Hello Marty,
I’m writing in response to comments made by Winnipeg Mayor Sam Katz on the Great Canadian Talk Show earlier this month, and to offer comment on the topic of “ambulance shortages”.
By way of introduction, I am the Chairman of the Paramedic Association of Manitoba (PAM). PAM is NOT a labour organization…it is a professional association for all licensed Emergency Medical Services personnel in the province with close to 1000 registered members across Manitoba.
In response to comments made by Mayor Katz:
“…if you are an ambulance driver…”
· Fire fighters aren’t fire truck drivers…police officers aren’t police car drivers…and Paramedics aren’t ambulance drivers.
“…paramedics on fire trucks has made Winnipeg the envy of other Canadian cities…”
· No other major Canadian city uses a fire-based EMS model. Edmonton tried and failed. Calgary looked at this model some time ago and abolished the concept. Ottawa , whose Fire Chief has lobbied their city council to move in this direction, recently decided it was more cost effective to place single Paramedics on Rapid Response Units rather than tie up a fire truck and three fire fighters in addition to a paramedic every time it responds.
There is no doubt having additional Paramedics capable of responding to calls in a “first response” capacity can have the ability to cancel unneeded ambulances in some situations. There is also no doubt that getting a Paramedic to a patient quickly to assess and begin treatment prior to transport can significantly improve patient outcomes. This first response/rapid response is the concept that other cities might envy…the model perhaps not so much.
“…if we didn’t have paramedics on fire trucks able to administer what they do we’d need 10 more ambulances…”
· Getting a Paramedic to the scene quickly has the ability to begin treatment prior to the arrival of a transporting ambulance, but I question whether sending three additional fire fighters and tying up valuable fire resources for extended periods of time waiting for the ambulance is a wise or cost effective use of those resources. The cost of staffing an ambulance…approximately $850K annually. The cost of staffing a Rapid Response Unit…approximately $400K annually. I have to think the cost of staffing a fire truck is at least $1.75M annually.
* If fire trucks are tied up at a medical call for extended periods of time…and that can be upwards of 2 hours in some cases…it means fire resources are lowered for that period of time. In all of these cases, a transporting ambulance is needed anyway. Only calls which result in “no patient found” or are identified as needing police in lieu of an ambulance actually reduce the need for a transporting unit to be assigned to that call.
“…we’re saving the province a lot of money…by providing that service we’re saving the province $10M a year…”
· Having Paramedics on fire trucks in Winnipeg has not come without a cost to the province. I can’t recall the exact year, but sometime around 2000 the Province allocated budget funding (Intergovernmental) to the City of Winnipeg to assist with placing Paramedics on fire apparatus as part of the fire/paramedic amalgamation…approximately $2.24M annually. In the most recent provincial budget an additional $4M of Intergovernmental affairs money was offered to the Winnipeg FIRE Department for EMS services for fire staffing, overtime and capital expenditures.
Other funding increases have been negotiated between the City of Winnipeg and the Department of Health. Having this service (Paramedics on fire trucks) has been funded by Government. The $6.4M in Intergovernmental Affairs money alone could staff at least 16 Rapid Response Units.
The City of Winnipeg does offer an enviable “stop the clock” response time. But “stopping the response clock” shouldn’t be the way we measure emergency health care. What we need to measure is the time it takes to get the “right care to the right patient”. Simply stopping the clock doesn’t get the appropriate cardiac care to someone experiencing a heart attack or other life-threatening cardiac event.
Stopping the clock doesn’t help a patient suffering from a stroke or severe respiratory ailment. Stopping the clock doesn’t relieve the pain for an elderly patient who has fallen, broken a hip and may have to wait for an hour or more for pain medication and transport. In these cases “stopping the clock” doesn’t mean the right patient has received the right care at the right time.
The “ambulance shortage” is a complicated problem, and one that needs to be addressed across the province. But to do so we need to recognize that Emergency Medical Service is exactly that…a medical service, and as such a component of our health care system. We may need to add some resources (Paramedics and ambulances), but we also need to better coordinate and more effectively utilize the funding and resources we have available today.
· Paramedics need to be able to treat and release patients when that is an appropriate option. Part of the reluctance to do that today stems from the fact that EMS services are “paid to transport”. If you don’t transport, patients can’t be charged the full ambulance fee and government funding could decrease.
