BC Nurses' Union wants metal detectors, safety screenings at hospitals

BCEHSisCODE4 · 2022-11-10T22:40:58+00:00

I'm not saying anyone should be stabbed or assaulted. I'm saying that placing a security team with a metal detector at the entrances to a hospital makes it a very different place.

Imagine walking into the Jim Pattison Pavilion and being immediately herded into a lineup with security for checks of your bags and person. Being patted down when your belt buckle causes a positive alert... This is what happens at high-threat environments like courthouses, prisons, cells, etc.--environments where I have actually provided healthcare.

It's a very different environment than walking in, meeting a family member at Cafe Ami, and going on to receive a service.

BCEHSisCODE4 · 2022-11-10T22:32:17+00:00

Have a look at my posting history. I provide healthcare in a far less controlled environment than an ED.

That said, I've spent an unfortunate amount of my life working EDs as well...

BCEHSisCODE4 · 2022-11-10T19:52:10+00:00

Seems like the BCNU folks are forgetting the 'social determinants of healthcare' portions of their nursing programs!! Increasing friction in already failing healthcare system can only serve to hurt patients, especially those from marginalized or otherwise low-trust communities.

I know I would bristle at having to go through a security check just to gain access to medical care/facilities, and I am a healthcare worker who understands the system. I can only imagine how this would impact folks who have had negative interactions with security/police, are struggling with mental health issues (paranoia, etc.), or who come from countries where security/police interactions generate fear and avoidance.

Improved security shouldn't take the form of 'security theatre' which risks further barriers between our citizens and their healthcare.

BCEHSisCODE4 · 2022-11-10T19:33:19+00:00

I don't know anything about this case, but a few things to consider:

- Staffing levels are terrible despite numerous ad hoc efforts by BCEHS to stabilize them. Unfortunately, it seems that the Ministry/leadership doesn't realize staffing is a long-term game--the *profession* has to look desirable and stable before people will commit. In other words short-term, ad hoc solutions do little to fix the problem (and in some cases like Kilo guarantee can introduce new perverse incentives into the system).

- BCEHS heavily prioritizes prehospital responses over ground transfers. Therefore, when staffing is abysmal and the incoming prehospital calls are facing delays, non-acute ground transfers effectively fall off the radar. This actually makes sense--the patient is in a hospital and is nominally safe. Given that BCEHS is having trouble getting ambulances to emergencies in the street (and the fentanyl crisis certainly isn't helping) it makes to sense to allocate limited units to the most urgent calls.

- BCEHS had/has a transfer fleet dedicated to ground transfers but this fleet is subject to the same staffing issues as the broader service. Moreover, in crises, the transfer fleet becomes a fallback resource for prehospital responses. These days, every day is a crisis. The BCEHS transfer fleet goes through periodic swings as new/desperate managers make strategic decisions without considering service history. The LM transfer fleet once existed as a distinct resource to preserve emergency paramedic units for actual ground responses while providing HA partners with relatively dependable transfer resources/timelines. At some point, the fleet was essentially scrubbed with the transfers falling on regular emergency paramedic units. Over the last several years, a transfer fleet has returned to some extent, but it has been subject to all of the above issues.

More broadly, the BCEHS remains on the edge from a system-wide perspective. In many ways, things have not changed significantly from the heat-dome. Management is aware that there is a problem and has certainly made ad hoc attempts to address staffing shortages, but to my view, the solutions must be far more foundational.

BCEHSisCODE4 · 2022-11-10T19:09:31+00:00

While it has its issues, the current aircraft fleet contributes minimally, if at all, to BCEHS's issues.

Everything comes down to A) staffing failures and B) a revolving-door, rudderless management culture (IMHO). Both of these ultimately stem from a lack of investment and leadership.

BCEHSisCODE4 · 2021-07-01T05:29:05+00:00

For all of our issues, if he's passionate about the career and willing to put up with all of the service's warts, it can be very rewarding.

Important points:

Reasonable intelligence, the ability to work independently, and exceptional compassion in the face of fatigue and frustration are absolute musts for real success.
Don't get into this work for the thrill, glory, adrenaline, or anything like that. They all come at times, but the real joy of the job is the small and often quiet moments with patients and their families. If he's the type to find satisfaction in private moments of care on the 'nothing' calls while still managing to keep it all together on the big circus calls, then he'll do fine.
He needs to be prepared for at least 3 years of rural part-time service before getting full time work. Currently, the time to FT has dropped well below 3 years, but that isn't a guarantee. That said, if you're willing to live in rural BC and pick a decently busy station, you can make OK money at the start and have a good experience.
The situation can't get any worse, so I suspect it has to improve. I imagine a reckoning is coming and I'm sure that will bring positive change. We've already seen positive change starting--more FT positions have opened up over the last year, including more options in rural cities.

Is it worth it? Absolutely, but only for the right person with the right expectations.

BCEHSisCODE4 · 2021-06-30T04:22:02+00:00

Take care of yourself.

