EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 1
Emergency Health Services provides Nova Scotians
with a high quality pre-hospital emergency care
system. EHS is pleased to be able to share its
activities, programs and accomplishments for
2002/03 in this report.
2 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
This report is dedicated to Denis Anctil. Denis is a
former pilot with EHS LifeFlight, who unfortunately
suffered a spinal cord injury in the summer of 2002.
Denis is one of the most dedicated and spirited of the
EHS team and in recognition of this and his many
contributions to EHS LifeFlight, the“Denis Award” has
been created. Each year, the Denis Award is given to a
member of EHS who demonstrates dedication and team
spirit. In 2002/03, the proud recipient is Tony Eden,
Director of Ground Ambulance Services.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 3
Dear Minister MacIsaac:
EHS proudly presents you with its third annual report… a report dedicated to a remarkable
EHS team member, Denis Anctil.
Denis, a Captain with EHS LifeFlight, personifies all that our emergency health system
values… a commitment to the highest standards of patient care and safety; team spirit;
courage; compassion and a belief in the value of human life.
Tragically, as the result of a fall, Denis will no longer fly his beloved helicopter; however, he
continues to inspire all of us. Thank you, Denis.
In recognizing Denis, I do not want to overlook the tremendous contribution other
individuals have made to our system over the past year. In particular, I want to acknowledge
the dedication and hard work of Chuck Porter and all the Communication/Dispatch staff in
obtaining the maximum three (3) year accreditation awarded by the National Academy of
Emergency Medical Dispatchers… one of only five (5) centres in Canada to achieve this
distinction. What makes that all the more remarkable is the fact that the Communication
Centre has only been in operation for six (6) years.
It should be noted that the 46 women and men who staff the Communication Centre and are
qualified paramedics have worked hard over the past year fielding 95,920 calls, 84,766 of
which resulted in ground ambulance transports; 588 in EHS LifeFlight (helicopter missions)
and 18,000 MFR responses. (See Appendix A for their names.)
An important part of every one of these calls, that largely goes unnoticed, is the interaction
between paramedics and medical oversight physicians. These physicians provide 24/7
coverage to paramedics in the field and are available to answer questions, give advice, or
accompany crew members on a mission if required. They are ably directed by Dr. Ed Cain,
EHS Medical Director, who works tirelessly to ensure the highest standard of patient care for
Nova Scotians. Thank you all. (See Appendix B for their names.)
And lastly, I would like to commend the work of the MFR Strategic Advisory Committee.
The contribution of committee members Bernie MacKinnon, Julia Stick, Wayne LeMoine,
Paula Poirier, Doug MacLean, Mike Eddy, Robert Cormier, John Craig, Ed Cain, Arnold
Rovers, Mike McKeage, and David Rippey, has led to the creation of a five year plan that
will see this enhancement to the EHS system flourish. This is one of the best examples of
what partnership and collaboration between a variety of public safety agencies, e.g., fire,
ambulance and communities, can create.
Senior Director, Emergency Health Services
4 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 5
1. Brief Overview ......................................... 3 EHS Ground Ambulance System ............................. 24
Communications Centre .............................................. 5 World Junior Hockey Championships ...................... 30
Ground Ambulance ..................................................... 5 Medical Oversight ..................................................... 30
Medical Oversight ....................................................... 5 EHS Provincial Programs ......................................... 40
EHS Provincial Programs ........................................... 6
5. Financial Summary ............................... 57
Financial Summary ..................................................... 8
Service Fees ................................................................ 58
2. What is EHS? ............................................ 9
Vision ........................................................................... 9
6. Contacts at EHS .................................. 60
Mission ........................................................................ 9
APPENDIX A.............................................. 61
Critical to Mission ....................................................... 9
EHS Communications Centre Staff .......................... 61
Strategic Directions: ................................................... 10
Background ................................................................ 10
APPENDIX B .............................................. 62
EHS Medical Oversight Physicians .......................... 62
3. System Wide Initiatives ..................... 12
EHS Research Consortium of Eastern Canada ....... 12
APPENDIX C .............................................. 63
EHS Service Inquiry Process .................................... 13
Members of the Medical First Response Strategic
Advisory Committee (as of April 2002) ................... 63
4. Programs .................................................. 17
Area of Service .......................................................... 17 APPENDIX D ............................................ 64
Paramedics ................................................................. 18 EHS Medical First Responders Agencies .................. 64
Communications Centre ............................................ 19
6 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 7
Emergency Health Services (EHS) is a division of the
Nova Scotia Department of Health. As a regulator, EHS
is responsible for the continual development,
implementation, monitoring and evaluation of pre-hospital
emergency health services in the province.
EHS integrates various pre-hospital services and programs
required to meet the needs of Nova Scotians across the
province. The main components are: 1) the EHS Communications Centre; 2) I must say how
the EHS ground ambulance system; 3) EHS LifeFlight; 4) the EHS Nova Scotia professional and
Trauma Program; 5) the EHS Atlantic Health Training and Simulation Centre; kind your team
and 6) the EHS Medical First Response program. In addition, all system were. I was on the
components are monitored by physicians specially trained in emergency and critical verge of breaking
care, otherwise known as Medical Oversight. down due to my
To enhance the care delivered by the EHS system, EHS utilizes a number of condition but your
partners and contractors. EHS has two main partners: the Izaak Walton Killam team took care of
(IWK) Health Centre and the Queen Elizabeth II (QEII) Health Sciences my emotions along
Centre. These partnership arrangements enhance the services and programs with the difficult
developed and delivered by the EHS Atlantic Health Training and Simulation task of caring for
Centre and the EHS NS Trauma Program, by providing networking opportunities my husband.
and logistical support.
EHS has found that partnerships with the private sector are beneficial in the Paramedics: Kevin Carey,
management and regulation of the pre-hospital system in Nova Scotia. For the
ground ambulance portion of EHS’ mandate, EHS has contracted the system
operations to Emergency Medical Care, Inc (EMC), a private company. EMC,
through this contractual agreement, has demonstrated its commitment to
excellence in delivering pre-hospital patient care by meeting and exceeding industry
8 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
standards in several areas such as: response time reliability and paramedic
progression. EHS LifeFlight, the provincial air medical transport
program, is managed by another contractor, Canadian Helicopters Ltd.
