Edmonton EMS Expanding Rapidly

THE EDMONTON, ALBERTA, EMS HAS IMMEDIATE openings for several paramedics and EMT's with still more coming online in the near future.  The need for additional resources including ambulances, stations, and medics to operate them, has come about for several reasons.  The Calgary Herald describes a few of them:

The median response time in the past two years for so-called "lights and sirens" ambulance calls increased to eight minutes and 13 seconds from seven minutes.

EMTLife.com photo

Health Minister Fred Horne announced Tuesday that five additional paramedics and 12 emergency medical technicians have been hired this month, and that 14 more vacancies will be fast-tracked to get to full staffing levels as soon as possible.

He also said Alberta Health Services opened a new EMS station in northeast Edmonton on Jan. 17, and that five more are slated to open across the province between now and 2014, including one in the city's west end.

Horne said response times are longer because the population is growing and aging, with the result being EMS workers are responding to more calls than ever.  (The Herald adds:)  City ambulances responded to nearly 48,000 lights and sirens calls in 2010-11, a number expected to increase to more than 65,000 in 2011-12.

In addition, Alberta is continuing to suffer with overrun hospital emergency rooms creating situations where ambulances are forced to "store" their patients for long periods of time, as much as 45 minutes or longer, before they can take them from the ambulance into the hospital itself, thus keeping ambulances out of service for longer times.

In April 2009 all provincial EMS responsibilities were transferred from the localities to the province-wide Alberta Health Services which also oversees all hospital operations.  And as always happens when local activities are transferred to a giant, centralized government-run agency, the entire EMS network fell apart.  This has had a direct bearing on the ability of local EMS departments to function as well as they did previous to the consolidation.  This has also created the situation where paramedics are fleeing the Edmonton EMS to escape the stress and frustration that has crept into the organization.  A survey taken of Edmonton EMS employees in November showed that 2/3 of them are actively looking for employment elsewhere.

 The Edmonton Journal recently reported:

The Health Sciences Association of Alberta conducted a survey which was completed by 146 out of 304 eligible members of the union (in Edmonton).

It found that in the last four shifts completed by those workers:

— 86 per cent experienced a lack of resources, including no ambulances available for emergency calls, otherwise called a red alert.

— 72 per cent said they could not meet their response-time targets three or more times.

— 72 per cent had pending calls of more than one hour, sometimes up to four times.

"According to our survey respondents, the emergency ambulance service in the Edmonton metro zone is completely inadequate as it is and the vast majority of our respondents have raised their concerns to the attention of Alberta Health Services’ management but to no avail," reads the executive summary of the online survey, done between last Nov. 4 and 11. "We shouldn’t be surprised then that two-thirds of our respondents are seriously considering seeking employment elsewhere."

After seeing those results – that were taken by somebody else instead of them – Alberta Health Services sprung into action and announced that they are going to form (another) committee and start having meetings in February.

Read the entire Calgary Herald article HERE.
The Globe & Mail has MORE.
Read the damning report from the Edmonton Journal HERE.

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The Signs Say to Not Drive Into Flood Waters

CHRISTMAS DAY IN MELBOURNE, AUSTRALIA, THIS YEAR will be remembered mainly by the widespread flooding through the area.  And the people in the northeast suburb of Eltham will remember it as the day the firetruck drove into the flood waters.  Despite the signs and the S.O.P.'s to the contrary, this tanker driver for the Victoria Country Fire Authority misjudged the depth of the water.

The CFA officers were not amused and have opened an investigation into the performance of the driver who is one of the most experienced operators in the department.  The Herald Sun is reporting:

Research Fire Brigade Capt Neville Stewart, who was not driving the truck, said the incident happened so quickly. "We weren't expecting it and then we just had to keep going, we couldn't stop it," he said.

The CFA's northwest metropolitan region acting operations manager, Tony O'Day, said the driver was one of the most experienced in the brigade. "It's an error of judgment," Mr O'Day said. "Once they started driving through the water, they were committed and made a decision to keep driving rather than stop. It's certainly not standard behaviour. We don't encourage it."

The crew got itself in deep trouble when it misjudged a signpost and sized up the water incorrectly.

