Health minister deflects criticism levelled at emergency medical responder program

Nova Scotia’s health minister touts the recently announced emergency medical responder program as a protocol that will allow the province’s paramedics to do the job they are trained to perform.

“We know this has worked in other places,” Michelle Thompson said in a Monday afternoon Zoom news conference about a program that already exists in Canada’s four most westerly provinces as well as New Brunswick and Newfoundland and Labrador.

“We announced it in January, with an enrolment in March and the first graduating class in June,” Thompson said of a program that is expected to turn out up to 200 emergency medical responders in the next two years.

“We are not reinventing the wheel here,” she said. “We are tailoring it specifically based on best practices and the learnings of other provinces that have implemented this before us.”

The Health Department released program information last week in a news release and on Facebook, where a series of responses disparaged the plan.

“Hire ambulance drivers?” said one responder. “This is a low and cheap way for the Nova Scotia government to save a buck. This is unacceptable.”

Another post said the move is setting the province back 20 years. Still another responder called it the “most dangerous thing the province could ever do,” and said it will lead to more paramedics leaving the Emergency Health Services system.

400 hours of training

The plan is to have emergency medical responders, buoyed by 400 hours of training and each paired with a full-fledged paramedic, working on ambulances and providing assessments, stabilization and patient transportation to hospital. 

“This is basically going to be a glorified ambulance driver,” Matthew Williams, a former Cape Breton paramedic, said in an interview Monday.

Paramedics are “very highly skilled,” he said, and the advancements over the last 20 years in what they are capable of doing are significant.

“This is really a massive step backwards in time, we’re basically going back 20 years,” Williams said.

“It’s just a major downgrade in care for the residents of Nova Scotia that need an ambulance. It’s also a downgrade in the working conditions and the safety overall for paramedics.”

Williams said he stepped away from the paramedic profession a year ago, primarily because of “burnout,” poor working conditions and a lack of appropriate mental and financial support from the employer, EHS, a branch of the provincial health department tasked with providing emergency medical services.

‘Downgrade’

“They are not hiring more paramedics,” Williams said of the medical responder program. “They are basically giving civilians a three-month course on how to drive an ambulance and do CPR, among a couple of other things. They will be splitting up the paramedics on the ambulances and you will have one of these emergency medical responders and one paramedic on an ambulance. 

“It is really a downgrade in the quality of care because you are not getting two highly trained, skilled paramedics responding to your 911 call. It’s downgrading the quality of care to spread everything out more to get the quantity out there.”

Williams said a lot of paramedics have a great partnership with the person assigned to share the ambulance with them, they are both well trained and they know each other’s strengths and weaknesses.

“You have two sets of hands, as opposed to one person making those decisions,” he said. 

Having an emergency medical responder in the ambulance is “not having an equal to bounce ideas off and to get more done efficiently, especially in those dire calls, those very, very sick patients who need that care very quickly,” he said.

Williams said the new protocol will convince more paramedics to abandon the profession as he did.

“When I left there were over 100 paramedics who had left the company in that year alone,” he said. “This is going to worsen it because the mental load is already so high. It’s a very physical and mentally demanding job as it is, (especially) without that support and having someone you can rely on and that you know has the same skill as you, if not greater if you are working with an advanced care paramedic.”

Frontline staff off job

EHS confirmed that approximately 1,020 frontline full-time, part-time and casual paramedics are employed in the EHS system. As of Nov. 30, 2023, there were 129 frontline ground operations staff, including paramedics and clinical transport operators, out of the workplace due to medical leave, including work-related and non-work-related leaves. 

Seventy-two of those leaves were psychological in nature, although not all of those leaves may be work-related.

Williams said two paramedics working as a team go call for call, with one person doing the primary patient attending on one call while the other would drive if transport to hospital was required. The next call, they would switch roles, relieving the stress, he said.

Williams said paramedics typically complete a two-year course, whereas the new responder class will be out of school in three months.

Thompson tells a different story.

“They are not helpers,” the minister said of the EMRs. “They are actually going to be trained emergency medical responders.

“They will be working on the ambulances with paramedics. On occasion they will be able to work together if there is a stable transfer. They will also be working in ambulance offload areas in order to relieve paramedics who are waiting with patients.”

They will work in the paramedics union, with a different classification, and will be regulated through the College of Paramedics of Nova Scotia. Their pay level will be negotiated between the employer and the union, Thompson said.

“They will have a scope of practice that is developed with the regulator,” Thompson said. “I want to assure paramedics that this is actually going to be an enabler to the role that they currently have, it will allow us to redeploy paramedics back into the system for higher acuity calls.”

Not all ambulances

The emergency responders will be deployed only on approximately 20 per cent of the province’s ambulances. 

“This will not be on every truck,” Thompson said.

Liberal Leader Zach Churchill said his caucus has heard from paramedics who say that the change could create a situation that’s less safe for both the paramedics and for patients “because they’ll be trading off a trained paramedic that can do emergency response for someone who is just going to be essentially driving them (paramedics) around and providing secondary support.”

Churchill said if paramedics leave the profession as a result of this decision, it will set health care back even further.

“They are stretched thin right now and they are being stretched even more thinly if they lose that second paramedic on their ambulance,” Churchill said. “If that’s going to be the final factor that drives them out of the profession, that’s going to create real problems for patients and real problems for the health-care system.

“The province really has to listen to what paramedics are saying at this point because we can’t afford to lose any more.”

Kevin MacMullin, business manager of Local 727 of the International Union of Operating Engineers Canada, the union that represents the province’s paramedics, said in a statement that the recently ratified three-year collective agreement with the employer has brought improvements in pay and benefits for beleaguered paramedics. 

“The starting wage for a graduating primary care paramedic is $67,857.00, and a new advanced care paramedic would start at $81,063.00,” MacMullin said. 

The contract also includes shift premiums that are currently an additional $3 per hour, plus overtime, medical, dental and short-term disability provisions.

“The government is introducing a new EMR program in Nova Scotia to supplement our existing programs,” MacMullin said. “While we have received information regarding this new program, it has been vague, without explicit details, which we understand will be forthcoming in the next few weeks.

“The union appreciates the effort of the government to assist in maintaining necessary responses to increasing demand, and properly using EMRs will be an asset to maintaining a high-quality paramedic response in Nova Scotia.”