British Columbia Ambulance Service
The British Columbia Ambulance Service (BCAS) is the sole ambulance service and provider of pre-hospital emergency care in the province of British Columbia. BCAS is managed by British Columbia Emergency Health Services (BCEHS) and falls under the jurisdiction of the Provincial Health Services Authority (PHSA). The service is tasked with the provision of emergency medical response province-wide. Today, BC Ambulance is among the largest Emergency Medical Services (EMS) provider in Canada and North America. The fleet consists of more than 500 ground ambulances operating from 183 stations across the province along with 80 support vehicles. BCAS provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities for treatment. BCAS also operates an Air Evac program that utilizes both fixed-wing and rotary aircraft.
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| Crown Agency | |
| Industry | Emergency Medical Services |
| Founded | July 1, 1974 |
| Headquarters | British Columbia |
Number of employees | 4750 (January 2018) |
| Website | www |
History
Prior to 1974, ambulance services in British Columbia was provided by a mixture of volunteer ambulance brigades, fire departments, funeral homes, and private operators. As a result of recommendations made by the Foulkes Commission's report on health care, titled "Health Security for British Columbians" released in 1973, the Government of British Columbia created the Emergency Health Services Commission (EHSC), which in turn created the BC Ambulance Service on July 4, 1974.
Governance
In British Columbia, responsibility for the provision of ambulance services is granted to British Columbia Emergency Health Services (BCEHS) under the auspices of the Emergency and Health Services Act. BCEHS reports to PHSA. The members of the Emergency Health Services Commission act as a Board of Directors to the BC Ambulance Service. The commission membership consists of health service administrators, medical professionals, and government representatives. BCEHS is also responsible for the operation of the BC Patient Transfer Network, which assists physicians when it is necessary to transfer a patient to a higher level of care.
The Emergency Medical Assistants Licensing Board is an independent regulatory body responsible for licensing Paramedics.[1]
Organization
There are 183 ambulance stations in British Columbia, including the transfer fleet.[2][3] Stations may be staffed with part-time paramedics, part-time and full-time paramedics, or only full-time paramedics, depending on where the station is located and the number of calls its crews are dispatched to. Each station is headed up by a Unit Chief, who acts as supervisor for the crew at the station. The Unit Chief also handles the day-to-day administrative duties required by the station, including payroll management, overseeing station and ambulance maintenance, and crew scheduling.
Each station falls under the responsibility of a District Supervisor. The District Supervisor has responsibility for the operations of all of the stations within a given district. The size of the district, and the number of stations it encompasses, varies depending on factors such as geography, station size and number of paramedics.
Each BCAS district is part of a larger region, which is headed by a Manager. Each District Supervisor is accountable to the Manager for that specific region. In some regions, a Program Manager works alongside the Manager with day-to-day activities. The District Supervisors are accountable to the Manager of the region, who in turn reports to the executive management team of the BC Ambulance Service.
The BCAS provincial headquarters is located in Victoria, BC. It is staffed by an executive management team, and other support services. Directors and Senior Executive Directors are members of the executive management team, and are in charge of specific functions pertinent to the operations of BCAS, but not day-to-day functionality. The final responsibility for BCAS operations lies with the service's Chief Operating Officer. The Chief Operating Officer is accountable to the Executive Officer, BC Emergency Health Services, who in turn reports to the Board of BC Emergency Health Services. BC Emergency Health Services is a subsidized agency of the BC Provincial Health Services Authority.
As of 2018, the BCAS employs 4,750 part-time and full-time paramedics and dispatchers. This includes management and administrative employees in the BCAS.[2]
Emergency medical communication centres
The BCAS operates four Communication centres located throughout the province. The Vancouver Island Communications Centre (VICC), located in Victoria British Columbia is responsible for all ground ambulance deployment for Vancouver Island and the Gulf Islands; the Lower Mainland Region Ambulance Communication Centre (LMRACC) deploys all ground ambulances in the Lower Mainland (i.e., Metro Vancouver & the Fraser Valley Regional District), the Sunshine Coast, as far east as Boston Bar and as far north as Pemberton; and the Interior and Northern BC Communications Centre (INBCCC) deploys resources to the remainder of the province, including the southern interior (Okanagan, Cariboo & Kootenays) and northern BC (Skeena, Northern Interior & Peace Regions, representing west-central, east-central and northern areas of the province, respectively). The fourth Communication centre, the Provincial Air Ambulance Coordination Centre (PAACC), is located in Victoria and has responsibility for coordinating and deploying of all air ambulance resources, whether they are used for scene responses, or for inter-facility transfers.