(CHL). CHL has established an exemplary safety record, providing
excellent service to Nova Scotians. By having contractors manage daily
operations of these services, EHS is able to focus on regulating the system,
integrating with other services and programs; and continuing to provide
strategic direction for the pre-hospital care system in Nova Scotia.
Figure 1.1 demonstrates the relationship between EHS and its main
contractors and partners.
DEPARTMENT OF HEALTH
Communications/ Ground Medical EHS Provincial
Dispatch Ambulance Services Oversight Programs
EHS Medical EHS Atlantic EHS NS EHS
First Response Health Training & Trauma LifeFlight
Program Simulation Centre Program
contractor: partner: partner: contractor:
Emergency QEII Health IWK Health Canadian
Medical Care Inc. Sciences Centre Centre Helicopters
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 9
1.1 Communications Centre
The EHS Emergency Medical Communications Centre is the vital link
that connects all of the province’s emergency health services. The Centre
monitors and dispatches EHS ground ambulances, EHS LifeFlight,
the Trauma Team Leaders and links with a growing number of EHS
Medical First Responders in the province.
In October 2002, the EHS Communications Centre received
accreditation from the National Academy of
Emergency Medical Dispatchers. To date, only five
centres in Canada have been successful in achieving
this accreditation. The standards that must be met,
to be accredited, are high and include: having an
established quality assurance program in place;
consistently auditing and evaluating calls coming into
the centre; and ensuring that a medical director
manages the centre’s clinical activities.
1.2 Ground Ambulance
EHS has a performance-based contract with Emergency Medical Care
Inc. (EMC) to deliver ground ambulance services within the province.
With more than 900 paramedics and 151 ambulances and support
vehicles, the EHS system provides high quality service in terms of clinical
care, response time reliability and financial efficiency.
In 2002/03, the EHS ground ambulance system responded to 94,120
calls, of which 84,766 (90.1%) resulted in transports. Of the total
responses, approximately 58% were emergency/urgent and
approximately 42% were transfers. In both urban and rural areas,
paramedics arrived in less than 9 minutes 69% of the time; between 9
and 16 minutes 20% of the time; between16 and 30 minutes for 9% of
calls; and paramedics arrived in greater than 30 minutes in 2% of calls.1
1.3 Medical Oversight
The Provincial Medical Director (PMD) has overall responsibility for
managing and directing the clinical activities of all EHS programs. The
Medical Director ensures that high quality medical care is delivered
to patients by paramedics in the pre-hospital setting through the
establishment of provincial medical policies, protocols and procedures
and regular audits of paramedic competency. 1
This latter category represents low
call volume/remote areas of the
10 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
The EHS PMD’s Office initiated and participated in a number of
research projects during 2002/03. These projects included studies on:
hypoglycemic patients and 12 Lead ECGs. The results of these studies
have had a positive impact on the delivery of patient care in Nova Scotia.
1.4 EHS Provincial Programs
EHS has several provincial programs consisting of: EHS LifeFlight,
the EHS Nova Scotia Trauma Program, the EHS Atlantic Health
Training and Simulation Centre, and the EHS Medical First Response
Program. These provincial programs comprise
some of EHS’ main components and through their
daily operations, integrate with all aspects of the
EHS LifeFlight provides a 24/7, rapid, safe, high
quality air medical transport service for adult,
pediatric, neonatal and obstetric patients. EHS
LifeFlight also provides its services to Prince Edward Island, on a regular
basis, and acts as a back-up to New Brunswick Air Care, when requested.
During the year 2002/03, EHS LifeFlight completed 588 missions (513
in Nova Scotia and 75 missions in other provinces). The majority of
the missions, (84%) were transports between two health care facilities.
Approximately 5% of patients were air transported directly from the
scene of injury or illness to the most appropriate health care facility.
EHS Nova Scotia Trauma Program
The role of the EHS Nova Scotia Trauma Program (EHS
NSTP) is to facilitate the provision of optimal trauma care
by providing leadership in injury prevention and control,
education, research and trauma system development.
In 2002/03, the EHS NSTP released the first “Provincial
Trauma Head Injury Guideline” poster. This poster was
developed for hospitals throughout the province to ensure
consistent, high quality care for trauma patients. The poster gives health
care professionals necessary information to ensure that patients who
require neurological care are identified early and receive rapid referral
and transport to a neurosurgical center.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 11
In May 2002, the EHS NSTP and the Dalhousie University
Department of Emergency Medicine released the Comprehensive Report
on Injury in NS. This report provided a clear picture of the magnitude
and extent of injury in NS and highlighted the fact that injury continues
to be a significant societal and health care challenge.
Once again, many
EHS Atlantic Health Training and thanks to the
Simulation Centre paramedics who
were very kind and
The EHS Atlantic Health Training and Simulation Centre (EHS professional. We
AHTSC) provides training and continuing education to health care sing their praises.
professionals; with an emphasis on developing critical thinking and Many thanks for
practical skills through hands-on patient care scenarios. being there.
The center provides a wide range of courses, from airway management
to crisis resource management to anesthesiology sessions. All courses Paramedics: Craig Deveau,
are delivered by expert personnel using sophisticated equipment, such Brad McLellan
as the METI® Human Patient Simulator and the Laerdal® SimMan
Since March 1999, almost 2500 health care professionals have
participated in courses at the centre, and in 2002/03, the centre hosted
680 participants. This in a slight increase over the previous year.
EHS Medical First Response
The EHS Medical First Response (MFR) Program is largely a volunteer,
rural-based program that serves as an enhancement to the patient care
provided by the EHS system. MFRs are Nova Scotians trained to
provide advanced first aid and perform initial patient assessments, which
are then communicated to the paramedics when they arrive on scene.
As of April 2003, there are 156 EHS approved MFR agencies in the
province offering four levels of service to residents of Nova Scotia. The
service levels differ in the types of calls responded to, not in the care
provided. These levels range from an agency that will respond to
situations in which a fire department would traditionally be dispatched,
e.g., a person trapped or a burning building, to an agency that will respond
to all emergency, medical and other, calls in its community.
In 2002/03, a Strategic Advisory Committee was established for the
MFR program. The development of this committee is a significant
improvement for the MFR program, as this committee will help to
improve the MFR program by developing: 1) a sustainable program
infrastructure; 2) a comprehensive training plan for all MFR personnel;
12 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
and 3) an appropriate sponsorship plan that allocates resources to the
areas in the provinces in which they are most needed.