· Paramedics should have the option to transport to non-emergent facilities when appropriate…Clinics, Urgent Care Centres, Physician offices, etc. Over 80% of the calls Paramedics and ambulances respond to are not life-threatening, and while many of these may still require treatment offered in an ER or hospital, many do not. Backlogs in ERs today, hospital re-directs (diversions) and delays in off-loading patients and returning ambulances to service are in part a result of overcrowded facilities.
· Utilizing Paramedics to assist with community health programs has proven very effective in other Canadian jurisdictions, and it’s thought to have saved a significant number of patient requests for ambulance service and emergency room visits. Again, it’s a matter of providing the right care to the right patient at the right time…and in the most appropriate setting.
· Manitoba has eleven Regional Health Authorities, operating eleven distinct and differing EMS Systems. While some coordination of rural services has been accomplished in recent years, Winnipeg can not and does not offer assistance to bordering rural services NOR do they seek assistance in times of abnormally high call volumes. The province needs to better manage, coordinate and utilize existing resources.
“First response” is a vital component in our EMS system. But once again, we need to ensure we’re able to send the right care to the right patient in a timely and cost-effective manner. Simply throwing more money at the problem won’t necessarily eliminate the problem.
I hope this provides some clarification and food for thought.
Eric Glass
Chairman
Paramedic Association of Manitoba
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question for Russ "our infrastructure is unsustainable" Wyatt
I want to know why Wyatt voted without hesitation or opposition, to green-light the largest bout of new infrastructure construction this city has seen in my entire lifetime. I'm talking of course, about the IKEA development.
Turning Kenaston into an 11-lane monster, new intersections, triple turning lanes, plus all other related anemities. Why was allowing this constuction not unsustainable? In fact it's so unsustainable, the city can't even afford to construct it, which is why the developer will assist us in doing so.
I suppose Wyatt could place the revenue from the 2% Asper Tax into a trust fund such that 30 years down the line we can afford to resurface Kenaston and Sterling Lyon?
Oh I forgot...It's SMART development! That makes it sustainable?
I'm still bothered by the whole IKEA thing, if only because of my realization of the following: nobody criticized the way the developer or the traffic engineers did anything. It was simply taken as the best way to do it, case closed, theyre engineers, what do you want us EPC folk to do? And from that, nobody, nobody, nobody, ever, suggested that maybe there was a BETTER way to do things, and that this kind of thing is no longer acceptable in Winnipeg.
I was shocked when a month later, Wyatt showed up at the Mayor's Sustainability forum, and made a 30-second speech about how unsustainable our infrastructure is. Wyatt had the power to say something, and change the way we DO infrastructure planning.
IKEA, Waverly West, CMHR, whatever, you name it, if you're promising millions in construction, jobs and potential tax dollars, you get a free pass in this city. THAT, Mr Wyatt, is what makes our infrastructure unsustainable.
Adding a 2% tax to help support said unsustainable infrastructure is like putting a band-aid on a geyser. As far as I'm concerned, the issue you are raising with infrastructure concerns is not about fixing what we have. It's about how we continue to build new things and new projects without thinking about how sustainable we are being. It's business as usual in Winnipeg, it's the status quo.
To make our infrastructure practices and expansions sustainable, you need to raise the bar by leaps and bounds. To make the new status quo mantra "this is not good enough for Winnipeg anymore."
Graham
www.progressivewinnipeg.blogspot.com
Why a tax for infrastructure will not work
You had Russ Wyatt on saying how he would support an increase in the PST if it was separate and it all went to infrastructure and here is why I think it will not work. First off thanks to Bill 38 I was under the impression that all provincial revenue has to go into general revenue, even if it’s revenue that they don’t receive like profit from the crown corporations. This way the province can claim to balance the budget while running a deficit. Secondly say the province ignores legislation, which isn’t that big a stretch since they did it with their last budget by reducing debt repayments, and actually keeps this amount separate and give it all to infrastructure will this actually increase the amount currently going to infrastructure or will it just increase spending in other areas.
Say the Province budgeted spending 10 million on infrastructure for this year and this tax increase generates 5 million that gives them an extra 5 million in general revenue that they do not have to give for infrastructure. Or say this new tax brings in 15 million, sure that’s an extra 5 million for infrastructure, but now that’s 10 million from general revenue that was budgeted for infrastructure that is going to go elsewhere. So basically 66% of this new infrastructure tax is not going to infrastructure --- how planful.
G.
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bike lobby
I don’t know that I consider myself a lobbyist, but as a cyclist I can tell you that cars are completely unaware of us. And if you’re cycling for any distance, the sidewalk is in worse shape than the road.
