Fifth in a series looking at serious issues with emergency health services in British Columbia.

If you have a story to share with us about your experiences, send an email to newsroom@castlegarnews.com.

Advocates of an improved pre-hospital care system argue that the overall costs of adding more ambulances, paramedics, helicopters and fixed-wing aircraft to British Columbiasa国际传媒檚 emergency health-care system would be countered by the savings generated from shorter hospital stays, less time spent in rehabilitation facilities, lower disability claims, etc.

sa国际传媒淔rom a cost perspective alone, all the politicians from all of the parties should be tripping over themselves to put together a vastly more capable pre-hospital care system,sa国际传媒� said Hans Dysarz, executive director for the advocacy group . sa国际传媒淚t is literally bleeding our health system out.sa国际传媒�

What is often referred to as the golden hour sa国际传媒� the first hour following a traumatic injury or illness in which prompt treatment is most likely to make a difference in preventing death or dire outcomes sa国际传媒� is often used up in rural B.C. before a patient ever reaches a hospital.

Missing that golden opportunity for treatment can result in extended hospital stays, need for long-term care and permanent injuries leading to disability claims sa国际传媒� all which cost the medical system.

According to the Provincial Health Services Authority, the yearly cost of injury exceeds $2.8 billion in B.C.

Over 700,000 people are injured yearly in B. C. Of these, approximately 1,800 die, 9,000 suffer permanent disability, 27,000 are hospitalized and an estimated 41,000 potential years of life are lost. (Trauma Services BC)

The Public Health Agency of Canada reports that in 2010 the total economic burden of injury across the country was $26.8 billion, of those costs, $15.9 billion was health-care expenditures and $10.9 billion was associated with reduced productivity from hospitalization, disability and premature death.

The costs of injuries have been climbing each year, so current numbers are likely a lot higher. These figures are only for injuries and do not include other urgent medical issues such as strokes or heart attacks sa国际传媒� two situations where timely treatment is of utmost importance.

So the question many are asking is: sa国际传媒淲ouldnsa国际传媒檛 an investment in better pre-hospital care reduce those figures sa国际传媒� lowering costs, permanent disabilities and lives lost?sa国际传媒�

When transportation is primarily done by ground ambulance, more than one million rural B.C. residents are so far from a trauma centre that transportation time alone takes so many hours that sometimes opportunities for improved outcomes are lost.

This is combined with the fact that almost all of the ambulances transporting those patients are Basic Life Support ambulances which are limited in equipment and not staffed with paramedics at the highest level of certification.

All three of B.C.sa国际传媒檚 Level 1 trauma centres are located in the Vancouver area. The Level 2 trauma centres are located in Kelowna, Kamloops and Victoria. Three of the Level 3 trauma centres are located in the Lower Mainland, one in Nanaimo and one in Prince George. That leaves a vast swath of B.C. residents with a very long way to travel to reach the help they need.

sa国际传媒淵et all of B.C.sa国际传媒檚 rural residents help to pay for these facilities and highly skilled staff year after year,sa国际传媒� stated Dysaryz. sa国际传媒淭hat is a form of taxation without representation sa国际传媒� or in this case, taxation without timely access. And rural residents are dying and ending up with permanent injuries as a result,sa国际传媒� said Dysarsz.

The long distances to hospitals designated as trauma centres are one of the reasons why BC Forest Safety Ombudsman Roger Harris called for the province to add more air ambulances to its emergency health care system in a recent .

In Harrissa国际传媒檚 report he says, sa国际传媒淲hen all factors are considered, HEMS (Helicopter Emergency Medical Service) may, in fact, be more cost-effective than ambulances in the total overall cost to the health-care system when you factor in patient outcomes to the equation; and second, if you apply the logic of using low call volumes as a determinant of allocating emergency medical resources to an area, then conceivably a community with little or no crime or fire could find themselves without those services as well. It simply is not a reasonable argument to make.sa国际传媒�

The report continues, sa国际传媒淭here are no technical, or infrastructure barriers to the delivery of helicopter emergency medical services within that critical first hour to each and every resident of B.C., regardless of where they live. The decision by the government not to provide those services is a choice.sa国际传媒�

sa国际传媒淔aster care results in less overall health care costs,sa国际传媒� states Harris. sa国际传媒淚t is an accepted fact the quicker an accident victim can access medical care, the better the medical outcomes, the shorter the period of time for rehabilitation resulting in an overall lower cost to the health-care system. As emergency response is one component of the cost, investing more in ensuring patients receive timelier treatment, could result in overall savings to the cost of moving a patient through the system.sa国际传媒�

Albertasa国际传媒檚 air ambulance service STARS estimates that: sa国际传媒淭imely treatment of stroke, heart attacks or brain injuries can save more than $1 million per patient. The economic benefits of helicopter ambulance missions are six times higher than the costs.sa国际传媒�

Every time an outcome is improved, the costs go down. A regular hospital stay costs less than an ICU stay, a temporary or partial disability costs less than a full disability and every day shaved off of a hospital stay saves thousands of dollars.

An out-of-province perspective

The Castlegar News heard from an Ontario paramedic leader with over 30 years of experience who is very concerned about the state of pre-hospital care in British Columbia.

