Research help for provincial vs. munipal EMS

[Bethadone]

I am in the early stages of a 4th year honours thesis on the debate between provincial versus municipal EMS in Canada and which is more effective (more on how I define this below) and am hoping some EMT City'ers may be able to help a bit with the research. Depending on the quantity and quality of information I find, I may limit it to a comparison between 2 or more provinces (Likely AB, BC, ON and NS) but am open to information from all provinces at this point.

Basically what I am looking for is published articles, case study examples, or even personal accounts for which you would be willing to undergo a short interview (while I'm sure you all have valid personal opinions, please limit this to action taken within a local service that may not be published, but has, at minimum, been addressed by management). If you know of something that may assist in my research but do not have a link to the article, please send me some basic information about the date, publication and subject and I'm sure I'll be able to track it down.

The following are general guidelines for the subtopics of information I'm looking for:

1) Examples of disparity in levels of care (ALS, BLS, EMR or protocols), type and condition of ambulances and emergency response time standards between municipal services or within a provincial service.

2) Public understanding and respect of the EMS profession, public advocacy and awareness of EMS affected by the existence of either municipal or provincial services.

3) The effects of either model on large scale emergency management capabilities including the level of collaboration and coordination between dispatch, ground and air ambulances, and the provincial health care system.

4) Internal labour conditions and standards for professionals in EMS, essential service legislation, bargaining power for EMS professionals to collectively advocate for themselves within either type of service (aside from info about the Calgary EMS debacle this summer, I've got lots on that).

Also, while I will be arguing for the transition to, or maintenance of, provincial EMS instead of municipal or private, I welcome any information you may have against my point of view as I would like to address both sides in my research.

Please e-mail me any documents you have at bethadone (at) hotmail.com

Thanks for your help!

[wilsteev]

Check out www.ambulancenb.ca The province of NB is in the process of switching from about 54 indivual services, some for profit, some non proft, some RHAs to a provincal system similar to NS. Go live date of Dec 16. 2007

[Acosell]

You could also consider the idea of province wide privatized EMS as was in Ontario previously.

[medicmole]

Have you seen the report done by Dr McNamara titled “EMS in Ontario”? It was written in 1999 and is about 70 pages long; I could scan it and email it to you if you are interested. It is mostly comparing fire-based EMS with other options, but it may have some information you could use.

I work for BC Ambulance and have been part time in a small community, full time in Vancouver and now back in a smaller community therefore I have a good perspective of the service and would be willing to discuss it with you.

[401commuter]

I am in the early stages of a 4th year honours thesis on the debate between provincial versus municipal EMS in Canada and which is more effective (more on how I define this below) and am hoping some EMT City'ers may be able to help a bit with the research. Depending on the quantity and quality of information I find, I may limit it to a comparison between 2 or more provinces (Likely AB, BC, ON and NS) but am open to information from all provinces at this point.

Basically what I am looking for is published articles, case study examples, or even personal accounts for which you would be willing to undergo a short interview (while I'm sure you all have valid personal opinions, please limit this to action taken within a local service that may not be published, but has, at minimum, been addressed by management). If you know of something that may assist in my research but do not have a link to the article, please send me some basic information about the date, publication and subject and I'm sure I'll be able to track it down.

The following are general guidelines for the subtopics of information I'm looking for:

1) Examples of disparity in levels of care (ALS, BLS, EMR or protocols), type and condition of ambulances and emergency response time standards between municipal services or within a provincial service.

2) Public understanding and respect of the EMS profession, public advocacy and awareness of EMS affected by the existence of either municipal or provincial services.

3) The effects of either model on large scale emergency management capabilities including the level of collaboration and coordination between dispatch, ground and air ambulances, and the provincial health care system.

4) Internal labour conditions and standards for professionals in EMS, essential service legislation, bargaining power for EMS professionals to collectively advocate for themselves within either type of service (aside from info about the Calgary EMS debacle this summer, I've got lots on that).

Also, while I will be arguing for the transition to, or maintenance of, provincial EMS instead of municipal or private, I welcome any information you may have against my point of view as I would like to address both sides in my research.