1.5 Financial Summary
The financial resources used to support Nova Scotia’s pre-hospital system
come directly from the Nova Scotia Department of Health. EHS’ budget
for 2002/03 was $56.9 million dollars. This represents approximately
3% of the Department of Health budget for 2002/03.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 13
W H AT I S E H S ?
Emergency Health Services (EHS) is a division of
the Nova Scotia Department of Health. It is
responsible for the continual development,
implementation, monitoring and evaluation of pre-
hospital emergency health services in the province.
EHS is a centre of excellence known for highest quality, best cost,
sustainable emergency and mobile health care services.
EHS assures the uninterrupted provision of integrated, competent,
compassionate emergency and other mobile health care services to
communities we serve.
Critical to Mission
An integrated emergency health system.
A cadre of competent regulators, contractors, paramedics and other
EHS staff and volunteers.
A sustainable system.
A performance based, accountable system.
14 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EHS fulfills its mission by:
• ensuring the provision of quality care.
• setting the system’s strategic direction through
planning, policy development and standard setting.
• monitoring, evaluating and reporting on performance
• Continuously ensure the improvement of patient care.
• Integrate EHS with the health care system.
• Establish the legislative framework.
• Refine contract management/formulation processes.
• Strive for efficiency.
I would like to • Support the production of outcome driven research.
express my • Foster innovation.
thanks for the
care and • Incorporate quality improvement principles
professionalism throughout the system.
shown to my mom.
It is so Background
Before 1995, there were over 50 private and public ambulance operations
know that these
paramedics go providing emergency transport services in Nova Scotia. The system had
above and beyond inconsistencies in terms of medical care, levels of staff qualifications and
what they are the type and condition of ambulances. The type of care patients received
required to do. was dependent on where they resided in the province. During the early
An act of 1990’s, the focus of the Department of Health’s (DOH) activity centered
kindness goes a on the administration of the agreement between the Ambulance
long way to Operators’ Association of Nova Scotia and the DOH. This agreement
someone on a consisted primarily of claim evaluation and payment, but did not set
stretcher. out standards for response times nor did it establish the medical care
that was to be provided for patients with certain conditions. In addition,
Paramedics: Mike Zinc, the dispatch of ambulances was left to each individual ambulance
Ross Welton, Mark operator. This resulted in wide variations of service with the operators’
Walker, Rob Boudreau residential phone being used in some instances and a central
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 15
communication center being used in others. As well, the pre-1995 system
did not have a coordinated air medical transport component, training
and simulation centre, trauma program nor a medical first response
Modernization of the system began in 1994, when
the province’s ambulance system began its transition
from being primarily a transportation system to
a pre-hospital medical system. Since that time, the
EHS system in Nova Scotia has become an
internationally recognized leader in the provision
of pre-hospital care.
Over the past eight years, the system has undergone
significant transformation. First, a new fleet of
ambulances, with standards for maintenance and
equipment was developed. Second, the fleet is now
staffed by registered paramedics, able to provide
a wide variety of medications and perform life saving procedures. Third,
an air ambulance was added to transport some of the sickest babies;
mothers-to-be; children and adults to specialized tertiary care centers
in the province and airlifts patients from the scene of motor vehicle
collisions and other injuries to the most modern rooftop and community
helipads in Canada. As well, a trauma program was developed that now
provides leadership and resources to a comprehensive trauma system.
Educational resources and programs designed to keep paramedics,
nurses, physicians and other health care practitioners current and
knowledgeable are now widely available as well. Next, a training and
simulation centre was created; one that provides a variety of health
professionals with realistic and challenging educational opportunities
that sharpen skills, enhance knowledge and most importantly, improve
patient care. And, most recently a provincially coordinated medical first
response program was developed to enhance assistance and care provided
to patients in rural and urban communities prior to arrival of a paramedic,
16 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
3 S Y S T E M W I D E I N I T I AT I V E S
3.1 EHS Research Consortium of Eastern
Eastern Canada Canada
The EHS Research Consortium of Eastern Canada (ERCEC) held its
inaugural meeting on July 9, 2002. ERCEC has been designed to facilitate
and promote high quality, multi-disciplinary, EHS/EMS research through
information-sharing and linkages between EMS organizations throughout
Eastern Canada and other affiliated health care organizations.
Through this consortium ERCEC hopes to encourage all systems personnel,
especially paramedics, to initiate and participate in research. Paramedics
have a wealth of expertise and knowledge that greatly benefits EHS systems.
“Discovering the path This consortium will tap into that knowledge.
for EHS research in Another important goal of the consortium is to coordinate research efforts
Eastern Canada” in emergency health services systems in Eastern Canada. Through this
coordination, EHS is working collaboratively with other organizations, such
as the Dalhousie Division of EMS, the Mobile Health Services Quality Agency
in New Brunswick, Holland College in Prince Edward Island, as well as many
others. This coordination will enhance research capacity in EHS systems in Eastern
The EHS Research Consortium of Eastern Canada is a leader in high quality
Facilitate and promote high quality, multi-disciplinary EHS/EMS research through
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 17
information-sharing and linkages between EMS organizations throughout
Eastern Canada and other affiliated health care organizations.
ERCEC is organizing an EHS research conference
and workshop to be held in October, 2003. Well
known Canadian and American EHS researchers will
be present to address the current issues and hot topics
in the EHS field. This workshop will be an excellent
opportunity to build research knowledge and enhance
research skills. The conference will be of interest to
service providers, researchers, educators,
administrators, policy analysts, paramedics and other
EHS health care professionals.
3.2 EHS Service Inquiry
The Emergency Health Services System in Nova
Scotia is an evidence-based organization that relies on customer and
provider feedback to improve quality and enhance efficiencies.
This patient focused system requires a process for clients, providers and
system administrators to easily query all EHS programs and services to
ensure that they are meeting the clients’ needs. The EHS system has
implemented a Service Inquiry (SI) process, that provides those who come
in contact with the system, the opportunity to inquire as to processes,
protocols, response time, paramedic interaction, or other issues that the
client was unclear of, or not satisfied with. This process is designed to
be client-friendly with prompt and appropriate responses. Service inquiries
are viewed by EHS as an opportunity to drive system improvements and
efficiencies, enhance customer satisfaction and recognize the good work
done by system personnel.
