Editorial: A crucial need for better ambulance service

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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.

A healthy ambulance service needs advanced care paramedics

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The decision last month by paramedics in Montreal and Laval to invoke pressure tactics against Urgences Santé to protest against the lack of ambulance resources is just one part of a larger problem with ambulance services in this province.

I have worked as a primary care paramedic with Urgences Santé for the past six years, and every year seems to be worse than the last.

Our response times have been unacceptable for quite some time now, and no one seems to be noticing.

However, there is a bigger problem here in Quebec, and it’s what we are doing once we arrive on the scene of an emergency.

Quebec is the only place in North America (aside from New Brunswick) where advanced care paramedics are not part of the operational routine. The rest of Canada has three levels of paramedics: primary, advanced and critical. Advanced care paramedics have more training than primary care paramedics and are able to bring the hospital emergency room, so to speak, out onto the road with them.

I completed my advanced care course in Ontario, a program that is accredited in all of Canada but not in Quebec, where it has been stuck at the pilot-project stage since 2001. Urgences Santé and the Quebec government fail to recognize my training, and keep me at the level of primary care paramedic.

For the last year, I have had to sit on my hands and watch as patients had seizures while being transported to the hospital, because I am not allowed to administer medication.

If you fall and fracture your hip in another province, the treatment you will get includes use of a scoop (a device that goes underneath you to lift you off of the floor), an IV, morphine for the pain and anti-nausea medication if you need it.

In Quebec, by contrast, you will be put in a vacuum mattress (a device that becomes rigid and acts as a full body cast), which requires a paramedic to turn you on your side, which is extremely painful if you have a hip fracture.

Why is it that we are the highest taxed citizens in North America, yet we are the only ones that don’t have access to advanced pre-hospital care?

It’s time we stand up and start demanding that we get treated just as well as our neighbours in the rest of Canada. As for me, I’ve been forced to move, to work in a province that recognizes my training and that will allow me to properly treat my patients.

Phil McHugh is moving July 7 from Montreal to Calgary, to take a job as an advanced care paramedic. He has worked the last six years with Urgences Santé.

CSL recognizes long serving veterans of EMS


It was a great honour for me to be included among those recognized last night for their many years of service in building the Cote Saint-Luc Emergency Medical Services. CSL EMS turns 50 years old this year.  The recognition event and graduation of the current class of new medics took place amid pomp and ceremony Monday night at Cote Saint-Luc City Hall.medal-003s

The Governor General’s EMS Exemplary Service Medal was presented by Mayor Anthony Housefather, Public Safety Councillor Sam Goldbloom and Director (and long time volunteer himself) Jordy Reichson to eight veterans following more than 20 years of dedicated service.

The Exemplary Service Medal, which was established in 1994 as part of the Canadian Honours System, recognizes individuals with at least 20 years of service in Emergency Medical Services and a strong commitment to exceptional performance.

I started at what used to be called EMO (Emergency Measures Organization) immediately after high school back in 1979. These were the years prior to First Responders and a coordinated ambulance service in Montreal. Residents would telephone directly to EMO and we would respond in our small fire-rescue truck, known as RMF-11 (Rescue, Medical, Fire).

Cote Saint-Luc EMO launched my side-career as an Urgences-Santé ambulance technician in 1980

Cote Saint-Luc EMO launched my side-career as an Urgences-Santé ambulance technician in 1980

Glenn J. Nashen on duty with Urgences Santé and Jeff Silver (in brown coveralls) with EMO

Glenn J. Nashen on duty with Urgences Santé and Jeff Silver (in brown coveralls) with EMO

Our first responder service was launched a few years later and I spent the next 20 years in active duty as a volunteer.

Shortly after being first elected in 1990, Councillor Ruth Kovac and I set off to form the EMO Review Committee and proposed upgrading the service to a full city service with a paid director, round the clock coverage, in-house training of our volunteer medics and widespread training of our residents, staff and visitors in CPR.

My EMO involvement also led to 5 years of volunteer service on the Canadian Ski Patrol.  I rose to the level of Assistant Patrol Leader at Mont Alta in Ste-Agathe.

