Community paramedicine adds life and health to remote Vancouver Island communities

B.C. Ambulance service program providing incentive for paramedics to work in small communities, making house calls before emergency arrives

When the weather is right, the road from Port Renfrew to Sooke is one of the Island’s most scenic, full of eclectic sights and beautiful vistas onto the Strait of Juan de Fuca.

It is also is poorly-lit, frequently bathed in grey rain or suffocating mist, and riddled with sharp corners, abrupt dips and sudden rises.

It’s not a road you want to be travelling when it’s a matter of life and death, particularly at night, and definitely not both ways.

But without proper staffing at the Port Renfrew B.C. Ambulance station that is exactly what can happen: paramedics from neighbouring stations in Sooke or Lake Cowichan are forced to make the hour-long drive, then stabilize and transport the stricken patient to the nearest hospital, 90 minutes away.

And staffing the Port Renfrew ambulance station is not easy, not when you have a permanent population of about 300 people to draw from and the amount of paid work the community can offer consists of maybe a couple calls a week.

It is a situation that is not unique to Port Renfrew. Rather, it is familiar to many of the small, remote communities scattered across Vancouver Island — places like Zeballos and Gold River. Even relatively larger communities like Tofino and Port Hardy suffer from attracting enough skilled paramedic support to meet community demand.

paramedicsThat is why their residents are excited for a groundbreaking new program called community paramedicine.

“I’m really hopeful it will help not only the current paramedics, but also the people in the community,” Port Hardy health advocate Pat Corbett-Labatt said. “We are absolutely thrilled this is happening.”

Last month, the province announced it was expanding its community paramedicine pilot project from six communities to 73 across the province, including 19 on Vancouver Island.

Essentially, the program will create new full- and part-time positions where paramedics will spending their time between calls doing community health outreach with vulnerable citizens — ideally reducing the need for future ambulance callouts and allowing at-risk people to stay in their homes.

“They can be eyes and ears out and about. It’s almost like when doctors did house calls. It would be a tremendous tool to help people stay in the small towns longer,” said Cameron Eby, a member of the provincial executive for Ambulance Paramedics of BC CUPE Local 873.

In addition to potentially improving patient outcomes through the outreach program, community paramedicine also gives paramedics financial incentive to work in small communities

According to Mike Hicks, Capital Regional District director for the sprawling Juan de Fuca area of Vancouver Island’s south coast, a lack of available bodies has put Port Renfrew in an emergency response crisis.

Many of the residents who would have traditionally worked the ambulance and the first-response fire/rescue team have been forced to take resource industry jobs out of town. Increased training requirements have worked as a disincentive for those who remain.

The bottom line, Hicks said, is that just one of Port Renfrew’s fire/rescue first responders remains fully qualified, while four others have let their qualifications lapse. Meanwhile, its ambulance station has about 40 days on its summer schedule where no one is available to work.

hikersWith thousands of tourists hiking the local wilderness and driving the Pacific Marine Circle Route, Hicks has been frustrated the province hasn’t done more to help.

“Our volunteer fire department is consistently going to the Juan de Fuca Trail hauling out people with broken legs and stuff,” he said.

In smaller communities the ambulance is primarily staffed by part-time paramedics on an on-call basis.

Chelsea Kuzman became the chief of Port Renfrew’s 10-member volunteer fire department in 2010, when she was 20 years old. She has augmented that position by working on the ambulance for the past two years.

She described Port Renfrew as a probationary location for paramedics. People straight off their training programs are assigned there and often leave for other communities before replacements become available.

“Because they are allowed to leave after six months we have such a rotation of people,” she said.

Meanwhile, those few locals who might be interested in signing up find it difficult to justify the investment.

Eby, who is also the unit chief for the Courtenay ambulance station, said the situation has been fuelled by changes implemented in 2005.

“The way the (previous) model was built was to entice people who were employed in another area to be on call,” he said. “Most of the education was brought to me, rather than me going to it.”

The 2005 change required nine months training to become a primary care paramedic, at a cost of about $10,000 and no guarantee of work at the end. Part-time paramedics make $2 an hour on call, with regular wages kicking in during a call. The smaller the station, the less likely they are to get calls.

”People aren’t willing to say ‘I’m going to leave my job for nine months and not have full-time work to come back to,’” Eby said.

What community paramedicine does is guarantee hours. Eby anticipates it will be at least a half-shift a week, with the opportunity to supplement those hours with more on-call hours.

“The government is reluctant to put in a full-time crew in a place where they can get two calls a week,” he said. “We haven’t been able to recruit qualified paramedics. In community paramedicine they are creating regular work.”

So far, he said, the program appears to be working: more than 300 people have applied for the first 32 positions.

Kuzman has no plans to apply at this point; operating a busy restaurant occupies most of her time. But she said the idea would have some appeal if that wasn’t the case. More importantly, she sees how small communities will benefit from the outreach aspect of the program.

“My grandparents are both in their mid-eighties,” she said. “They both could use it.”

According to Eby, the community paramedic’s duties will be tailored to the community he or she is working in.

”They will do a needs assessment of the community,”he said. “What is needed in Ucluelet may not be what is needed on Cortes Island.”

ambulancePilot projects have laid the groundwork that could see the program operating in Tofino, Ucluelet, Port Hardy and Cortes Island as early as this fall.

Other Vancouver Island communities tapped to implement the program some time next year include: Alert Bay,  Denman Island (including Hornby), Gabriola Island, Galiano Island, Gold River, Mayne Island, Pender Island, Port Alice, Port Renfrew, Port McNeill, Quadra Island, Sayward, Sointula, Tahsis, and Zeballos.

Corbett-Labatt said Port Hardy is developing its community paramedic’s duties based on input from its doctors and other health professionals. She hopes that some of the people the program attracts to the north Island will decide to stay.

Kuzman said awareness of community paramedicine is something that has been slow to come to the citizens of Port Renfrew, but she thinks Renfrewites will grow to appreciate what it offers.

“We’ve never really had the luxury. (Lack of emergency support) is something that we’ve lived with.”

According to Eby, community leaders across the province are embracing the idea with open arms.

“We launched this at the (Union of BC Municipalities conference) in 2013 and have had a huge, huge response,” he said. “They said this is the first thing we’ve heard in a long time where we are bringing services back to small communities.”

— with a file from Tom Fletcher

Follow me on Twitter @JohnMcKinleyBP

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