Letter: Hand over responsibility for ambulances to the municipal level

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THE GAZETTE JULY 18, 2014

Re: “A critical need for better ambulance service” (Editorial, July 16)

This is an excellent editorial about the substandard level of the pre-hospital emergency medical care across Quebec. Sadly, there have been many excellent editorials over the decades just like this one.

Many of us have been advocating for the recognition of Advanced Care (Advanced Life Support) Paramedics for 30 years as Quebec lags woefully behind its neighbours. While “Paramedic” is now emblazoned across our ambulances, the term gives a false expectation to the public.

We continue to lose our most skilled ambulance technicians to other jurisdictions. Quebecers need not suffer, or die, before getting to the hospital when there are so many eager ambulance technicians available and willing to be trained to perform at a much higher level.

The lack of transparency, lengthy response times and fleet availability in the regional ambulance service cited by the editorial is fixable. Hand over the service to the municipal level. Fire and police services for the Montreal Island are not run by the province, nor should they be. The same stands true for ambulance services. The level closest to the citizen will result in better care and a higher quality of services.

Glenn J. Nashen

City Councillor

Côte-St-Luc

© Copyright (c) The Montreal Gazette

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CSL EMS volunteers – At the ready

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While Urgences Santé emergency medical technicians are set to go on strike tonight, Christmas Eve , Cote Saint-Luc volunteers will be manning our local Emergency Medical Services station round the clock.  CSL’s first responders will ensure there is no disruption when a 911 medical emergency happens in our town.

Ambulance is an essential service and therefore the strike is largely symbolic. Medics will likely wear army fatigues or jeans rather than their proper uniform and will plaster stickers across their ambulances.  Unprofessional to be sure and largely disrespectful of property paid for by the public. True, the vast majority of “paramedics” are wonderfully dedicated and very talented, but the union has a way of getting their way.

Nonetheless, Cote Saint-Luc volunteers are always ready and able, and look mighty fine at all times.  We’ve asked our volunteers to put in some extra time over the holidays and even to double up so multiple calls will be answered without delay.

You can help too.  If you’re baking or cooking why not prepare a couple more helpings and drop it off at the station with a bottle of coke – 8100 Cote Saint-Luc Road?  Our crews will be thrilled with the attention and the grub as they man the fort during Christmas and right through New Year’s Eve and Day.  Your thoughtfulness and generosity will be warmly appreciated.  Just ring the bell at the front door, and as long as they’re not out on a call you’ll see some pretty big smiles. (If they’re out you can leave it at the door.  It’ll stay cold!)

CSL EMS volunteers are highly skilled life savers.  Fully trained in-house, they are multilingual, young and energetic and  very happy to assist those in need.  So, thank a medic from CSL EMS when you see them next.  They’re on duty for you.

Ambulance strike off, for now

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This Urgences Santé ambulance spotted on Cote des Neiges Road Friday afternoon was readied for strike actions that were called off at the last moment

Urgences Sante ambulance paramedics were set to go on strike this weekend but this action was called off at the last minute.  Ambulances were already defaced with stickers by disgruntled union activists by Friday afternoon despite the strike being called off.

By law, ambulance service is considered essential and therefore the would-be strike action is limited to administrative delays, defacing property and not wearing uniforms, for example.  But delays in service is a possibility as evidenced by previous strike activity.

Nevertheless, Cote Saint-Luc’s volunteer Emergency Medical Services is always at the ready to respond to emergency calls as the authorized first responder service of this city.  EMS responds to Priority 1 (life threatening) and 3 (potentially life threatening) calls unlike the rest of the Island of Montreal where the Montreal Fire Department responds to Priority 1 only, when available.

EMS has ben known to respond to multiple emergencies at the same time.  With a fleet of three emergency first responder vehicles and some volunteers even equipped with radios and gear in their personal vehicles EMS has been able to answer as many as four emergency situations at the same time.  This is incredible service to those in Cote Saint-Luc and any strike action by ambulance technicians in the future would result in several volunteers being available to tend to the sick or injured while awaiting ambulance response.

Bravo to our dedicated and talented EMS volunteers.