My EMO involvement also led to 5 years of volunteer service on the Canadian Ski Patrol. I rose to the level of Assistant Patrol Leader at Mont Alta in Ste-Agathe.

In total I have been involved in our Emergency Medical services and every aspect of Public Safety for 35 years, well over half of my life!

Receiving the Governor General's medal from Cllr. Sam Goldbloom, Mayor Anthony Housefather and Public Safety Director Jordy Reichson

Receiving the Governor General’s medal from Cllr. Sam Goldbloom, Mayor Anthony Housefather and Public Safety Director Jordy Reichson

Additionally I served 18 years as an Emergency Medical Technician with Urgences Santé, five years on the Canadian Ski Patrol, and founded and spent countless hours with the CSL volunteer Citizens on Patrol group. My involvement doesn’t stop there having overseen Public Safety and Emergency Preparedness on City Council since 1990.

I am very proud to have championed the first municipal bylaw requiring bike helmets in Canada and spending the last three decades advocating for mandatory helmet requirements for cyclists. It is with passion for caring for the injured, sick and needy that I  have promoted the legal recognition of Paramedics in pre-hospital emergency medical care in Quebec.

Proud to be among many deserving veterans of EMS including Patti-Bath Lietman, Hal Newman, Rick Liebmann

Proud to be among many deserving veterans of EMS including Patti-Bath Leitman, Hal Newman and Rick Liebmann

There are so many highlights in my years in EMS. I have performed CPR more than 125 times and successfully revived one in four patients. One of my most memorable occasions serving on Montreal ambulances was my first and only delivery of a baby boy in his mother’s house, which permitted me to proudly wear a tiny blue stork pin on my uniform.

Riding aboard Cote Saint-Luc's first Rescue Medical Fire vehicle RMF-11, 1981

Riding aboard Cote Saint-Luc’s first Rescue Medical Fire vehicle RMF-11 in 1981

I remember with pride serving CSL EMO in a historical torrential downpour in 1987 that closed our underpasses stranding thousands of residents and spending fifteen straight days overseeing emergency services and communications during the 1998 Ice Storm.

Glenn J. Nashen on duty with Cote Saint-Luc Emergency Measures Organization, 1981

Glenn J. Nashen on duty with Cote Saint-Luc Emergency Measures Organization, 1981

Of major importance was my involvement, seven years ago, alongside Mayor Housefather, Councillor Kovac and MNA Lawrence Bergman in solidifying community support for EMS and the adoption of a special law in the National Assembly to allow our city to keep EMS as the First Responder service when the Montreal Fire Department took over this mandate everywhere else on the island.

Saving EMS at the Quebec National Assembly

Saving EMS at the Quebec National Assembly in 2007

Thank you to Mayor Housefather for his confidence in appointing me to my public safety and emergency preparedness positions for the last ten years and to Jordy Reichson for his collaboration and dedication to serving our community.

Councillor Glenn J. Nashen on duty with vCOP

Councillor Glenn J. Nashen on duty with vCOP

This has been a most rewarding, inspiring and epic journey for me, and for the thousands of volunteers who have crossed through the doors at Cote Saint-Luc Emergency Medical Services. Thank you to all those who have been involved in EMS for this great honour and immense privilege to serve.


Outstanding Cote Saint-Lucer wins prestigious award

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Congratulations to Dr. Marc Afilalo, winner of the Jewish General Hospital 2013 Award for Excellence in Physician Management. Dr. Afilalo is Chief of Emergency Medicine at the JGH and one of the leading emergentologists in Quebec and has served as advisor to several Ministers of Health and Social Services.

Dr. Afilalo is also an outstanding Cote Saint-Lucer and has been a strong supporter of CSL’s campaign to recognize Paramedics in Quebec since the 1980′s. During the municipal merger era (2002-2005) faced with the prospect of losing the CSL Emergency Medical Services Dr. Afilalo organized a letter of support signed by nearly every emergency medicine physician at the JGH. This crucial support, coupled with D’Arcy McGee MNA Lawrence Bergman’s push in the National Assembly and strong community support from Anthony Housefather, Ruth Kovac and myself, ensured the continuation of EMS on CSL territory.

