Paramedics face crises everyday as a basic part of their job. In British Columbia, they are also facing entirely avoidable crises of understaffing, low pay, and burnout. All of this was cruelly exposed in the summer heat dome, with soaring distress calls, long waits for ambulances and unnecessary deaths.
It wasn’t always this way. BC’s Paramedic Service was once seen as a world renowned service, emulated by many both within Canada and abroad. The BCAS 10-7 Association Society –– a group of 274 retired BC Ambulance professionals including Paramedics, Managers, Emergency Dispatchers and Support Staff –– pleaded in July to restore the service to its previous excellent standards. They emphasized that the service breakdown that occurred during the heatwave was not a sudden phenomenon. The service has been eroded over more than a decade.
The service was established in 1974 by the radical NDP government of 1972-1975. A long-time paramedic said on social media that the BC Liberals had always seen the paramedic service as a NDP project and let it slowly erode. In 2009, prior to the Olympics in Vancouver, the Liberal government legislated paramedics back to work after an eight-month strike. A leader of CUPE 873 said then that the legislation forcing paramedics back to work would do nothing “to fix the broken ambulance service.” A year later the Liberals considered privatizing parts of the service.
In 2016 BC declared a public health emergency due to opioid deaths. These fatalities and near deaths placed a huge additional strain on paramedics. But things have only got worse. In 2016, the death rate was 20.4 per 100,000 people; by 2021 it had reached 39.7 per 100,000 people. In March 2020, COVID started its death march, further adding strains to the ambulance service.
Heat Dome Deaths
The record-breaking, climate-change-fueled summer heat dome in western Canada completely collapsed BC’s ambulance service. According to official records, 570 people in the province died as a direct result of heat in just four days. In a shocking display of bureaucratic ineptitude, British Columbia Emergency Health Services (BCEHS) did not even activate its emergency coordination centre until the day the heat began to subside. Wait-times stretched into multiple hours, and hundreds of lives which could have been saved were lost.
One example of the unnecessary suffering is the case of 71-year-old Gian Goel, who died of heatstroke in July while waiting 90 minutes for an ambulance. He wasn’t living in a far-off corner of BC, only a 10-minute drive from Langley Memorial Hospital. His wife wasn’t strong enough to transport him to the hospital herself, and had to call 911, which was only the beginning of his family’s anguish. Goel’s grieving daughter said “I want answers. What good job did you do? I don’t blame the paramedics, they’re overworked, they’re short-staffed. What can they do? It’s the system.”
BCEHS had been teetering on the edge of such a disaster for some time due to underfunding and neglect. The emotional and physical toll built up over years, on both paramedics and patients, reached far beyond breaking point in July. Problems persist today. This will continue without big changes to healthcare funding and without putting power in the hands of paramedics themselves.
A CTV report from early November 2021 revealed that up to 40 percent of scheduled paramedic shifts in BC can go unfilled every day, due to burnout, injuries and unfilled job vacancies. A mere 4,500 paramedics and dispatchers serve the province’s 5.1 million people, and approximately one-third of those paramedics are currently receiving support for mental health issues, including suicide attempts. This chronic lack of (and lack of care for) trained caregivers is present as well in other health and caring professions, most notably nursing, elder care, child welfare and general practitioners (the last especially in rural areas). Much of the stress stems from the inability of dispatchers and paramedics to respond to calls in a timely way because of staff and ambulance shortages, says APBC union president Troy Clifford. The paramedic shortage is present in both urban and rural stations. The town of Pemberton, for example, reported 140 unstaffed shifts in the month of July, including going completely without overnight ambulance service for 17 of the month’s 31 days.
Crisis Continues
More recently, the understaffing of ambulance dispatchers made the news. During Thanksgiving weekend, some Lower Mainland residents had to take their chances by trying to catch a cab or walk to a hospital, as they were left waiting on the emergency line for as long as 13 minutes until an overwhelmed dispatcher was finally able to provide assistance and send an emergency vehicle, which in many instances arrived too late.
Another problem that first responders face is closely linked with the underfunding of the healthcare system generally: the requirement to stay at hospitals with patients they are transporting until beds or nurses are available. Especially with COVID already straining hospital resources, this often results in delays, sometimes lasting hours, leaving them unable to take other calls. When paramedics do get back to their ambulance, they are so overwhelmed by multiple urgent calls already on hold that they sometimes need to duck away from their supervisors and dispatchers just to find time for a meal or a bathroom break in a 12-hour shift. The fact that governments treat literal lifesavers in such a fashion says nearly all that needs to be said about capitalism’s regard for human life.
