. The first of these new ambulances was put into service April 18 with the remaining nine to be operationalized by July 3.
These new ambulances will help address not only capacity pressures at Red Deer Regional Hospital Centre by providing more transportation options to move patients who don’t require the site’s specialized care, but will help keep other EMS resources freed up to respond to emergency calls.
Provided by contracted partners, these ambulances will be dedicated to scheduled and predictable non-urgent inpatient transfers which will also help patients return to their home communities sooner to heal closer to friends and family. These new resources will be used for all scheduled, low-acuity, inter-facility transfers throughout the Central Zone.
AHS EMS has accpeted the recommendations of the Minister’s Advisory Council. More information on these recommendations can be found here.
One Spruce Grove Fire Department’s pilot project allows for the department’s paramedics to cancel an incoming ambulance when they determine one is not needed, and another pilot project allows for firefighter-paramedics to transport patients themselves if that option is better for the patient. If these prove successful by increasing capacity while ensuring patients receive quality care, they may be expanded. The pilot projects are being assessed on an ongoing basis to determine their effectiveness and applicability in other locations.
In 2022, 19 new ambulances were added. All new ambulances are in service and Advanced Care Paramedics (ACP) and Primary Care Paramedics (PCP) have already been hired to staff them.
From January 2022 to December 31, 2022, EMS hired 461 new staff members including 345 paramedics. Looking over the longer term, there has been an 11.2 per cent increase in paramedics employed by AHS between December 2019 and December 2022.
Additionally, in 2022, EMS recruitment and hiring was consolidated into a single, provincial program that is ensuring greater consistency in hiring practices across all zones. Previously each zone was responsible for hiring and recruitment. This change has allowed for more streamlined hiring processes, elimination of duplication and a decrease in onboarding time.
Beginning in 2022, EMS no longer automatically dispatches an ambulance to collisions. This practice avoids unnecessary use of ambulances and becomes most apparent and effective during severe weather events where fender-benders are common. From January 2022 to November 2022, 83 unnecessary automatic ambulance responses were prevented, and the practice is now part of normal operations.
The Metro Response Plan (MRP) began in March 2022 and is an ongoing strategy that helps keep suburban ambulances in the communities where they are based. It allows dispatchers to return ambulance crews to their home communities, instead of being tasked with other emergency responses outside these areas.
For example, before this change, ambulances from communities including Airdrie and Cochrane may have been brought into the City of Calgary about 400 times per week. After implementing this plan, as of April 16, 2023 (the most recently available data), that number has dropped to about 14. In Edmonton prior to the response plan changes, there were about 400 suburban responses into Edmonton per week, and this has dropped to 58.
The EMS Pre-empt and Divert initiative allows dispatchers to override computer-automated assignments for ambulances and is used to switch (or pre-empt) an ambulance from a lower priority assignment and divert it to a higher priority call when needed. This is continuing to assist in reducing response times to patients with life threatening conditions.
EMS shifts and work pattens can be long and stressful on staff. Over the past two years, EMS has reassessed historical shift lengths and days on/days off patterns to create more sustainable and ‘normal’ working shifts. Having more balanced shifts and workweeks helps to alleviate staff fatigue and contributes to the retention of staff. In some cases, shifts are adjusted to provide more staff capacity.
Following feedback from frontline paramedics, an End of Shift strategy was also implemented, to minimize paramedics being kept on overtime past the end of their shifts. Previously if paramedics were already caring for a patient and their shift ended, overtime was automatic. Under the new guidelines, several strategies are in place to avoid or minimize overtime.
Calgary and Edmonton’s IOCs opened in 2022. These facilities help put all the medical leaders from the two largest zones together into one place so they can better see and re-balance the needs of the system. The IOCs allow for ambulances to be directed to hospitals where wait times are shorter, for example, or to know when a hospital has multiple EMS crews waiting to transfer the care of their patients to admissions, so these patients can be grouped together, allowing paramedics to be freed up and returned to service.
The Draft EMS Provincial Service Plan is complete. This long-term plan coupled with yearly operational plans will guide EMS services now and into the future and is in alignment with the AEPAC recommendations.
When appropriate, EMS is already moving calls to the Poison and Drug Information Service (PADIS). From January to August 31, 2022, 464 calls met the criteria to be diverted to PADIS, meaning dozens of unnecessary ambulance responses were avoided.