Dr. Marc Afilalo

Dr. Marc Afilalo

Dr. Afilalo was also the recipient, earlier this year of the Queen Elizabeth II Jubilee Medal which was presented to him at a public ceremony at City Hall.

Congratulations, yet again, to a truly remarkable Cote Saint-Lucer and an extraordinary leader on this well deserved honour.


Outstanding CSLer awarded Queen’s Jubilee Medal


Félicitations au Dr Marc Afilalo , recipiendaire du Prix d’excellence en gestion médicale de l’Hôpital général juif. Le Dr Afilalo est le chef de la médecine d’urgence à l’HGJ et l’un des principaux urgentologues du Québec et a siégé comme conseiller de plusieurs ministres de la Santé et des Services sociaux .

Le Dr Afilalo est également un remarquable Côte Saint- Lucois et a été un fervent partisan de la campagne de CSL à reconnaître les paramédics au Québec depuis les années 1980. Pendant l’ère de la fusion municipale (2002-2005) face à la perspective de perdre les Services médicaux d’urgence CSL le Dr Afilalo a organisé une lettre de soutien signée par presque tous les médecins de la médecine d’urgence à l’HGJ. Ce soutien crucial , couplé avec le support du député Lawrence Bergman à l’Assemblée nationale et un appui solide de la communauté par Anthony Housefather, Ruth Kovac et moi-même , a assuré la poursuite de SMU sur le territoire de CSL.

Le Dr Afilalo a également reçu, plus tôt cette année, le Médaille du jubilé de la reine Elizabeth II qui lui a été remis lors d’une cérémonie publique à la mairie.

Félicitations , encore une fois , à un remarquable Cote Saint- Lucois et un leader extraordinaire pour cet honneur bien mérité.

En savoir plus:

Outstanding CSLer awarded Queen’s Jubilee Medal

Training paramedics from Jordan and Israel

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14 Jordanians and 40 Israelis finish a groundbreaking three-year bachelor’s course in emergency medicine at an Israeli university.

Training paramedics from Jordan and Israel | ISRAEL21c.


Quebecers short-changed in pre-hospital emergency medical care

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April 3, 2009

Montreal Gazette
Letters to the editor (published Apr. 4, 2009)

Re: MDs call for air ambulance, Gazette, April 2, 2009

Why is it that Quebecers continue to be short changed when it comes to pre-hospital emergency medical care? Calls for air ambulance helicopters for major trauma and medical emergencies in rural areas has been going on for 20 years or more but we still have none in Quebec. The life-saving skills of advanced care paramedics is undeniable, unless you live in Quebec.

And why aren’t helmets mandatory for cyclists, or for skiers, when they are proven to reduce the risk of traumatic brain injury by 80%. The prevention of injury and reduction in visits to already crowded emergency departments and hospitalization would result in huge savings to taxpayers and would ease the burden on our over-stretched health care system.

Quebec prides itself in leadership and innovation yet trails far behind in pre-hospital emergency medical care and preparedness. Time to play catch up right now. Air ambulances, advanced care paramedics, helmets and wide-spread education in cardio-pulmonary resuscitation all save lives. Time to invest where it really counts.  Our lives depend on it.

Glenn J. Nashen
City Councillor (Public Safety)
Cote Saint-Luc

Postscript:  I have been advocating for legalization of paramedics in Quebec for 30 years.  Despite the widespread use of the word “paramedic” in Quebec over the last few years the province still does not permit ambulance technicians to perform advanced life support as in nearly all other jurisdictions across North America.

In the mid-90s I worked with then MNA Robert Libman to introduce helicopter air ambulances.  We asked the government to implement such a critical service but 15 years later the same questions are being asked.

Cotes Saint-Luc became the first municipality in Canada to legislate the wearing of bike helmets when I introduced this life-saving proposition.  This law has since spread widely across Canada but is still not mandatory here in Quebec.

Search this blog for more on paramedics, bike helmets and emergency medical services.

If you want to make a difference please call or write to your Member of the Quebec National Assembly and ask for support in legalizing advanced care paramedics, launching an air ambulance helicopter service and requiring all cyclists and skiers to wear a helmet.

