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Paramedic shortages still plague rural areas, but some remedies may be in the works

"I was in the middle of real pain, and that was stressful," said Quadra Island resident Carol Woolsey.
Quadra Island resident Carol Woolsey had to wait for an hour for paramedics to respond to her medical emergency because none were available in her own community.

Quadra Island resident Carol Woolsey had the misfortune of experiencing a medical emergency in her rural community last month after the last ferry had sailed for the night. 

After developing searing pain in her lower abdomen, the 77-year-old and her cousin called 911 about 10 p.m. on April 2. 

Disoriented by pain and vomiting continually into her kitchen sink, it seemed to Woolsey it was taking forever for paramedics to arrive. She was relieved to see two people come through the door about 20 minutes later. 

However, relief turned to alarm when she learned the two were local volunteer firefighters responding because there were no paramedics available on the island. Woolsey had to wait for a crew to come by water taxi from Campbell River. 

It took at least an hour before paramedics came to provide medical care, and the trip to the hospital in Campbell River — just three kilometres across the water on Vancouver Island — took about another half-hour, Woolsey said.

“When I heard that, I thought, ‘Oh, my God. How long am I going to have to wait?’ ” Woolsey said. 

“I was in the middle of real pain, and that was stressful.” 

Quadra, like many small, ferry-dependent communities in coastal B.C., is facing a double whammy of acute paramedic shortages made worse because BC Ferries no longer guarantees off-hour sailings for medical evacuations at night. 

The lack of local paramedics and ferries to get people off-island to hospital in a timely manner is a persistent worry, said Woolsey, especially in a community where nearly 40 per cent of the population is 65 or older.

An online petition started last summer has garnered more than 2,200 signatures and calls on Transportation Minister Rob Fleming, B.C. Emergency Health Services (BCEHS) and BC Ferries to rectify the island’s barriers to emergency care. 

“People talk about what happens in the middle of the night,” Woolsey said. 

“What kind of help is available? That’s what I hear most people are concerned about.” 

No local paramedics on multiple occasions

Three of the four scheduled on-call staff positions at the Quadra paramedic station are vacant — two since the fall of 2021 and the other since May 2022, a freedom-of-information request by Canada’s National Observer shows. 

The station currently relies on casual on-call staff or staff pulled from other locations to back-fill scheduling gaps, and volunteer firefighters to drive the ambulance when only a single paramedic is available. 

From May to early October, there were 11 occasions when no local paramedics were available for emergency medical calls on Quadra Island — a community of 2,700 residents with a large seasonal tourist population. There were no complete gaps in paramedic coverage in the final three months of 2022. 

However, during the first four months of this year, there were nine instances where no paramedics were on Quadra to respond to emergency calls, data from BCEHS and the paramedics’ union shows.  

Rural paramedic shortages on the mend, BCEHS says

While vacancies on Quadra Island have been acute, a new labour agreement is expected to improve staffing on Quadra and in rural communities provincewide, BCEHS told Canada’s National Observer. 

The February agreement includes a wage increase for casual on-call paramedics and does away with the unpopular part-time staff scheduled on-call positions used in small rural communities, said Glen Greenhill, BCEHS Comox-Strathcona patient care manager.  

Formerly, on-call paramedics — typically a pool of casual employees who let BCEHS know when they can cover shifts — didn’t get full wages for being on call, but they will now receive $12 an hour, up from $2. 

Additionally, any existing scheduled on-call positions, which made it difficult to attract paramedics to work in rural stations, will be phased out across B.C. and replaced with an alternative part-time staffing model by the end of March 2024, Greenhill said, and maybe sooner on Quadra. 

Under the current SOC system, paramedics are scheduled to work an eight-hour shift but must remain on call for a further 16 hours — for a total of 24 hours daily over a three-day rotation. This ties up staff for a full three days but potentially only pays them full wages for one, unless they respond to emergencies while on call. 

A new staffing model hasn't been fully determined for Quadra yet, but Greenhill said he’s confident future changes, along with transitional incentives, improved wages and ongoing recruiting efforts, will improve service in rural B.C. communities. 

Paramedic coverage on Quadra is expected to improve moving forward because four new on-call paramedics have been recruited to the Quadra station to help cover shifts, for a total of six members currently available for scheduling to support the existing SOC paramedic position, according to union data. 

There aren’t any scheduling gaps projected for May, Greenhill said. 

The objective is to have employees scheduled to drive ambulances 24/7, he stressed. 

“Quite honestly, the crew on Quadra Island have been working miracles to do that,” he said. 

“We're still not going to let our foot off the gas pedal and will continue with recruitment and retention strategies.”

Quadra Island’s Volunteer Fire Department has agreed to provide drivers for ambulances on days when only one paramedic is available when possible, and pick up paramedic crews coming from Campbell River at night when no local paramedic is scheduled, Greenhill said. 

Weather and availability permitting, a water taxi in Campbell River is called out on an ad hoc basis if a patient needs transport off-island at night since BC Ferries’ own staffing crisis means vessels can’t run outside of scheduled hours, Greenhill said. 

Failing that, if a patient’s condition is serious, an air ambulance or Canadian Coast Guard vessel may be dispatched, he added.

Troy Clifford, president of the paramedic and dispatchers union, says it is critical that rural stations are fully staffed given the extra challenges and long transport times for patients from remote areas. Submitted

Troy Clifford, president of the paramedics’ union, said the added difficulties and travel time with evacuating patients from remote communities underscore the need for rural stations to be fully staffed. 

And using volunteer firefighters as an ongoing stop-gap solution diverts the department from its primary purpose, he added. 

“It puts pressure on those [firefighter] resources, and it’s absolutely not what they are there for,” Clifford said. 

But he is also cautiously optimistic rural paramedic positions will be easier to fill under the new contract. 

There are approximately 60 rural stations operating under the scheduled on-call model in B.C., with up to half of them vacant, he said. 

The union, BCEHS and the province are discussing shifting up to a third of those communities, often those with higher call volumes, away from any on-call model and staffing them with full-time, 24/7 ambulance crews, Clifford said. 

Gabriola Island, Bella Coola and B.C. Interior communities such as Alexis Creek and Clinton are some of the communities being considered, he said. 

In small communities with fewer calls, like Quadra, the scheduled on-call model will be shifted to a regularly scheduled part-time position — involving 12-hour rather than 24-hour shifts and a limited on-call component that offers a better work-life balance and sustainable wages, he said. 

Water taxis not a long-term solution for patient transport 

While relying on water taxis may be a necessary short-term solution to not being able to roll an ambulance onto a ferry at night, the vessels aren’t designed to accommodate paramedics or complex patient care, Clifford said. 

Woolsey is thankful the weather wasn’t miserable and she was still able to walk the ramps to the water taxi on the Quadra dock, which isn’t designed to accommodate wheeled stretchers. It would have been a struggle for paramedics to get her aboard the boat if she were unconscious on a stretcher or weighed a lot, she noted. 

She has nothing but praise for the local firefighters and the paramedics who came from Campbell River, Woolsey stressed, noting they had to overcome difficulties and pull resources from their own community to respond to the 911 call. 

At the hospital, it was determined Woolsey had a kidney stone, which is extremely painful but not typically life-threatening. 

But that wasn’t something she knew during the anxious wait for paramedics in the company of the local firefighters. 

“I think the firefighters felt badly,” Woolsey said. 

“It must feel helpless to see somebody in pain, but you can’t do anything to help.” 

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