In the SI process, all service inquiries are logged and categorized in order
to establish trends in customer satisfaction. SI forms are available on the
EHS website under Medical Communications, as well as through any
The province of Nova Scotia has
EHS office. been divided into four regions for the
purposes of monitoring and
In 2002/03, EHS received a total of 67 service inquiries. Figure 3.2.1 evaluating the performance of the
shows that the Eastern (Guysborough, Antigonish, Richmond, Inverness, EHS ground ambulance system.
Victoria and Cape Breton) and Western (Lunenburg, Queens, Shelburne,
Yarmouth, Digby, Annapolis and Kings) regions2 had more inquiries per
patient transports than the other two ground ambulance regions.
18 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
On behalf of
our family I
would like to
responded to a
call for my
father. It takes
a special kind
of person to do
the job you do.
is very much
appreciated. While the Central and Northern regions had more inquiries in total
that the other two regions, the number of inquiries in those regions
Paramedics: JP Belen,
are proportionate to their call volumes.
The Eastern and Western regions had lower numbers of patient
transports per service inquiry than the other two regions. Figure 3.2.2
illustrates that the Western region has the lowest rate with one service
inquiry for every 921 patient transports.
Ambulance Patient Transports
Region Per Service Inquiry
This suggests that the number of inquiries in the Western ground
ambulance region is disproportionate to the call volume in that area.
This can be seen in Figure 3.2.2.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 19
Source: EHS CAD
Inquiries are categorized by their nature and origin. There are various
reasons for making an inquiry, for example, a patient may want
information on the care they received.
Figure 3.2.2 is a summary of all inquiries received in 2002/03 categorized
by the nature of each inquiry.
*For example, Unit Assignment Issues. Source: EHS CAD
20 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
A number of individuals accessed the service inquiry process in 2002/
03. Figure 3.2.3 gives a summary of these individuals.
Source: EHS CAD
The service inquiry process is very useful in helping to identify potential
areas for improvement. In 2002/03, the majority of inquiries were
regarding delayed ground ambulance response for transfers and the
majority of inquiries were made by nurses. The EHS ground ambulance
system identified, from this data, a need for improvement in its
performance relating to non-emergency transfer response times. To
remedy this situation, the ground ambulance contractor now has a
dedicated Provincial Transfer Coordinator. This person will be
responsible for identifying issues and making recommendations as to
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 21
EHS integrates various pre-hospital services and programs into one system
to meet the needs of Nova Scotians. This system is designed to provide a quality
service at a sustainable cost. Emergency Health Services Nova Scotia is comprised
of: (1) the EHS Communication Center; (2) the EHS ground ambulance
system; (3) Medical Oversight; (4) EHS LifeFlight; (5) the EHS Nova Scotia
Trauma Program; (6) the EHS Atlantic Health Training
and Simulation Center; and (7) the EHS Medical
First Response Program.
4.1 Area of Service
For the purposes of monitoring
and evaluating the performance of
the EHS ground ambulance
system, the province of Nova
Scotia has been divided into four
Ambulance Region Counties District
Central Region Halifax and Hants West 9
Eastern Region Guysborough,Antigonish, Richmond,
Inverness, Victoria and Cape Breton 7&8
Northern Region East Hants, Colchester,
Cumberland and Pictou 4, 5 & 6
Western Region Lunenburg, Queens, Shelburne,
Yarmouth, Digby, Annapolis and Kings 1, 2 & 3
22 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
Under the licensure of the EHS Medical Director, paramedics in Nova Scotia are
able to perform certain designated medical procedures. The scope of practice however,
depends on the level of paramedic training. There are four classifications of paramedics
in the EHS ground ambulance system: (1) Primary Care
Paramedics, (2) Intermediate Care Paramedics, (3)
Advanced Care Paramedics and (4) Critical Care
Primary Care Paramedics (PCP) are trained to perform
basic patient care and automated external defibrillation,
administer symptom relief medications, maintain
peripheral intravenous locks or infusions, calculate,
monitor and adjust flow rates, and recognize and manage
complications of intravenous catheters and infusions.
Intermediate Care Paramedics (ICP), in addition to the
competencies of the PCPs, perform the following:
advanced airway management including endotracheal
intubation, initiation of intravenous therapy, and the
administration of specific emergency drugs.
Besides having the essential competencies of PCPs and
ICPs, Advanced Care Paramedics (ACP) can initiate and
maintain intravenous therapy including intraosseous
I want to access, perform cardioversion, manual defibrillation and external pacing, and administer
thank the a wider range of medications.
team of Critical Care Paramedics have the essential competencies of PCPs, ICPs and ACPs
professional as well as the training to: prepare for and transport patients via EHS LifeFlight;
paramedics perform rapid sequence intubation; insert chest needle decompression catheter and
who came to heimlach valve; and administer a wider range of medications as per EHS Provincial
my aid. I Protocols and Policies.
felt safe and In April 2003, over 900 paramedics and emergency medical dispatchers were registered
so well as active in Nova Scotia. Of these, there are over 600 full-time paramedics working
looked in the EHS ground ambulance system. The remainder function in a variety of roles,
after. They e.g. EHS LifeFlight, the EHS AHTSC, or they are working as casual employees.
are a credit
to their In 2002/03, EHS distributed “EHS Response Times”, a newsletter used to communicate
profession. system activities with paramedics in the province. In this newsletter there are updates
from each program and service area in the province as well as general system updates.
Paramedics: Glenn This newsletter has been well received and is a useful medium for interaction with
Knot, Chris Renaud paramedics. Copies of each edition are mailed directly to all paramedics in the province
and are also located on the EHS website.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 23
4.3 Communications Centre
The EHS Emergency Medical Communications Centre is a vital link
connecting all of the province’s emergency health services. This centre monitors
and dispatches all EHS ground ambulances, EHS LifeFlight,
Trauma Team Leaders, and a growing number of Medical
First Responders in the province. The EHS
Communications Centre offers a single point of contact for
requests, assignment, and following of all ground and air
ambulance transportation in the province of Nova Scotia.
Approximately 140 ground ambulances and one rotary wing
aircraft are dedicated to meeting the direct patient care needs
of Nova Scotia’s citizens. For 2002/03, this resulted in close
to 96,000 requests for ground service with over 84,000
transports (see table 4.3.1), and almost 900 requests for air service with just
under 600 transports.
