and SkyMedical. Most of the Basic Air ambulance transports

38 Pages·2013·1.41 MB·English

and StyMadial Most ofthe Basi Arambssance transports rigine inthe north and provide servlce
forthe Northem Pati Transpotatian Program al the First Nation Inu Wealth Branch,

“The companles providing Basi Ar amlulnow allue either King At or Math alta. They have @
capisin nda frst offer plus a Reload Muse, haa graduate «recognized erat core or
‘emergency nursing program with related aeromedea training or an Advance Cae Parade ufth
‘eromedhealilng. The pationtstransprted on Batic air amblanens are typical table, requng
medical monitoring by angeroredtsl attendant, anda stretcher for their comfort.

‘Mec began dlspetchng ee Air Amblance cls n March af 2012. They have gathered espatch data
sHnce the ge Ive date on March 19,2002 us July 26,2012, Dureg ths fot manth prlod thee were
2700S dase Ar Medes crested, CF these 2005 incident, 1907 Inedents wave aadghed and depetched
‘toa aad wing siren These 1907 Indes had 2572 alt resources sslgned to tho ident. This
umber reflects the fect that some transports may have ha multiple esau sgned DT the 2572
sr resource asignments, 1867 ofthese ascgnments completed 8 patent transporte the prescribed
‘estnation During the four month reports paid, MTCC recelved a total of 2447 pation iansport
requests tom factor and Mursng titans,

‘the 2.572 eslanments 435 were responded to by acing caret. Tha westtwo buses atts
orld 41% ofthe assignments. Cre take asthe conmmon akport pc locaton aed Winn.
Icerntional Alport was the mot frequent destnatan forall Gast: Air Ambulance fights

‘he ndvisual cartes have not entered Into performance canrect With Manitabs Health, Mantobs
Heath x cumantiyin the proces of dean «performance camtratt template whlch woul be ured fa
anterng ints a forme contract with each asl lr caer Thre isontyaloosaUnkage, with no dsr
sccoumtabity Ines, batween Manisa Heath and/or the EMS Branch andthe carers. When'a
Province resident frotinchaing First Nation members) transported by Bas Al: Ambulance those
tharges ara billed to the appreptate AltA al eimbursedutoftha Norther Patient Transport
Program. in 2010/12¥anitoba Haalth paved en estimated Sm in fundng for Basic Alr ambulance
sels, These cots are funded aut ofthe Morther Patient Tranaporttion Program but ae not tacked
separaih. ne case ofthe transport of Fes ation member th cra bil the apprograte Nursing
‘Statioa/Hosptat and thone charg are forvarce ta th Folara evernment Fist HationIvit eal
‘ranch for payment,

vars
‘Shock Trauma Air Rese Socety (STARS) bagan operating In Maitaba in Apr 2005, tial for
hurmankarfan effrt reatetto tho 2008 Mood In sauthern Ma tabs n 203% the province contracted
‘wlth STARS agen to asit with another flood. At the hegfnlag of 2012 He Province oF tito
centered Imp 10 yer Service Aurchase Agreement with STASS ty provide rapid amd epeciaed
femergengy care on plevary responses and urgent Inter Aaily transports, STARS opeetesa¢ a Non
oit/chrtable agency, using retary wlag altcrafs, It has created a separate Foundaivn to overare
‘und raking acti. tha only land armbutanc or alr artbulancearvce provider that ectiety

Mantaba EMS Sytem Reve ape 35 arch 08
marks ts series to the public The progrart kas the emergency roar (@ the patient wile proving
ngaing pre-hospla cave. STARS ete has operations 4 Alberta and Satkatchewen. As gull in the
ntact with Manitoba Heath sch year Maritoba Health and STARS negoicte the conta and
‘eeating budget fr the sing yaar. The contrat does not include oanda etl, As part ofthe
<antract STARS to orgunte/eeltate an ongolg erklcal and emenget care transpartvedclne
‘eduction pragram for rotery wing elr medial providers, fad whaand eround EMS provers and
‘ther rural and rea care providers across the Provinc.