Each Communication centre is staffed with a mixture of Emergency Medical Call Takers (EMCT) and Emergency Medical Dispatchers (EMD). The Vancouver Communication system is the largest of the four Centres. A Communication Supervisor who is a bargaining unit member, provides line supervisory support to Communication centre staff, with a Director and a Communication Superintendent managing the centre. Other centres have a Charge EMD in the role of Supervisor, with a Superintendent managing the Centre. Training for EMCTs and EMDs is provided in-house by the BC Ambulance Service.
The BC Ambulance Service utilizes the Advanced Medical Priority Dispatch System (AMPDS) to triage calls and a customized Resource Allocation Plan (RAP) to allocate First Responders, Primary Care Paramedics, and Advanced Care Paramedics to calls as needed.
Within the Metro Vancouver region, BCAS utilizes the E-Comm Wide-Area Radio Network for one-stop communication between police and fire agencies.
Fleet
Ground response
BCAS operates a variety of ground vehicles for ground transport. Most ambulances operated by BCAS are Type III ambulances with some Type I ambulances being used in remote communities. Some Type II ambulances based on the Mercedes-Benz Sprinter chassis are in use following their acquisition during the 2010 Winter Olympics. SUV's are also used as response units by some Advanced Care Paramedics. These response units carry their Advanced Life Support equipment and medications in the SUV and then transport the patient in a Basic Life Support ambulance. Critical Care Paramedics also have ground ambulances available for when aircraft is grounded or when responding to an area where it is not possible to land a helicopter. BCAS operates a number of other support vehicles to respond to HAZMAT, mass casualty, and public events. These vehicles include pickup trucks, gators, bicycles, and retired Type III ambulances. BCAS supervisors drive SUV's, Dodge Chargers, or Mini- Vans.
Airevac response
The BCAS is responsible for the delivery of air ambulance services throughout the province of British Columbia. Critical care paramedics are deployed from bases in Prince George, Richmond, Kelowna and Kamloops, Nanaimo, Langley and Vancouver. Each team is composed of two CCPs who transport all Adult patients and some pediatric patients. The infant transport team (ITT) based out of BC Children's Hospital in Vancouver handles the critical care infant, child, and maternity transports. The ITT have completed advanced training and provide emergency medical care to pediatric, neo-natal and high-risk obstetric patients.
The BC Ambulance Service air ambulance fleet consists of six fixed-wing aircraft, five Beechcraft Super King Air 350 turboprops and one Cessna Citation Encore jet. Additional aircraft are chartered on an as-needed basis. The BCAS also operates four dedicated air ambulance helicopters, two based in Vancouver and one based in both Prince Rupert and Kamloops. BCAS also utilizes approximately 40 pre-qualified charter carriers throughout British Columbia.[4]
Training
Paramedics in BC obtain their initial training before employment by pursuing either their EMR or PCP License at their own cost.
EMR training is available through a variety of instructional agencies throughout the province. EMR courses that are approved by the EMA Licensing Board include those offered by the College of the Rockies, Paramedic Academy of the Justice Institute of BC (JIBC), HeartSafe EMS, St. John Ambulance SJA, the Academy of Emergency Training, EMP Canada, First Aid Certified Training Systems, Vancouver Island University Centre for Continuing Studies and Okanagan College Continuing Studies.
Primary Care Paramedic training is offered by the Paramedic Academy under the School of Health Sciences at the Justice Institute of BC, and through HeartSafe Paramedic Training Ltd. Advanced Care Paramedic training is only available through the Paramedic Academy.
All ITT and CCP training is conducted 'in-house' by BCAS Clinical Education Division in conjunction with BC Women's, BC Children's, Vancouver General, St. Paul's hospitals and BCIT.
The EMA Licensing Board maintains a list of approved training agencies available to potential students. Those students who do not complete one of the approved courses will not be permitted to apply for a licensing examination.