CALL VOLUME ANALYSIS
2000 / 2001 2001/2002 2002/2003
REGION Calls Responses Transports Calls Responses Transports Calls Responses Transports
Central 26,160 25,178 20,705 25,896 25,259 20,765 26,014 25,359 20,462
Eastern 28,207 27,594 26,238 28,078 27,705 26,350 25,508 25,067 23,488
Northern 17,387 16,994 15,887 16,857 16,595 15,566 21,086 20,772 19,639
Western 22,993 22,487 20,915 23,575 23,192 21,492 23,312 22,922 21,177
Total 94,747 92,253 83,745 94,406 92,751 84,173 95,920 94,120 84,766
Call: Any request for ambulance service to which an ambulance is assigned Source: EHS CAD
Response: Any call to which an ambulance arrives at scene
Transport: Any response that results in a patient transport to an approved health care facility
24 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
The EHS Communications Centre is responsible for receiving and
processing all emergency and non-emergency requests for ambulance
transportation received through the provincial enhanced 911 service,
dedicated provincial 1-800 lines, and designated inter-facility telephone
and fax lines.
Accredited Centre of Excellence
In October 2002, the EHS Communications Centre was deemed an
Accredited Centre of Excellence by the National Academy of Emergency
Medical Dispatchers (NAEMD). The
centre exceeded all required standards for
Upon receiving accreditation as a Centre of accreditation to become the 5th accredited
Excellence from the National Academy of centre in Canada and the 73rd in the world.
Emergency Medical Dispatchers, the EHS The centre was given the maximum
Communications Centre had a visit from Anne allowable 3 year accreditation.
MacLellan, Federal Minister of Health.
To be accredited by NAEMD, a centre has
Minister MacLellan toured the facility, met
to meet twenty key performance standards.
with a few of the communications officers and
Once accredited, a center must submit a
was introduced to the highly specialized
record of its call-taking performance to
equipment in the centre. She was also able to
NAEMD for review every six months. This
listen to a taped emergency call, in which a
review is to ensure the centre is continuing
communications officer helped rescue a
to meet the required performance standards
choking child by giving the mother medical
to maintain this accreditation standing.
advice over the phone. EHS would like to
thank Minister MacLellan for visiting the Some of the standards included in the
centre, as her visit helps to recognize the twenty points of accreditation are: the
important work that the communications appointment and involvement of a Medical
officers do on a daily basis. Director; consistent case evaluations; and the
implementation of a Continuing Dispatcher
EHS would like to congratulate everyone involved in this accreditation
process. This accreditation recognizes the many improvements that
have been made in emergency health services in Nova Scotia in the past
few years. The names of the dedicated individuals who work in the
EHS Communications Centre can be found in Appendix A.
A detailed listing of the twenty key
performance standards can be viewed
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 25
EHS COMMUNICATIONS CENTRE
The centre, in addition to its primary role as a ACCREDITATION VIDEO
command and control centre for all EHS ground
ambulances, also acts as the access point playing a In celebration of this remarkable
coordinator role, for a number of provincial achievement, a video of the EHS
programs; including: Communications Centre was created.
This video showcases everyone involved
EHS LifeFlight in the accreditation process and is
In 2002/03, the EHS Communications Centre accompanied by a song, recorded by
implemented flight following software as part of its Jamie Cooper, a communications officer
operations for EHS LifeFlight, and in February in the centre. This video was developed
2003, added a dedicated Air Medical Transport to recognize the hard work and
dispatcher between the hours of 0700-2300 daily. dedication of everyone involved in this
Flight following in the EHS Communications process. Anyone interested in a copy
Centre refers to the centre’s ability to monitor all of this video may contact Chuck Porter
EHS LifeFlight missions, whether by rotary or fixed at the EHS Communications Center (902)
wing. Throughout a mission, the flight following 832-0861.
system tracks the flight path of the aircraft, tracking
variables, such as altitude, airspeed, departure
location, destination location, heading and estimated time of arrival.
The center tracks all EHS LifeFlight missions with position report
updates every two minutes. A sample version of this software is located
in the EHS LifeFlight section of the EHS website. The web version
tracks the approximate position of the EHS LifeFlight helicopter, with
updates every five minutes.
On-line Medical Control
The EHS Communications Centre facilitates contact between field
paramedics and medical control physicians for treatment orders, advice,
and assistance. The Medical Control Program provides paramedics
with expert assistance twenty-four hours a day, seven days per week
anywhere in the province.
EHS Medical First Response
Through the work of the EHS Medical Director, EHS approved MFR
agencies are now dispatched according to certain medical determinants.
The Medical Director made these determinations by reviewing each
of the medical complaints in the Advanced Medical Priority Dispatch
System and analysing the level of care required for each of these potential
conditions. This has helped to effectively manage call volumes for MFR
agencies in the province and is assisting the EHS system in providing
optimal care to patients.
26 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
Tools and Technology
In order to effectively communicate throughout the EHS system, the
Communications Centre uses the following technologies:
Computer Aided Dispatch (CAD) System
The CAD system allows the Communications Centre to
manage the entire fleet of ambulances and resources to best
suit demand in the field. The CAD system acts as a reference
for all incidents and provides a master incident number
(MIN) for each request for service. This MIN is used for
tracking and audit purposes.
The CAD system utilized in the EHS Communications
Centre is a Tri-Tech Software CAD System called“VisiCad
Command”, which is upgraded periodically by the vendor Tri-Tech, based on
need and user demand.
VisiCad Command is an award winning Windows-based Computer Aided
(CAD) software solution, which has been tailored to meet the needs of the pre-
hospital system in Nova Scotia. This software allows the Communications Centre
staff to efficiently and effectively manage the demand for ground and air ambulance
services in the provinces.
VisiCad Command integrates seamlessly with Medical Priority Dispatch
Software (ProQA), which triages patients via telephone and provides the
communications officers with the appropriate information they need to instruct
callers to perform lifesaving skills directly over the telephone, while awaiting
In February 2003, as part of regular equipment maintenance, the Dictaphone
Voice Recording System was upgraded from Dictaphone’s ProLog system to
the Freedom FT platform.
The Freedom FT platform reduces time spent searching for recorded information
by using newer, faster access storage technologies and software. This new
technology also minimizes human intervention and potentially reduces human
error in the tape archiving process.