As for bike maintenance, any serious cyclist will ensure that their brakes and lights are working – we tend not to add the danger that oblivious drivers put us in.
Jill
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RE: Where have all the visionaries gone? by Free Press editor Margo Goodhand
She might not be wrong about Winnipegers lacking vision but I would rather have a say in what visions are brought to fruition instead of some boneheads and his "girlfriend" deciding for me.
L.
Cranes at the hydro site on Portage for years. Cranes at the U of W residence site. Cranes at the 3 separate condo construction sites on Waterfront over how many years?
Lots of cranes for lots of years. Those cranes don't represent the same hope?
Maybe the hope she's talking about is the "Holy S! I hope we can afford to build this!
JM
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Marty,
I caught your segment on the announcement last Friday of $3.1 million in federal funding for youth gang prevention. I heard you reading quotes from Leslie Spillet, executive director of Ka Ni Kanichihk which caught my attention. Spillet said that aboriginal youth had a "disconnect with mainstream institutions" because "they don't really reflect back to children who they are as young indigenous people. Our children don't feel that sense of belonging, it's not automatically there, as it is for European children who walk into these schools and see themselves reflected in the staff."
So not only is Spillet blaming mainstream institutions for what these youth feel, she is also saying the colour of a person's skin should matter. This is someone who deals with children?
One of the programs Spillet is involved with provides "cultural programming and counseling," and a library is available that focuses on 'aboriginal history'. In other words, racial pride and revisionist history will prevent aboriginal youth from going into gangs... and into politics. Spillet's dualism of aboriginal and European overlooks a lot of children in our schools who fit into neither category and I wish reporters would challenge her to deal with the present state of human diversity in society instead of letting Spillet remain comfortable in her nineteenth-century polarization.
Writing as I listen to the Sunday night replays, M
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waiting times at Hospital ERs
Hello Marty,
I always feel bad for patients waiting a long time in the ER - especially 10+ hours. You can imagine how busy we can get is someone is waiting that long before they can be seen. I am not happy when it happens, but i know it does happen that people may wait in the ER overnight before being seen by a physician, and usually that's because the night physician is dealling with ambulances, people crashing in the hospital or ED etc.
At any rate, I can appreciate the young man's frustration. One has expectations that their doctors are going to perform their jobs competantly and ably and it can be frustrating when this does not happen. Although the fact that "we are humans too" is not comforting, i hope it does buy us some forgiveness.
A couple of things:
1) We do not always take xrays when wood is thought to be the foreign body. This is for a couple of reasons. Cellulose resembles flesh on an xray unless it is painted with lead, and it is often difficult to pick up on an xray, and the xray often entails an extra hour or two wait. Having said that I do xray more readily for any foreign body just because of the rare time that xray does pick up wood.
2) Sometimes people do not react to anesthesia as well as we expect. The question then is - do we give more freezing, or do we proceed without. The reason this is a question, is often the freezing process is as painful (or more) than the proceedure itself. Also xylocaine (which is used for freezing) is dangerous in certain quantities, and a doctor may not feel comfortable giving enough to get the job done, and they may not want to perform conscious sedation to remove a sliver.
3) Hallway medicine is a reality. If one can generate a sterile field in a hallway, and get the job done, there is really no reason to kick someone out of a room for a simple proceedure.
4) This proceedure is not surgery. It is something that I have done out at the lake when needed.
Just a friendly FYI.
Dr XX
Melita Dr shortage crisis
This is sad, but not surprising. It is easy to blame the RHA for this problem as they are the ultimate fallguys.
At the same time, there are RHA's which appear to work hard to alienate physicians, and it would not surprise me if Assiniboine was one of them.
There are some good RHA's which work hard to both obtain and retain good physicians, and I think their success needs to be examined and emulated. In the meantime, a useful minister of health might actually try to figure out where the problems are and how other systems solve them - maybe by talking to physicians who have not succumbed to the terrible disease of administration.
Now a GOOD minister of health would prevent these problems by doing something other than blaming the previous government - a sad practice which gets more difficult the longer one is in power.
Take the Grace Hospital, for example. What did the government do to deal with the problems when the ER was being emptied of physicians? They threw money at the problem. No one was asked why doctors were leaving, including the doctors.
The funny thing is, I almost never hear my colleagues complain about money, and the things they complain about would be more easily solvable than increasing salaries.
Thanks for the opportunity for the rant.
Dr XXX
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Doer and the "pitchfork issue of the day"
Hi Marty.
Is it any wonder that the NDP is so hostile? For an entire decade leading up to this, they were able to act with relative impunity, questioned only by a handful of true journalists such as yourself and Tom Brodbeck.
