IN DEPTH: Manitoba's rural paramedic service

To paint a picture of the province’s rural paramedic service, the Winnipeg Free Press asked Manitoba Health a series of questions about response times, staffing levels, closures. Manitoba Health answered fully, providing reams of data. Here are the questions and answers.

The number of advance care, paramedic technicians and technicians on staff in each regional health authority (RHA).

Technicians - Also known as first responders, they're often cross-trained firefighters who have done about 200 hours of training. They can administer oxygen, immobilize patients following car crashed and provide basic splinting and wound care. They can’t administer many medications but they can transport patients.

Techncian paramedic - Also known as basic paramedic or primary care paramedic, they’ve done about 1,200 hours of training including practicums in ambulances. They can start IVs, administer medications like nitroglycerine and ASA for chest pain, IV glucose for diabetes, epinephrine for allergic reactions and ventolin for asthma. They can insert breathing tubes.

Techninan Advanced Paramedic - can do many of the procedures a doctor would do in an emergency room, including giving pain medications such as morphine, cardiac drugs like epinephrine, midazolam and atropine, They can treat seizures and drug overdoses, postpartum hemorrhage, and do all the advanced skills on pediatric patients.

Manitoba Health notes:

These figures do not include stretcher attendants, dispatchers or air ambulance personnel.

The number of technician-paramedics has seen the greatest increase over the last ten years, in part due to increasing provincial investment in training opportunities, including the $1.3 million paramedic training program at Red River College, which delivers a primary-care paramedic program at the college’s main campus and at three rural and northern sites throughout Manitoba.

There are challenges to retain advance care paramedics in rural and remote regions of the province, because there are fewer calls that require these more specialized skills. The RHAs continue to look at their EMS plans to find the right balance of skills and education levels to meet the needs of the area.

The number of ambulances in each RHA or each station for 2004 and 2008.

Manitoba Health notes:

Regional health authorities review the demands placed on EMS and can allocate their ambulances to locations (either geographic locations or an actual station) as needed.

The provincial ambulance fleet (in rural and northern areas) has increased to deal with increasing demands being placed on emergency response. The growing number of calls to 911 is not unique to Manitoba – most provinces and other countries like Australia, the UK and the US are experiencing similar challenges.

Rural and northern areas will be receiving four additional ambulances in 2009 and the province is purchasing nine new ambulances for 2010. The province has refurbished another 30, with another 30 set to be refurbished next year.

Manitoba has also developed the $7.8 million Medical Transportation Co-ordination Centre in Brandon so that ambulances can be geo-posted, which helps to ensure appropriate EMS service to communities because an ambulance can cover more area and serve more communities. So while Boundary Trails and Falcon Lake may have one fewer ambulance, the ambulances have been located in the region strategically to provide support if needed (For example, if the Boundary Trails ambulance is on a call, others in the region would shift to provide adequate coverage).

Station-by-station breakdown of calls last year and in 2004.

A growing number of calls to 911 is not unique to Manitoba – most provinces and other countries like Australia, the UK and the US are experiencing similar challenges.

Although the number of interfacility transfers has increased over the past four years in the province it is unclear what is driving this increase in overall volumes. Studies have been done in a number of jurisdictions and note that most calls to 911 now come from cell phones, so an increasing number of calls may be linked to the growing number of Manitobans with cell phones.

The province is looking at why the increase is happening. Manitoba is also using MTCC to utilize existing resources more effectively while adding trained paramedics, providing more funds to RHAs to hire staff and adding / updating the ambulance fleet.

In response to growing demand, the province has invested over $4.6 million to construct and upgrade emergency medical stations in Morden/Winkler, Oak Bluff, Carmen, The Pas, Killarney, Swan River, Minnedosa, Rivers, Ste. Anne, Gypsumville, The Pas, Steinbach, Lundar, Kinisota Trails, Ashern and Dauphin.

Response times

The province measures response time based on the "90th percentile." Using this measurement, the provincial response time is 32 minutes. This means that 90 per cent of the time, the response time is 32 minutes or less.

The clock starts the second the call comes to the Manitoba Transportation Co-ordination Centre through E-911 and includes the time needed to collect information from the caller, make the dispatch, receive confirmation that the dispatch has been received, chute time and time needed for the ambulance to reach the scene.