The Public Safety Radio System
The Trunked Mobile Radio (TMR) network forms the basis of radio
communications between the EHS Communications Centre, paramedics in the
field and other public safety organizations, such as police and fire. This province-
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 27
wide radio network is the primary communications medium for the
The EHS Communications Centre consists of 12 positions utilizing
Motorola Centracom Gold Elite Consoles with twelve local workstations,
and one remote workstation for emergency/disaster operations. EHS
also has a Back-Up site location that operates remotely from the primary
site. The back-up facility provides EHS with a secondary facility in the I would like you to
event of a catastrophic event occurring directly in or near the primary know that I was
site. treated with the
utmost of kindness
In the field, there is one mobile radio wired into each ambulance and
and respect, it
each paramedic team has one portable radio.
couldn’t have been
any better. Thank
In-vehicle Computers and Digital Mapping
you for your
Civic address mapping for all regions of Nova Scotia is essential for
concern and keep up
public safety organizations such as the Emergency Measures the good work.
Organization, 911, RCMP, municipalities, Department of
Transportation, and many others. The EHS system also utilizes civic Paramedics: Dennis
address mapping to locate patients and to allocate ambulances to Devereaux, Duane Cameran
efficiently service patient demand.
To assist paramedics in the field, the EHS ambulance fleet is equipped
with Motorola MW520 workstations, which are portable computer
devices. These workstations are integrated with the Nova Scotia digital
map and the AvelTech / Trimble Global Positioning System application.
These tools allow field paramedics to accurately geo-locate their position
relative to the location of an emergency and thus respond more efficiently
to each call.
Over the past three years, ongoing changes from population trends in
our province, have resulted in both inaccurate and outdated civic address
mapping details. To remedy this situation, EHS and EMC are working
together to develop an enhanced provincial civic address map. This
map will increase the accuracy of civic address mapping for paramedics
and Communication Centre Dispatchers and will improve their ability
to locate patients in the province more efficiently.
In 2004/05, the EHS Communications Centre will be moving to a new
facility. To ensure there are no interruptions in patient care delivered
by the centre during this move, in 2003/04 the Back-Up site will be
regularly tested for functionality so that it may be used for operations,
as part of the move process.
28 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
4.4 EHS Ground Ambulance System
The EHS Ground Ambulance system is regulated by the Nova Scotia
Department of Health and managed by the private company, Emergency
Medical Care, Inc. (EMC). This performance-based, contract with EMC
includes standards for consistent quality and cost of service throughout the
province. The contract identifies the performance expected in three main
areas: clinical care, response time reliability and financial efficiencies. There
are other performance standards in place such as, fleet/equipment
maintenance as well as ensuring timely reporting and accountability to EHS.
The ground ambulance system employs a variety of
resources to ensure an efficient and effective response to
all calls. The system is fluid, deploying its resources, in
various ways, by time of day and day of week to ensure
that patients needs are met. This may be as simple as an
inter-facility transfer using an EHS Patient Transport Unit
(PTU), or as complex as a large coordinated response to
a disaster situation, requiring the full mobilization of
resources, including: ambulances, supervisors, disaster
resources/supplies, and the EHS Medical Command
Center (MCC). Together, the EHS ground ambulance
system works with other health and public safety team
members to support high levels of public safety within the province.
In 2002/03, a long-term facilities plan was developed and implemented; a
plan to ensure appropriate facilities are in place to support the system status
plan. Within this plan, facilities are strategically located in communities
throughout the province to house paramedics as they prepare to respond
to calls and provide access to back-up supplies. The goal of this plan is to
ensure that staff, vehicles and equipment are all ready and available for service
in a timely and efficient manner.
In 2002/03, paramedic bases were relocated or replaced by the ground
ambulance contractor, EMC in the following six communities:
••• Tantallon ••• Berwick
••• Guysborough ••• Margaree
••• Chester ••• Kentville
Many thanks to all those involved: the paramedics, supervisors and managers
for their support and patience in the development and implementation of
this facilities plan.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 29
The Fitch Report—An External Audit
In the Fall of 2001, a comprehensive audit of the EHS Ground
Ambulance system was performed by the consulting firm, Fitch and
Associates, called the “Fitch Report”. The authors of this report recognized
EHS as being a Canadian leader in pre-hospital ground ambulance
service and one of the top ten percent of systems in North America.
The report states that the ground ambulance service in Nova Scotia
has vastly improved since EHS was created in 1995. Citing improved
patient care as an example, the report states that, prior to the
amalgamation of the multiple ambulance providers, the level of service,
the responsiveness of service and the quality of care was dependent upon
patient location. The report states that, after the amalgamation this
was not the case:
Currently, the province enjoys high levels of consistency and We never know
equity for its citizens and visitors. The EHS system’s the importance of
ambulances are distributed throughout the province delivering your job until we
reliable response times to those who need emergency care. need you. Thank
you for your
Another example of system improvement is seen in the use of technology prompt and
within EHS. Technologies from: the installation of a state-of-the-art excellent care.
We know it made a
computer aided dispatch (CAD) system to manage the deployment
of the fleet; to the installation of satellite locators and onboard electronic
maps to aid paramedics in finding patient locations. Paramedics: Jason Hawley,
As part of the audit process, Fitch also identified areas requiring Reggie Currie
improvement within the EHS system. Since this audit, EHS and EMC
have been working together on these areas for improvement. An example
of this is in relation to“on-time performance” for transfer calls. In response
to the Fitch report, EHS has developed clearly articulated response time
standards for scheduled and unscheduled transfers in the province. EMC
will begin to report their performance in relation to these standards
30 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
System Vehicle Design
In 2002/03, EHS undertook a review of the vehicle design to ensure
that the ground ambulances best meet the needs of patients and
paramedics. Through a series of meetings and focus groups held
throughout the province with paramedics, fleet technicians, users of the
ambulances, e.g., paramedics, and patients, a series of improvements were
recommended. These recommendations included:
••• An enhanced lighting system using a LED (Light
Emitting Doides) system
••• Improved heating and cooling of the patient area
••• Improvements to the siren warning system
••• Introduction of a “Mini-Mod” ambulance. This new
style of ambulance is a type III chassis, with a smaller
modular box than has traditionally been used by EHS.
While feedback from the paramedics and fleet technicians has been very
favourable in relation to these changes, the EHS system will continue
to explore other options for improving patient care and system
performance within the vehicle design.
