Retired paramedic Don Sharpe on AHS hindering EMS reforms
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Summary
Don Sharp, a retired EMS paramedic, joins us to talk about the lack of ambulance service in the Foothills area of Alberta, and why it's a problem. Don also talks about the need for non-emergency patient transport services in the area.
Transcript
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And I've got Don Sharp in. He's a retired EMS paramedic. He's been on the show a number of times
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before now, I believe. And he's in studio with me today to talk about these things. So, hey,
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Don, good to see you back. Corey, good to see you again. Thanks very much.
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I appreciate you coming in in this miserable weather. I mean, this winter's really hanging
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in this. Right? No bugs. Yeah. So, I mean, where to begin? There's so much to cover on this.
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Well, and there's been so much news lately, too. I mean, we've had that dysfunction in EMS
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article that came out in Alberta Views. We had this recent lights and siren report from Michael
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Korman, published by the Parkland Institute and funded by HSAA, the Union of Paramedics. We've had
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all this in the news lately about this email from a Foothills ER manager, I guess, to her staff,
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and somebody leaked it to the opposition and the legislature, and that caused a big
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brouhaha. I could talk about what's going on in healthcare for hours, Corey. I could.
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Yeah. Well, one I want to talk about, kind of start with the emails we had a couple weeks
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ago before we hooked you on. And one of the fixes we want to have, I mean, you've talked
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about these common sense fixes a lot for a long time, was patient transfer. You know,
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we're using fully staffed and equipped, you know, paramedical vehicles to move a low, low-risk
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patient from one facility to another as taking people off the street who are specialized and
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trained for emergency response. Right. And tying them up. So, I mean, it sounds like,
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okay, we're going to allow some other outside provision of these non-emergency transfers and
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that. But then they put out this, this notice for, for the bids that basically put it right
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out of bounds. It's like AHS is saying, oh, we're opening the door, but here, basically,
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you've got to provide us with a fully equipped ambulance if you're going to do it.
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Well, and again, let's look at the, at the basics of this problem is emergency ambulances,
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the critical care vehicles that look after the sickest patients, staffed by our very best
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paramedics, they're a finite resource. And to use those vehicles to transport patients who need a
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cast change or need to go in to get fitted for orthotics, that's like taking a limousine to the
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grocery store. It's way more vehicle than that person needs. So let's look at alternative transfers.
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Let's make sure that those critical care vehicles are available for our sickest patients
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patients. And isn't that the problem right now is a lot of them are stuck in the hospital hallway,
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right? And they're not available in the community to respond. So it's, it's real easy for me to see
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the need for alternative transport. This should have been done years ago. But again, AHS dragged its feet.
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I asked them numerous times to look at this issue and they refused. Well, now they're kind of being
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forced to. And let's look at, let's remember when we talk about AHS and the government, they're two
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different things. AHS is the large bureaucracy that frequently takes instruction from the government
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or has in the past and gone, yeah, yeah, we'll get on that. Right. And then they either do it for six
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months and ignore it or just refuse to do it altogether. So now they've been instructed by the
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advisory committee to actually enable alternative transport, which right now, Corey, is happening.
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There's a paramedical company here in town right now that is taking phone calls from the Foothills
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Hospital. In fact, they have two trucks staged at the Foothills right now, private operators to move
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patients out of the Foothills Emerge to places where they need to go stable, non-emergent patients.
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And there's also, I know every day, because I talk to these people, I talk to the crews,
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they're taking calls, they're doing transfers from the Peter Lougheed to the Foothills, from cardiac
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rehab centers to nursing homes. It's happening now. And it's happening with a phone call.
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Hi, I need an ambulance to move a patient from the PLC to the Foothills. Can you do it by 2.30?
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Yep, no problem. Click. So what's AHS's answer? That's the question. From what I understand,
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hearing about this new request for interest is that AHS is going to try to put a mobile data
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terminal in every one of these transfer vehicles. These vehicles only have to be staffed to admit or
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equipped to a minimum standard. I understand with an AED and a basic first aid kit.
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They don't have a lot of equipment. They've got a couple of basic providers who are provincially
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registered. They're trained. They've been hired by a responsible business owner who probably this isn't
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his main business. Some of them, a lot of them do oil field work, but they have high quality vehicles.