[MTCC proved the dispatch servic ding the 2009 2011 fonds and thereftar when STARS
become petmanent service in the province MTCC ithe call ator and coontnates the ubpatch
process foreach cal but oes not provide triage services. Onboard even STARS fght are twa pts, 2
ital eae nurse, and an advanced ave paramedi.Aqualied emergency physkianinaleo avait by
phone andsravelstn the helper whenever evesiealy necessary. Tha aptnal operating ange witht
‘refuel Is approtmately 200 klcmetra, within the province

During tne 2011/12 teal yaar there wera 258 cients resoing In 268 patient tursports. Ninety sb
‘uansports were|FTs and 20-weve pebnay responses for vende crashes.

"atrentiy STARS opeates cut ofa basen Winnipeg, This thei primary landing she for pationts
‘wansporad to Wincipe, Currently 2 newhelped is under construction st HSC at the new Lingnostc
Corre of Exelon. There ate cutrentl no hllpads located In ruthern and erthernAferitok This
hus negative mast on trensoart time provided kya hlicaptrsinoa presently alnnd ambulance must
stil plek up the matient tthe Winnipeg airport and prove te ground transport the hospital

‘currertypeltherStAR5 nor tha Province LIDFRIME torte transport of First Nation member, So far
‘the east hasbeen absorbed hy the Province. n 2011/12 Mantobs Hest provided $10.2min funding
forthe STARS program. This funding Indes $2.71 or lod costs, Me budget For 2012/14 cueenty
being negotiated berweca Manlioba Hee wal STARS,

lity Teaysport Prngrom (Saas
‘The Souther Ar ambulance inter-fadity Tranepert program was impiemented os a pr project to
rove tar facity air ambulanca sera thet would ethers have been proved by the land
smbutance syst) to resident who would eaperance one way ambules ips renter eho Wt und
‘ne lf haus. This program to transport patients in southern Manitoba war begun In Nowerbet, 2013.
Govetnment Services provided the nieraft nd the ight crew whe the peknary cave paramedles
were seconded from sevetal ofthe RAS. Oversight fortis program va provide bythe EMS Bratch,
Inthe plat stage FNS war not bla for any Fst Nation transport,

or the pelodtovernber 14,2011 June, 2012 SAAP transported 321 patients. SAAP peked up
patents frm 24 aorta and transported them t0:9 aiport destinations. The primary pickup and
#estinationloestion wos Lfefight hanger TS In Winnlpeg. The Dauphin apo was th second highest
ichupaed destination ation,

Manitoba ENE Sitar Review ne Meh xa
‘As ofNovernber 2012 ths programas pai optrationa and wllaperete ah @ permanent bai. At the
fend of twelve mont a pragram rasaw willbe completed at whieh tie tha resus ofthe EMS review
wl be taken oto acount. Tha sence operates. whi similar audellnt asthe eal elt project
[Government Ar Seivices to provide thealrtat nd fight crew and the paramedics to be zaconded tom
an RHA,

‘n thelr dlscussions wth grougs of paramedics, partleulary nthe northern perc ofthe Paritnd RHA, the
reviewers heard many poi camments about the Souther Ait Abulance proc. Areal problem for
the Partanc RMA isthe ong FT tranaport mas and tha srs pts on the patient and! paramedics A
‘transport from Dauphin ar Swan Rher to Winnkoeg con take 45 hour ving te naneh eet and
Potentell n3 04 hour wat time belore they can scharuethe patient tothe ecg hsptal. Thi
Droject helped to reduc thse for transport times anda pu the ambulance bac inservice for
another callin a much shorter time. Cleat SAAP i an important response to Imgrtvingthe IF erica,

What Needs to be Accomplished ~ Alr Ambulance
In oer to achieve resto Integation of lad ambulance and zr wmbulence na cebnginted provincial
EMS save is lar some signet changes ae redued. Current the only place these serves
‘coe together a nthe elpateh serves provided by MTCC. MICCdgpatches the lane rule
‘which ic @nesescry part ofthe a arbulance servoes As recta sk month ago thete was no
commen dispatch service and there was evan las coordination of these two sera Today the lane
ambulance serces are operated by the RHAVSPAS au there ino common place where the and
ambulance serdces and al arbulaneasewvies interact with exch other. Asie apparent ters also
titi Imereti or Hanning between the ¢eren alr ambulance services. Al servicesincadg land
ambulance, sr abulace, medial ist remponte end stretcher car shoud idee be part of sng
provinca wide EMS entity that would hava oversight ofall EMS operons of any descr. allares
‘his should Include performance contacts with exch athe serie providers.