The EHS Ground Ambulance system uses Systems Status Planning
(SSP) to match demand for service with the appropriate response
resources. This allows for effective and efficient use of resources in the
system. SSP also enhances response time performance, as through SSP,
paramedics are strategically placed throughout the province in such a
way as to best meet demands for service. For example, they are located
in an areas identified as being a higher demand area for that particular
time of day or day of week. The results of this SSP is an efficient and
timely response, which is known to increase the chance of a positive
outcome in an emergency.
EHS has defined minimum standards for response time reliability.
Response time is the“actual elapsed time between when a call is received
at the EHS Communications Centre and the actual arrival of the
ambulance at the location”. By setting these standards and evaluating
compliance with them, EHS offers an effective emergency service to
Nova Scotians. Figure 4.4.3 shows the response times for emergency
calls for the entire province (urban and rural areas) during the year 2002/
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 31
Response time: The actual elapsed time (in minutes and seconds) Source: EHS CAD
between when the call is received at the EHS Communications Centre and
the actual arrival of an ambulance at that location
One way to determine the skills and equipment that paramedics require to
do their job efficiently is to identify the most frequently requested types of
emergency services. Figure 4.4.4 illustrates the “Top Ten” chief complaints
received for the year 2002/03, as a percentage of total calls received.
Source: EHS CAD
32 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EHS utilizes 151 vehicles, consisting of: ambulances and system support
vehicles to deliver service to Nova Scotians. Of these, 140 are used for
the direct delivery of patient care and transportation, three are used
for supervision, and the remaining are used for various purposes,
including: education, disasters and in providing support to paramedics
and ambulances in the field.
FLEET COMPOSITION – GROUND AMBULANCE
Vehicle Type 2001/02 2002/03
Ambulance type II 114 117
Ambulance type III 13 20
Patient Transport Unit (Type III) 3 3
Paramedic Supervisor 4 3
Fleet Support 4 4
Medical Command Center 1 1
Mobile Training and Simulation 1 1
Administrative 3 2
Source: EHS Director of Ground Ambulance Services .
As part of the commitment to delivery of safe patient care and provision
of a safe work environment for paramedics and fleet technicians, EHS
continues to replace ambulances on a regular basis, through lease
agreements, before they can provide significant safety risk to patients
or providers. During 2002/03, a total of 33 ambulances were replaced
at the end of their 36 month lease period.
And as part of the commitment to government and the taxpayers of
Nova Scotia to deliver emergency health services efficiently, EHS
continues to look at ways to reduce costs. As a result, a study is currently
underway to measure the risk and financial impact of using EHS
ambulances beyond the current 36 month lease period, as well as
extending the kilometers traveled over this same period of time. This
data will provide the evidence needed to maintain or revise replacement
schedules in the future. In order to evaluate the most appropriate life
of an EHS ambulance, during 2002/03, a total of 5 ambulance leases
were extended for 4 additional months and additional kilometers. These
5 vehicles were replaced with new ambulances at the end of the evaluation
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 33
period for a total of 38 ambulance replacements during this past year.
Table 4.4.2 illustrates the age of the ambulance vehicles in the system,
over a two year time period.
THE AGE OF THE FLEET*
Less than 1 year 52% 28%
Between 1 and 2 years 23% 41%
Between 2 and 3 years 25% 31%
*as of April 2003 Source: EHS Director of Ground Ambulance Services
All EHS ambulances are identically equipped to support the delivery
of patient care provided by paramedics. Every ambulance includes all
necessary primary and advanced care equipment, such as: LifePak 12
monitor/defibrillators; advanced airway management
tools; and advanced telecommunications equipment.
THE FLEET INSPECTION PROGRAM
The primary goal of the Fleet Inspection Program is
to measure and assist the ground ambulance contractor
with a pro-active, preventative maintenance schedule
which identifies potential issues or component failures prior to these
actually occurring. This program also facilitates collaboration on the
development of high standards for maintenance and vehicle
specifications, therefore, assuring the uninterrupted access to reliable
emergency vehicles to communities in Nova Scotia.
In 2002/03, the EHS Provincial Fleet Inspector completed 173
inspections. Of these, 124 vehicles inspected were in full compliance
with vehicle maintenance standards, 46 had minor deficiencies and 3
vehicles had critical failures, resulting in them being taken out of service.
These inspections indicate a gradual but steady decrease in the number
of deficiencies. The results of these inspections are used to enhance
preventative maintenance practices and schedules.
34 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
In 2003/04, EHS ground ambulance services
will continue to work on the redesign of the
Type II ambulances in the provinces. This
redesign is anticipated to better meet the needs
of patients and EHS system personnel.
4.5 Medical Oversight
The EHS Provincial Medical Director (PMD)
has the overall responsibility for managing and
World Junior Hockey directing the clinical activities of all EHS
Championships programs. Essentially, the PMD ensures the
In December and January 2002, Nova
quality of medical care received by patients in
Scotia hosted the World Junior Hockey
emergency pre-hospital settings.
Championships (WJHC). Paramedics Medical oversight can be divided into three
throughout the province came to Halifax areas:
and Sydney to volunteer their time to
1. Prospective - this involves such
provide medical assistance at this event.
aspects as education, registration, re-
EHS would like to thank each of the
registration, equipment and protocol
paramedics who took time out of their
busy holiday schedules to volunteer at this
event. 2. Concurrent or Immediate - this
involves “off line” - the provision of
written policies and protocols and“on
line” - the availability of physician
advice in real time.
3. Retrospective - this involves a continuous quality improvement
program that strives to improve patient care and outcomes.
