All British Columbians should have equitable access to medical services regardless of where in the Province they live. Access to quality healthcare is an important consideration for attracting and retaining qualified employees and often a key factor in the decision to relocate away from working and living in rural communities. In the 2017 report by the BC Forest Safety Ombudsman Roger Harris titled “Will It Be There? A Report on Helicopter Emergency Medical Services in BC”1 Ombudsman Harris noted “nearly three quarters of all people who die of trauma related conditions in Northern BC do so before they can be brought to a hospital. In Northern BC this number is 82% compared with 12% in Metro Vancouver.
Ombudsman Harris’ initial investigation was focused on forest safety and industry personnel access to medical services in the event of an accident. Through his investigation he determined that if you live or work near an urban centre it is more likely that, in the event of an injury, you will receive access to a medical centre within one hour. There are no such assurances however if you live or work in rural BC.
The findings of his report indicate there are serious gaps in the provision of emergency medical transportation services to people living and working in rural parts of the Province and it threatens the safety of workers and residents. While it is acknowledged that rural communities cannot support or expect the same level of medical facilities as those in urban centres, they should not lack access to emergency medical transportation services. As the distance to the nearest medical facilities increases, access to timely medical transportation should be enhanced not reduced.
The UBCM (Union of BC Municipalities) and NCLGA (North Centralized Local Government Association) have endorsed several resolutions related to this issue since 2007. One such resolution in 2013 called “for the provincial government to support the development of a reliable air ambulance service that fully meets the emergency health care needs of all British Columbians.”2
In the 2012/2013 BC Auditor General Report 13 “Striving for Quality, Timely and Safe Patient Care: An Audit of Air Ambulance Services in BC,3 the Honourable John Doyle reported, “Air ambulance services are a critical component of the provincial health care system, providing emergency lifesaving treatment and transporting patients across vast distances to the necessary level of care. This service, provided by the BC Ambulance Service, is particularly important in British Columbia due to this province’s large size and the remoteness of some communities. My overall conclusion is that the BC Ambulance Service is unable to demonstrate the quality, timeliness and safety of its patient care. This is largely because the BC Ambulance Service lacks a performance based approach for managing its air ambulance services. It has not clearly defined objectives or measures and while it has processes to support quality care, timeliness and patient safety—it does not assess its own performance to find out how well it is doing and look for ways to improve.”
BCAS (BC Ambulance Service) audit response of March 21, 2013 stated “BCAS accepts the findings of the OAG and will apply the findings which support the organization’s philosophy of continual improvement of patient care. BCAS will implement all of the OAG recommendations”.4 In the HEMS report by BC Forest Safety Ombudsman Roger Harris, we clearly see that nothing has changed.
Whether working, living or travelling in rural British Columbia, citizens are entitled to emergency services and when this access is not provided or fails, the cost to families, employers and tax payers increases. In the case of a Haida Gwaii worker, it took 11 hours to get to medical access and resulted in the loss of a leg. It took 24 hours to transport a stroke patient in Northern BC to a critical care centre well outside the 120 minute treatment window. This remains an ongoing issue in 2020, a stroke patient in Northern BC could not be transported by provincial medivac in the time required and the patient’s family had to charter a private airplane to get him to medical care. Covid-19 has further highlighted the need to improve access to medical services for rural and remote communities.
In an April 2020 news release, Premier John Horgan said “People living in rural, remote and Indigenous communities have unique challenges in accessing the health care they need”5; this was made in relation to developing a framework for medical support during the Covid-19 crises. With more services centralized, and travel and clinics restricted, BC needs to recognize these issues are more than just Covid related and ensure British Columbians can access timely care for emergency medical health complications.
Dr. Dave Snadden, recently appointed the founding chair in rural health at the University of BC also questioned the issue in a January 21, 2017 issue of the Vancouver Sun. “If you have a stroke in Vancouver, you can be at Vancouver General Hospital in less than half an hour, receiving highly specialized medical care from on-site neurologists. But what happens if you have a stroke in Dease Lake, a community of about 450 almost 1,000 kilometres northwest of Prince George, or you suffer a traumatic injury in the Eastern Kootenays that requires a higher level of care beyond what the local hospital can provide? These are the questions Dr. Dave Snadden is keen to tackle in his new role as founding chair in rural health at the University of BC. “How does that patient get access to the same degree of expert care that would give us a good outcome?” said Snadden. “That, to me, is the challenge of rural health.””6
Emergency and non-emergent care can and should include access to technology that enables patients and caregivers to access specialized services and consultation from remote locations.
In comparing BC to similar jurisdictions, Ombudsman Harris found that Washington and Alaska, both representing similar geographic challenges as BC yet have legislation that ensures all residents have access to a level 3 trauma centre within 60 minutes. “There are no technical or infrastructure barriers to the delivery of air ambulance within that critical first hour to any resident of BC, regardless of where they live. The decision by government not to provide that access is a choice,” asserts Harris. His recommendations “support faster care for workers and all residents regardless of where you live in the province. Faster care results in better medical outcomes for the patient – which in turn, results in lower cost to the health care system.”
The recommendations put forward by the Ombudsman in his report include:
1. BC consider mandating – through legislation or policy – guaranteed timelines for the public to be able to access Trauma 3 level care, similar to other jurisdictions.
- Establishing guaranteed timelines will direct BCAS to put in place the necessary assets, protocols and procedures that will ensure a patient focused service delivery model.
2. BC undertake a review of the effectiveness of the legislation as it pertains to the provincial emergency ambulance service. The BCAS was originally established in 1974. A lot has changed since then.
- The Emergency Health Services Act puts significant limitations on the ability to access and utilize other potential service providers. Section 5.2 4 however, does provide the minister with flexibility. Expanding the scope of practice and the role of First Responders in the transportation of accident victims to medical facilities would allow them to be better utilized. A patient focused system needs more flexibility, not less.
- Health services in BC have been regionalized with the establishment of five regional health authorities, the First Nations Health Authority, and the Provincial Health Authority. Like policing and fire protection, there may be value to administering some aspects of the services from a local and regional perspective – services can be tailored to meet the dynamics of the communities and region being served, and geography can be considered when designing transportation systems, protocols and allocating resources. The value of having BCAS set provincial standards could be maintained while transferring certain procedures and processes to more regionalized bodies.
3. EMBC and BCAS expand the use of hoisting in the Province of BC
- There are some significant advantages to incorporating the use of hoisting over the current practice of longlining. The answer may not be in utilizing one method over the other but rests with incorporating both methods and developing a plan that uses the right technology in the right place at the right time with the flexibility to evolve over time and respond to incidents as required
- If hoisting were to be adopted, the skills sets of BCAS personnel could expand with additional training, incorporating the deployment of medical crews directly to the accident site to prepare a patient for extraction and transport to a hospital without additional transfers from helicopter to ground ambulance or another helicopter.”
THE CHAMBER RECOMMENDS
That the Provincial Government:
To provide greater access to quality healthcare as an important consideration for attracting and retaining qualified employees and key factor in business locating in rural communities:
- Enact legislation providing targeted timelines for the public to access the appropriate level of care including Trauma 3; and
- Review and implement the recommendations of the Forest Safety Ombudsman in his February 2017 report “Will It Be There – A Report on Helicopter Emergency Medical Services in BC”.