EMS System Pressure & Mitigation

Emergency Medical Services

EMS 10 Point Plan Update – September 27, 2022

As AHS EMS continues to manage a sustained and significant increase in 911 calls, its implementation of all items in the EMS 10 Point Plan is helping to address these continued system pressures, creating capacity within the EMS system.

Progress on each of the initiatives is outlined below, and we continue to update the AHS EMS website.

The EMS 10 Point Plan is one of AHS’ critical health priorities.  A list of all current AHS priorities can be found here: Action on Priorities.

New Ambulances in Calgary and Edmonton

Between January and September 26/22, AHS EMS has added 19 new ambulances in Calgary (9) and Edmonton (10). Additionally, extra hours of ambulance coverage were added in Okotoks and Chestermere in August.

New staff have also been hired to support the new ambulances: AHS has hired 40 new Primary Care Paramedics – 20 each in Calgary and Edmonton and this augments an additional 40 paramedic positions that AHS EMS hired in Calgary and Edmonton in the spring of 2022.

Relieving some of the pressure on the EMS system by adding resources in the two largest cities in the province, and the areas of highest demand, is having a positive ripple effect on neighboring communities, as this allows EMS to help retain ambulances in the community where they are based.

Operational Changes

These changes assist in creating capacity within the system, by working to free ambulances up for urgent patient care needs and allow EMS to better manage continued high call volume.

EMS continues to divert calls when appropriate, to the Poison and Drug Information Service (PADIS) as part of the initiative to transfer low priority calls. From January to August 31, 2022 464 calls met the criteria to be diverted to PADIS.

A project in conjunction with Health Link is being established to further refer calls for secondary triage. In the coming weeks work will get underway to assess the staffing, Information Technology and medical protocols related to this initiative. It is estimated this work will evolve throughout the remainder of 2022 and into early 2023. Numerous complexities have emerged that are being managed including IT considerations to ensure calls are not dropped or disconnected, nurses are being engaged for feedback, and protocols are being created to ensure appropriate transfers and follow up mechanisms are in place. Regular meetings are being held between EMS, Health Link 811, IT and leadership to create a rollout plan and specific timeline for this work.

EMS has also ceased the automatic dispatch of ambulances to non-injury motor vehicle collisions. Since the implementation, EMS Emergency Communications Officers have already noted instances where under previous guidelines an ambulance would have automatically been sent. This initiative will become most apparent and effective during the coming winter, likely during major weather events.

The Metro Response Plan (MRP) has been implemented as of March 2022, and since then there have been significant and noticeable improvements in keeping suburban ambulances in their home communities. EMS is continuing to see a significant decrease in suburban and rural ambulances coming into metro areas, which allows for local community coverage to be increased and suburban and rural response times to decrease since this was first implemented in March 2022. For example, before this change the average number of weekly calls for suburban and rural ambulances being called in to the Calgary Zone was approximately 400. Currently the weekly average is approximately 130. In Edmonton prior to the response plan changes there were about 400 outside of community responses per week and currently there are about 290. Further data is still needed to evaluate this change and EMS is monitoring for other impacts it may have.

Related to the MRP, the EMS Pre-empt and Divert initiative has been helping create capacity in the system since it was launched earlier this year. This allows Emergency Communications officers to pre-empt an ambulance from a lower priority assignment and divert it to a higher acuity call when needed. This is continuing to assist in reducing response times to critical patients.

The EMS Provincial Service Plan is being prepared for submission to the Minister. In the spring of 2022, surveys about the current and future state of EMS have been shared to staff, the public, contract service partners and municipal leaders. Due to concurrent and ongoing work by the Alberta EMS Provincial Advisory Council (AEPAC) and the evaluation of dispatch services by a third party, the Minister has approved submission of the draft Service Plan by November 30, 2022.

Pilot Projects

An EMS pilot project which helps manage non-emergency inter-facility transfers has concluded successfully in Calgary and North Zones and will be expanded. This project transports patients that do not need acute care using means other than ambulances (i.e. family, shuttles, taxi, etc.). Both data and anecdotal evidence shows a positive impact and a reduction in the number of ambulance trips needed for these types of transports however there are more transports that can make use of these resources. A working group has now been formed that will guide creation of a formal policy to plan expansion of the pilot project to all zones beginning in the fall-winter of 2022/23.

