Air Ambulance Service Under Review

[rock_shoes]

I think it's probably fair to say that Dr. Wheeler is an expert, based on his credentials. But, as you've pointed out, he is only one expert. There is also a clear and obvious conflict of interest here, in that he runs the BCAS program, which has a coverage area that overlaps with STARS bases in Alberta. To some extent, these services are in competition, and the potential for STARS to expand further can't have been overlooked.

I haven't met a lot of people from the BCAS CCT, or from ON ORNGE CCP programs. I'm sure they're excellent people, and it sounds like their training programs are very rigorous. I have met a lot of people from AB STARS, interacted with them on calls, and benefited from training programs offered from them. I found them to be extremely well-trained, knowledgable and competent, and have learned a lot from them.

Of course, my opinion is somewhat meaningless, as I am not an expert. It's also hard to compare the training between the different locations without having taken the training. There are a lot of unanswered questions here, that make it difficult to present an informed opinion.

-----------------------------

On another note entirely, the US audience may be interested to see that the discussion here is revolving around the provision of a single RW to a geographic area roughly the size of Texas (*albeit very sparsely populated), and whether this is even beneficial versus FW. Not a narrative likely to be explored stateside any time soon.

Actually STARS and BCAS are not in any kind of direct competition. STARS flies into small strips of BC along the BC/AB border. They only do so at the request of BCAS into areas that would not otherwise have rotary services available. BCAS has the sole mandate to provide public emergency health services in BC. Other providers, in this case STARS, may only operate in BC with direct permission from BCAS. Response to private work sites is a little different in that an employer can request STARS service directly (typical on oil and gas sites in STARS service radius).

With regard to training standards let me shed some light on the subject. All critical care training programs for paramedics in Canada start from an Advanced Care Paramedic candidate base. The 18 month BC CCP program is only the second in the country to be recommended for accreditation by the Canadian Medical Association. It is a rigorous process involving constant QA/QI, hundreds of hours in ICU, frequent case reviews with EPs/Intensivists, and huge volumes of didactic study.

The STARS program by comparison is 10 weeks in duration with a couple of fly alongs. STARS gets away with this because most of the CCP SOP is included in the Alberta EMT-P SOP (ACP equivalent). It's simply insufficient by comparison and that's exactly what Dr. Wheeler has highlighted. Dr. Wheeler's primary recommendation is that the STARS program be brought in line with the critical care standard set in BC, Ontario, and Nova Scotia.

I trained as an EMT-P in Alberta. I can run a vent if I have to. There's no way in hell I can run it as proficiently as a CCP or RT.

[systemet]

Either the forum's glitching or I am, as I'm having trouble using the quote function today, but...

You have a rotary wing operator, based in a neighbouring province. It's previously run operations in Nova Scotia. It's recently expanded aggressively into Saskatchewan and Manitoba. In at least one instance, it's been introduced without a competitive tender process. It's a "not-for-profit", run with minimal provincial funding. It collects a large percentage of it's revenue from corporate donations, and fund raising. It already flies missions in your own province.

Let's say you're responsible for medical oversight, and have developed (arguably) a Cadillac system in your own province. But, and I'm just guessing here -- probably an expensive system, if every new hire is going through a government funded 18 month training program, while receiving a full-time wage from the employer?

And you're not threatened by the possibility that in these days of social services cutbacks, your own system might get replaced by the cheaper option from next door?

I'm sure Dr. Wheeler is a very ethical man, whose primary interest is patient care. It's hard to argue against anyone who wants to raise the standard of training and education. Many of his criticisms may well be valid. But the conflict of interest here should be obvious, and it should be clearly stated. This doesn't render his conclusions invalid, it just makes everyone aware that it may be difficult to be completely impartial in this situation.

[Arctickat]

And the drama continues....

http://www.cbc.ca/news/canada/manitoba/stars-air-ambulance-not-a-good-value-in-manitoba-says-union-1.2579997

[rock_shoes]

Either the forum's glitching or I am, as I'm having trouble using the quote function today, but...