The BCEHS has hired 271 paramedics since January. On July 14, BC’s Health Minister Adrian Dix announced funding for 85 additional full-time paramedics, 30 full-time dispatchers and 22 new ambulances. This announcement also included plans to restructure 22 rural ambulance stations to 24/7 ALPHA stations. This will improve ambulance coverage in rural communities. Further, health authorities have been directed to add additional staff to emergency departments to help receive and provide care to patients, presumably to free up paramedics from the long waits in emergency. In addition, they announced plans to put together a team of mental health and wellness professionals to work directly with dispatch staff and paramedics. Addressing a long-term grievance of paramedics, the government announced a restructuring so that the day-to-day management of the service is done by a “Chief Ambulance Officer,” rather than through the Provincial Health Services Authority.
On September 14, the government announced that by November 1, 24 stations in rural communities will be converted to 24/7 Alpha, meaning they will all have a complement of eight full-time paramedic positions, with an additional 177 positions associated with these conversions. As well, 26 smaller stations have moved to, or will move to a Scheduled On Call (SOC) staffing model and are getting more permanent, regular paramedic jobs. However, there are still issues.
It is still too early to judge whether these changes will be enough. Troy Clifford said in an interview on November 17 that the crisis will not be over until the ambulance service is able to effectively manage the volume of calls it receives.
The increases may sound substantive — 14 percent more paramedics and 11 percent more dispatchers — this falls short of even filling the system’s current gaps of up to 40 per cent, never mind expanding the system. It is another too-little-too-late non-solution. Given the confluence of an ongoing opioid crisis, COVID and the potential for more climate disasters, such as this past summer’s heat dome and the November flooding and evacuations, we need an expanded paramedic service that can respond in a timely way to health and other emergencies throughout the province.
Low Pay – Rural Areas Worse
Not only are staff shortages an issue, but wages are also insufficient. By the collective agreement of the paramedics’ and dispatchers’ union, Ambulance Paramedics of BC (APBC, a Canadian Union of Public Employees affiliate), one of this year’s much-hailed new emergency medical responders will start at just $24.54 per hour. An emergency medical dispatcher will start little better, at $27.69 per hour. (A Vancouver Police Officer starts at $34 an hour.) Remember that these workers are already forced to do the job of their compatriots who have burnt out and had to take leaves of absence or who have left the profession altogether. How long before many of these new hires are condemned to similar fates?
Further to the financial inadequacies of the job, many communities operate under a scheduled-on-call system, meaning those stations will only be staffed with a full-time crew for day shifts. The remaining hours will be covered by “kilo” shift paramedics, with the requirement to carry a pager and respond to any calls as quickly as possible. For this they are paid $2 per hour, with regular pay kicking in only if they respond to a call (and are then paid a minimum of four hours). In the instance that no call is received (the best-case scenario by any sane, humane metric), the paramedic will make $24, minus deductions, for a 12-hour shift. It’s difficult to hold another job if you can be called away from it at any time by a car wreck or a mother going into sudden labour. This situation makes it extremely challenging to to fill vacant positions. This unpredictability of pay cheques adds another element of stress to an already incredibly taxing job. The more remote the location, the more precarious it gets.
Part of Country-wide Underfunding of Health
This failing system is not unique to BC. A paramedic in rural Manitoba recently told the Winnipeg Sun, “People are burning out from the extra workload and staffing shortage, which in turn causes greater shortages as staff are calling in sick more often now.” Alberta paramedics are warning of a “code red” in Edmonton. In Quebec, paramedics are being dragooned in to filling in for burnt out nurses in hospitals. Paramedics threatened to strike in Montreal and Kitchener–Waterloo in June and July, respectively.
Paramedics themselves have been demanding action from the BC government. APBC president Troy Clifford has been lobbying BCEHS and the provincial health officer to look for long- and short-term remedies. The BCAS 10-7 Association Society is calling for a complete overhaul of the whole system.
Fight for a Safe Ambulance System
BC has just been hit by another disaster with massive flooding and landslides. With climate change getting worse, stoked by fossil fuels, the emergency system not only needs to be fully staffed for present requirements, but it also needs to expand to meet the now common climate disasters.
However, lobbying or behind-the-scenes negotiations with the province will not deliver what paramedics and the public need. It will only deliver what the government and the ruling class it serves will acquiesce to. Paramedics and dispatchers, with the support of other healthcare workers, should build toward strike action in BC as a concrete goal. As lives will literally be on the line in such a circumstance, they will have to win the public to their side by a frank exposure of their terrible working conditions and how those are a far deeper and more pernicious threat to public safety than any job action could be. And they will have to abandon any hesitancy to embarrass the ruling New Democratic Party unless the latter does an about-face and lives up to its once-professed ideals of being a party of the working class.
It is imperative that the massive staff shortages at BCEHS be filled, and done so by offering liveable wages. The kilo shift model needs to be discontinued, and guaranteed wages need to be offered to ensure that staff do not have to deal with financial stress on top of the stress that comes with the nature of their job. Weekly hours for employees must be greatly reduced, without loss of pay or benefits, to improve their mental and physical well being. Free and high-quality healthcare is a right for which working people have fought for centuries, and for which we must continue to fight today. Ensuring good conditions for healthcare workers is imperative not just for their health, but for that of their patients and of our healthcare system as a whole.