Please e-mail me any documents you have at bethadone (at) hotmail.com

Thanks for your help!

Interesting thesis,

If you start out with a bias towards one system or another, why would anyone put any stock in your conclusion? Any "results" you might espouse have already been tainted. It is imperative that system comparators and relative benefits be examined constantly, regardless of the industry. That is how organizations grow and improve. It is equally imperative that all members of an organization be involved and have an opportunity for input. These groups of individuals, from the political end, from the management ranks, to comm officers, to paramedics are tasked with providing the best service to the patient, in whatever environment they find themselves in. All have different roles, but are, theoretically at least, working toward the same goal. For a "research" paper to arrive at a conclusion as to what is "best" (although you have already made up your mind) involves thorough, objective and broad information gathering, and a solid, inclusive assessment of that information.

Consider.......

Municipal systems have advantages in responsiveness to the community that provincial systems do not.

Provincial systems have economies of scale and an ability to standardize equipment and performance that municipal systems do not.

Provincial labor issues have a generic flavor that does not generally account for local practices or conditions.

Municipal labor issues lack a recognition of what are generally provincial credentials.

The point is that "better" is a nebulous concept, which cannot be categorically established by the narrow, biased focus of your thesis.

[Bethadone]

401Commuter - I'd be offended, but clearly you don't know what you're talking about considering even the most basic of research methods courses emphasize that ALL research, even natural science research, is biased by researcher perspective. My "narrow, biased thesis" is what I seek to prove and revealing my bias is part of the research process. A better question would be "why would anyone put any stock" in something that doesn't make a point, or take a side?

Thanks for the advice, as misguided as it was....

[northernmedic]

I am an ACP in Vancouver and I can give you personal info about our provincial system. I also started my career in a rural area. I am not aware of any recent published papers surrounding our system other than the Cameron Report which addressed only fire dept first responders. Send me a PM with any specific questions and I will do my best to answer.

[401commuter]

401Commuter - I'd be offended, but clearly you don't know what you're talking about considering even the most basic of research methods courses emphasize that ALL research, even natural science research, is biased by researcher perspective. My "narrow, biased thesis" is what I seek to prove and revealing my bias is part of the research process. A better question would be "why would anyone put any stock" in something that doesn't make a point, or take a side?

Thanks for the advice, as misguided as it was....

So you aren't offended? Sounds like you are.

It is possible that I misinterpreted your intent, but there is a difference in trying to prove something and researching something. Of course there must be a hypothesis, but that is not what I read in your post. What I read was an unsupported opinion.

As far as taking a side goes, that was exactly my point in pointing out the narrowness of the exercise. Better for who? The patient? The overall healthcare system? Paramedics? Paramedics as employees? Paramedics as health care providers? The taxpayer? Municipal organizations? Provincial employers? Better for one, may be detrimental to another.

I'm not sure why you you would (almost) be offended, my intent was to elicit a discussion on aspects of EMS that exist in this country, to point out that different systems have advantages and disadvantages that are mutually exclusive of one another and see if you had given consideration to reconciling such issues.

Ontario of course does not fit either mold, as the municipalities deliver the service under provincial regulations, with the province for the most part controlling deployment and call prioritisation through their own dispatch centres. There are advantages to this model as well, depending on what perspective is used.

It reminds me of the story of the three blind men describing an elephant after touching it.

What do you hope to accomplish? Do you want to foster change? Or is it simply an academic exercise, in which case I'll leave you to it.

[Happiness]

I work in a remote part of bc. So if you would like that view for your paper you can also pm me with specific questions. My level is P1. Hope your paper goes well.

[gerg 68]

just to let you know that in newfoundland we have 3 setups . One is private and for profit , there is a community based which is not for profit and we also have hospital based , which is also not for profit . the strange thing that happens here is that all systems are subsidised by government . Another funny thing is that the government gives more money to the private system than the not for profit systems . And there is no provencial 911 system in the province . Hope this enlightens you on the system here .