further sue that requiessttemton show theairambulgce sence should ba truetute. Curent
‘wo ofthese sendces ae operated by the provincll gavetnment ag Lifsfight and SAAP, one seve
provides by arvate cara but withaute contact eq. Basic Bir Ambulance andl another service Is
‘oparatad by 2 nan-gratkcorportion under @ contract wih Manitaba Hlth eg, STARS. As mentioned,
Inthe case cf Base Al Aimance, thee carers provke near all tha zones eventhough there area
total fsx crrors proving service. It has been suagestad Lo the reviewers that al ofthe Basic Ar
Armaloncs serves could be prove by singe catia, Others hav uggetted that there should sil be
‘more ther one carrer provlng serves. Cna way In which the matter could be sortad out is bya public
Regucs for Proposats (FP). The RFP would deaty sate what requirements he carers} would havea
meetin orderta be select to provide Basic Air ambulance sevcas.

“The reviewers understand that atthe end nf further year ot operation SAAP wlll avahsated. THs
evaluation may Include the question oF whether Government Al Services should prod the wenice or

‘Mantas sistant Paeea6 are 2013
whether the service willbe opened ype private carers ether n whole or In pet ft were to Ince
private carrerstt could operate Ia very tar aon asthe curentnorther Bac Ar Ambuvance
sevice. Again If prhnte carer: were Co provide sanvicts thats be determined by an REP proces.

Currently the ar ambulance carers provide the aiplane and Might crew a wel a he nurse and
advanced care parumlic. Another apich would le 1 hve ese two components separated snd the
rrr gost only the alpine an theft cew and the EMS service provide ll zhemedical taf,
tnd servlet. Thisarangamnts in place In some other provinces.

‘We Lefighe has been dethetlg qualey heath cae cries Hl viaje patients tn atl
“Manitoba for many yearsanothe orion might ue to hava private caress approved to delver these
cermergoncyrericas as vn This nad nat eau in the currant Lefght program coming io an end but
‘oul rather be seen as proving adelttnal capacity 2 peak periods

Specific Recommendations:

26. Involve Basic Ar Ambulance carers as Important partners ithe tata isl and smbubanoe
sence. This maybe assole provider or In coopereton wit Government A Senvioes,

27. Pubs a Request for Proposals (FP] ing appletont Lo provide Basic Air ambulance
sendces le both the northern and southemn portions ofthe province The RTP could befor
vation series only. This could rasatin multiple eantersrelng epproved.

28, Insthuta performance contract wh al Ste Air Ambulance carters.

IFT SYSTEM (LAND & AIA)

Key Accomplishments and Current Situation
The lterSaciey Transport Pragram (Fis both stralgtferaard and complex. straightforward in
that every ansport must be preauthorzed by @dactr/nurse athe fl cet of he transport it
auered by Manitoba Hesih. The enmepletty ecu from the nartber of ifferen ransporcprovider,
the various funding arrangements, the tarytg IF wer fees and multiple Aspatch systems in one f0
stevlop a cormplata picture ofthe IFT gragrom Infacmatian must be leced together from aferent
sarees en frequently estinates must be relia onsite consistent ptovince wide data doesnot ets
far the tal program

‘Ag prt afer propram the wonsporatin ie eovided by both and and ar ambulances ann Winnipes
sso by teicher ar. In rural Manitoba ~ south ofthe 53 the sere spree irovded by the
ANA EMS sence orn fe cases ban SPA provider, Inthe north he ere is provided by
combination oftand ambulances and asic Air Ambulance providers, Typically the nd amiadance
provides the transport tothe apart fram where he patient: own tothe approved detinaton.
‘yplealy,thaugh not abe, the destination lew hosel a Winneg and most frequent HSC ert

antaba EMS Sytem Review new arc an
Boniface hospital, An ambulance a stretcher car meets the plane In Wlonpag and tronspars the
patent tothe hospital Ths prooess reverses self when the pation is eadym retim home.

LUefight and STARS ae ambulance operatars preile transport forthe mine ec FY patents,
‘etic, 35 fica wing provider, serves both rural and northern Manitoba, STARS,» rotary vine
‘parator provides service many rural Manitoba snc inte to Z hous fight me before
‘refueling. Again the lod ambulance provides the tansporeton to and fram the sifot, There ares
seen SPA operators located mostly nthe former Burntwood raion tht sll dspatch, At ths pont all
ofthe Alr Ar bulance operators are dspace by MTCC In Winnlaeg WES proves the dspatch
service forall the lane ambudancas.

