Gazette Editorial, July 16, 2014
Not that long ago, calling an ambulance in Montreal often meant summoning a vehicle from a funeral home. True, the optics weren’t good, but emergency response in those days was a private business — and a competitive one. Funeral home station wagons could carry stretchers, so they took calls.
Emergency services have come a long way since then. They are now highly professionalized and centrally coordinated. Montreal police took over ambulance service starting in 1958, and Urgences-Santé was established in 1989 to cover Montreal Island and Laval, although Côte-St-Luc maintains its own supplementary first-responder service. But the reality is the greater Montreal region today lags behind almost every other jurisdiction in Canada and the U.S. in pre-hospital emergency care. And now our shortcomings have been highlighted once again as the union representing almost 1,000 Urgences-Santé employees threatens pressure tactics as they negotiate a new contract.
Quebec may call those first responders ambulance paramedics, but the vast majority are not trained — and not permitted — to provide the same level of emergency care that is allowed in other jurisdictions. For years, the Collège des Médecins, and the professional order of nurses, have jealously guarded the right to perform “medical acts.”
When Premier Philippe Couillard was health minister a decade ago, a pilot project created 18 new “advanced care paramedics” — trained in Ontario for work in Quebec. But until two years ago, they still couldn’t use their new skills unless a physician was on board. Today, only 12 of those original 18 are still left; the others have left to work in cities where they have more freedom to practise independently at advanced levels.
Now the union for first responders wants to see 150 or more advanced-care paramedics in their ranks. This is a long-overdue reform. Empowered paramedics have proven to be a valuable asset outside of Quebec, not a public-health liability.
A broader challenge for Urgences-Santé, however, lies in improving its basic response times. The ambulance operator claims its average response time, for the highest priority calls in Montreal and Laval, is 7.04 minutes. But anecdotal evidence, from both patients and first responders, casts doubt on this. There are times when there are no ambulances in Laval, and vehicles are directed there from as far away as LaSalle. Urgences-Santé has denied a Gazette access-to-information request to open its books, so there is no way to tell how response time is being calculated.
The lack of transparency is troubling, but there’s reason to suspect that there simply aren’t enough ambulances and paramedics. In fact, the union is asking for 20 more ambulances and 40 more paramedics as part of its contract talks. The government, as overseer of health care in Quebec, should take this bargaining period as an opportunity to review the entire structure of Urgences-Santé. In Toronto and Ottawa, ambulance services are run by a body accountable to the cities, rather than the provincial government. At the same time, user fees should be reviewed, and brought into line to support higher standards of service, especially as the population ages.
Ambulance services aren’t entirely unwritten by the public purse. People pay out of their own pocket; a ride to the hospital costs a basic $125 and $1.75 per kilometre. There are exceptions — those on welfare, those over 65, anyone involved in a car crash or a workplace accident. But the rates haven’t changed since 1997; meanwhile, services still trail other jurisdictions.
None of these issues are new — but they are still issues of life and death, and they deserve closer public attention than they are getting.