The Red Deer Inter-Facility Transfer (IFT) Pilot Project is progressing. This project focuses on managing low-acuity patient transfers between facilities with dedicated transfer units, freeing up ambulances to handle emergency calls. Modelling for the plan is complete, and EMS is developing several options for bolstering IFT service in the Red Deer corridor to determine impact. A tentative service schedule and timeline for the project has been proposed. Budgets and each of the options will be evaluated this fall. It is recommended at this time the pilot project take place over a minimum of two years, due in part to capital costs and new staff required.

AHS has also been working to implement two AEPAC recommendations as pilot projects in Spruce Grove. These two projects are designed for Medical First Responders (MFR) to both allow Critical Patient Transport when appropriate, and to permit Spruce Grove’s regulated and cross trained MFR members to cancel an incoming ambulance when, after assessment, it is determined that the patients does not require a higher level of care, or transport to a hospital.  The Pilot Project will run from September 2022 to March 2023, and data will then be evaluated to determine the outcome of this pilot, and any opportunity for expansion.

Workforce Initiatives

EMS has engaged with contract service partners and has provided the Hours of Work/Fatigue Management project recommendations to mitigate fatigue risk.  EMS is continuing to prepare for phase two of this project where additional communities have been identified as needing assistance to mitigate fatigue risk. $12.2M has been approved to support implementation.

To date, significant work has been done to define fatigue, objectively assess areas where fatigue may pose the greatest risk, and develop recommendations including:

Any or all of the recommendations may be implemented at a site.

Calgary Integrated Operations Centre opened on May 11, 2022. This initiative brings paramedic leads and zone and hospital staff together to improve integration, movement of resources and flow of patients. To date, EMS has begun to see a decrease in hospital wait times in part through an increase in transports to Urgent Care Centres. Transports to UCCs tend to result in faster EMS crew turnaround time, and ambulances returning to service faster after transferring care of their patient. This spring, Edmonton expanded the hours of its IOC to further support this work.

Hiring continues within EMS and since January, EMS has hired 202 new employees (from January 1, 2022 – June 30, 2022) including 167 paramedics. Specifically, Calgary Zone has hired 47 paramedics and EMRs since May (May-Aug) and Edmonton Zone has hired 54. Looking over the longer term, in June 2019, 2,569 paramedics were employed by AHS. In June 2022, 3,022 paramedics were employed by AHS. That is 17.6% increase.

EMS continues to have ongoing meetings with some learning institutions regarding hiring of new graduates and potentially expanding future training capacity.

EMS in conjunction with EMS Human Resources and AHS International Recruitment, has launched a public paramedic recruitment initiative with learning institutions in Australia, which currently has more qualified graduates than available jobs. The call for applications is public and provides guidance through the Alberta application and licensing process.

We are working together with our people, our patients and our partners, to ensure our system is robust and sustainable. We thank everyone for their involvement and support, and will continue to keep Albertans updated on this effort.

EMS 10 Point Plan Update - April 8, 2022

AHS EMS continues to address ongoing system pressures and create capacity within the system, working on the initiatives first outlined in the EMS 10-Point Plan.  This work is focused on managing high volumes of EMS calls, freeing ambulances up for urgent care needs and ensuring our EMS workforce is robust and well supported.  Innovative thinking and operational efficiencies are already helping ease pressures.

For example, to ease call volumes, appropriate calls to EMS are now being redirected from a EMS dispatcher to the Poison and Drug Information Service (PADIS).  This ensures the best support provided for calls that don’t require EMS response, but still require immediate health advice.  A similar project with Health Link is being established to allow our EMS dispatchers to refer calls to Health Link or physicians, if they don’t require EMS response.

To help keep our ambulances available for urgent responses, EMS has also stopped automatically dispatching ambulances to non-injury motor vehicle collisions. This was implemented in December 2021, and our EMS Emergency Communications Officers have already noted several instances where ambulances were not required to respond, and instead remained available for true urgent care events. This is just one way that we are allowing ambulances to be averted from lower priority assignments and diverted to higher priority assignments, ensuring that we are responding most rapidly to those critical patients who need EMS care the most.

We have also implemented the first parts of the Metro Response Plan (MRP), which is working to keep suburban ambulances in their home communities instead of using these ambulances to cover urban areas when call volumes are highest.  This ensures that response to urgent events in suburban areas is swift, and within our target times.  Since implementing these first steps in March, unit availability has been increasing already in many places including Stony Plain, Beaumont, Airdrie and Cochrane, to name only a few.

