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Thursday , 21 January 2021

Danger of exhaustion on paramedics averaging 96 hour shifts

The Alberta Paramedics Association (APA) has been laying out the dangers of current core-flex scheduling model for paramedics to municipalities around the province including the County of Vermilion River and the County of St. Paul.

During their regular council meetings, APA president Dusty Myshrall and COO Marc Moebis led a presentation on exhaustion stemming from the current work model and how it could be improved.

Myshrall works as a flight paramedic in Lac la Biche, and Moebis noted that he had worked as a paramedic and lived in Vermilion for five years. Long time paramedics from Vermilion that also sit on the board include registrar Josie Nichols, and board secretary Rob Snow.

“Were here today to talk about a very dangerous schedule that paramedics are doing and looking for resolution that rural communities will no longer stand for being treated as second class citizens as far as paramedic response in concerned.” said Myshrall.

“Core-flex is potentially life threatening and poses a serious risk to public safety. Paramedics are working extended on call – a typical term is 96 hours. This has been going on for a long time and the call volume was relatively low, but in the last several years with the centralization of health care they have been utilizing EMS services more often.

“Paramedics are working four days straight, and in some places seven days or even more.”

‘…the work-life balance is horrendous’

He said the APA is not a union or regulating body but works to promote the well-being of practitioners and quality of services Alberta residents are receiving. Based on emergency factors, he said paramedics had their rights waived creating an exemption from the regular labour standards, allowing them to work these extreme hours.

CVR Councillor Les Cusack said, “How many people can work 96 hours straight and still be functional? A truck driver is 15 hours maximum, and nurses work 12 hours – my nephew is a paramedic and working that long is not even something you would want to do.”

“People either want to leave quickly, going to the city because the work-life balance is horrendous, or leave the industry all together even though they love being a paramedic,” said Myshrall.

“They can’t have a dog because they can’t take their dog to the base, but they can’t leave a dog at home for four days straight. This model is putting people out of work because they are exhausted.”

Moebis said Vermilion used to see 30 – 50 calls per month and now have the same number of units responding to over 100 calls per month.

“The game has changed but the system has not,” said Moebis.

“As a paramedic you have to ask yourself, ‘Do you really want your loved ones in my vehicle after I’ve already been up 24 hours?’”

There are some fatigue management policies in place – for instance after 14 hours of a crew being on task, that ambulance will be taken out of service for eight hours.

Myshrall said people often wonder why response times take so long, but sometimes when they are taken out of service they won’t even know the call has occurred or be allowed to respond.

‘Half-hearted measure’

Neighbouring communities responding could be 30 – 45 minutes away if all of the local units are out of service. He said the core-flex model has been used for over 20 years, but the fatigue management policies that are causing ambulances to go out of service have only been around for about four years.

In addition, they have transitioned to a borderless EMS system, meaning whoever is the closest unit will respond.

If a transfer to Edmonton was taking place from a rural response unit, on their way back they could receive another call to provide assistance out of area before returning home. Myshrall said it has worked quite well reducing response time in many areas, but in Alberta it was a half-hearted measure because it does not work with the core-flex model.

“Theoretically it works quite well, but now we are moving more trucks around, it racks up the hours, and your community can go without an ambulance for long periods of time,” said Myshrall.

He said a paramedic’s time-on-task does not begin until they receive their first call, creating an irregular sleep pattern and leading to exhaustion.

Sleep inertia is another aspect, said Myshrall, and a daily occurrence, meaning they are still groggy when in the first 30 minutes of getting a call, they have responded from their house and to an ambulance and have started driving (which is a high-efficiency skill) and providing care.

After working with psychologist, Dr. Jennifer Short, they established that sleep deprivation among paramedics led to negative moods as well as increased risk of medical errors and public safety by motor vehicle incidents.

“The national standard for response time in urban centres is eight minutes,” said Myshrall.

“Urban centres have more ambulances, more resources, and less travel time.”

He said response time includes chute time (meaning the time a call is received to the time the ambulance begins moving) which in the city is 90 seconds, and in rural areas they are given eight minutes plus the travel time.

“Eight minutes seems like a long time but it goes by fast when its -30 and you are trying to get dressed and your ambulance started,” said Myshrall.

“Eight minutes can change the outcome of your patient drastically as well.”

‘There needs to be a change’

He said EMS is not funded by community tax dollars, but by provincial tax dollars, meaning everyone paying the same – urban and rural.

“I think the people in Vermilion, St. Paul or Lac La Biche deserve the same quality of service as the people in Edmonton,” said Myshrall.

St. Paul County councillor, Kevin Wirsta, said he’s been advocating for the area on the issue of ambulance services at the district AHS meetings.

“There really needs to be a change,” said Wirsta.

St. PC Councillor, Darrell Younghans suggested asking MLA David Hanson for a letter of support as well. St. PC Reeve, Steve Upham, expressed doubts that the MLA would get involved at this point in time because of the funding implications for AHS.

Myshrall said the regulator felt it was a union issue, and the union felt code-reds (having no ambulance in the community available to respond) in the city were more important, so the APA is bringing awareness to communities and hopes to attend the next RMA asking for their support. They do not want the labour exemption to renew in March.

Their long-term goal is to approach the government about changing the model creating a 90 second chute time for everyone no matter where they are, as well as allowing communities to not go out of service because paramedics are fatigued.

Myshrall said they could achieve this by supplying an approximate 20 per cent staffing increase on 190 units.

-With files from Meredith Kerr

About Angela Mouly

Angela comes to Lakeland Connect after leaving traditional newspaper where she spent the past four years reporting on community events. Her repertoire includes writing about history, politics, agriculture, sports, entertainment and art. She was the third place recipient of an AWNA General Excellence Award for “Best Front Page” during their 2016 Better Newspaper Competition. Angela has lived in rural Alberta all her life and in Vermilion for the past 15 years. She looks forward to continuing to serve and inform the Lakeland community by joining in people's many adventures and sharing their stories.