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They have high quality staff. They're able to start tomorrow moving patients. But AHS is going,
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we got to go through this whole big rigmarole. We got to make sure we got to check your financial
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underwear. We got to have a quick pick at your details. And we got to make sure, I mean, I think
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it's onerous. I think it's irresponsible. And I don't think AHS can put any of these alternative
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transport vehicles in that fashion on the street until the end of June. And we need them today.
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Well, and we need them today. And those vehicles are there now. I mean,
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I worked in the oil field for 20 years. They're fine vehicles. They're often,
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yeah, at this time of year, there's a lot of them sitting on standby, more than equipped enough to
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just take some of the load off. Every one of these vehicles that takes somebody from hospital to
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hospital means that you've got some highly trained paramedics are now available somewhere else.
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Right. But so here's the question, who's enabling these transfers, making them happen,
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and who's blocking them at AHS? Well, the people who are making it happen are brave unit managers
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at some of the hospitals who say, look, I have three patients in my eMERGE. I've got a lot of
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people waiting in the hallway to get into eMERGE. I need these patients taken back to the nursing home
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right now, not six hours from now, not tomorrow, right now. So I'm going to phone a private company,
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and they're going to come and get these patients. They're going to move them where they need to go.
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And they send the bill to Alberta Health and they get paid. And it's a reasonable fee. They're not
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grossly, they're not overcharging or gouging anybody. And they're getting the patients moved
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safely and quickly. Those brave unit managers are succeeding in this. Now there's unit managers
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at urgent cares in places like Cochrane and Okotoks who frankly refuse. Say, I don't care what happens,
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I'm not calling. I'm going to call AHS. I want an AHS ambulance because I don't want to get in trouble.
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So those patients, remember some of these urgent cares close at 10 o'clock at night.
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If there's a serious patient in the urgent care in Okotoks, Cochrane, any one of these places,
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10 o'clock comes, the urgent care closes, but that patient's still there waiting for transport.
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So now the urgent care manager has to keep a nurse and sometimes a doctor overnight at overtime to look
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after people that if they had simply called somebody else, if there was somebody else available,
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they could call that patient would get moved to the hospital.
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So we've got a big bureaucracy. You've got levels and levels, unfortunately,
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of resistance. I mean, that's the hard thing. With a big ship, it just doesn't turn easily.
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You did mention the union. And I mean, the unions have been excellent
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in highlighting, for example, the way rural amulets have been drained and pulled into the
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city and misappropriated in my view. But at the same time, isn't there a bit of the resistance,
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I guess, when it comes to, because that's instinctive for a lot of unions. Well, we don't allow private in here,
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though. We can't let another group come in here and start taking care of it.
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Well, look at this latest report by Michael Korman, published by the Parkland Institute,
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commissioned by HSAA, the union. Neither one of them are interested in talking about privatization.
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They're very much against it. And I would support 100% public health care if they could do the job.
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But I think AHS and especially EMS have proven they can't. We simply don't have the vehicles or the
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staff to move patients right now. And I'm not talking about, we could grow more paramedics. Do you
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remember that article? Bill, I can't remember, Bill McFarlane published. He blamed the lack of
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paramedics these days on the low birth rate over the last several years. I laughed so hard. He
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wouldn't call me back. I don't think he wanted to talk about it. It takes time to train paramedics and
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buy trucks. New ambulances, by the way, from, you can look it up, wheeled coach type three,
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brand new ambulances, $240,000 US. That's prohibitive.
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Over a quarter million dollars. It's a huge investment. So we've got responsible business
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owners who own these trucks. They maintain them, frankly, better than AHS. I used to work on an
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ambulance not too long ago for AHS. Their vehicles are not well maintained. They are not clean.
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You sent me that picture of the gas tank, a simple maintenance issue.
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There's so many of those. They don't manage their own fleet very well. And yet they want to be able to
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micromanage a responsible private business owner's fleet and their staff. It's frustrating. It's
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frustrating to see this unfolding. And it's frustrating to see the non-cooperative and
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unfortunately the reality politicized attitude of trying to make sure that the current government
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isn't successful no matter what they try. I mean, I'm really seeing some of that.
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And when there was that leaked email about the memo and everybody lit their hair on fire and suddenly
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the government's on its heels and backtracking because the memo is saying,
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we want these ambulances out of here within 45 minutes.