Catt Volume
‘As mentions information fom diferent seurces will eed tobe gieced together In onder to geton
cestenate on te provincial Tall vue,
"im 2024 MTCC prosdel 2925 IF land ambulance dgatches to thot asi it serves in rab
nn wore Manitoba, This resutedI 21,505 total IF patent renspons, Of thls number 2372
‘were emergent and 20,133 were noreatnergert.
= 1n2012 Winnipeg WPS had approximately 8000 IFT alepetchas, The mort ef thoes
dispatches were far crcal cae patiews. Median, astratchr car aperster provided ust
‘oer 16 0001Fvenaports in 2011.
+ ThesaSPA operators that selftigpatchad, or which here ave nectntral ecods, han
estimated 3300 IFT alapetces,

‘According tothe above dea and eetimetes there wore ote of 2,700 rurl IFT land ambulence
‘lspatches in 2001, The surat and northern IFT dispatches represented approximately 43% ofthe tot
lepatehas for tat yr. n Winnipeg thate ware spproxlnabely BOODIFT ambulance dispatches and
spproximately 16,009 stretcher car dispatcheafrenaports in 2011 fr atta of approximately 24,000 IFT
fepatches, Of des total Winnipeg clspaches rpprnimately 255 reprasanted IFT dispatches.

In edfon to aad ambulnce and suetcher cr dlpatchae air ambulange ese provides an fF serie.
‘2012/12 MTEC recalved 745 toques fora Liteflght al tanspor, of which 456 requests resuked ine
patient bing transported an one ofthe Lifcfighalreats. STARS Inthe same period had 168 patient
‘transports of which 3b were FT transports MTCC began dispatching Bosc Ar Arb lace in March of
2012. Belween March andthe middle of ul there were 2005 Barc Ar Avbwlancy incidents created. OF
‘these 2005 incidents, 1907 Ineldents Were assigned ad lspatched to 8 Fd wingalrerat and A867
patients were transported Duing the 7 morthsIt was in oparation SRAP tranyfarted 321 IFT poles
‘out oF 69 sthadlod tps. In total it eshte thatthe fouraramiulene programs provided
‘approximately 2,7501FT transports for 2014/12. (rapolatingto the full eo there woul be
approximately 6000 IFT transports

Manca EMS Sym Rote age so rh 2088
In regard to IFT picky lacations for ptlent Land tsnaport there wer out lations that he oer 2000
‘lckups n 2034, They were Brandon, MSC, Selkirk Hospcal and. Banfarn Resp, Another them
lecatons had over $000 nls annual. These locations are Boundary Tall espa, Dauphin Hospital
and Portage Hespla in total thera wera 228 pickup lecetionsn 2003,

Im 2011 (FT patient lane rorapor estiation lations inluded 371 patonts wih HSC as thelr
ttestnatlon an over 2000 patients had St Sonifaco Hospital and Brandon Hosp at hair destnaton,
‘Over 1000 netents had Dauphin Hospital, Boundary Tralls Hsplal an SelMFk Hospital a hair
destination, Asin pup ection there were many destination cations that rece fess than 200
patients,

‘my 2011 Base A ambulance used 36 apors 2s IFT ptietplelu leations. Nine locatlons out of 36
locaton had the maja ofthe patient wlekups, Inline: Cross Lake Aiport, Thompson Alor,
Winnipeg Int. Arpar.and St Theres Polat Alport. tn regard to destnatlan facts the three pmary
locatons were Winnipeg th por, Thompson Airporcand The Pas Spor. iffight uid 36 pekup
loegtons, The four lations tat were most frequently used were eflght HangerTS, Dauphin alr,
‘The Pas Alrport and Thomason Aiport. The primary dartntion location was Leight Manger 75 in
‘Winnipeg, STARS pekedup IFT patente fom 47 laatioas of which Boundery Fails was the busiest. Tha
‘nal destinaton for petits tas predominantly HSC and St. Benfse Howl

eonaing
‘Te cost for all FT transports ie uty covered by Manitoba Health, voices for ech FY transprt mast
Da submitted bythe EMS aperstorin order ta ecelun ment fom Manitoba Heath. nthe ata oF
FPS nvciess need vot be submitted snes the WRHA provides an agreed upon amount oF funding out
offs globel funding tron Maritoba Hel, Each ENS operator sts the user fee ft FT tranepars lt
hate rtes that ace used when baling Manltaba Heath The olan Anant infrmation sa
‘combination of information paved by Markobe HeaRh and information extracted from ether

Manitoba Heath provide the folowdng fang orth FT program in 2011/12
ter flty TrmsportanicnProgeam.
4 Lifofight air ambulance Program {Ops & emar/nt
1 STARS Ar Ambulance Program 57% of total con.
= Souther Ai Ambulance Program.