Ambulances slower in ’04

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2004-11-24 Ambulances slower1 Suburban

Les services ambulanciers québécois ont besoin des paramédics

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Les services ambulanciers québécois ont besoin des paramédics

Le 29 mars 1999

Depuis près de vingt ans, je fais la promotion de la légalisation des paramédics au Québec.  Déjà, à l’école secondaire, j’étais captivé par tout ce qui touchait le système de services médicaux d’urgences québécois et, depuis, je suis perplexe et troublé par l’approche unique du Gouvernement en matière de soins préhospitaliers.  Cela m’a poussé à obtenir une formation en tant que «technicien ambulancier», comme on l’appelle au Québec,  la plus élémentaire d’une suite de formations menant au diplôme de paramédic, et la seule qui soit reconnue au Québec.  Mon intérêt à ce sujet fut aussi le tremplin de ma carrière politique en tant que conseiller municipal, mon but étant d’améliorer les services médicaux d’urgences de ma ville, Côte Saint-Luc, et du Québec par la suite.

Les paramédics font la différence entre la vie et la mort pour plusieurs victimes d’infarctus ou autres maladies du cœur, du diabète et de l’asthme, pour ceux qui souffrent de réactions allergiques sévères, les brûlés et toute autre victime d’urgence médicale ou traumatique. Ailleurs, au Canada et aux États-Unis, ces spécialistes des soins d’urgences hautement qualifiés et spécialement formés sauvent des vies et allègent la souffrance en ayant recours à des équipements d’urgences très sophistiqués.  Sur la route, les paramédics sont en communication constante avec les médecins responsables des urgences dans les hôpitaux.

Toutefois, les paramédics sont un seul anneau d’une importante chaîne: Ailleurs en Amérique du nord, les services médicaux d’urgences sont composés de plusieurs types d’experts en soins d’urgence, du premier répondant, avec 50 heures de formation de base, au technicien ambulancier qui possède de 150 à 300 heures de formation, au paramédic qui a reçu plus de 1 500 heures de formation.  Ainsi, les ressources sont soigneusement sélectionnées en adaptant l’équipe de secours au type d’urgence à laquelle on fait face.  Cette méthode est économique en plus d’être efficace.

Au Québec, les services ambulanciers sont organisés de façon très différente du reste de l’Amérique du nord.  Par exemple, à la CUM et à Laval, Urgences Santé, une agence gouvernementale québécoise,  gère toutes nos opérations d’urgences médicales.  De plus,  huit municipalités de banlieues offrent des services parallèles de premiers répondants par le biais de leur service d’incendies.  À Côte Saint-Luc, 50 bénévoles partagent cette responsabilité.  Les techniciens ambulanciers ont plus ou moins reçu la même formation de base en réanimation et toutes les ambulances sont sensiblement équipées de la même façon.  Qu’ils transportent un patient convalescent entre deux institutions, qu’ils répondent à l’appel d’un aîné qui ressent un malaise bénin ou qu’ils soient appelés à se rendre sur les lieux d’un sérieux accident routier, les techniciens d’Urgences Santé possèdent la même formation et se déplacent toujours dans le même  type de véhicule.  Cette uniformité dans notre système limite, pour le moins, toute possibilité d’envoyer la ressource la plus appropriée lors d’une urgence médicale.

Afin d’améliorer le système québécois et de l’élever au même niveau que le reste de l’Amérique du Nord, nous avons besoin de paramédics hautement qualifiés capables d’opérer des équipements spécialisés en réanimation.  De plus, nous devons former plus de premiers répondants et les placer dans des véhicules d’urgence contenant seulement l’équipement de base qu’ils sont habilités à utiliser, donc, des véhicules de moindre coût.  Les coûts de formation, de véhicules et d’équipements seraient ainsi réduits, et les salaires proportionnellement.  Ce type de formation devrait aussi être donné aux pompiers et aux agents de sécurité publique dont les services sont diffusés un peu partout dans les villes.  À Toronto, par exemple, lorsqu’une urgence médicale est signalée, les policiers ou les pompiers les plus proches des lieux y sont envoyés, suivis d’une équipe d’urgence médicale appropriée (premiers répondants, techniciens ou paramédics).  Cette approche contraste en tous points avec celle du Québec.

