As a family physician in Campbell River, Dr. Anna Kindy knows that when someone suffers life-threatening injuries or becomes critically ill, time is crucial.
The longer it takes to receive emergency medical care, the worse the outcome. Time is a killer — it increases the morbidity of injuries and raises the risk of death. Countering that, Kindy says, requires a nimble, well-equipped ambulance system capable of bringing the hospital to the patient — wherever they are — on what may be the worst day of their lives.
But according to Kindy, British Columbians, especially those in rural areas, are too often let down by gaps in the province’s emergency medical response system.
Kindy, the BC opposition health critic and MLA for North Island, says the ambulance system is inefficient and lacks the resources to provide adequate coverage across the province.
“Too many doctors and nurses whose patients need to be moved immediately to a higher level of care are frustrated waiting for an air ambulance that arrives too late,” she said. “Too many paramedics are seeing worst-case patient scenarios that traumatize them and lead to stress leave. Too many patients are losing limbs or suffering long-term brain damage after strokes because they didn’t receive timely treatment.”
Kindy doesn’t expect a smaller city like Campbell River to offer specialties such as cardiac surgery. But she says that where those services are lacking, the province must ensure better patient transport.
“Knowing we don’t have that service, we should have the best transport possible, and that’s what we’re not getting,” she said.
The Fraser Institute projects BC will spend $39 billion on health care this year, including a $1.7-billion boost from the Eby government, a 4.6 per cent increase in the health budget.
“Health-care reform is clearly on the mind of most Canadians and was a core issue in the recent BC election,” the institute stated. “Unfortunately, with its latest budget, the Eby government has decided to follow a staple of ‘health-care reform’ in Canada — namely, to spend more but make almost no fundamental changes.”
Kindy is calling for radical reforms to bring the province’s ambulance system in line with other Canadian jurisdictions and many Western European countries. She wants BC to scrap what she describes as a provider-centric, paramedic-only model and shift to a patient-focused approach that uses multi-disciplinary teams.
She believes a properly functioning, patient-first ambulance system would ultimately save the province money, as faster treatment would shorten hospital stays and lead to better recoveries.
“If we have a pre-hospital system that works well and treats patients on site or during transport, it prevents disabilities or severe injuries and saves lives,” said Kindy. “People with disabilities tend to cost more in the long term. Up-front costs will save you money down the line.”
In January, an infant awaiting air transport in Cranbrook died before a BC Emergency Health Services (BCEHS) medevac team could arrive. The team had been expected within two hours. Staff at East Kootenay Regional Hospital requested a STARS helicopter from Calgary as a backup but were told the BCEHS infant transport team was en route.
“That should not be happening,” said Kindy. “If it’s patient-centred care, let’s get that person to the highest level of care as soon as possible.
“If you look at a typical city in Europe, it has more (medevac) helicopters than all of British Columbia. We’re under-resourced.”
Currently, BCEHS operates six air ambulance helicopters: two in Vancouver and one each in Parksville, Kamloops, Prince Rupert and Prince George. It also has nine fixed-wing aircraft: three in Vancouver, two in Kelowna, two in Prince George and two in Fort St. John.
Medical crews consist of advanced and critical care paramedics, not nurses or doctors. Availability, along with weather conditions, limits when and how often they can fly.
“Care levels are centralized and access to tertiary-level care is normal, but we should be able to access them more quickly with a Code Red urgent patient,” said Kindy.
“We’ve got dedicated teams here, but they’re under-resourced and under-staffed. If there’s a call-out, they’re delayed because of staffing issues. When you have a Code Red that becomes inaccessible for air transport, that’s traumatic for the doctor waiting, dealing with a very sick patient — sometimes a pediatric one.”
To better understand how multi-disciplinary medical transport teams work, Kindy visited the STARS (Shock Trauma Air Rescue Service) base in Calgary earlier this month. The not-for-profit helicopter-based system has operated since 1985 and now serves Alberta, Saskatchewan and Manitoba from six bases.
“It’s a very impressive setup, very professional,” said Kindy. “They have a lot of pride in their operation, and communities that access the STARS program seem pleased with it. I think we have to look at that kind of model for BC.”
She says the Alberta system is focused on patient outcomes, with decisions and quality measures based on patient needs.
“They’ll do everything to make sure the outcome for the patient is as good as possible, meaning rapid transport with appropriate staffing,” said Kindy.
STARS operates three bases in Alberta, two in Saskatchewan and one in Manitoba. It is funded through a combination of provincial government support and private or corporate donations.
“When I was there, they had four crew members in every helicopter, with a backup team,” Kindy said. “That includes two pilots, one or two advanced-trained paramedics with critical care capacity, and an ICU nurse trained in pediatric advanced care. They’re ready.”
STARS also allows doctors trained in emergency, critical care or anaesthesia to board flights as needed. Air medical crews are on standby next to the helicopters 24/7, ready to launch a mission within 10 minutes of a 911 call, weather permitting.
STARS has an agreement to serve parts of eastern BC from bases in Grande Prairie, Edmonton and Calgary.
Kindy acknowledges there would likely be pushback from union leadership — specifically the Ambulance Paramedics of BC CUPE Local 873 — if the province allowed hospital staff to join air crews. But she believes many individual paramedics would welcome the opportunity to work alongside doctors and nurses.
“Training a paramedic at a higher level and having enough bodies when you transport — sometimes with backup from an ICU nurse, respiratory tech or doctor —brings more job satisfaction for everyone,” she said. “If a patient has a better outcome, everybody’s happy.”
Kindy says discontent with the current ambulance model is growing among medical professionals, including former BCEHS staff who resigned in frustration over the agency’s resistance to reform.
“We’re lucky to have people who are knowledgeable about medical transport and who are advocating for a better system,” she said. “We need to access their knowledge and look at where our system is failing. Why aren’t we putting patients first? It’s time to review our transport services and make them patient-centred.”
She also criticized what she called a culture of censorship in BC health care, where workers are discouraged from speaking out.
“Throughout health care, there’s a real censorship issue,” said Kindy. “People who want to advocate — nurses or doctors — are either not listened to or even reprimanded. I’ve heard that throughout the province. People tell me things in private but don’t want their names attached.
“We’re at a stage where, if a physician, nurse or paramedic wants to speak out, they usually aren’t allowed. That creates burnout and then they quit.
“There have been repercussions for advocating better care, and that should never happen. If you silence the front lines, you don’t get the information you need to change the system.”
She cited the closure of tertiary pediatric care in Kelowna as an example of systemic failure.
“This was years in the making, and they had years to find a solution. The front lines offered one, but they weren’t listened to,” she said. “We’re in a health-care crisis, and the only way to solve it is to work together.”