‘The folowing funds came more inlet from Mentaba Heath

‘+ ealloaton fm WURHA to WPS. —-$3204207
BEL Ar Ambulance OSE errr nena $009,000
srrtaher ca estimates $2,000,000

_Afew poets should beaded fr arfiatlon. The Base Ai rntulance expenditures ae pat
Northern Patient anspor rogiarn and can only be asimated since they are net traced earatey

Maitobs EMS System Review Page at arch 2083
‘The STARS IT fungi an estimate based an the fae tha S7M a al STARS transporte ae ITT
twansports. Tha sratcher car ransportsaze remburzed bythe hespal or PCH requesting the trenspork
‘nd are aborted inthe tora ncevtional ming

What Needs to be Accomplished

There wos nother item on whieh the nevewer haa a many comtlants rom EMS managers and
‘ont ine params a5 on the IFT program. This became topic of conversation at eat every Vt
ct pacemedes et the dierent stations, These eamplatsabout the IFT program fel nm three gone
areas: transport withorzation, the transport procee Il and unloading the patient st Winnipeg,
hose,

‘We hearth mary complains about doctors and nurses authoring tranaporation by ambulance when ft
‘was not required and other means of transport shookdhave been ule, Whi theres no data
svalele onthe inence of potently inppropriateauthorkatlon we heard mary anaott store,
‘he facing among paramedics that misuse of the program was occuring frequently. our
isassons Ideas were shave ab Lo haw this paeelved peobom right be acesaed wes aly
recogrzed that doctoe and nurses are Influenced by many factors When makinga desion tnauthorce
‘the traneportation so findeg an cverl sltion wl be aft The Ides discussed Inded taking
‘ha iter-faety transport check Is mora detalied sa thet more diagnostic Informa must be
proved by the doctar/urge ha requesting tha transportation was fel that th ingle the
Sactorfrurse think more caetilybefare autheridng trancpot. Many paramiics ao fe that dacrrs,
‘rttularty new doctors, dd ct fly undeetand the purpase and parameters of the IFT rogram and
spam educatonalinistve with doctor might lad a more apprprizte deine, Siar might
help the communty was better inform! on te purpose ofthe plogram and under wat
‘Sraumstanees medical traportation sauteed. A move aggressive des cluded establishing a
entra contro point where each request for ransportate fom a decir er nurse would have Re Be
formally aproved before en eenbulance woul be dispatched, (this standard protein Ort}
‘wasfelt thot his aonalstep should not be too problamatc since most FF sansparts must be
scheduled in advance typical the day before. Dactrs and muses may, however, hae diy
amceptng such an ntererdon inthaauthortion press,

‘here were two primary complaliessxpresael beat the FT transportation process sll-The demand
fac tFT transportation was so great hat alto frequently negativalyimpocted the S prmary
serve. Shmpy put respon tothe IFT transport request left nsuictent vehicies avilable to
respond co tha primary cals The second complain eated to the lent of transport. sl. the
Assiniboine and Pariand RAS transports Winnipeg can ty take 4 or Sours each way. We
‘ere tol tha it was nat unusual te have to welt # hour forthe patlant te baumlcaded. Consaquealy it
was not that unusual for the transport of angle satan take 12 to 14 hours or even XG hours. These
Jong transports put grea sttexs ou te paramedics kee raquently they Ivo sania nt evertine
ch contest Talgue and the poss af road aeldents Underta nb these lenthy
‘transports wera ao very sessul forthe pint

arte 19 Systm Aeest Page ara.2003
‘Ths shuations most serousin asiabotne and Pordand HAs and the nrthem partion of he Intalake
BAA, While we azo heard compton thaworh this problem is es sewer vere since the IFT
‘transports re provided by Basic Air Ambrlance. Ths only regulres the lad ambulance ta prove
‘transportation a and fom the aren sling cher te be back in service much more quik. Transport
{ine salsa less ofan nse In the scutheen yar of Cra province near to Winnipeg. Howeve, these later
ress ae sso tpacted by the growing dean for FT transport ervcs.in Winnipeg stetchor ears
towée approximately two-thirds ofthe IFT transports reduing the pressure onthe ambubnce sevice.