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Yeah. And what did Notley say in the lead? She said,
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patients are going to get dumped and emerge. Okay, let's back the truck up. Number one,
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that letter, that email was written internally from a manager at the ER to her staff. And quite frankly,
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I think that's an email written by a weak leader. That whole attitude of that was, we're going to fail,
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look out. You know what? That 45 minute target time is, that's a target. It's not a hard stop on March
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15th, 45 minutes, we're going to leave. No, I mean, nurses and paramedics are very responsible.
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We're never just going to drop people and run away. That's, especially if they need extra care.
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So that's a target time. March 15th was going to be a slow rollout. It wasn't well publicized,
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but the medics and the nurses knew about it. We're all kind of cooperating. What's the goal here?
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The goal is to move patients into the hospital in a timely and efficient manner so that we can then
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extricate the medics out of the hospital, get them back into the communities where they serve,
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so that patients aren't waiting an hour for, Corey, you know, people are scared. Like I,
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we have all of these citizen action groups and that is the primary comment now on most of our
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citizen action groups is, you know what? I'm afraid. I'm afraid that if I call an ambulance,
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I'm not going to be able to get one. I might have to drive my mom to the hospital
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myself. And setting a target at 45 minutes to get somebody in, drop off, do the paperwork,
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do the transfer and get out. I mean, that's the goal. And that's a long, I mean, that sounds
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unreasonably long already. It's twice as long as we used to drop them off. And, and not only that,
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but the Canadian standard for turnaround times in hospitals and emerge is 45 minutes. Alberta is the
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outlier right now with AHS is 90 minute turnaround time. It's a, and it's gone on far too long. Like
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I said, they've had years to fix this. And again, making it clear the government can only do so much.
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There's legislation that prevents them from moving too quickly to make changes at AHS. That's for a
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reason. But AHS has got a responsibility here that they've failed to fulfill. And I think I, at the end of
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the day, this is a leadership problem. And we need erasing the board, the healthcare board was a great
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move. Making sure moving on from having our chief paramedic in charge. And, and now we have a provincial
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lead, a provincial head of EMS, Athena Metzolopoulos, you know, she's done some work before with the red tape
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reduction project, I think she's very skilled. So I'm looking forward to some positive changes. But
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again, alternative transport, that should be happening right now. Not next week, not two weeks
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from now, not three months from now, certainly. The vehicles and the equipment, the people are ready
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to do it right now. And they're needed right now. Well, yeah, and it's a solution in front of our
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faces. I mean, a lot of the things that, again, we listened to, and I won't even go left, right,
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we're hearing it in every province, but saying, we have more money, more money. Well, no, if there's only a
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finite number of bodies, you can pump all the money in there that you want. I mean, if we're talking about
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nurses and doctors, but when we are talking about patient transfer, actually, we do have the means
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handy, we have the trucks, we have the people, money will take care of that. And it's not expensive.
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That's the thing, these guys aren't looking for a windfall. I'm not sure exactly what the financial
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structure is going to be, I hear it's going to be a flat fee, based on so many transfers a day.
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Here's the interesting thing, though, what HS wants is total control of these private operators
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resources. In other words, they want to put an MDT in the truck, a computer, so the crews have to
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learn how to use that. They want to control, here there's going to be a rule that they can't refuse
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a transfer. So if you're offered a transfer, you're told to do a transfer at the end of the day,
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that's going to run you past the end of your shift. That's fine. In EMS, we understand late trips.
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But if it's going to happen three times out of four shifts that you end up doing a late trip,
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I mean, this is what they're doing to the emerge crews now, keeping them late, running them hard,
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burning them out. And that's why 40% of them are off six. So again, I don't see I've talked to
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some of these people who work as as they used to work for HS. But now they've left HS, they don't
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want anything to do with HS EMS. And they've gone to work for these private operators, they say,
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what are you going to do the first time somebody says you have to stay late and do a transfer? He goes,
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huh, that's not going to go well. Well, and unfortunately, why left,
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it sets up some of the conflict potentially too. And that's why you get fearful of when they start
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basically already creeping in and turning these alternative transport vehicles into full out
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ambulances, you give it two more years, next thing you know, well, now we're going to require you to
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be unionized. Now we're going to require your certification to be up to paramedic level. Next
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thing you know, you're back to basically HS ambulances on the road again, that can be tied up
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very expensively doing patient transfers that we were trying to avoid in the first place.
