An expert on pre-hospital health care has determined that the evidence-based methodology used to refine the ambulance and fire department response to medical calls is based on industry best practices and places BC Emergency Health Services (BCEHS) as a leader among major emergency medical service (EMS) systems.
“In both whole and in detail, the EMS system policy decisions which the BCEHS Resource Allocation Plan (RAP) process embodies are consistent with contemporary best practices nationally and internationally,” stated Alan Craig in his report ‘External Review of the British Columbia Emergency Health Services Resource Allocation Plan’.
“The methodology has a strong foundation in robust clinical evidence of the actual medical needs of British Columbia’s EMS patients, and is superior to the processes used in many major EMS systems.”
A key recommendation in this report is that evidence-based alterations to the RAP must be implemented across the entire system. Moreover, the report notes several strengths of the BCEHS RAP review process:
- methodology was evidence-based using a very robust data sample of more than 630,000 recent pre-hospital medical calls from B.C. patients rather than relying solely on expert opinion or stakeholder advocacy;
- the final response recommendations reflect the contemporary medical consensus that ‘lights-and siren’ responses carry significant risk to providers and the public and is therefore warranted in only the most serious incidents; and
- dispatching first responders is most useful when focused on EMS incidents where truly time-sensitive interventions such as CPR, defibrillation and ventilation are likely to be needed.
BCEHS is continuing to consult with local governments and first responders throughout the province about the changes and can also discuss the recommendations in the report. In order to strengthen future RAP review processes, the report suggests:
- increasing reliance on clinical data and less upon expert opinion and stakeholder advocacy; and
- improving data analysis of actual clinical interventions performed for each patient; this includes enhancing reliability of data for time-sensitive first responder interventions (CPR, defibrillation, ventilation) in order to support decision-making about dispatching fire departments to specific types of calls.
In order to continue to protect public safety, provide the high quality patient care, and ensure pre-hospital health care resources are being used in the best manner possible, BCEHS will also review the RAP at six, twelve and eighteen month intervals as recommended in the report. BCEHS is continuing to consult with local governments and first responders throughout the province about the changes.
Alan Craig is a leading expert within the EMS industry in North America, and was hired at the request of the Board of Directors to review the BC Emergency Health Services (BCEHS) Resource Allocation Plan (RAP) update process, to ensure that a comprehensive evidence-based review took place. Craig has authored 17 research studies that have been published in peer-reviewed academic journals including the New England Journal of Medicine. Craig’s research also brought evidence-based response planning processes to Toronto EMS to optimally match resources to patient need.
EMS is an emergency primary care system, whereby paramedics provide emergency medical care in people’s homes and other locations much like the emergency department in a hospital – just without the walls. This system ensures patients will be seen in the hospital emergency departments where they will be triaged; those with the most acute conditions are seen first, regardless of whether they were transported to hospital by ambulance, taxi or private vehicle. Ambulance response times, which have improved for the most urgent calls since the RAP changes were implemented, are aimed at getting paramedic care to patients with acute conditions as soon as possible.
Facts: Emergency Medical Services in B.C.
- In 2012/13, BC Ambulance Service’s 3,800 paramedics and dispatchers responded to over 504,000 pre-hospital and inter-facility patient transfer events.
- Paramedics provide pre-hospital patient care that is:
- consistent with BCEHS’ Treatment Guidelines and other clinical and operational policies,
- supported with access to physicians 24/7 by phone for support during complex medical cases; and
- ongoing – paramedics must undertake yearly clinical education to enhance and maintain their skills.
BCEHS also has robust patient care safety and quality systems and infection prevention and control program, and accepts and responds to complaints from patients, families and other health care providers through the Patient Care Quality Office.