Inciscussng this ares manr Idess and options wers shared, They Included the following:

* Typlll ambulances ony trensport ne patient even thaugh theyre dale ta holo
steochers. Theres lit emhuslasm among paramedis toute the amulancetatiansport
‘wo patents tating. effecively Implemented ibis option coud reduce pressure oe the
system. Current ambulances ra ured vary neque to transport two ptlets

vada to orkukacas mult patio vehicle should nso be edded othe fet th
appropriate coordination of apprintments these vehides coli transport number of patlants
ata tine. Ths would obviously rece the number of ambulaces dong IFT wansgert any one
‘Ime and would lsu reduce the total suber of parameddesrequred for transport

1 Som ofthe leat implemented ty RHAC coud be fied more broadly. asinibcne has
‘consolidated ns EFT transport tc laiger stations. Parkdand and post sone other RAS
hve then thelr ton feet of aniblances and designates 2 number ofthe ambulances tobe
‘aed pvimarily for IFT transports andthe rastof the ambulances ta prvi the primar services.
‘Wheo al the FT designated ambulance are busy thereglon stanpteto reschedule new
requests or Pid other sluts.

In Wnipes stretcher cats are used tatransport stable FT patients, areas selene to
‘ohnnpegRemight be fabio hava stretch ears return te patient ame This would reduce
‘he numberof tripsthat a wal ariulance woul have to sma, This ea may frst reqtre an
parade and an expansion tothe vent sree cat xtvces,

= Winnlgeg obo uttzes specitty teams for transport g. Neonatal Tearsport, Gil Gre
“Transport. When transporting advanced or basc lve escorts are tan raul.

1 Asreviowrrs we heard enthusiast praise forthe Sautharn A Anbubnce serie. Whe his
serve wasnot In operation at the tne ofthe Intervows everyone hoped that taal ba =
srtabluhed aca parmanent sence it hes snc been e-etabhed, Depending on how It
‘operated this prograrn could heve avery beneficial irpact on IFT ransports inthe southern
areas ofthe province. air transports are ess tesfl for patents, ambulances are retumed to
sarvice more suicdy andthe stres en paramedis is reduced, Thsatvce would be even mone
‘effective Falrplones wth multe capacty were pat oft program,

+ anotheriden thats receiving stiou attanan is tho establish men of hub and spoke centres.
‘This option was medeled snd the resus are outlined belaw inthe section titled “Hut ant
spate”

Manito EMS ize Paiaw Page Marsh 20
fn area where we heard malo compas was are the whole kav of excessive welt acs before &
Patent can be unkoaded.Eavessva dey is oecuringparteaary at HSC and St. folie Hospital. The
hogptas have started various ways to solve this problem but > Far withoua any reals. Any
Jong term oF permanent solution wll, nevertheless, hve a come fora the husplal and acute care
system tel THe EMS service con only offer temporary band abl auggertlone, Sine ur Ferme of
Reforencs da nance revlew af the aoe care system es reviewers we are natn &posion to
bropose any permanant or long team soksonsfortNsproblam. need ta he urgently stdressed,
howevn, hos mceisivedelaysin unloading ee having detrimental Impact on EMS,

In our discussions with the paramedics sama aggestions were nevertheless made on how this isu
‘might be addreted tes, nthe short nee. These suggestions included etelenga separate
holding centre athe hospital so patents cov be unloaded mare promptly and the embulanes and
crew be put ack nserice mare prompt, Another suggestion wns that EMS or the hosp see
‘employ paramedics who would look aftr the patent whlle swlting agition and/or set the patent
In completing thelr sehaduled appointments, This would aes allow the ambulenré end crew to be put
back tasers with lets delay. Ary significant use of mutant anspor uals would requle &
igh evel of coordinaion anlthe seaming of dingrostic and ether medical appolntments,