EMS Director becomes Paramedic / Directeur des SMU devient Paramédic

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L-R: EMS Director Stephane Kallos, Councillors Ruth Kovac and Glenn J. Nashen

L-R: EMS Director Stephane Kallos, Councillors Ruth Kovac and Glenn J. Nashen

Congratulations to EMS Director Stéphane Kallos who received his certification as a paramedic from the National Registry of Emergency Medical Technicians–the organization that certifies emergency medical technicians in the United States. The paramedic certification is the highest one offered. This gives him the ability to work as a paramedic anywhere in the United States.

In the past several years Stéphane has used many of his vacation periods to travel to the United States where he worked in ambulances and did the required 1,478 hours of on-site paramedic work.

On behalf of the city council and staff, I congratulate Stéphane on this outstanding achievement, which is a great benefit to Côte Saint-Luc EMS and the people who are helped every day by our crews.


Félicitations à Stéphane Kallos, directeur des SMU, qui a reçu sa certification du National Registry of Emergency Medical Technicians, l’organisme qui homologue les techniciens médicaux d’urgence aux États-Unis. Il n’y a pas de certification paramédicale plus haute que celle obtenue par Stéphane. Ainsi, il pourra travailler comme paramédical n’importe où aux États-Unis.

Depuis quelques années, durant ses vacances, Stéphane se rendait aux États-Unis pour travailler à bord d’ambulances afin de compléter sur place 1 478 heures de travail paramédical obligatoire.

Au nom du conseil municipal et du personnel, je souhaite féliciter Stéphane pour son accomplissement exceptionnel, qui bénéficiera les SMU de Côte Saint-Luc et les individus aidés quotidiennement par nos équipes.

Quebec one step closer to Paramedics

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Dec. 15, 2004

I have been promoting recognition of full-fledged, highly trained pre-hospital emergency paramedics in Quebec since the early 1980s. CTV News reports that we are one step closer.

You can read much more about the long push for paramedics here on my blog.

Paramedics would save lives in Quebec, Opinion

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OPINION      November 18, 2004     The Gazette

Health Minister Philippe Couillard should worry less about the initial cost of training 18 paramedics at Urgences Santé and be more concerned about the need to have Paramedics in the first place.  Quebec is indeed in desperate need of Paramedics.  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 are emergency medical providers, highly trained in Advanced Life Support (ALS). ALS includes advanced airway management, administration of intra-venous solutions and life-saving medications.  Paramedics, along with other emergency personnel (i.e. ambulance technicians, police, firefighters and first responders, professional and volunteer), providing rapid intervention to the sick and injured save lives and alleviate suffering.  Paramedics are, in essence, the eyes and ears of the doctor.  They also happen to be illegal in Quebec.

More than 100 Quebec municipalities (including the majority of former MUC suburbs and Conference of Suburban Mayors) and the Union of Quebec Municipalities have passed resolutions in favour of Paramedics. Leading experts across Canada and the U.S. support the concept of Paramedics in Quebec including the Canadian Society of Ambulance Personnel, the Canadian Coalition for Emergency Cardiac Care, internationally renowned professor in the field of resuscitation, Dr. Joseph Ornato, and the President of the American College of Emergency Physicians.  Some have warned of dire consequences that could result in the absence of ALS in Montreal.

Ten years ago, the physician coordinator of Urgences Santé predicted that plans to eliminate ALS intervention would seriously jeopardize pre-hospital emergency care and would have a direct and negative impact on illness and mortality. This position was supported by the Association of General Practitioners of Montreal.

The Quebec Auditor-General and successive coroners have agreed that ambulance services must improve the level of care and maximize efficiency in order to save more lives and safeguard tax dollars.  Finally, Urgences Santé recognizes the need for Paramedics.

Decades of medical research also show that many victims of cardiac arrest can be saved when the proper “Chain of Survival” is in place.   The chain has four links:   1. Early access to EMS (9-1-1);  2. Early CPR;  3. Early defibrillation (shocking the heart);  and  4. Early ALS response.  Because we are missing the fourth link, people are dying needlessly in Quebec.