Mr O'Day said people were always told not to drive through floodwaters because of the dangers, and the firefighters should have known better. He said the crew regretted the decision. "They are fairly shaken," Mr O'Day said.

Firegeezer got a kick out of the windshield wipers continuing to operate while under water.  And as the tanker comes up out of the water, watch the captain open the cab door and let the water run out.
Thanks to the Gnome Handler for finding this gem.

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Tuesday Morning  (I think)

Just how important is an ambulance, anyway?  Naturally we have our own ideas about that, and in most places the citizens agree with us because they buy and staff enough of them to take care of the community's needs. 

But in some places there are bureaucratic and managerial bunglers who are so intent on their own interests that the sick and injured are being left to suffer.  While these impeders are well-meaning, their actions filter through the system and degrade the EMS more than they help it.  We have documented here on several occasions how local medical directors in a few areas are so intent on upgrading patient care at the entry level (i.e. ambulance) that they drive away many potential first-aiders who could do good work in getting effective care to the emergency victim.  Those areas end up with scant ambulance service and even in some cases, untrained drivers who only do that … drive.

You may recall, if you're a long-time reader, that about 3 years ago I calculated that on a regular weekday the London (England) Ambulance Service has more desks in service at HQ than they have ambulances on the street.  Nationwide, many of the 12 National Health Trusts that operate the hospitals, ambulances, etc.,  have begun using more and more so-called Emergency Care Assistants (ECA's) who have nothing more than basic first-aid training and are supposed to be ambulance drivers and assist in loading and unloading the patients.  But the cash-strapped ambulance trusts have been using these lesser-paid workers more and more in place of paramedics.  The Telegraph reported last month  that half of the 12 Trusts have been at times sending out ambulances with nothing other than ECA's on board - no paramedics (even though the taxpayers are paying for them).  This is the end result of the intertwined actions of the bunglers in all levels of the organizations.

Some areas of Canada and Australia have been suffering from hospital mismanagement where the emergency rooms are literally unable to accept patients as the ambulances bring them (called "ramping").  Then you get this ridiculous situation where the hospital parking lot is filled with ambulances where the medics are maintaining patient care for 45 minutes and up to 2 hours while waiting for the disfunctioning hospital to make room for their patients.  During all that time there are no ambulances available to respond to fresh emergencies.  The Canadian provinces have apparently gotten their acts together and have largely eliminated the loading dock backups, but in some areas of Australia the situation has not improved at all.

"Ramping" at PA Hospital, Queensland, Australia

What brought this up today was the news from Down Under about a locally famous TV cooking show chef whose family home burned down Monday morning killing the mother and their three children and leaving Chef Matt Golinski in critical condition with 40% burn coverage.  Also making the headlines was that the ambulance dispatched on this most urgent call did not arrive until a half-hour after one was called for, and there was only one – one! – person on the unit, a paramedic / driver.  The Sydney Morning Herald reported yesterday:

The spokeswoman said an intensive care paramedic was dispatched from Maroochydore but confirmed only one person was in the ambulance, so a police officer then drove the vehicle from the scene to hospital while the paramedic tended to Mr Golinski.

She said there was nothing unusual about sending the first available ambulance, even if only one paramedic was able to attend, given other emergency response agencies were able to assist.

"If they're the closest vehicle then yes, it is standard operating procedure that other agencies would assist with driving the vehicle [to hospital]," she told this website.

You got that?  In the minds of the bunglers, there is "nothing unusual" about an ambulance showing up with only a driver.  They also further say that the delay and failure to send more than one ambulance was because all units were busy on other calls.  This was at 3:30 am.  The ambulance supervisor, by the way, didn't arrive until 45 minutes after dispatch.

I'm not deliberately picking on the Queensland Ambulance Service, but merely using this most recent example to point out just what is going on in the civilized world as the governmental bureaucracies grow and starve out the basic functions they are charged with.  And don't think it isn't happening in the U. S., too.  Just this past Saturday, on Christmas Eve the city manager of Pontiac, Michigan, handed out layoff notices to the entire fire department.  Every single FD employee.

Ok, watch your back and let's get started on this equipment check.  I'll head for the Bunn-O-Matic and get another pot started.