EMS also recently received budget approval to add five new ambulances, each, in both Calgary and Edmonton, every year for the next two years.  Adding 20 new ambulances will relieve some of the pressure on the EMS system by adding resources in areas of highest demand.  This in turn will have a positive ripple effect on neighbouring communities.

In March, EMS concluded the first phase of a pilot project that reduced the amount of time our ambulances are spending managing non-emergency inter-facility transfers. By allowing patients that do not need acute care to use other means of transferring between facilities, our ambulances are freed up to provide urgent care on the street.  Early findings from this first phase were positive, and the project is being extended to all hospitals in Calgary Zone, while continuing in other areas for an additional six months.  A similar project taking place in Red Deer is also currently under development, specifically focusing on the use of EMS transfer units instead of ambulances, for inter-facility transport.

Our people remain our most important asset, and we are investing to ensure our people are supported, and that we have a robust workforce.  Since January, EMS has hired a total of 66 staff: 9 temporary full time, and 57 casual staff.  EMS has also engaged with contract service partners on an Hours of Work/Fatigue Management project which is focused on mitigating fatigue and the associated risk to our people.  An additional $12.2M has been approved to support implementation of supports for the next phase of this project.

Funding has also been allocated for the implementation of the Calgary Integrated Operations Centre. Set to open in May 2022, this initiative brings our expert people together - paramedic leads and zone and hospital staff - to improve integration, movement of resources and flow of patients.

Finally, work is underway on the overarching Provincial Service Plan, which will guide the next 5 years of EMS operations. EMS is engaging with our people, as well as the public and other partners, to understand current experiences and perceptions of EMS.  This will then guide the identification of areas for potential improvement, now and over the coming years. This engagement launched in mid-March, and since that time, EMS has already heard from thousands of Albertans including patients and families, elected officials and AHS staff. Updates are available on the EMS Together4Health page and anyone is invited to sign up and take part.

EMS continues to be here for all Albertans.  We are working together with our people, our patients and our partners, to ensure our system is robust and sustainable.  We thank everyone for their involvement and support, and will continue to keep Albertans updated on this effort.

10 Point Plan Details

1. EMS Is Addressing Fatigue Management. Known as the EMS Hours of Work project which launched in November 2021, EMS is adjusting working hours, shifts, and scheduling at some ambulance stations, to help to alleviate fatigue among staff.

2. EMS Is Transferring Some Non-Emergency or Low Priority Calls: These calls are transferred to other agencies such as the Poison And Drug Information Service (PADIS) (and are working to include Health Link 811) when appropriate, and in consultation with our EMS physicians in dispatch.

3. Non-Injury Collision Response: Since December 1, 2021 EMS is no longer automatically sending an ambulance to a motor vehicle collision where there are no injuries reported.

4. AHS EMS Will Continue Hiring Paramedics. While EMS is always hiring, there are also conversations happening with training institutions about how to potentially expand training capacity.

5. Managing Non-Emergency Inter-Facility Transfers: Two pilot projects are underway in Calgary and North Zone, where patients who do not need urgent medical care are transported from hospitals to appointments, or back to care homes and residences by means other than ambulances.

In addition to the above initiatives that are already underway, work is moving forward rapidly for some additional initiatives. These include:

6. Creating a Calgary Integrated Operations Centre: This will mirror Edmonton’s IOC which brings together paramedic leads and zone and hospital staff for improved integration between EMS and the hospital system, to improve overall flow.

7. EMS will be implementing additional dispatching processes provincially, including prioritization to determine if an ambulance from out of area, though it may be closest to a 911 call, is most appropriate to respond.

8. Pre-empt & Divert Workflow: This works hand in hand with the Metro Response Plan. In dispatch, this allows ambulances to be thoughtfully and safely pre-empted from assignments which are not critical, and diverted to more urgent calls, instead of being automatically dispatched.

9. Developing a Provincial Service Plan: at the request of Alberta Health, EMS is looking at all current EMS services and will create a 5-10 year plan.

10. Creating an IFT Pilot: This new concept would assist in managing the volume of low acuity Inter-Facility Transfers in one geographical area with dedicated transfer units, freeing up ambulances to handle primarily emergency calls.

Alberta Health has also announced an EMS advisory panel. EMS appreciates Government’s awareness and action on EMS.

Government of Alberta News Release, January 24, 2022: Addressing Emergency Medical Services Pressures