You have a rotary wing operator, based in a neighbouring province. It's previously run operations in Nova Scotia. It's recently expanded aggressively into Saskatchewan and Manitoba. In at least one instance, it's been introduced without a competitive tender process. It's a "not-for-profit", run with minimal provincial funding. It collects a large percentage of it's revenue from corporate donations, and fund raising. It already flies missions in your own province.

Let's say you're responsible for medical oversight, and have developed (arguably) a Cadillac system in your own province. But, and I'm just guessing here -- probably an expensive system, if every new hire is going through a government funded 18 month training program, while receiving a full-time wage from the employer?

And you're not threatened by the possibility that in these days of social services cutbacks, your own system might get replaced by the cheaper option from next door?

I'm sure Dr. Wheeler is a very ethical man, whose primary interest is patient care. It's hard to argue against anyone who wants to raise the standard of training and education. Many of his criticisms may well be valid. But the conflict of interest here should be obvious, and it should be clearly stated. This doesn't render his conclusions invalid, it just makes everyone aware that it may be difficult to be completely impartial in this situation.

Here's the thing. The service next door isn't cheaper in their expansion plan. The service they provide in Manitoba is costing Manitoba tax payers huge sums of money as in "177 missions for $10 million = $56,497 per mission." STARS might be a "not for profit" but that certainly doesn't make them any cheaper. BCAS critical care operations transported patients in 2012/13 for an average cost of $6,406/patient moving 8600 patients by ground (1900), fixed wing (4800), and rotary (1900). Even if rotary operations were responsible for the entire cost of critical care transport operations (which it is not as only 1900 out of 8600 patients were moved this way) the average cost per flight would come to $29,000/patient (still significantly less than Manitoba is paying per flight directly out of the taxpayer's pockets).

http://www.bcas.ca/factsheets/critical-care-transport-program-factsheet/

STARS dirty little secret is out. This "not for profit" isn't any cheaper per flight than other operations and the training standard by all observation would appear to be less rigorous than other Canadian air ambulance operations.

[Arctickat]

Just because an organisation is considered not-for-profit doesn't mean that someone isn't making a whole lot of money. Look at the ORNGE Scandal. It's a NFP and Mazza was making over a million a year, getting interest free loans from the company and more.

[systemet]

Re: NFPs

You both raise excellent points. The ORNGE scandal was frankly depressing. The main comparisons being made here are STARS v. Manitoba Lifeflight v. BCAS, all of which, are NFPs, right? Being an NFP doesn't guarantee that money is being spent wisely, or, in some cases, legally.

Re: Costs for air ambulance providers

If you look at the per capita costs by province in the cbc link that AK posted, there's a huge difference in the volumes between the different sites. The 3 AB Helicopters are far busier than the two SK and single MB helicopter, which drives the net cost per capita down.

I'm not sure how useful the BCAS figures are, in that they include a lot of fixed wing and ground transports, which aren't included in the statistics from the other providers. There's also some difficulty in comparing the costs from the different service providers. There has to be some caution in making sure that you're comparing apples to apples, and that the same costs are included in each budget, otherwise the comparisons may be fairly meaningless.

Certainly STARS is more expensive on a per capita basis in MB versus the other province, if the figures in the CBC news article are correct. I suspect that the methodology may be a little suspect.

The question raised by the CBC, as to whether this money would be better invested in rural ground paramedics is very interesting. I don't know much about ALS in MB, besides that there are very few ALS providers, even in Winnipeg. Does anyone have opinions about this?

[Arctickat]

Does anyone have opinions about this?

I have many, however as an individual looking toward a career change into provincial politics this summer, I've probably already said too much in this thread and shouldn't have started it in the first place.

[island emt]

TREVOR : You a politician

Bwahahahahaha

[Arctickat]

I have been for a couple of years now buddy...Ahem...

His Worship Mayor Trevor Lowey

I know...it's probably an exercise in futility, I don't suffer fools lightly.

Edited March 23, 2014 by Arctickat

[island emt]

but you said Provincial wide.

Would that make you the potentate of Saskwatch land ???

Or the solicitor of Saskatoon????

Being the mayor / selectman in a small town is just something thats a rite of passage on the road to the asylum .