Quebec Ambulance Technicians are trained only in Basic Life Support.  They cannot provide ALS skills, as do Paramedics.  Continuing to restrict Paramedics in Quebec is dangerous and unacceptable.

An EMS system with Paramedics, in constant communication with physicians, would allow for a substantial increase in survival rates, as well as improved post-hospital quality of life. This would provide a cost-effective, ideal level of patient care.

Government planners aching to find places to cut should realize that the cost-effectiveness of Paramedics would be startling:  They could competently cover a much wider area at much reduced cost compared to Urgences Santé physicians who used to traverse the city and have been cut back to negligible numbers. Furthermore, rapid Paramedic intervention results in shorter hospitalization, thereby saving the health care system millions of tax dollars in the long run.

The proof Dr. Couillard is looking for is clear – legalization and implementation of a province-wide Paramedic system of pre-hospital care as is the case throughout the rest of Canada and the U.S.  Our MNAs have a responsibility to address this issue promptly.  It’s time to change our outdated and inadequate system.  Legalization of Paramedics would save many lives in Quebec each year.

Glenn J. Nashen served more than 11 years as  City Councillor in Côte Saint-Luc and has chaired the local Emergency Services Committee since 1990.  He served as an Emergency Medical Technician with Urgences Santé for 17 years as well as with the all-volunteer Côte Saint-Luc Emergency Medical Services. He co-founded of the Coalition for Pre-Hospital Advanced Life Support and has advocated for the legalization of Paramedics for the last 25 years.

Resolution in support of pre-hospital emergency care

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Adopted by the City Council of Côte Saint‑Luc

15 March 1999

WHEREAS the Auditor General of Quebec has issued a report on March 20th

1999 wherein certain observations and recommendations have come forth

with regard to Pre‑hospital Emergency Care in Quebec with a view to its


WHEREAS the City of Côte Saint‑Luc has consistently promoted the need

for a higher level of training for Ambulance Technicians, and has long

advocated the recognition of Paramedics in a manner similar to that of

other Canadian and U.S. jurisdictions;

WHEREAS twenty‑one (21) municipalities in the MUC have already passed

resolutions declaring support for the recognition of Paramedics;

WHEREAS the City of Côte Saint‑Luc has vigorously promoted the teaching

of CPR to as broad a spectrum of its population as possible;

WHEREAS, in his said report, the Auditor General has pointed out the

inadequate ambulance response times and the relatively low percentage of

citizens of this province who are trained in CPR;

WHEREAS the City of Côte Saint‑Luc remains convinced that First

Responders must assume greater importance with the Pre‑hospital

Emergency Care system;

It was

MOVED BY   Councillor Glenn J. Nashen

SECONDED BY Councillor Ruth Kovac


“THAT the City of Côte Saint‑Luc reiterates its call for the

recognition of Paramedics and that they be permitted upon certification

to provide Advanced Life Support;

THAT Urgences Santé  be directed by the provincial authorities to

improve their ambulance response time;

THAT First Responders Services be encouraged by provincial authorities

and be provided with the tools necessary to provide effective and rapid


THAT the Ministry of Health, in concert with the Ministry of Education

require that every student graduating from high school be trained in


THAT the Ministry of Health, in concert with the Ministry of Education,

establish  a paramedic programme including Advanced Life

Support at the CEGEP level;

THAT a copy of the present resolution be sent to the following:

Auditor General of Quebec

Ministry of Health

Ministry of Transport

Ministry of Education

Opposition Critic for Health

Opposition Critic for Transport

Opposition Critic of Education

Executives of the Régie Régionale de la Santé  et des Services Sociaux de

la Région de Montréal Métropolitain

Director General of Urgences Santé

MNA for D’Arcy McGee

MUC Executives

Member Municipalities of the MUC.”


Use of paramedics urged, Gazette

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Cities should run ambulance services, Gazette Op-Ed

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Quebec urged to train paramedic teams

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1997-11-08 Quebec urged to train paramedics, The Gazette.

Nashen wishes Danyluk well

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Dec. 7, 1993 | Monitor Newspaper | Click to enlarge

Let paramedics save lives

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1988-03-31 TMR Post paramedics

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