Recently I came across a tweet that I think helps set the tone for this discussion perfectly.
Moral in EMS is not down, it’s in the gutter. Lets try to understand why.
EMS in Alberta is in crisis. Put lipstick on it all you want but it is still a pig. Tell the public response times are on the decline, things are getting better, the problem is under control, but within EMS there is a cancer in leadership. In our last post there was discussion at length about messaging from EMS Leadership, and the embedded dishonesty in it. Simply put, telling a lie, no matter how hard you try to spin it cannot turn that lie to a truth. Slapping a bandaid on a bullet wound will not stem the bleeding.
For those that watched the CTV documentary series ‘Broken System’ the documentary comes to a close with an interview with Darren Sandbeck, the former Chief Paramedic in Alberta, and he asserted that there has never been any repercussions, discipline, or retaliatory action against a Paramedic for whistle blowing. That was not true, and he himself was later revealed to be part of the campaign to bring discipline down against a Paramedic. This article is not going to be a mud slinging match however, what can, and needs to be said was this was the action from the top, and at the top is where organizational culture begins. The Chief Paramedic left his role as of January 9, 2023; additionally weeks earlier two more senior managers were walked off the job for overtime misconduct:
What is to be said then? Not all is well with EMS. If you comb through media sources, and interviews with EMS Leadership in recent years there is a trend noted, all things are blamed on one of two things. COVID, and the opiate crisis. A report done by the Parkland institute they concluded “While SARS-COV-2 (hereafter COVID-19) and the opioid and overdose crisis (hereafter overdose crisis) have exacerbated the challenges experienced by paramedics in Alberta, the root of the current crisis dates back at least to the amalgamation of emergency
medical services in the province in 2009.” So what then can be learnt about the current state of affairs? For years EMS crews the province over became all too familiar with what could often times be thought of as a perpetual state of purgatory. Do a call, transport the patient, put the patient on a hospital bed, and too often that was the shift. 12 hours spent staring at a blank wall in hospital, broken up by the occasional bark of the radio, dispatch pronouncing that it was a Red Alert, consolidate and clear. Problem was, crews already had, sometimes several times, there was no more consolidations to be had. Management would always pronounce they had a plan, problem was, having no plan, or worse, a bad plan is still a plan. Those same talking heads are still gainfully employed to spots well north into the 6 digits. Your tax dollars at work.
The phenomena of hospital purgatory persisted, but outside the walls of the Emergency Departments all was not well.
From 2015 to just before COVID the province saw an increase of 87,413 EMS events, and in the same time period saw too few ambulances added to the fleet. Worse, AHS implemented OPTIMA, a computer system that was designed to make up for the short fall in physical Ambulances by constantly moving resources in a ‘borderless system’.
This included relocating Rural Ambulances from outlying communities to the Cities, sometimes every day, all day. Does Okotoks have a Ambulance? Yes, they have two. How many of them are currently doing calls in Calary? Two. Both. All. They managers did nothing to help. They did tell crews that OPTIMA ‘was learning’. Problems persisted, the solution EMS leadership came up with was, ‘Hire more Managers’. These new managers were kept busy, fixing problems caused by the solutions previously implemented that weren’t working. If you’re wondering what the crux of the CBC opinion piece was, it was this. ‘I loved being a medic but I couldn't accept the dysfunction in our system’.
Also mentioned in the article is the terrifying ‘table of tears’. This is one truism that cannot be ignored, the frivolous and vindictive discipline of front line staff. Investigations that EMS managers spend countless hours, sharing little or no details with the crew involved as exhausting and morally repulsive. It’s no surprise to Paramedics that a recent CTV interview quoted a Paramedic who stated, “There is a toxic culture of fear and intimidation.
The mantra from EMS Supervisors to Paramedics has always been, ‘No Complaints’.
Ambulance Crews quickly learned it was easier to just put Patients in the Ambulance and take them to the Hospital, if that was what they wanted. No one who calls an Ambulance want’s to hear, ‘You need to call your family doctor’ or ‘feeling like there’s something in your eye doesn’t warrant an Ambulance’ or ‘you’ve had a sore wrist for two days, why not have your wife drive you in one of the three cars in your driveway?’
So where does that leave the EMS system? The Parkland institutes report sums it up as; “an overall sense of inability to cope with an EMS system that is neither patient nor provider-centred.” As Dr Peterson noted, ‘AHS EMS is unable to truthfully identify what’s wrong anymore.’ Here’s how it plays out when your EMS leadership is incapable of fixing anything.
In 5 years, from 2018 to 2022 an 86962 increase in sick hours. An increase from 90.53 per full-time Paramedic to 120.81. There is a point to be made here with extenuating consideration due to COVID, and a requirement of staff who were symptomatic to take time off work due to the illness, but that was a primary consideration at the outbreak of the Pandemic, and by 2022 was allowing COVID positive employees back to work:
One would think that this would send a management team scrambling looking for solutions to fix the problem and come to terms with an EMS system does not work if the Paramedics are unable to function.
EMS Crews can only endure stress injuries, physical injuries, moral injuries and physical illness for so long. The trend is significant enough that you could see an exponential year over year rise in the rate of WCB claims in addition to time off sick.
You would think that this would prompt managers to fix the problem, try to right the ship. At EMS, the opposite would happen. Meetings to discuss excuses, consultation with AHS Media spin experts, writing, approving and disseminating bafflegab which no one believes anymore. Then, the hiring of more managers, while Ambulances remain idle with no staff available.
It was not until 2023 that Alberta saw any substantial increase in the number of Ambulances. That’s when AHS increased the number of Ambulances in Calgary and Edmonton. They also attempted to frame this as an increase in rural Ambulances in the Calgary zone by two, but this was patently untrue, as they simply extended the hours of two ‘peak’ ambulances from 12 hours to 24 hours in Okotoks and Chestermere. There was not two Ambulances added, they simply increased the number of scheduled hours.
Behind the scenes, AHS managers were becoming more adept at constructing deception, rather than accountable stewards of a functional EMS system which has brought us to where we are today. The rate at which Paramedics are finally saying they’ve had enough and are walking away from full time employment with AHS.
Numbers like these would suggest to any competent observer that something is very wrong in EMS. Are Paramedics easy to replace?
What are Paramedics walking away from? A job they love, one that fits their personality and desire to be part of their Community. They’re walking away from good benefits, a pension, a career they spent 4 years of school preparing for. They’re leaving because AHS now considers Paramedics expendable.
EMS has come to a point where dishonesty and failure has created chaos.
This government has a tough row to hoe, getting this protected bulwark that is AHS under control. As Danielle Smith has said, managers must get on board or be shown the door.
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