The OGM Interactive Canada Edition - Summer 2024 - Read Now!
View Past IssuesEmergency medical services (EMS) are a type of emergency service dedicated to providing out-of- hospital acute medical care, transportation to definitive care and other medical transport to patients with illnesses and injuries which prevent patients from conveying themselves.
The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to the next point of definitive care. This next point is most likely an emergency department at a hospital. The term “emergency medical service” evolved to reflect a change from a simple system of ambulances providing only transportation, to a system in which actual medical care is given on the scene and during transport. In some developing regions, the term is not used or may be used inaccurately, since the service in question does not provide treatment to the patients, but only the provision of transportation to the point of care.
The first use of the ambulance as a specialized vehicle in battle came about with the ambulances volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte’s chief physician, during the Battle of Spires between the French and Prussians. He settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers.
In the late 19th century, the automobile was being developed, leading the way to the dawn of a new era. Consequently, the earlier horse-drawn ambulances gave way in the early 20th century to models that were powered by steam, gasoline and electricity, reflecting the competing automotive technologies then in existence.
Emergency medical services in Canada are the responsibility of each Canadian province or territory. As such, the services, including both ambulance and paramedic services, may be provided directly by the province, may be contracted to a private provider or may be delegated to the local government level, which may in turn create its own service delivery arrangements with municipal departments, hospitals or private providers. The approach and the standards vary considerably between provinces and territories.
Emergency medical services exist to fulfill the basic principles of first aid, which are to “Preserve Life, Prevent Further Injury and Promote Recovery” and are rendered by the following steps:
1. Early detection
2. Early reporting
3. Early response
4. Good on-scene care
5. Care in transit
6. Transfer to definitive care
In Canada, the responsibility for emergency medical services, as part of health care in general, has been allocated to the provincial/territorial level of government. Typically, the provincial/territorial government will provide enabling legislation, technical standard, accreditation or licensing and oversight to a variety of potential system operators, including municipalities, hospitals or private companies.
Canadian provinces are also served by air ambulance services. These arrangements may come in a variety of forms, including direct service provision, contracts between private companies and the provincial government. They also can be “brokerage” arrangements, in which one private company takes the lead on service provision, perhaps, even operating some of their own aircraft and providing dispatch services, but subcontracting many of the operations to smaller air charter services.
In some cases, the inter-facility transport of high-acuity patients may be a mix of air-based and ground-based resources. Canada is a vast country, and the sheer size dictates that in many cases, the traditional helicopter-based air ambulance service found in the U.S., the U.K. or Europe is impractical, as the distances required exceed the flight range of the helicopter. For this reason, the use of fixed wing aircraft is commonplace.
Another feature, which is somewhat unique to Canada, is that in some jurisdictions not all air ambulance calls are emergencies; long distances to tertiary care centres mean that patients with lower-acuity medical conditions will also be flown on occasion.
According to EMS Chiefs of Canada (the Canada-wide organization of the heads of EMS programs, www.emscc.ca), the current pressures on Canada’s health care system call for a renewal and redefinition of the traditional model of pre-hospital emergency care.
In Canada, emergency medical services (EMS) treat more than two million patients annually. An aging population, a shortage of health care professionals, and other challenges have drastically changed the roles for EMS in the overall health care system.
In order to address these growing challenges and continue to meet the needs of their communities, the EMS Chiefs of Canada say that the EMS systems must change the way they deliver services. New strategy should envisage the following:
A. | Clear Core Identity (the inclusion of EMS leaders in the governance of health care systems). | |
B. | Stable Funding (should reflect the actual cost of service delivery—be stable, predictable, and sustainable to allow for optimized planning and enhanced innovation). | |
C. | Systematic Improvement (enhanced data collection and research capabilities—the development of a Canadian accreditation system). | |
D. | Personnel Development (all provinces and territories should endorse and adopt the Paramedic Association of Canada National Occupational Competency Profile, enabling consistency in training and education approaches, a higher standard of training and education, and national credential portability). | |
E. | Leadership Support (flexible career pathways for leaders must be created). | |
F. | Mobilized Health Care (collaboration of EMS and community organizations such as primary health care providers, social service agencies and public safety groups). |
Oil and gas, onshore and offshore, companies in Canada use emergency medical services provided largely by private firms which are capable of reaching and taking care of patients in remote places and on work sites.
From the rugged East Coast of Canada to the tropics, Atlantic Offshore Medical Services (AOMS) has been providing quality industrial medical services in harsh, remote industrial environments since 1978. A thorough screening process and their depth of experience allow AOMS to match every client with the right team of qualified medical personnel (www.aoms.nf.net).
UMS is an occupational health service organization, offering an extensive range of effective corporate health and disability management services for a wide range of workplace environments.
UMS prides itself on having physicians and staff with proven expertise, including a complete focus in occupational medicine in safety/sensitive—safety critical workplaces (www.ultimamedical.com).
Extreme Safety & Services Ltd. is dedicated to the Canadian oil and gas Industry. With fully equipped 4×4 units, professional personnel and a 24-hour on-call physician, the company offers a wide range of medical care: from first aid to advanced life support (http://extremesafety.ca).
Polar Medical Services began providing medical services to the mining industry in 2005 and since then has branched out to other sectors. The company’s client base now includes companies involved in mining and mining exploration, construction, oil and gas, forestry throughout Northern and Western Canada, including British Columbia, Alberta, Northwest Territories, Nunavut and the Yukon (www.polarmedical.ca).
Unlike others, delivering traditional occupational health services, Praxes offers in addition to them the Canada’s premier national telemedicine service for the oil and gas industry.
The company’s 24/7 global medical response system (EMdoc) guarantees the caller will be talking to one of their emergency doctors in 5 minutes anywhere in the world.
Praxes provides a service guarantee, a web based medical record for every call and an alert to Head Quarter staff if desired. The company has a call centre that records every call and a translation service that covers the languages of its customers. (www.praxes.ca)
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