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Saturday Morning – Let's Go Watch the Fire

There is no lack of towns that have incompetent politicians that run the treasury dry and then try to blame the city employees for their failures.  How they propose to bail out of their crises can become innovative and sometimes even comical.  Danbury, Connecticut, is the latest city council to don clown hats and big red noses while they toy with the citizens' public safety.

Earlier this month the fire chief announced that the department will be shutting down one of the city's busiest engine companies (Engine 21) during the day as "a crucial cost-saving measure."  In its stead, the firefighters will not be used to fill in vacant positions, oh no.  They are being kept in quarters and given an SUV to drive to fire calls in.  No water, no pump, no tools…. just a big uh-oh squad to comfort the taxpayer as they all gather to watch the house burn while waiting for the 2nd- and 3rd-due companies to arrive.  "Listen… do you hear the sirens?  They're coming!"

"Observer 21 responding…."  (Danbury Patch photo)

It seems that nobody but the fire chief understands how this will save money or maintain protection.  Local 801's president recently talked to the Danbury Patch:

"It's all smoke and mirrors," said Louis DeMici, president of Local 801. "We've asked them for documentation. We've yet to be provided it."

Both Mayor Mark Boughton and Fire Chief Geoff Herald have said the city is saving money on the SUV for many reasons. It is smaller, uses less gasoline, its maintenance costs are a fraction of that of a fire engine. They argue a fire engine isn't required on most calls, because most calls to the fire department are not fires.

DeMici said the city is claiming replacing Engine 21 with a smaller, red SUV is saving money, but really, when the SUV arrives at a fire, other fire departments in the city have to send an engine, so they're sending them farther, adding extra wear and tear. In those cases, the SUV is more expensive than if the SUV was still Engine 21.

"The union is opposed to this," DeMici said. "When Engine 21 is closed, another company has to respond. It's a longer distance."

According to the Local's WEBSITE, the unit serves the downtown area south of West Street to the Bethel Town line and the Long Ridge Road area, where the reduction in resources could be a big problem. The coverage area has several pockets of densely-populated neighborhoods, apartment buildings and schools.

Does this clown council qualify for listing in the "silly season" file?  I sure hope that you don't have bosses that think that way.

Let's get started on the equipment check now while I get the Bunn-O-Matic into high gear.  Watch out for all those last-minute shoppers and traffic jams today.  See you back in the day room in a little while.

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This Explains That Big Blip on the Graph

A WOMAN IN NOTTINGHAMSHIRE, ENGLAND, WAS SURPRISED, then upset, and now is disgusted after an ambulance arrived at her house for a scheduled transport to take her husband to a medical facility.  The problem was that the man has died nearly four years ago.

The Press Association reports:

Doris Keeley, 65, said: "My husband had never been for any such appointments. I took his death badly at the time and, you know, you just get on with life, and then this comes and brings it all back. I'm very upset. If it had happened six months after his death I'd have been finished.

"I saw George's name on the pick-up list along with our address and postcode and was told the ambulance had been requested by Barnby Gate Surgery in Newark. We had never used that surgery."

A spokeswoman from the surgery confirmed that they had booked an ambulance two weeks in advance, but for a different patient at a different address.

The East Midlands Ambulance Service has started an investigation into what caused the snafu.

East Midlands Ambulance photo

The Press Association has the STORY.

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A brilliant and terrible Tuesday morning

Fourteen months into retirement I am teaching a Fire Officer II class at the Reagan National Airport fire station. The classroom is also their kitchen. The kitchen has a television.

The acting battalion chief steps in, apologizes for the interruption, and turns the television on. 

Good Morning America (ABC) is covering the breaking news of a plane that has hit the World Trade Center.

As the news camera focuses on the entry hole, many of the experienced air-crash-rescue guys are speculating on what type of plane hit the tower and the issues facing FDNY.

After a dozen minutes I try to restart the class. Agree to leave the television on with the sound turned down. I get one or two sentences out when we see the second plane hitting the tower.

Class over!

You do not need a Formal Announcement to Mobilize

As FDNY Firefighter James Hanlon (Ladder 1) points out in the opening of the Naudet Brothers documentary 9|11:

… there were days we would go to the Trade Center five times in a single shift. My point is, we knew those towers as well as anybody. But nobody, nobody, expected September 11th.

