Municipalities have serious concerns about proposed changes to rural EMS, and western Manitoba is at the head of the pack.
The western region is expected to take the greatest hit if the province moves ahead with its plan to close 23 community ambulance bays, replacing them with five larger centres and two more enhanced stations staffed by full-time paramedics.
Over a dozen of those closed community stations are expected to be in that area.
Stations in Wawanesa and Boissevain are expected to close, along with Elkhorn, Grandview, Hamiota, Hartney, McCreary, Oak Lake, Birtle, Baldur, Rossburn, Reston, and Ethelbert. Elsewhere, the list includes Cartwright, Treherne, Elie, Manitou, Swan Lake, Lundar, Pinawa, Reynolds, Riverton and Bissett.
Alonsa, Eriksdale, Manigotagan, Miniota and Cowan will be home to the new EMS hubs, while stations in Virden and Glenboro are slated for upgrades to take on a more regional role.
The province says they will relocate ambulances most efficiently using “geo-posting.” Under the system an ambulance might be moved closer to a neighbouring station when that station’s unit is called out, in order to minimize wait times in both areas.
Those promises have not been enough to ease anxiety for communities preparing for a future without their local EMS.
“We are a vibrant municipality right on No. 10 Highway, right by the International Peace Gardens, and with the closure of EMS in our community there would be absolutely no ambulance anywhere on No. 10 Highway between the U.S. border and Brandon, which is a fair distance,” Judy Swanson, councillor with the RM of Boissevain-Morton, said.
Ambulances would come from Killarney or Deloraine, both about 30 kilometres off Highway 10 and a 25-minute drive from the town, should the Boissevain station close.
Response times have been at the heart of the issue, with the province arguing its plan will reduce times, while concerned municipalities say it will make the situation worse.
In 2015, a compliance report from the Manitoba Transportation Co-ordination Centre found that over half of rural stations were not meeting the required half-hour window between an emergency call and arrival on scene.
The province says that the plan will replace volunteer paramedics with full-time staff and address safety concerns for EMS. The Paramedic Association of Manitoba supports the plan, arguing that current service creates long shifts and less effective personnel, since an on-call paramedic might be woken in the middle of the night while full-time staff will already be on shift. Wait times will be reduced for that reason, the association adds, since on-call staff must first get from their homes to the ambulance bay, while staff on shift will already be in place.
Cindy Hunter, councillor for the Municipality of Pembina and former EMS worker, acknowledged those EMS safety concerns, but suggested an improved shift scheduling model rather than the removal of stations.
“We’re reducing our health-care services as it is in our small communities and we were provided many years ago with, ‘Don’t worry, you don’t have the acute care health services, but you’ll have an EMS station,’ so it’s another step backward,” she said.
Not a cut
Provincial Health, Seniors and Active Living Minister Kelvin Goertzen protested any idea that the plan is about cost cutting, saying it will cost “in the tens of millions of dollars.”
No price has been announced for the 10-year plan. In the short term, the province expects to add 29 paramedics in the Interlake and south-central Manitoba at a $1.7-million cost.
“There’s a shortage of full-time paramedics,” Goertzen said. “There are many people who have done good work when it comes to volunteer service, but the reality is with the call volumes and the complexities that people are calling with, they need full-time trained paramedics to be at their door or to be at the scene of an accident.”
The issue was a consistent topic during the Association of Manitoba Municipalities convention Nov. 27-29 in Brandon.
Local governments tackled details of the plan with Teresa Mrozek, assistant deputy minister for Manitoba health, seniors and active living, and the Paramedic Association of Manitoba’s Eric Glass Nov. 28, while a number of communities expressed questions or concerns during this year’s forum with the provincial cabinet.
Goertzen acknowledged municipal concerns, but defended the provincial plan.
“Of course there are questions,” he said. “There should be questions. That’s an important part of any change in any democracy. (I’m) happy to try and answer those questions, but to recognize that this is a significant increase and a significant investment in EMS service in Manitoba and particularly in Westman. This is about ensuring there is 24-7 paramedic service; that there are well-trained professionals able to respond quickly to concerns.”
Twenty local governments, mostly drawn from western Manitoba, met privately with Goertzen following the forum.
“We were very glad that the minister agreed to sit down with us and we were able to voice our concerns,” Swanson said. “There were a few municipalities in the southwest corner (of Manitoba) that actually got together before the meeting and we talked about our concerns in our own municipalities. What we did find is though each municipality is a bit different, we still have the same concerns.”
Swanson and her colleagues have not been impressed with the province’s argument that the plan will cut down on wait times so far.
“The nearest station for us would be a 35-minute (drive) if road conditions are good,” Hunter said.
Others have argued that the addition of non-local staff will impact service, despite the use of geo-location.
“We have back roads that are in our municipalities that our local people know,” Swanson said. “If you’re bringing in somebody from outside our municipality and you’re putting a paramedic in there, they would not know these things. They couldn’t know these things. The people who we hire locally are local people. They know our roads; they know us; they know our area.”
The RM of Killarney-Turtle Mountain has begun numbering farms in the hopes of avoiding that problem.
Ministers were asked Nov. 28 whether EMS changes would come with any investment in cellphone coverage.
In 2016, a Brandon University study noted significant gaps and slow speeds along the international border and north through the Riding Mountain area.
The provincial EMS plan, dependent as it is on geo-location, might run headlong into those issues, RMs say.
Jeff McConnell, mayor of Virden, says the plan addresses a number of issues he has heard from his community’s paramedics, but also raises concerns both from the town of Virden and surrounding communities.
Virden is one of two towns slated for an upgrade to their paramedic station.
“For our neighbouring communities, they obviously have very serious concerns with respect to response times — understanding how these particular changes will affect their communities and I don’t think those answers have been given properly yet,” he said.
McConnell has questions of his own. With his community’s station taking a more regional role, he said, there is concern that ambulances may become tied up in surrounding communities and Virden’s emergency capacity may drop despite the enhanced station.
“We have not been advised when or how the facility will be upgraded,” he said. “It’s our understanding that there should be upgrades made to our facility in order for it to be able to accommodate the changes that will be made. Before they make changes to other communities and making changes to the service they have to ensure that they’ve created the infrastructure they need in order to accommodate the additional people in our community.”
Hunter pressed Goertzen on a possible stretcher service to take strain off rural ambulances.
A significant number of ambulances are tied up with patient transfer rather than responding to emergencies, she said during her turn at the mike.
“You do have people in the community, especially some of your personal-care residents, who have to go for appointments,” she later said. “They can’t handle riding in a Handi-van. They can’t be sitting up that long, so they actually have to go by ambulance. They actually tie up a lot of our acute, highly trained people for the necessary appointments where a stretcher service would be much more cost effective.”
Goertzen made no promises, but said he was open to exploring the idea.
The health minister has promised to meet with municipalities prior to any changes and his office has promised that all infrastructure would be in place before stations begin to close.