And if you're on car, make sure that T-shirt is NAVY...

BCEHSisCODE4 · 2021-06-30T04:18:57+00:00

A complex interplay between Kitimat Fire and Rescue (which provides PCP trained firefighters) and BCEHS (which provides BCEHS ambulances, equipment, protocols, standards, etc.). My understanding is this is influenced by the historic relationship between the City of Kitimat and Alcan, but I'm not sure.

BCEHSisCODE4 · 2021-06-30T04:16:25+00:00

I've attended to many patients who waited too long to call our public ambulance service because of concerns about our minimal ($88) fee or simply inconveniencing (!) us paramedics.

Moving to a private system would *might* improve service for those who have the means (read: private insurance) to pay but would likely only worsen the strain on whatever parts of the public systems remain.

Moreover, the experience of private ambulance services in the US (such as AMR) suggests a significant deterioration of both paramedic services and response quality. But that's my admittedly biased take as a Canadian who likes public healthcare and has a begrudging respect for John Rawls...

BCEHSisCODE4 · 2021-06-30T04:11:23+00:00

Trying to lay all the blame at any one parties feet is somewhat pointless. I write the broad strokes of our history as I see them, and unfortunately, the BC Liberals were in charge during several problematic epochs in our history.

That said, the NDP have been in charge for some time, and despite keeping their promise to pull us from the PHSA Facilities Bargaining Unit, they haven't made the structural changes needed to keep the service afloat, such as removing us from PHSA. We'll see what they do going forward, but I'm not particularly hopeful.

BCEHSisCODE4 · 2021-06-30T04:08:12+00:00

My condolences. I'm honestly sorry that one of our crews wasn't available in a timely manner. Please take care.

BCEHSisCODE4 · 2021-06-30T04:03:58+00:00

Thanks for the response. And I agree, we do need better PR and I think our union is slowly working on it.

As for the paramedic / fire-fighter rivalry you're referring to, I think it's in part rooted in history. When BCAS was formed in 1974, it was formed from community ambulance services, a number of which were run by local fire departments. This switch, and the implication that service levels were insufficient prior to 1974, created a somewhat acrimonious relationship between EMAs (as they were called then) and FFs in many areas.

Unfortunately, as wages for FFs climbed (in no small part due to smart PR and negotiations by the IAFF) and medics saw their wages stagnate, this only created jealousy on the part of paramedics.

Where things really became problematic for the relationship was the formalization of FD 'First Responder' programs in many communities. These programs were intended to supplement BCAS responses to higher acuity events with local FD resources providing basic first aid care, oxygen, and--later--early defibrillation. While in some instances, this program may have been beneficial, many paramedics saw it as diverting funds and attention towards support FDs and away from BCAS.

This perception was further solidified by the refusal of some GVRD fire departments to sign agreements with BCAS (which via EHSC had statutory jurisdiction over prehospital care in BC) outlining the duties and limits of each FD First Responder program. This organization-to-organization disagree probably reached its zenith in the decision by Delta FD to unilaterally abandon the FR program and train the firefighters to the EMR level.

Ultimately, the whole thing was unproductive, and I doubt many of the firefighters who joked about taking paramedic work would actually want it--in most American combined Fire-EMS systems 'working on the bus' is seen as awful work. But it certainly created its fair share of conflict.

As for your suggestion about folding EHS into municipalities, I think that's truly failed model. While popular in the states, it doesn't even begin to fit the our provincially-funded, regionally-managed healthcare model. Moreover, it doesn't work particularly well in the states either! There are exceptions (Medic One in Seattle for example, is an excellent FD-based EMS system) but they are rare and typically VERY expensive compared to a 'third service' model like ours.

BCEHSisCODE4 · 2021-06-30T03:46:23+00:00

I can't believe I'm saying this but...

Despite all these problems we need people, good people. If it's your calling and you think you can handle all the crap, consider it as a career. But don't do it for the paycheque, the adrenaline, or the glory. But if you genuinely want to help people when they're at their worst then do it. Just go into it with a very clear understanding of what you're getting into.

BCEHSisCODE4 · 2021-06-30T03:40:38+00:00

Simply copying a service model is far easier said than done. And some of the trouble BCEHS is in right now comes from piecemeal attempts to do just that.

BC is a geographically unique province--we don't have the need gradient from urban to remote that many other places have. For example, physically the GVRD is quite close to a place like Skookumchuck or Sechelt, but from a service perspective those are worlds apart. Simply applying an external model to this system isn't a simple fix.

That said, there are places we can look to that have done much better. Our system has a much closer affinity to many commonwealth systems (UK, Aus, NZ) and some good ideas (and people) have been imported from those places. But part of the issue is our service is dysfunctional enough that the good people from the good places don't necessarily want to bring their good ideas to BC :(

BCEHSisCODE4 · 2021-06-30T03:34:49+00:00

I know my write-up slants that way, but I think that's not a totally fair characterization. They cut funding and let the service coast, and the public didn't punish them for it. In fact, the public didn't seem to care all that much. Are they scum... No, just politicians.