He shared that he has many friends in the British Columbia Emergency Health Service that are afraid to speak out about their concerns due to potential repercussions, so he has made a commitment to his B.C. paramedic friends to advocate for better service for B.C. residents.

This paramedic has worked at the primary care and advanced care levels, in ground ambulances and on helicopters and in both urban and rural areas.

He is advocating for more ambulances and paramedics, more helicopters and planes and more equipment on board, especially ECG monitors.

In B.C. primarily only Advanced Life Support (ALS) ambulances staffed with Advanced Care Paramedics (ACP) have ECG monitors on board. The total of ALS ambulances in the province is less than 30. Other provinces utilize ECGs much more extensively in ambulances staffed at the Primary Care Paramedic (PCP) level.

sa国际传媒淓quipping PCP crews with the tools that every other province does makes financial and moral sense,sa国际传媒� explained the Ontario paramedic. sa国际传媒淭he rest of the country considers [ECG] a staple tool required to do the profession.sa国际传媒�

sa国际传媒淐over the province with a net of well-trained paramedics in both fixed wing and helicopters and survivors will be lining up to say thanks,sa国际传媒� he added.

He also stressed that paramedics should not be looked at as just a means of conveyance sa国际传媒� they should be treated as a huge part of the medical team.

In his experience in Ontario, PCP paramedics daily diagnose patients having critical cardiac arrhythmias, treat the patient with oxygen and ASA and then based on a 12 Lead ECG either redirect the patient to a cardiac center for emergency surgical intervention sa国际传媒� bypassing emergency rooms sa国际传媒� or in the absence of a cardiac centre, alert the hospital of an inbound patient with clinically significant 12 lead changes so that the sa国际传媒渄oor to drugsa国际传媒� time can be reduced.

sa国际传媒淭his in no way is meant to disparage the hardworking staff at BCEHS,sa国际传媒� he said. sa国际传媒淏ut it is time that the government look at what the rest of Canada is doing and start being a leader instead of bringing up the rear.sa国际传媒�

Personal stories

Castlegar News has been approached by people who wanted to share their personal stories related to ambulance services sa国际传媒� here are two of these accounts.

One woman shared her familysa国际传媒檚 experience after her mother became ill in 2016. The patient ended up in the hospital and needed surgery for a blockage in her stomach. The surgery was performed, but the next morning the patient was in critical condition and moved to ICU.

sa国际传媒淪he was not there long before they contacted Vancouver and called BC Ambulance Service for a transfer,sa国际传媒� added the patientsa国际传媒檚 daughter.

She reports that the call for an urgent transport was made before noon and the critical care team arrived shortly after 2 p.m. It was after 4 p.m. when the patient was flown out of Trail and arrived at Vancouver General Hospital just after 6 p.m.

sa国际传媒淢y mother was rushed into surgery shortly after she arrived but sadly passed away two days later,sa国际传媒� said the patientsa国际传媒檚 daughter. sa国际传媒淢y mothersa国际传媒檚 hepatic artery proper had been damaged in the first surgery and her organs were starved of blood flow.sa国际传媒�

sa国际传媒淢aybe if it didnsa国际传媒檛 take six hours to transport her to Vancouver she might have been saved.sa国际传媒�

She questions the purpose of having a helicopter pad at Kootenay Boundary Regional Hospital if it is seldom used sa国际传媒� last year there were five helicopter transports in Trail.

sa国际传媒淲hy did we donate and raise $800,000 for a helicopter pad if we donsa国际传媒檛 use it?sa国际传媒� is one of many questions she has about why it took six hours to transport a critical high-priority patient.

The nearest helicopter operated by BCEHS is stationed in Kamloops.

BCEHS has stated that helicopters are sometimes limited in flying capabilities based on the weather sa国际传媒� it is unclear whether that was a factor in this situation.

Asthma attack

Another woman shared her story about what happened when she called for an ambulance when her husband was experiencing a sa国际传媒渃ritical life-threatening asthma attack.sa国际传媒�

sa国际传媒淭he crew did an amazing job in relation to their limited training and limited scope of practice,sa国际传媒� she said. sa国际传媒淏ut my husband had minimum air entry and needed a medicated nebulizer immediately that they werensa国际传媒檛 able to administer.sa国际传媒�

She reports that the crew was proactive and contacted another BCEHS crew with higher levels of training, but the ambulance had to drive 30 minutes before meeting up with the second ambulance and before he was given medicated treatment.

This was then followed by another 30 minutes of driving to get to an emergency room because the emergency room at the hospital nearest where they live is not open during evenings and weekends.

sa国际传媒淲hen you cansa国际传媒檛 get air into your lungs that is a long time to wait,sa国际传媒� added the patientsa国际传媒檚 wife.

sa国际传媒淚f Interior Health is not going to provide emergency care 24/7 to B.C. residents, then first-time responders should be at the highest level of scope of practice in order to provide life-saving treatments and medication to patients in a timely fashion,sa国际传媒� she said. sa国际传媒淭his training/education should be made available to the present dedicated BCAS personnel.sa国际传媒�

sa国际传媒淏.C. emergency care and first responders need to be modernized from their present 1980 model so that lives are saved and prolonged suffering for patients isnsa国际传媒檛 endured any longer,sa国际传媒� she added when sharing her frustration.