Le vérificateur  général a finalement confirmé ce pourquoi je fais campagne depuis des années: Le Gouvernement du Québec doit exiger des services ambulanciers qu’ils améliorent leur niveau de soins et qu’ils maximisent leur efficacité afin de sauver plus de vies et sauvegarder l’argent des contribuables.

– En légalisant les paramédics;

– en mettant sur pied plus d’un niveau de formation et d’expertise en soins préhospitaliers d’urgence;

– en utilisant les véhicules appropriés à ces niveaux de formation et d’expertise;

– en utilisant pleinement les ressources des services municipaux d’urgences existants;

nos services ambulancierspourraient répondre plus rapidement aux urgences médicales et leur affecter les ressources appropriées.

Finalement, le gouvernement doit faire la promotion des cours de réanimation cardio-pulmonaire partout où il est possible de le faire. Par exemple, ces cours pourraient être rendus obligatoire pour les finissants du secondaire ou encore pour ceux qui désirent obtenir un permis de conduire.  Ainsi, des citoyens familiers avec cette technique de réanimation seraient, eux aussi, en mesure de sauver des vies.

Depuis le début des années ’80, j’ai fait campagne seul, d’une ville à l’autre de la communauté urbaine de Montréal et de Laval, et j’ai ainsi réussi à faire adopter une résolution pour reconnaître les paramédics dans 21 des 28 villes approchées, dont la Cité de Côte Saint-Luc. Ceci a été ma campagne personnelle depuis presque 20 ans et j’espère qu’elle mènera d’autres à manifester leur souci pour leurs concitoyens. J’espère que le jour approche ou la question de la légalisation des paramédics au Québec sera résolue par une mesure législative. Entre-temps, je continuerai de pousser cette question avec autant de détermination et de persévérance qu’il en sera nécessaire, jusqu’à ce que le Gouvernement du Québec donne suite aux recommandations de son vérificateur général, de ses coroners et de ses contribuables surtaxés. Parce que plus de vies peuvent être sauvées, les Québécois revendiquent la reconnaissance des paramédics ainsi que l’amélioration des services pré-hospitaliers d’urgence.

Glenn J. Nashen est conseiller et président du Comité consultatif sur les services d’urgence à la Cité de Côte Saint-Luc.  Il a travaillé en tant que Technicien médical d’urgence chez Urgences Santé pendant 17 ans ainsi qu’en tant que bénévole aux Services médicaux d’urgence de la Cité de Côte Saint-Luc.

Quebec Ambulance System Needs Paramedics

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Quebec Ambulance System Needs Paramedics

An Opinion Piece by Glenn J. Nashen

23 March 1999

For nearly 20 years I have advocated for legalization of Paramedics in Quebec.  Since my high school days I have been captivated by Quebec’s emergency medical system and have been troubled and perplexed by the government’s unique approach to pre-hospital care.  This drove me to train as an Emergency Medical Technician (known in Quebec as “Technicien  Ambulancier”), the most basic level of training of several levels leading to Paramedic certification, and the only level recognized in Quebec.  This interest also launched my  political career as a City Councillor:  My goal was, and still is,  to improve our Emergency Medical Services in Cote Saint-Luc first, and across Quebec second.

Paramedics are the difference between life and death for victims of heart attack, diabetic and asthmatic crises, severe allergic reactions, burns and a variety of other medical and traumatic emergencies.  Paramedics throughout the rest of Canada and the United States save lives and alleviate suffering very effectively because of their high level of training and access to sophisticated emergency equipment .  While on the road, Paramedics are in constant communication with the supervising doctors in hospitals.

However, Paramedics are only one link in an important chain:  EMS services elsewhere in North America include several levels of skilled emergency care providers, from First Responders with 50 hours of basic training to EMT’s at 150-300 hours and full-fledged Paramedics with 1500 hours or more.  Resources are carefully selected and dispatched, matching the crew to the type of emergency.  This method is both economical and efficient.