Option of Creating Two Separate Services
‘As prt ofthe review we ware asked ta explore whether the IF program shoud remain integreted th
‘he primary EMS sence of qperate as a serate system, The evlewors cored ts question In mony
siferent venues ond with numerous FA managers and parsmedie. For iausion BlnpoLe wre
selvancaé sore practic options. Conceptually In passibiats Pink of two separ yrtams, These
‘separate eyttems could be operated ss two parte af ene relanal EMS cele or the IFT system could be
‘separated fiom EMS et the provid] level. The das of each system would be determine by Is
primery pumase. the ease of IT the primary pupae i te broke prearranged tanzperation i> a
stesigneli lotion where adtéanal medal ar dlagnntl avi isto be ravided, The tansport
provided by IFTinvols noth gatents who arn need of rca cars ant patie wha ae table rd
‘te unlely to requle any sgnlicant cre during uansport, A much highet percentage of IFT transports
ae forpatonts who ae stable. Nevertheless the number af etal care patients being transported is
substantial These pation beenuse of hel care needs must be aneporteby ambulance whlch are
_saffed with appropietely trained paramedics. Typcaly thls means Primary Coe Paramedes ork some
instance ttarmediebe Care Paramedics,

‘The question i rw reduced to whether ssbla IFT patients can be ranaged bya seperate transport
system, Such a IFT system could utilize ferent Winds of vehicles and not nest flly equipped
smbulances. in Winnipeg stretcher cars curently provide mach aft traneprtzton the systema
were property ccordinted multcpatient writs could sls be uso negara to the meal erow it would
be conpoced a staff with sserquaMfctons. as an axamiple the stretcher cr setice in Winnipeg uses
stafetrained in hase first. Cute They ths eevics would have & ory of staf trained et the EMR

ano ES ser Reese Page at Mares 2033
level. The escerta point a that the ambulance attendant inthis new separate FT sytem would not be
2 wel qulied asthe paramedics onthe ambulance

‘According to tha EMS managers and parumedies v/th whom thls option was tested the begest
shortcoming of ths proposal te eaparat tha two saris was tht Itwauld eave the reqpectiveserdces
‘thou ary bac caaciy in peak periods. TMs wuld be portelarlyproblamatic forthe primary care
Service shee the separated FT service woul no longer use qualfed peratnadica but mare Thi EMS.
‘Adonaly he IFT staff would hove na expertenee in providing pre-hospital arbulence care, The FT
service col rau more east from the primary service butin soning would use over qualified taf
and partly defeat he purpos of soparating the services

‘As redawers wa di net project the coat of te separate systems but It posable that two separate
services woul be af coma the currents system. Separating he to sacveet woul eo emt
sxddtone| capital cost for the purchase of new and diferent vehicles. KiIng tra zarvies sould a>
mean astparate management structure wth alfthe atonal cost that might go with tha, Thora
also the ick tha separating the two service could rasut In twa woak services ther than in twa trong,
sertoes

In the resewer opinion there ls more tobe glned fram implementing ceatvesolwvons athe cal or
regional level than there ito be apned from estabrhing wo fully separated systems, Thess colulons
‘an be tafred ta th local elt. Asan example new approaches mey worn ations with high
volumes of Frtraneparts but not be feasible ow volume stuations, Araleady inte i Wis
‘aport nv appraathet are curenty being ed bythe RMAs. Hopeuly as resi oF th review other
‘as and intrives yl be puree

The Hub & Spoke Cancept
Inner fcilty ransperts ae acallenge every communi, they ars bended with emvargency ells
thay remave valuable resources from the coramuntythatmay be required to read to the ret
‘emeryency cil I they resource the Inter-Fefty ambulances Independant tothe SUL services,
eta: over resurcng of ambulnens and drat cost Up exponential,

In Maitobe the halen stat rural ambuleree serves tre doin interact transports that take x
slgniant length af ee. Even though MTCC andthe RHAS take all avalible meatus to provide as
wide a range of serdzes ae posse, there ate sil times communities are without timely bless
sources for signiant periods.

Since aediona resources are ack always an aptian the hast optln Is oii thelength of time thet
‘ambulnces are away fom thet cortmunty This can be achieved by ntellger tain; caging isthe
roncept of ransportrg ag oF toa i, handing off patients from an provider another thus

Inte the distance that each serie is covering. The problem lth Hat pation err ands very

Manitoba ENG Sitam fonew Pape as Marek 032