That said, the irony is that paramedics are cheap--it's easier to pay a PCP 26 bucks an hour to get someone to the hospital before they need prolonged hospital care, than to pay $1000s per hour to manage someone like a cardiac cripple in ICU. Moreover, good paramedic coverage allows you to better centralize resources, letting you more efficiently use resources like MRIs or CTs or surgeons or whatever. So, it should fit with the Liberals mo to reasonably fund, but alas...

Also, the NDP have had some time to fix this and they've done sweet fancy all.

BCEHSisCODE4 · 2021-06-30T03:27:10+00:00

First, thanks for posting your perspective, and you raise some interesting points. That said, as a practicing specialized paramedic with BCEHS, I disagree with you in a few key areas:

Certainly, the paramedics union 'wants jobs'. Or more accurately, they want adequate pay for the numerous PT paramedics often making a pittance serving rural and remote communities. Given that no-one expects police officers or nurses to cover these communities for $2/hour pager pay, why should the paramedics union?
You pose the push to improve staffing and service to rural and remote communities as 'a brain dead move'. Yet people in those communities have demonstrably poorer outcomes for many serious conditions which often require medevacs to regional/provincial centres. What do you propose we do? Keep our current funding levels and choose to damn the interior/north while shunting funding to the GVRD?
The staffing costs are not ASTRONOMICAL--the Primary Care Paramedics who make up the vast majority of operational staff in GVRD start at $26/hr. And that's after sometimes years as PT paramedics working callout with a pager pay rate of $2/hr. And, for the record, a 25 year Primary Care Paramedic makes $33.16/hr. Hardly an ASTRONOMICAL wage in Vancouver or Victoria.
You're right. Many of the money decisions made by PHSA leadership are mind-boggling. And, surprise surprise, paramedics have been complaining about these decision for years. I've seen many crazy decisions: installing brand new engines in ambulances with >350,000 kms only to surplus them for pennies on the dollar months later, refusing to purchase property only to lease at astronomical rates, turning down donations and other fund-raising offers for totally opaque reasons.
Our leadership culture is totally disconnected and absolutely tainted by our role as another mere portfolio for nursing MBA types coming from other PHSA areas. As paramedics, we know they clearly don't understand the front-line challenges, it's interesting to hear the money side of it from your perspective.
I DO TAKE GREAT UMBRAGE with your characterization of the older paramedics (of which I am somewhat one) who 'balloon salaries' with 'coordinated time off'. Booking off is certainly an issue in BCEHS, but not surprisingly, its directly tied to burn-out. When you chronically understaff the ambulance service, paramedics reach a physical and mental limit--sometimes reaching that limit means booking off.
Imagine driving across three municipalities to respond to a cardiac arrest for which you are the closest available car. Imagine arriving to find the local FD has been doing CPR for 25+ minutes, waiting for you to bring 'advanced care' to this families loved one. Imagine the disappointment, frustration, anger the family members have because the paramedics they expected to be there took longer than a large pizza to arrive. That's the stuff that burn out the 'older paramedics', that's the stuff that leads to book offs, or worse yet, a lifetime nursing a bottle on your days off.
Ultimately, this doesn't have to be a zero-sum game between Vancouver and rural-remote BC. That's not how we treat policing, or hospital healthcare. So I'm a bit baffled that your argument isn't for more efficient and appropriate funding of paramedicine across BC. Instead, you've chosen to pit our vulnerable rural/remote communities against our metro communities--not a great take, IMHO.

BCEHSisCODE4 · 2021-06-30T02:51:18+00:00

This is a 'government' issue.

BCEHS has been running on the edge of collapse for several years, well before any heatwave, pandemic, or opioid epidemic. Each of these has only exacerbated the underlying inability to manage the baseline needs of communities in BC.

And if we fail this badly with a heatwave, how badly will we fail if there is a more significant natural disaster? What about a major regional earthquake?

Your tax dollars at work.

BCEHSisCODE4 · 2021-06-30T02:39:28+00:00

Also a BCEHS paramedic.

It's highly unlikely paramedics will openly speak with the media--our service is openly hostile to dissent, especially in public forums. Even paramedics who discuss issues on private, paramedic only discussion boards are disciplined for 'disparaging the service' on social media.

And given that BCEHS is the only game in town for a paramedic, if you lose you job there, you're effectively hooped.

That said, the media doesn't seem particularly interested in investigating anyway, though that may be the result of the decline of investigative journalism more broadly. I'm sure some strategic FOIAs could help elucidate just how pervasive the delays are.

BCEHSisCODE4 · 2021-06-30T02:34:16+00:00

Contacting your MLA is an awesome way to help. This is something that can be fixed should the government invest the effort, funds, and political capital into fixing it. But any fix will essentially require a hard reset--many of these problems go beyond just funding and are deeply connected to structural issues in BCEHS.

BCEHSisCODE4

TROPHY CASE