Ambulance services in Quebec are organized in a very different fashion from the rest of Canada and the United States. Our system, in the Montreal Urban Community and Laval, is the responsibility of Urgences Santé, a Quebec government agency.  Additionally, eight suburban municipalities offer parallel First Responder Services through their Fire Departments, while in Côte Saint-Luc  50 volunteers share the responsibility.  More or less, all ambulance technicians receive the same training in basic life support and all ambulances are equipped like the next.  Whether they are transporting a convalescent patient in between institutions, responding to an elderly person who is merely weak or feeling unwell or answering the call of a choking child or a life-threatening car crash, Urgences Santé technicians have the same training and ride in the same type of vehicles.  This uniformity in our system totally limits the possibility to send the most appropriate resources to emergencies.

In order to upgrade the Quebec system to the level of the rest of North America we need highly skilled Paramedics to operate specialized equipment in advanced life support ambulances.  In addition, we should train more First Responders and position them in lower cost emergency vehicles throughout the area.  Training, vehicle and equipment costs are minimized in this manner and salaries are kept lower.  Also, this training should be given to fire-fighters and public security officers who are already scattered throughout cities everywhere.  As an example, a medical emergency in Toronto would have the closest police or fire personnel dispatched along with the appropriate level of ambulance crew (basic EMT or advanced Paramedic); this approach is in stark contrast to the Quebec model.

The auditor-general has finally confirmed what I have been campaigning for all these years:  The Quebec government must require ambulance services to improve the level of care and maximize efficiency in order to save more lives and safeguard tax dollars.  By legalizing Paramedics, implementing more than a single level of training for emergency care providers and spreading them around in vehicles equipped to their level of training, ambulance services in conjunction with existing municipal emergency services would be able to provide faster response and dispatch more appropriate resources.

Equally important, the government must promote the teaching of cardio-pulmonary resuscitation.  Quebec should make CPR a requirement in order to graduate high school or to obtain a drivers’ permit.  In this way many more lives would be saved by rapid intervention of bystanders and First Responders followed by quick response from advanced life support Paramedics.

Since the early 80s I have single-handedly brought a resolution to recognize Paramedics from city to city across the MUC and Laval, starting in Côte Saint-Luc.  21 of 29 cities have supported this resolution.  This has been my personal campaign for nearly 20 years and I hope it will lead others to demonstrate their concern for their fellow citizen.  I hope that one day soon the issue of Paramedics will finally be resolved by provincial legislation. In the meantime, I for one, will continue to push forward with as much determination and perseverance as necessary until the Quebec government heeds the advice of its auditor-general, and its coroners, and its overburdened taxpayers: There are lives that can be saved and Quebecers demand recognition of Paramedics and improvements in pre-hospital emergency care.

Glenn J. Nashen

Bring in paramedics – Gazette Editorial

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Friday 19 March 1999

Bring in paramedics

The Gazette

One of the most exasperating of all public health-care issues has to be the quality of ambulance service in the Montreal region.

In Cote St. Luc, a municipality with one of the highest percentages of senior citizens in the province, municipal officials have documented the atrocious performance of Urgences Sante ambulances, including chronic delays and a response time that averages far longer than Urgences officials have claimed.

The provincial auditor-general said recently that, among other things, ambulance technicians in Quebec are receiving inadequate training and are allowed to perform too few emergency procedures on patients while transporting them to hospitals.

Several years ago, the provincial government responded to criticism by increasing the training for technicians, but this instruction still lags far behind the norm for North American cities. Quebec still does not train them to become true paramedics capable of starting intravenous lines and administering numerous medications, including things as basic as asthma medication or nitroglycerine. Because they can’t get this kind of elementary aid before reaching the hospital, some people die needlessly.

What makes this all the more appalling is that successive Liberal and Parti Quebecois governments have never given cogent reasons for refusing to upgrade the technicians to the status of paramedics.

If the government did license paramedics, it would have to pay the personnel more, but that has not kept almost all other parts of Canada and the United States from doing so. These other jurisdictions realize that saving lives is worth the investment.

Two-thirds of the municipalities of the MUC have passed resolutions calling for paramedics to be allowed to practice in Quebec. When will the provincial government start listening?

Health Minister Pauline Marois has said that she will respond to the auditor-general’s report in May. The least she should do is hold public hearings on the issue. It would be prudent to examine all aspects of paramedical care in the light of the experiences of other provinces and states.

For anyone who suddenly is a victim of a car crash or heart attack, care by paramedics can be a matter of life and death. It is not too much to expect Ms. Marois to act.

©1998 The Gazette

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