Table 3 Emblematic quotes and provider-suggested solutions for response times

Implement and enforce provincial hospital offload target times

Expand ATR protocols

Offload targets incentivize against inappropriate and counterproductive utilization of EMS staff at hospitals for large proportions of shifts. A recently implemented 45-minute target in Alberta has been considered an effective strategy by a majority of practitioners.

Practitioners need to be able to provide treatment on scene and refer patients for alternative follow-up, without hospital assessment where possible. A new January 2023 general assess, treat, and refer (ATR) protocol for practitioners was perceived as successful in preventing unnecessary transport to EDs or Urgent Care Centres (UCCs).

Where high-risk factors are present, paramedics need to be able to consult a physician via On-Line Medical Consultation (OLMC) or similar means.

“[There needs to be] ways to figure out how to resolve bed block within hospitals. People waiting for long-term care back up the borders of emergency, which backs up the ability to get people, which backs up throughput through the emergency department”(P18).

“We’re seeing that now with that general ATR protocol where we can actually tell people to stay at home… I’ve used that quite a few times. Whereas the default… still is to transport, but we’re not supposed to tell a 100% of our patients to go to the hospital” (P4).

“Trying to decide whether [the patient should] go to the hospital. Now I’m calling OLMC to get advice whether [the patient] should go in, or stay.” (P9).

Avoid deprioritizing EMS relative to emergency departments

Ensure adequate staffing numbers

Increase provision of additional community resources

Regulations and practices need to change to proactively prevent use of EMS providers as a captive workforce to supplement overburdened EDs. Paramedics need to be able to serve in their intended roles unless specifically assigned to ED-specific roles.

Need to improve recruitment and retention strategies, and decrease attrition.

There is significant need for addiction treatment or mobile outreach teams that respond to street-level intoxication and unhoused individuals to allow EMS to focus on core health roles.

“When an ambulance brings a person to the ED and they don’t get to offload and get back into service right away, that impacts availability of the resource. Then the other big question, “Is it the best place for the patient, best outcome?” (P11)

“Downtown clientele… have larger social programming needs. They have addiction problems. They have trauma and they don’t need the hospital” (P19)

Target health literacy education

Share 811/911 response

Create an emergency mobile integrated health (MIH) branch

Inappropriate use of emergency services needs to be reduced. Public education and self-direction to more appropriate services may have some benefit.

Low acuity calls often require more time and resources than higher ones. More effective 811 may reduce emergency calls. This needs to include prioritization of reducing ‘bounce back’ of low acuity 811 calls, especially by effective integration of physicians into the 811 system and increasing available response options.

While capable of providing some limited immediate assistance to patients, EMS services lack the resources or scope of practice to help more effectively or definitively. Mechanisms to facilitate mobile definitive care are needed.

“[The general public needs education] on when to call an ambulance and when not to” (P5).

“[When providers are dealing with low acuity calls for prolonged periods, we] could be providing a higher level of care to someone in cardiac arrest two blocks away” (P5)

Rural Challenges

The is a need to impose guardrails to ensure rural ambulances are not used consistently to support urban areas. Participants referenced First Nations (with independent EMS services), responding outside their geographic area only if the call is a Delta or Echo (the highest acuity calls).

Need to evaluate current ambulance optimization algorithms to account for Alberta context including geographic and staffing shortages.

“My ambulance that belongs to my town and my area is very often gone. It’s gone. It’s in Calgary, it gets sucked into the vortex, and it never comes back, but we can’t escape” (P15).

“[There] should be a bare minimum [of ambulances to ensure minimum coverage of rural communities” (P10).