When the civilian editors of Fire-Rescue Magazine and Journal of EMS were vetting my article, Attack on the Pentagon: The Initial Fire and EMS Response (April 2002 issue), they struggled with the concept that hundreds of emergency responders initiated action without receiving a formal notification.

The Metropolitan Washington Airports Authority Fire Department never expected a 757 to be used as an assault weapon against the Pentagon. When the second plane struck in New York, the dozen off-duty members attending the Fire Officer class joined the 16 on-duty members preparing for the unknown.

They were not alone.

Most of the senior staff and urban search and rescue commanders in my department started purposeful action when they heard of the second plane in New York City. The information came through radio and television, informal digital networks and word-of-mouth.

Rapidly deploying 72 USAR members and 75 tons of equipment

It takes dedicated action by dozens of staff, support and non-USAR firefighters to make a deployment happen.

A point of pride is the ability to assemble the team well within the response deadline for domestic and international response. A deployment represents an administrative five alarm event.

A small role I had while assigned as a company officer at the Fire and Rescue Academy was to respond from home to get the facility unlocked on evenings, weekends and holidays. The Academy, with six classrooms and a large training bay, is the point of staging and assembly for the team.

Far from high tech. The tasks included moving apparatus out of the bay, properly configuring the "quad" – a large space with movable walls to create smaller class spaces, and powering up the facility.

Have to do Something

Ten years ago I also had a part-time job as a civilian Fire Instructor III at the Fire and Rescue Academy.

American Airlines Flight 77 struck the Pentagon shortly after I left the airport.

I was stunned. What could I do? No fire gear in the car, not in uniform, my "retired" fire department ID card did not provide KardKey access to headquarters or communications.

Headed for the Academy. Maybe they are assembling a fire crew with Engine 407.  I was at the Academy in 1982 when we loaded up a Suburban with EMS gear and responded in near-blizzard conditions to the Air Florida 90 crash at the 14th Street bridge.

Not this time. All of the on-duty uniformed staff are away, either responding to the Pentagon or the anticipated USAR deployment. None of the remaining staff experienced a USAR deployment. 

I looked up in time to see the South Tower collapse on live TV. 

Purposeful Action – Setting the Academy for USAR deployment

No more wondering what to do.

Without asking for authorization, started moving academy apparatus out of the high bay building and up the hill. Configured the quad. Tried to set up the communications equipment, but no one had the key to the cabinet.

Before the 11 am official federal mobilization notice, the academy was ready …

… and I was on my way home, satisfied that I did something worthwhile in reaction to the unthinkable.

An Inherent Orientation to Action

Emergency service folks are hard-wired to take action.

To validate the impact of our Citizen CPR program we tried to identify the background of every person who performed CPR prior to the arrival of the department. More than half of the citizen responders were off-duty or former police, fire, ems and health care staff. 

The same orientation that motivated Jeff Simpson, a Dumfries-Triangle Rescue Squad volunteer EMT who was near the World Trade Center. 

From the National EMS Memorial:

"I have no doubt whatsoever that, while I was stricken with disbelief and inaction, Jeff was figuring how he could help.

It was clear in the few minutes we were in the plaza that thousands of people had and would continue to be injured. There were many police, fire and EMS squads arriving at the scene and it was toward these and the injured that Jeff was headed the last time I saw him.

Frankly, there was no other reason for him to go towards the World Trade Center. His hotel, work site and safety were in the opposite direction.

With the second plane hitting the tower, Jeff would have been thinking about the increased number of casualties. I believe Jeff was caught in the collapse of the towers.

I do not know if he was inside the towers or working at one of the triage stations that had been set up close to the towers. In either case, he was doing what he was trained to do and spent his final hours helping the victims," stated Joseph T. Finnegan.

Mike "FossilMedic" Ward

Earlier 9/11 essays:

2011: Remembering 41 EMS responders who died at WTC, including a hero from Prince William County, Virginia

2010: A Terrible and Brilliant Blue Sky Morning

2008: Reprint "The Anger Never Dies"

After Fire Department takeover of MAST, a year of poor ambulance response times

An April 23 editorial in the Kansas City Star:

The Fire Department has failed in every three-month period since the takeover to meet the council’s response requirement citywide.