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Yeah, that kind of creep. I guess I hadn't thought of that as certainly possible. I mean,
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my focus is the immediate problem right now of just the patient who's right now in the High River
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Hospital. She's an inpatient, she needs a stretcher to get to South Health Campus to get an MRI.
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Right now, the nurses will phone and say, I need an ambulance tomorrow to move a patient on a
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stretcher for MRI. If she doesn't make that appointment, that MRI sits empty, she doesn't get looked after.
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And that's happening over and over and over. And that can be changed. That's a stable stretcher
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patient that could go. Now, here's the other problem, this alternative transport issue that
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AHS has got planned, isn't going to affect any communities outside of a 50 kilometer radius
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from Calgary or Edmonton, big centers. So if you live in Banff or Canmore, you're outside,
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no, that's not going to affect you. Or if you live in Sundry, Sundry right now is moving patients
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sometimes by taxi to the city. And their concern at the hospital is who's going to pay for that.
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So when I heard that question, I said, send it to Alberta Health Services,
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send it to the same people, these other paramedical outfits. And I mean, that's,
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that should be paid for by this organization, AHS, that said they were going to take care
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of EMS and inter-hospital transfers, and quite frankly, isn't doing a good job. Here's,
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they, they're not doing a good job now. Now they want to take on the additional
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monster of alternative transfer. You think they welcome, you know,
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take some of this off our hands because we've got a million other things we're doing.
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Right. NHS believes that there's no amount of managers that they can hire. We're always going
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to need one more manager. So that's another, like, it's, I think the whole thing's crazy. It's,
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they're, they're not doing themselves a service. They're not doing patients any service.
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And I'd like to see them move forward with a more, with a, with a quicker solution.
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Well, we've been talking about it for years. And that's part of the issue.
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Governments move very slowly with it too. I mean, we keep bringing up, I mean,
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it was that horrific case of that woman who was attacked by dogs and most definitely could have
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possibly been saved with a quicker response. She was a 10 minute drive from the biggest hospital in
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So let me jump on this. Another little side note here, the Health Quality Council of Alberta,
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Alberta, they're the ones who did the report on the fatal dog bite. They left out all of the issues
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with leadership. They didn't mention leadership and poor leadership at eight, not even once.
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I appear, I spoke, I phoned them and said, can I come in and talk to you in 2018? I went to the
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Health Quality Council, I made a presentation. I said, your little focus website you have with all
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the times. I said, keep some EMS stats, response times, hospital turnaround times, hospital wait times.
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Oh yeah, we can't do that. We're, we're really busy. I said, no, this is important. And this is
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healthcare. This is EMS. This is hospital. Yeah, no, we're too busy. I got blown off by them two or
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three times. And you know what? Now I see them doing this fatal dog bite review and I go, you guys
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dropped the ball. Health Quality Council of Alberta dropped the ball four years ago. They could have,
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they could have gotten in front of this and actually been part of the solution rather than sweeping up the
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mess with this report on that fatal dog bite attack. So getting onto the solution,
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you know, how do you, I mean, you're trying piecemeal. We've got things that are proposed
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here and there, but again, you got that, that, that big monstrous leviathan of a bureaucracy with
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AHS. What can government or people or just anybody do? How are we, how? That's, that's the hardest
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question. I mean, you know, the solutions, but how can we get this machine to embrace the solutions?
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Well, the first thing you got to do is you got to talk to the people that are doing the work.
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Right now, the only time they talk to the people that have solutions or make suggestions is they
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punish them. Take a look at that paramedic right now who's been disciplined multiple times
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for speaking up, simply FOIPing documents and going and speaking to a reporter. Brave kid. I am a,
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he's a, he's a brave guy. He's got a family. He could lose his job. He won't quit fighting. And that's,
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it's a, it's unfortunate. That's what it has to come to. And again, that's a leadership issue.
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If my, you want my opinion of what we should do now, the first thing we should do. So we should
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start replacing some of the people that are leaders in this organization, not just EMS,
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but the hospitals too. Quite frankly, how many years have they had to solve issues like access block,
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moving patients from emerge into the hospital? And I hear all the time, number one, it's a long-term
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care problem. Okay, great. You've got a problem, not an EMS problem. Right. And then they tell me,
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well, we're all on the same team for patient care. You know, you got to, I said, well, I agree.
