An ambulance parked at the Strait-Richmond Hospital during last week’s code critical.

By: Adam McNamara

HALIFAX: The union representing Nova Scotia’s paramedics – International Union of Operating Engineers, Local 727 – resumed their Code Critical program as of July 6.

The program alerts Nova Scotian residents, when two or less paramedic crews are available to respond to 911 calls in a given county.

The union says this can lead to slower response times.

Since the restart of Code Critical, each municipality in the area saw varied instances of these alerts. As of July 29, there were 28 in Richmond County, 11 in Inverness County, in Antigonish County there were 45, and Guysborough County recorded 35 alerts.

In total, this is 119 times the Strait area had these notifications between July 6 and 30.

The paramedic’s union started Code Critical in 2013. It is movement which took a brief pause during COVID.

Realizing the stresses of the pandemic, the paramedic’s union was hesitant to continue the Code Critical movement.

Business Manager for Nova Scotia’s paramedic’s union, Michael Nickerson, says this shortage is not a reason to be hesitant about dialing 911, but the union feels it is important to restart the alerts.

Nickerson says the union, “postponed code critical for a time, due to trying to be cognizant in the fact of not alarming Nova Scotians while we dealt with a deadly variant.”

“But I do want to say, just because we postponed, it was still happening every day. It never went away,” he said. “We just stopped highlighting it, and then we said, okay our numbers are down again and our members are hurting, we need to shine light on this again.”

The union says the issue is affecting the wellbeing of paramedics, who naturally want to deliver the best care possible. Nickerson says something has to be done to protect both the patients entering the health care system, and paramedics delivering the care.

“We’ve been in a health care crisis far too long, I’m here to tell you we are on the brink of collapse or disaster,” said Nickerson, when addressing how bad the developing situation is for paramedics, who want to deliver what they’ve been trained to do.

“Paramedics are tired, they’re angry, they’re frustrated and fatigued… They’re breaking down physically, mentally and emotionally.

“When you look at the computer screen on the ambulance and you see that you are the only ambulance for 100 kilometres or more, and you know that you’re going to be responding, and you could respond up to an hour or longer. It’s just that they’re tired,” he said.

What is needed to solve the problem, says Nickerson, is more staff when it comes to paramedics. He also thinks getting more nurse practitioners, more doctors and more long-term care beds would help. He would also like to see unions joining the decision-making process.

“We need all health care unions, the government, the health authority, the ambulance service provider, EMC Inc. We need all of us to have a conversation and figure out how are we going to fix this mess we are in. Because it is all intertwined,” he said

Emergency Medical Care Inc. is a private company contracted by the province to provide Emergency Health Services. EMC Inc. provides all pre-hospital care in the province.

They have 160 ambulances, which include ground and air, and approximately 1,200 paramedics making up Emergency Health Services (EHS) in Nova Scotia.

Charbel Daniel is Executive Director of Provincial Operations with Emergency Health Services.

Charbel Daniel is Executive Director of Provincial Operations, with EHS Operations. He says since the pandemic, there are several challenges the health care industry is facing as a whole.

“It’s no secret that the health care system and industry is facing several challenges right now, namely due to the face that we’re still in the middle of a global pandemic that’s truly been unprecedented in the healthcare career that’s currently operating today.”

Daniel says, “knowing that the system is changing and evolving, we have to change and evolve as well.”

In 2018 the Department of Health and Wellness hired Fitch and Associates, a consultant group specializing in emergency medical system design. They investigated the current emergency medical services model in Nova Scotia and 90 per cent of the findings from the report were accepted by the government at the time. The report helped inform, and develop the new contract for a new EHS design.

This past March, the province signed a new contract with EMC Inc.

Marla MacInnis, Media Relations Advisor, for the Department of Health and Wellness, says that as part of their new contract, EHS will be providing an annual report beginning next spring.

Nickerson says this annual report is long overdue. He would like to see it released now, not next year.

He says these reports include call volumes, category and code of a call, whether the call was a transfer, and also the overall call volume, and kilometres driven by the fleet.

Nickerson says paramedics and the union do not receive this information anymore, and this lack of information isn’t helping his ability to represent and advocate for his members.

“We as the union can’t advocate properly in my opinion for our members, not knowing that call volume. Anecdotally, we know call volume has increased over the years. But we don’t know if physical resources meet the demand of the increased call volume, because we don’t know the numbers,” he said.

The Department of Health and Wellness said in 2020 alone, EHS has answered over 175,000 emergency and patient transfer calls.

“It’s important Nova Scotians know that care begins the moment the phone is answered. Communications Officers are trained professionals who coach callers to care for patients while paramedics are on the way,” said MacInnis.

Daniel says EHS has coordination with trained medical first responders situated in every municipality in Nova Scotia.

He says they have approximately 3,600 Medical First Responders as part of the response program. A program which he says is unique to Nova Scotia, innovative and different of its kind.

“That program is designed on a notification basis given the fact that some are volunteers and such. So, when notified, and they’re available, they are dispatched to their own agency and sent.”

“I definitely want to mention how much we appreciated all the hard work and effort the medical first responders put in, and the service that they provide to all the areas across the province,” Daniel said.

Nickerson also says he is also thankful for the services medical first responders provide in an emergency, but says they are not a replacement for paramedics.

He says each emergency department has its own specialized training, and only paramedics can administer certain medications, perform procedures, and transfer patients.

“You wouldn’t call paramedics to put out a house fire, you shouldn’t rely on firefighters for medical calls. We have to remember too that these fire fighter’s, the majority of them are volunteer and have full-time jobs,” said Nickerson. “Nova Scotia paramedics are some of the highest trained paramedics in this country and actually North America. And EHS is the safety net, and the safety net is full and over flowing. Now, there is no more safety net.”