This allowed them to gloss over so many issues that have been dealing Manitoba its proverbial death by 1,000 cuts – Crocus, mismanagement of the Floodway, the shutdown of the Trans Canada at Portage LaPrairie, Gage Guimond, Phoenix Sinclair, the Seven Oaks School Division development fiasco (how do you lose money in one of the hottest real estate markets the world has seen?), the car theft epidemic, the rise of gangs in the city, Bipole 3 and the list goes on.
I would argue Mr. Doer should have felt the pitchforks long before this – unfortunately many journalists within the MSM handled their antics with kid gloves which only emboldened the leaders on Broadway.
Steve Andjelic
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hey Marty,
I'll start off by saying your show is THE best show on the radio, it deals with real issues, and you guys aren't afraid to pull the pants off of bigshot political figureheads. Also, this is kind of long so just read it when you get a chance, and bring up some of this with a bigshot :P. I'm a young guy, only in my early 20s and have a degree from the U of W.
For the past few years, I've found myself complaining about everything in Winnipeg, from transportation, to road conditions, the general beauty of the city, and how it's run, and I'm never satisfied by thinking about it, because I know it will never be solved.
I'm just going to outline a couple of the REAL problems that a lot of the youth in this city want to see changed, and that would hopefully keep them here (many of which just go somewhere else), and possibly attract a few more here as well!
1. the city is really really, ... emphasis on really, ugly.
- i understand that were under snow for half of the year, and it's not practical to try to look like british columbia with all the flowers and what not, so why not have a clean and modern feel to the city?
A small example is Henderson Highway's boulevard, has mulch, tree's, and flowers, all of which are terribly maintained, and not needed: remove them, and just have road where road should be. the city just needs to get the crap out of the way, and stop paying people to replant the flowers that grow for a week and then die again. also, pick up garbage, and sand etc.
2. Downtown
- downtown in any city should be the place to be, it should be where everyone goes for business, and fun, usually shopping as well.
In Winnipeg we have an infestation of run down buildings, homeless people, drugged up people, and the worst traffic flow in the universe. My opinion: relocate things like the booth center, and make some sort of regulations on the area's homeless people can stay (i know it sounds perverse, but thats the world we live in, nobody wants to get mugged). In general, just clean up the area, did nobody think of that?
3. Transportation .. this is a biggie.
- living in the north, going to U of Manitoba was out of the question. an hour drive to travel 20-30 km ... that's out of this world. Winnipeg is a really small city, getting more heavily populated, and we have a terrible method of transportation. This city is terribly planned, no question about it, but city planners aren't making an effort to change it. They have no long term goals, they just want to patch everything up. Why do you think there are potholes in the same spots every year?
The emphasis should be on public transportation, but by that I don't mean buses.
- the general consensus of the youth of Winnipeg (from survey's I've done the last year) is that they want a fast transportation system. Something like a subway, rapid train line, or dare I say ... Skytrain.
Skytrain (one from Vancouver) is the most beautiful invention. It doesn't interfere with the roadways, except for the concrete beams they need to put into the ground everyso often. It can get you from one end of the city to the other in 5 minutes, we have Manitoba Hydro, so we can just power the thing with electricity / solar or wind panels on the top of the train. It snows here all the time, so the snow will not interfere with the running of the skytrain. plus the city can make money off of train tickets because I assure you, everyone will use it, at 4 or 5 bucks a day. Beats the price of a car! ...
Anyhow, basically, people want out of Winnipeg because of functionality, and beauty ... we dont want a new museum of human rights, we dont want a new stadium, and we dont want bike lanes, we want functional transportation, and a pretty city to look at.
Theres my rant!
-Dexter
p.s. Hail Aurtaurlia, Land of the Freep!
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Today at 5.05, Crimewatch with CTV's Kelly Dehn, and at 5.15, MMA fighter Jason Geiger on life in Japan, grappling against UFC legend Dan Severn, and his upcoming bout on Friday for Tony Condello's Ultimate Cage Wars 16 at the Convention Centre
(call Tony for ticket info at Phone: 229-9173 or Email:tony@ultimatecagewars.com)
Also listen to TGCTS every day to win tickets for the PCW Premier Cup wrestling tournament next Wednesday, June 24th at Dylan's on Pembina, with:
* Ring Of Honor & Montreal Star El Generico
* Ring of Honor and DDT Japan stand-out Kenny Omega
* Evil Mike Angels and other stars of PCW