Clinical Education is the Division of BC Ambulance Service that provides Paramedic development once a Paramedic has been hired. The main goal of the Clinical Education Division is to support the delivery of quality patient care through curriculum development and course presentation. A new employee can expect to be offered about 11 courses of paid training in their first six months of service. These courses may include:
- Occupational Safety and Health (OSH) 1-5
- Cardiac Arrest Management
- PEPP,
- ITLS,
- AIME
- Emergency Vehicle Operations Level 1
- Introduction to Treatment Guidelines
- Safety Awareness for Emergency Responders (SAFER).
In addition, new employees must pass a driving preceptorship prior to being allowed to drive Code 3 (lights & sirens). BCAS fosters an environment of lifelong learning and offers a combination of face-to-face and online educational opportunities for Paramedic development.
Licensing and qualifications
Paramedics qualified in British Columbia are broadly referred to as Emergency Medical Assistants and are licensed by the Emergency Medical Assistants (EMA) Licensing Board (EMALB), a government regulatory agency, under one of five categories:[5]
- Emergency medical responder (EMR)
- Primary care paramedic (PCP)
- Infant transport team (ITT) paramedic
- Advanced care paramedic (ACP)
- Critical care paramedic (CCP)
EMR and PCP are Basic Life Support (BLS) qualifications while ACP is an Advanced Life Support (ALS) qualification; ITT has some pediatric advanced protocols; CCP has a whole different scope of practice. BCAS treatment guidelines are universal, which a qualified practitioner may employ at any time, up to his or her license qualification, within the provincial borders, given that the required equipment is at hand. Licensing qualifications and endorsements can be found in the EMA Regulations under Schedule 1 and Schedule 2.
Emergency medical responder
An emergency medical responder (EMR) licensee is qualified to deliver a limited number of medications, under the class of 'symptom relief', including ASA, nitrous oxide, nitroglycerin, naloxone, and oral glucose. They are also qualified in the use of an automated external defibrillator (AED) and may monitor an existing IV line. Their protocols include cardiac arrest, cardiac chest pain, diabetic emergencies, and management of pain using nitrous oxide. The "Schedule 2" endorsements appear as "symptom relief" and "iv maint".
Primary care paramedic
The vast majority of paramedics in BC are primary care paramedic.[6]
In addition to the EMR guidelines, PCP licensees have increased treatment guidelines. PCP-qualified paramedics may also be endorsed for CPAP, intravenous cannulation (PCP-IV) and will have an additional guidelines for hypovolemia as well as enhancements to the anaphylaxis, diabetic, opioid OD guidelines. Additional PCP-level medications include salbutamol, glucagon, epinephrine, diphenhydramine, thiamine , dextrose 10% (D10W), tranexamic acid, and normal saline.
BCAS Medical Leadership has introduced 'Treatment Guidelines', which is a more generalized framework within which paramedics can operate with more flexibility and clinical decision making.
Infant transport team
Infant transport team (ITT) paramedics are specifically trained for critical care of perinatal, neonatal and pediatric patients. They respond as an equally qualified team of two and sometimes take a physician with them for critically ill patients. When dispatched on street calls these are targeted response ambulances that often assist or intervene when necessary, but can hand a more stable patient off to a layered or co-responding PCP ambulance. The team currently consists of only 26 specially trained paramedics for the entire province.
In addition to the PCP guidelines and medications, they may also administer Acetaminophen, Adenosine, Atropine Sulphate, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Gravol), Hemabate, Indomethacin, Lorazepam, Magnesium Sulphate, Midazolam (Versed), Morphine Sulphate, Ondansetron, Oxytocin, Sodium Bicarbonate and Out-of-Scope medications with orders from a CCTA. ITT paramedics have their own unique set of prehospital treatment guidelines that mirror ACP guidelines in the areas of pediatrics, having the ability to treat respiratory/cardiac arrest and disrhythmias. The ITT practitioner also has adult ACLS guidelines and intubation in the event they encounter an adult cardiac arrest.