Response times for stations

Note: Information provided is based on MTCC data, so communities served by EMS that do not yet run through MTCC are not included. These communities are , Cross Lake, Thompson, Peguis, Wabowden, Gillam, Nelson House, Easterville, Grand Rapids, Fisher River and Hodgson.

This data is used by RHAs to assess response times for each station to determine where additional investments or resources may be needed.

The province has only been collecting this data since MTCC became operational, over the last two years. Some of the RHAs had been collecting similar information but without using similar baselines, it would be difficult to compare. Over time, the MTCC data will allow us to better evaluate response times across the province.

Chute times

"Chute time" describes the difference between the time the Manitoba Transportation Co-ordination Centre dispatches an ambulance and the time the ambulance in en-route to the call.

Across the province, the fastest chute times are generally between 7 a.m. and 7 p.m., and the province-wide measurement is within three to four minutes. Between 11 a.m. and noon, the province-wide chute time is less than 3 minutes.

Province-wide chute times for the rest of the day range between four minutes and just under eight minutes. The longest chute times are in the late evening and early morning. More paramedics are on-call and not within the station during these times, so this is the likely reason the chute time rises during this period.

Each station’s chute times could be split into ‘primary’ and ‘secondary’. Stations that do not have staff on-site around the clock will use ‘primary’ to identify the hours that staff are on-site and ‘secondary’ when staff are on-call, to provide a more accurate picture of their chute times. If a station chute time is for 24-hours (no secondary time), then "None" is listed under secondary.

These chute times are for 2008.

Station closures

This chart indicates closures that lasted more than 24 hours.

Following the introduction of MTCC, the province and regions are able to collect better information about station closures and the paramedic workforce. This data is allowing us to better identify the needs of rural and northern EMS and has helped to direct recent investments with a goal of reducing the number of station closures.

The computerized automated dispatch system at MTCC will automatically determine the closest available ambulance to respond to a call and this is how ambulance coverage is adjusted in the event of a closure. This would be the same process used to direct a call if an ambulance was out for maintenance or already responding to another call in the region. The dispatch also calculates the best ambulance to respond based on road speed, distance to the call and other logistics.

Staff types

RHAs determine their staffing levels for each station, but Manitoba Health has information about the staffing levels at each station (see below, for 2008).

All stations must have two licensed technicians, but if call volume is over 750 per year, at least one technician must have a paramedic license.

Stations are staffed with either "in-house" or "call-back" service.

Stations with 24-hour in-house service:

• Beausejour
• Boundary Trails
• Brandon
• Dauphin
• Flin Flon
• Gimli
• Gypsumville
• Kinosota
• Michele Memorial
• Norway House
• Pine Falls
• Portage la Prairie
• Selkirk
• Shilo
• St. Paul
• Steinbach
• Swan River
• The Pas
• Thompson

Stations with 16 hours in-house, 8 hours call-back:

• Falcon Lake

Stations with 12 hours in-house, 12 hours call-back:

• Altona
• Arborg
• Ashern
• Carman
• Churchill
• Erickson
• Gladstone
• Killarney
• Lac du Bonnet
• Lundar
• Minnedosa
• Morris
• Neepawa
• Oak Bluff
• Roblin
• Springfield
• St. Pierre
• Ste. Anne
• Ste. Rose
• Stonewall
• Teulon
• Treherne
• Virden
• Vita

Stations with 8 hours in-house, 16 hours call-back:

• Boissevain
• Grandview
• Mafeking
• McCreary
• Pinawa
• Souris

Stations with 24-hour call-back service:

• Baldur
• Birtle
• Bissett
• Carberry
• Cartwright
• Cranberry Portage
• Cross Lake
• Crystal City
• Deloraine
• Easterville
• Elie
• Elkhorn
• Ethelbert
• Fisher
• Gilbert Plains
• Gillam
• Glenboro
• Grand Rapids
• Hamiota
• Hartney
• Leaf Rapids
• Lynn Lake
• MacGregor
• Manitou
• Melita
• Notre Dame
• Oak Lake
• Prawda
• Reston
• Rivers
• Riverton
• Rossburn
• Russell
• Shoal Lake
• Snow Lake
• Swan Lake
• Waterhen
• Wawanesa
• Whitemouth
• Winnipegosis