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We're all on the same team for patient care in the hospital, but don't forget when it's three o'clock
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in the morning, it's 40 below. And I'm in a ditch on the side of a highway at an overturned car.
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I don't see anybody from the hospital on my team. That's an EMS responsibility. You know,
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picking people up who've been hurt and are sick critically in communities. That's my job.
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Well, and that's a specialized skill. It takes a certain kind of person to do it. Just as an EMS,
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a paramedic wouldn't necessarily be a good nurse. I mean, that's a separate skill as well. And,
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and, and, you know, I know people who are both nurses and paramedics. They're fantastic people.
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And I know terrific practitioners who are able to straddle that. I never could. I mean,
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I was a good paramedic at best. You know, I've worked with some great, great clinicians,
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great paramedics. I think some of the things that I've seen are just process issues. You know,
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why, why, why is this taking so long? Where's the paperwork? Why am I here when this has to be done?
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And again, in EMS, you know, when you show up on a call and somebody is critically ill,
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we're trained to move very quickly. And then we drive lights inside of the hospital and you give
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report to triage and they send you down the hallway and you're going, are you kidding?
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Like this guy's sick, but their process is different and their problems are different.
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Now back to my original point, which is if you can't find somebody to fix these hospital problems,
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Well, and there's something, I mean, consequences for senior managers,
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and someone want to bring up is, I mean, AHS, it was a representative who was caught in an outright lie.
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That was on the documentary. The great one was CTV with Kathy Lee.
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When he said we do not discipline people for speaking up and then after it pops up,
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well, here's one being disciplined for speaking up. Now there should be consequences for him lying
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to the public on a critical issue like this. There was no consequence.
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You know, it's funny. One of the, one of the managers mentioned, well, he retired and I go,
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well, did he retire or was there? And he goes, actually, we can't talk about it. I said, well,
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if you can't talk about it, he probably didn't just retire, did he?
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So, and that's, more of that needs to happen. But again, what's the biggest problem after
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leadership is transparency and accountability, AHS. AHS doesn't want people FOIPing data. They
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make it very difficult to actually get, and they, you know, these presentations that EMS goes out to,
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they send executive directors out to speak to these town councils in these small towns,
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and they just baffle them with all this gibberish, which is what it is, if it's medicine, right? And it's
00:20:36.320
all these statistics and a PowerPoint. And really, town councils should be going, wait,
00:20:40.480
I don't need any more information. Where's my ambulance? I want it here when my people need it.
00:20:46.880
And that's, that should be just a line in the sand. And like Jeff Ganung, the mayor of Cochrane
00:20:51.600
said after the last presentation in Cochrane, he said, look, people here are scared. And after years
00:20:57.760
of asking for better service, trust has been eroded. People don't trust AHS anymore. He says,
00:21:03.360
we got to repair that. Well, and you've been very active in Cochrane out there. I mean,
00:21:07.760
you've got some great people working on things out there and doing stuff. Great group. And part
00:21:11.680
of what the last time you were in talking with me, we talked about was some efforts and municipalities
00:21:16.960
to say, you know what, screw you guys. We'll take care of it ourselves. We will do it. And, but that's
00:21:21.920
where we're seeing the creep with AHS seems to be, well, we're going to find ways to regulate this out
00:21:25.600
of existence too. Well, here's an interesting one, fire departments. You saw what happened in the MD of Willow
00:21:31.040
Creek? The MD of Willow Creek bought three ambulances. Now you can't call them that because
00:21:35.600
it's against the law. It's a fire department, paramedical response, whatever. It's an ambulance.
00:21:41.120
So they bought three of them and they put one in Fort McLeod and Claire's home in Nanton because they
00:21:46.640
saw repeatedly that they were spending long time on scene with critical patients who they needed to
00:21:52.400
move. And how many times I think Canmore, yeah, Canmore just last weekend moved a patient in the fire
00:21:58.160
truck to the hospital. We don't have a lot of details. We don't need a lot of details. We've
00:22:01.920
all heard the stories, but now, and I think it's my opinion. And this is what I've told people is
00:22:08.000
every fire department in Alberta should have an ambulance, a fire paramedical response vehicle.
