Non-emergency transfers via ambulance being trimmed

Duane Hicks

The Rainy River District Social Services Administration Board, which runs the ambulance services in Rainy River District, is limiting its non-emergency ambulance transfers.
As opposed to emergency transfers, such as when a person is injured in an accident and has to be rushed to hospital, non-emergency ambulance transfers include:
•the transport of an individual to another facility for a specialized test;
•the transport of an individual from the hospital to their home; and
•the transport of an individual from the hospital to a long-term care facility.
Dan McCormick, Health Services manager for the local DSSAB, said that since Oct. 1, the ambulance service has been trying to pre-schedule its non-emergency transfers in Fort Frances between Rainycrest and La Verendrye Hospital, which make up the majority of such transfers.
“What we’ve said is let’s pre-plan it,” he explained. “We do run a second vehicle in Fort Frances on days which we commit to doing these low-priority transfers during the day.
“Right now, we’re saying from 7:30 a.m.-5 p.m. we’ll try to do all those transfers for you and maintain that flow of patients coming to see a doctor, things like that.
“After [5 p.m.], we’re going to look after our emergency calls,” McCormick noted.
After Dec. 31, McCormick said non-emergency transfers will be restricted to the actual hours the second vehicle runs, which is 7:30 a.m.-3:30 p.m. on weekdays.
“All we’re asking of the hospital is do some pre-planning, give us a list the day before if you know what transfers you have to do,” he remarked.
“The other thing they do is move a lot of patients from the outlying hospitals, such as Rainy River or Emo, so if we end up with one of those vehicles tied up, we have to ensure that our other vehicles are ready for emergency calls,” McCormick added.
“You can’t be doing two or three transfers and have all your resources tied up on your non-emergent stuff,” he stressed.
“We want to be there for that heart attack or stroke patient or MVA [motor vehicle accident].”
McCormick said other ambulance services have been cutting out non-emergency transfers for a couple of years now, and that Rainy River District is one of the last places in the province to deal with this issue.
“Generally speaking, low-priority transfers aren’t under the mandate of the ambulance service and they’re not part of the Ambulance Act,” he noted.
“If you get into the Ambulance Act, there’s some very specific clauses in the act.”
McCormick clarified that an ambulance is for transporting someone who’s experienced trauma, an acute onset of illness, or determined by a physician to be unstable.
The person being transported must be in the care of a physician, nurse, or paramedic, and they must require use of a stretcher.
“So, basically, if you’re not on a stretcher, you’re not unstable and you’re not ordered to have that level of care,” McCormick explained.
“You’re not required to be in an ambulance.”
McCormick said the Local Health Integration Network did a report on emergency departments, and said in it that non-emergency transfers are outside the legislation of EMS, not a priority for EMS, and generally accomplished in a highly-inefficient way.
“The idea is: choose the right transport, choose the right time, provide the right care, and then make sure the patient or the escort can get back,” he remarked.
McCormick said a problem here is the ambulance staffing levels are limited, with two ambulances responding to emergency calls during the day and one at night.
“The low-priority transfers come at the expense of emergency coverage, and that’s our biggest concern,” he stressed.
“We’ll pick grandma up at Rainycrest because she’s having difficulty breathing and take her to the hospital because that’s an emergent call.
“But the question is, if she can walk and talk as she leaves, why does she have to go back with an ambulance?”
Because of the limiting of non-emergency transfers, patients and family members may be required to make necessary transportation arrangements for non-emergency transfers either to another facility or to their home.
McCormick said there are alternatives for travel, but admitted the choices aren’t plentiful.
“You’ve got your regular private vehicles, and that’s where family members may have to do some transport, but we have limited public transportation,” he noted.
McCormick added there’s no buses and while some communities have taxis, others don’t (and if they do, they only run certain hours).
“There are some handi-vans around that are well used, but again they’re not staffed to appropriate levels to cover this all, either,” he said.
“And in our district, we don’t have any ‘stretcher services’ yet.
“That’s not for want of people wanting to do it, it’s who is going to fund it?” he remarked.
McCormick said some health care centres are running their own non-emergency transfer services (also referred to as “stretcher services”), including at the Thunder Bay Health Sciences Centre, which is running two vehicles, and North Bay Hospital, which is trying it on a trial basis.
McCormick said the change in service here is not sudden, and that the local DSSAB has been meeting with Riverside over this for the past two years.
They also have met with the local LHIN.
He noted a committee is expected to release a report soon regarding the transfer of patients between facilities, which McCormick hopes will contain something “concrete” to direct the province in the future.