In fact, the department hasn’t yet reached the mandated response time citywide in any single month. The times have been slowest north of the river, and often not much better in the city’s southern parts.

(ambulance picture from Mike Ransdell @ Kansas City Star )

Read more here: The Star’s editorial | KC’s ambulance response times are unacceptably slow

Issues with the work hours and compensation of the former MAST paramedics. 

Accusations that the fire department is forcing single-role ems providers to work a 52 hour work week for the pay they were getting while working a 40 hour work week.

A proposal to place single role providers on a 24 hour shift was reversed last month after consulting with the city attorney. 

While the discussion remains a "private lawyer-client" matter, pretty confident it may relate to the experience from other fire-based ems services that struggled with application of the Fair Labor Standards Act to "uniformed civilians."  (article HERE)

Firefighters receiving cross-over training and taking ems overtime shifts instead of the single role civilians.

Single-role former MAST employees not confortable with fire union representation.

Another hostile takeover of an ems service with a messy and unfinished merger one year later.

Mike "FossilMedic" Ward

related articles:

November 22, 2009 (KCFD takeover of MAST):  The Neon Red Elephant of EMS   

November 05, 2010 (why firefighters would want ems):  The F-word in EMS .  

THE WALES AMBULANCE SERVICE IN UK HAS been under constant criticism for more than two years for its extraordinarily-long response times that are consistantly the worst in the UK.   Ambulance service executives have come and gone in a constant attempt to bring in somebody who can solve the problem.

Today BBC News is reporting that Catherine O’Sullivan, of Aneurin Bevan Community Health Council – the health watchdog which covers the former Gwent area – said the “difficult geography” of Wales should be taken into account when calculating ambulance response times.  Apparently more hills and dales add minutes to the time it takes to travel a few miles to the emergency.  Listen to the audio interview HERE.

LATE SATURDAY AFTERNOON A 20-YR.-OLD WOMAN fell off a 5th-floor balcony in Fatehgunj, India.  Immediately neighbors started calling the emergency number for help but the town’s only ambulance was on another call at the time.  When it failed to show up promptly, the locals put the woman in a private vehicle and drove her to a hospital.

The Indian Express relates what happened next:

When the 108 emergency van arrived 30 minutes later, the angry crowd attacked it.   The van left, but returned with a staffer flashing a cricket bat at the crowd. This made matters worse. “The locals must have made around 25 to 30 calls in the period, but the ambulance arrived half an hour late. By then, the crowd had completely lost patience and started pelting stones at the van. At this, someone from inside the vehicle pulled out a cricket bat,” said Firoz Sheikh, an eyewitness.

Apparently the brandishing of the cricket bat was the tipping point because the crowd then set upon the three ambulance workers and beat them up while they trashed the ambulance.

Meanwhile, the woman for whose aid the ambulance was called, Somaiya Memon is in serious condition. “The woman’s mother informed us that she has a medical problem that makes her feel dizzy and faint at times. She was on the balcony of her apartment on the fifth floor when she had a similar attack. She was rushed to a private hospital and is in a serious condition,” said Head Constable Jayanti Vallabhi.

FOUR CHILDREN UNDER THE AGE OF 5 perished Saturday night when a fire swept unchecked and unreported through a townhouse in Flint, Michigan.  One of the children lived there and the others were being watched by the child’s father, a 28-yr.-old man who was cooking something and fell asleep.

Flint Journal / Hollyn Johnson

When he woke up, the fire was well advanced and he dove out a first-floor window to escape.  The children ages 4, 3, 2, and 1 were all upstairs and trapped in the fire.  At about that time, shortly after 11 pm, a neighbor saw the fire breaking out the windows and called the fire department.

Battalion Chief Andy Graves told the Flint Journal that the home was fully involved when the units arrived, but they made an attempt anyway, advancing a hose line up the stairs while knocking down the fire.  However, all the children were already dead by that time.  Chief Graves added that the prolonged response time of seven minutes was created by the closure of a nearby fire station.  He also said that none of the smoke detectors in the public housing unit were working and that contributed greatly to a delayed alarm.

The fire got up into the common attic and spread throughout the building, damaging the other five units in the structure.

The Associated Press has MORE.