00:22:12.960
But if for three reasons, number one, you go to a big fire, that's a good place to rehab your
00:22:16.960
firefighters. Get them in, take a pressure if you need to. Number two, it's a safe place to look after
00:22:21.920
people at a car crash on the highway, out of the elements. You got to, you got a place where you can
00:22:25.440
literally sit eight people so they're not freezing cold, sitting in their overturned car or stand on
00:22:30.320
the side of the road. And three, it's a place you can use as a base for treatment. You go over and you
00:22:35.840
find a lady who's fallen and broken her hip in her driveway. You're going to leave her in the snow for
00:22:40.640
40 minutes till AHS gets there, or are you going to put her in a nice warm bus design? And number four,
00:22:46.400
if you have to transport, giddy up. You phone medical control. You say, listen, I got a lady here who's
00:22:51.280
really sick. AHS is too far away. Hospital's 10 minutes away. We're going to, we'd like to go.
00:22:56.160
Oh, we didn't. And that's that overlap of the skills too. I mean, you know, we know that there's
00:23:00.880
a degree of emergency health training for firefighters, but they are firefighters. Their
00:23:06.960
primary role is getting that fire. We don't expect the paramedic to go into a place where the propane
00:23:12.080
tanks ready to blow and knowing what to do with that. And we don't expect a firefighter to be the best
00:23:15.680
paramedic. Well, hang on. I'll disagree with you there because Cochrane has a number of,
00:23:20.960
I think they have eight or 10 people who are trained to the absolute top paramedic level.
00:23:25.680
A lot of them work part-time for EMS. They're terrific practitioners. I would work with any
00:23:30.560
one of them. I would let them treat my family. They're terrific paramedics. There's also small
00:23:34.960
services, volunteer services in towns where they really have the minimum MFR, medical first responder
00:23:40.320
training. And they do a great job too. They can do CPR. They can stop the bleeding. They can hold
00:23:44.640
somebody's head still in a crash. But you know, there's lots of fire departments who quite frankly,
00:23:49.760
could run an ambulance service tomorrow better than AHS could. And I encourage every fire department
00:23:54.880
to get an FPRV. I won't devolve into the Prentice issues as we have in my area. I mean, we,
00:24:00.880
and our proximity to the city means we are constantly drained of our local resources. And it's frustrating.
00:24:05.760
Prentice is known as the bitch truck. Nobody wants to work it because it's never there.
00:24:09.600
No, it's too close to the city. It's just there right for the taking.
00:24:12.720
Yeah, it gets it goes to cover everywhere else. And it just means that maybe you don't deserve
00:24:17.760
the same coverage as the city. Yeah, it doesn't sit well, does it?
00:24:22.960
They've got a resident down there who's going to make more noise about that yet.
00:24:26.800
All right. Well, there's so much to cover. I mean, it goes fast when I have you in,
00:24:29.760
Don, we'll have to have you back because this issue is just so frustrating, so stupid, so
00:24:33.520
relatively easy, at least to bring in some solutions. And we've got resistance to those solutions.
00:24:38.160
It just ticks me off every time. I really appreciate that you keep bringing it up and highlighting it and
00:24:42.240
putting this stuff on the web and Facebook and such. So before I let you go, where can people
00:24:47.280
find more info? Because I know people are concerned everywhere with this one, but it's just a shotgun
00:24:51.040
approach. Right, because you're seeing it in the news all the time. So we found Facebook to really
00:24:54.640
be really effective. Citizen action groups in each community are springing up and people are
00:24:59.280
working together to try to put pressure on their, on HS locally and also on their town councils,
00:25:03.680
give them good advice and back them up. And I really hope that RJ Sigurdsson, who's doing great work as
00:25:09.920
the parliamentary secretary. I really hope that he starts touring around the province
00:25:13.600
and meeting with people in these towns and talking about EMS. And I encourage people locally,
00:25:18.480
especially in the smaller communities, to get together and start working on solutions. Call me
00:25:23.120
anytime. You can find me on the web. Great. Well, thank you very much, Don,
00:25:26.720
and I'm sure we'll be talking again. Thanks, Corey. All right. Without the CSSA, our gun rights would have
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