Their additional training and skills include the use and monitoring of Incubators, Endotracheal (ET) Intubation, Intraosseous (IO) Access, nasogastric (NG) tube insertion and suctioning, manual defibrillation, cardioversion, chest decompression, Venous pressure monitoring, Arterial & Central Line Monitoring, Chest Tube Management, transthoracic pacing, Blood Product Infusion, IV Infusion Devices, 'IV with Medication' Maintenance, Mechanical Ventilation (using the LTV 1000 and 1200 and BMD CrossVent), Foreign body removal with laryngoscope, ET/IO/PR drug administration, Central & Parenteral Line Management, Venous & Arterial blood sample collection, point of collection analysis of ABG's and chemistry using the I-Stat, Lab & X-ray interpretation.
The ITT paramedics also transport pediatric and adult ECMO (extracorporeal membrane oxygenation) patients with a perfusionist from BC Children's.
While there are some areas of overlap between ACP and ITT, the additional ITT 'Airevac' class of skills that are not included in the standard ACP skill-set are Venous Pressure Monitoring, Arterial & Central Line Monitoring, Chest Tube Management, Blood Product Infusion, Mechanical Ventilation, nitric oxide delivery systems and Out-of-Scope Medications by orders.
Advanced care paramedic
Although there are relatively few advanced care paramedic (ACP)-staffed ambulances compared to PCP, the majority of the population is covered by ALS service. These are targeted response units with two ACP-qualified paramedics. They are able to defer transport of a more stable patient to a layered or co-responding PCP ambulance. This ensures that most patients have access to ACP but that the resource is not tied up on a call they are not needed on. It also ensures that ACP-qualified paramedics treat a "critical mass" of the most acutely ill patients, thereby maintaining their high skill level.
ACP paramedics have protocols to administer all PCP plus Adenosine, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Benedryl), Ipratropium Bromide (Atrovent), Lidocaine, Morphine Sulphate, Midazolam (Versed), Ketamine, Fentanyl, and Amiodarone (Cordarone). Their additional skills include synchronized cardioversion, airway isolation devices, endotracheal intubation, end-tidal CO2 monitoring, external jugular vein cannulation, transcutaneous pacing, IV colloid/crytalloid volume expanders, nasopharangeal airways, needle thoracentesis and surgical or needle cricothyrotomy.
Critical care paramedic
Critical care paramedic (CCPs) are paired in British Columbia.
To become qualified at this level, experienced ACP paramedics take further training consisting of a portion of the CCRN program through BCIT, followed by an intensive hospital-based program through St. Paul's Hospital. Next, there is a work experience portion, and finally, CCP licensure. Formerly, an ACP could take a much shorter course and receive a "Full Schedule 2" endorsement.
CCP's have standard operating guidelines for common critical patients; SIRS/Sepsis, RSI, Chest decompression, Ventilation strategies using the LTV 1000 and 1200, ACS and coronary care, etc. CCP paramedics sometimes take an intensivist with them, but consult with Critical Care Transport advisors.
CCP qualifications follow the NOCP guidelines as endorsed by the Paramedic Association of Canada. In addition to standard ACP protocols, the CCP can perform Schedule 2 ACP skills and procedures as well as administer virtually any medication following assessment and consult with the Critical Care Transport Advisor (CCTA). CCTAs are essential to both the air-evacuation and ground critical care transport programs.
Labour mobility
With the introduction of the Trade, Investment and Labour Mobility Agreement (TILMA), the process of transferring one's license between provincial jurisdictions has been streamlined.
Research initiatives
- Frontier Trial
- Resuscitation Outcomes Consortium (ROC)
Uniform issue
Rank and qualification insignia
The BC Ambulance Service is a uniformed organization and as such, has a similar rank structure to most police or fire departments. The medical qualifications of a uniformed member are denoted with collar insignia, commonly known as 'collar dogs', while rank is denoted using epaulettes. Excluded management and administrative employees in regional offices and provincial headquarters do not wear uniforms.
Current qualifications designated by collar dogs include EMR, PCP, ACP, ITT, EMCT and EMD. The EMR and PCP levels are shown on bronze and silver circles, respectively, forming the BCAS logo, along with a circumform bar below, denoting the EMR or PCP qualification. ACP and ITT (Infant Transport Team) paramedics are recognized with gold caducei, with either "ALS" or "Neonatology" imprinted upon them. CCP (Critical Care Paramedics) have a gold coloured shield with blue star of life and CCP on it. Within the Communication Centres, EMD (Emergency Medical Dispatcher) and EMCT (Emergency Medical Call Taker) are designated by gold and silver shields, respectively.
For rank insignia, Paramedics and dispatchers who hold the position of Unit Chief or Charge Dispatcher wear a black epaulette with three gold stripes. District Supervisors and Dispatch Supervisors wear the same coloured epaulette with four gold stripes while Dispatch Officers wear two gold stripes. Ranks above District Supervisor are management positions and are distinguished by a varying number of pips on their epaulette. District and Platoon Superintendents wear an epaulette with three pips, Managers wear one pip and one crown, Directors wear two pips and one crown and the Executive Director of a region will wear three pips plus a crown. Each station and dispatch centre has a staff member designated as its Occupational Safety & Health (OSH) representative. These paramedics and dispatchers are identified with a black epaulette with a single royal blue bar. Staff who are designated as OSH representatives hold no supervisory authority, but are available to assist staff with safe work practices. BC Ambulance instructional staff wear a black epalette with the word "INSTRUCTOR" embroidered in gold, facing laterally.
Shoulder flashes for field staff are navy blue with a navy blue trim, and include the British Columbia Coat of Arms, with the words "Ambulance" above, and "British Columbia" below, both in white.
Other pins and insignia
- Service Bars - issued one for every five years service with BCAS or combined time with another bona fide EMS agency.
- Line of Duty Death Pin - worn only in the event of a BCAS line-of-duty death or during Paramedic Appreciation Week, the first seven days of July.
- 25, 30 and 40-year Service Pins - issued after the designated years of service, full- and part-time inclusive.
- Union Pins - permitted one on a uniform at any given time.
- Stork Pin - awarded when a crew performs a pre-hospital delivery of a baby. All license levels eligible.
- Q-Pin- A pin awarded after a crew member, a unit chief or someone of the public notices a member performing with outstanding quality.
Labour relations
Ambulance paramedics, emergency medical call-takers, and emergency medical dispatchers are members of the Ambulance Paramedics of British Columbia (APBC) Local 873 of the Canadian Union of Public Employees (CUPE). Provincial headquarters and administrative staff are members of the British Columbia Government Employees Union (BCGEU).
Wages and benefits
Wages are paid according to license qualification, years of service and supervisory status.
| Paramedic Wage Scale[7] | January 2018 | |||||
| Experience Pay | EMR | PCP | PCP-IV | ACP | ITT | CCP |
|---|---|---|---|---|---|---|
| Base | $24.08 | $25.64 | $26.41 | $34.84 | $40.81 | $40.81 |
| 1 Year | $25.91 | $27.49 | $28.26 | $36.74 | $42.72 | $42.72 |
| 2 Years | $27.76 | $29.34 | $30.11 | $38.41 | $44.39 | $44.39 |
| 3 Years | $29.85 | $31.39 | $32.16 | $38.94 | $44.92 | $44.92 |
| 10 Years | $30.16 | $31.70 | $32.47 | $39.25 | $45.23 | $45.23 |
| 15 Years | $30.47 | $32.01 | $32.78 | $39.56 | $45.54 | $45.54 |
| 20 Years | $30.77 | $32.31 | $33.08 | $39.86 | $45.84 | $45.84 |
| 25 Years | $31.11 | $32.65 | $33.42 | $40.20 | $46.18 | $46.18 |
Community involvement
- Highschool CPR
- Vital Link Award
- Public Access Defibrillator Program (PAD)
See also
- E-Comm, 9-1-1 call and dispatch centre for Southwestern BC
- List of EMS Services in Ontario
- HealthLink BC
References
- "Emergency Medical Assistants Licensing Branch".
- "BCEHS factsheet" (PDF). Archived from the original (PDF) on 2016-12-20.
- Shew, Frances (January 2014). "Map BCAS Stations Districts.pdf" (PDF). Retrieved April 29, 2017.
- "Critical Care Program". BCAS. Retrieved 2014-10-03.
- Health, Ministry of. "Emergency Medical Assistants Licensing Board - Province of British Columbia". admin.moh.hnet.bc.ca. Retrieved 30 March 2017.
- https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/colleges-boards-and-commissions/emergency-medical-assistants-licensing-board/emergency-medical-assistants-licensing-branch
- https://intranet.bcas.ca/areas/payroll/wage-grids/pdf/ft-uhr-wage-grids-20170317.pdf%5B%5D