Out-of-Hospital Cardiac Arrest
The main clinical outcome measure for most EHS systems is cardiac
arrest. During 2002, 589 cardiac arrest patients had resuscitations
initiated in the field. Figure 4.5.1 presents the Out-of-Hospital Cardiac
Arrest survival rates for Nova Scotia for the years 1998-2002.4
Survival is defined as a patient being
discharged from hospital neurologically
intact after having an out-of-hospital
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 35
Year Resuscitation Cardiac Arrest Bystander VF/VT Survived to
Attempted Etiology Witnessed CPR Discharge
1998 492 438 (89.0%) 207 (47.3%) 139 (13.7%) 128 (29.2%) 12 (2.7%)
1999 558 495 (88.7%) 270 (54.5%) 176 (35.6%) 159 (32.1%) 27 (5.5%)
2000 574 506 (88.2%) 274 (54.2%) 177 (35.0%) 165 (32.6%) 35 (6.9%)
2001 697 590 (84.6%) 293 (49.7%) 210 (35.6%) 158 (26.8%) 31 (5.3%)
2002 589 475 (80.6%) 260 (54.7%) 152 (32.0%) 135 (28.4%) 30 (6.3%)
The improvement in survival to discharge from 2.7% in 1998 to 6.3%
in 2002 is a result of significant improvements in the EHS system, such
as: the introduction of evidence-based medical policies and protocols
and advanced medical equipment and communications. A survival rate
of 6.3% is higher than the rate in 2000/01, and is within the range of
normal statistical variation that will be seen from year to year. The low
percentage of patients receiving bystander CPR continues to be a
36 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
Mutual Recognition Agreement
In 2002/03, Nova Scotia co-signed the Mutual Recognition Agreement
(MRA), which was spearheaded by the Paramedic Association of
Canada (PAC) and Human Resources Development Canada. This
agreement provides the basis for consistency in the categorization of
paramedics, as all provinces will be using the National Occupational
Competency Profiles. In this agreement provinces agreed to use the
National Occupational Competency Profiles as the comparison tool
for evaluating paramedics from another province for registration.
Provinces also agreed not to place any barriers to registration on
paramedics currently registered in another province. Provinces still have
the right to require paramedics who are missing specific competencies
at a certain registration level to attain these competencies before the
province will register them at that level. PAC will provide paramedics
with information regarding which educational institutions are able to
assist them achieve specified competencies.
Long and Brier Islands—Paramedic
Excess Capacity Project Evaluation
The Long and Brier Islands paramedic excess capacity project is a joint
venture between the Department of Health, EHS, EMC, Inc., the
community of Long and Brier, the Dalhousie School of Nursing and
Kim made at least
the South West Nova District Health Authority. This project, which
four home visits to
has been in existence since September 2000, aims to improve access
check on me,
to medical care in the community of Long and Brier and to make better
I needed, and gave use of down time of paramedics, without jeopardizing emergency
me the support I response time performance. Evaluation results to date indicate that
needed. I am feeling project goals are being met.
better now and This past year saw the beginning of Phase III for this project, with the
many thanks to Kim addition of a Nurse Practitioner working in a collaborative agreement
who is qualified and with a local family physician. This addition has expanded the range
generally a great of medical services available on the Islands. Table 4.5.3 illustrates the
person. Thanks to increasing numbers of patients being seen by the clinic, with a month-
Paula also who was to-month increase since February. This will continue to be monitored
always very pleasant over the next year.
and always got me
when I needed it.
Kim LaMarche and
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 37
Month Number of patients Percentage
received medical increase
February 145 -
March 181 25%
April 212 17%
The project also welcomed the addition of a project coordinator in 2002/
03. The coordinator provides assistance to the paramedics and helps
to enhance communication and collaboration of the health care team
involved in the project. EHS has received very positive feedback regarding
this project from residents of Long & Brier.
The collaborative health research study, regarding the Long and Brier
project, that began in 2002 will continue into 2003/04. The purpose
of this study is to evaluate the impact of this innovative collaborative
practice model. This study is a joint effort between EHS and the
Dalhousie School of Nursing.
Provincial Medical Director Research
In 2002/03, the Provincial Medical Director initiated and participated
in several research projects. These studies are briefly outlined in the
Industrial Cape Breton 12 Lead ECG Project Study
This study was conducted in the Industrial Cape Breton area of Nova
Scotia over a six (6) month period. The project was an evaluation on
the use of pre hospital 12 Lead ECGs on patients with non traumatic
chest pains and examined feasibility of performing 12 Lead ECGs and
measured the effects on (1) scene time, (2) the door to needle interval
and (3) mortality.
38 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
Challenges The most frequent problems
encountered by paramedics
in trying to attain a 12 lead
ECG were attributed to the
Participants Conclusions Eighty-six (86%) of
paramedics and the majority
of the nurses and physicians
felt that attaining the pre-
hospital 12 lead ECG should
continue and become a
standard for EHS.
Conclusion Though the numbers were
small, in this particular study,
the trend and magnitude of
the decrease in the door-to-
needle interval is in keeping
with relevant literature. This
decreasing time interval
should translate into
improved patient outcomes,
such as decreased morbidity
in heart attack patients.
This study was conducted in the Halifax Regional Municipality in Nova
Scotia during 2001 and has been accepted for publication in the Pre-
hospital Emergency Care Journal. The purpose of this study was two
fold: (1) to determine the outcomes of patients treated and not
transported for hypoglycemia; and (2) to identify non-transport criteria.
No significant difference
between patients transported
and not transported During the study period,
there were 220 calls for adult
patients with hypoglycemia.
Of the 75 calls that resulted
in transports, there were a
total of 17 repeat
requiring a call for an
ambulance (22.7%) and 3
recurrences (4%). Of the 145
calls that did not result in
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 39
transport, 40 repeat episodes
of hypoglycemia (27.6%) and
3 recurrences (2 %) were
reported. These differences
were not statistically
significant (p=0.43 and 0.33
Recurrence rates similar
to other studies The overall recurrence rate
was 2.7% for the 220 calls. Of
the 47 calls entered in the
study, there were 7 repeat
calls for hypoglycemia (15%)
and 1 recurrence (2.1%).
These numbers are I wish to say
comparable to other studies ‘thanks’ to the
that have looked at this (4%
for transported patients and
6 – 9% for non transported provided
patients). professional and
No significant difference in to my daughter.
It is very
hypoglycemic episodes There was no statistically
significant difference in the
intervals between know that
hypoglycemic episodes for paramedics like
patients transported (51.1 these are
days +/- 65) compared to available
patients not transported for
their previous hypoglycemic
episode (40.7 days +/- 53.5) needed.
Of the 220 calls there were 61 (27.7%) calls were for patients over 65 Frampton, Steve Baker
yrs. Of these 37 (60.6%) were transported. This is much higher than
the percentage of the total population that was transported (34%). This
may reflect the paramedics’ heightened concern for this group or it may
be that this age group may rarely refuse transport. Of the 37 patients
transported, 6 (16%) had another episode of hypoglycemia during the
study period. Of the 24 patients not transported, 2 (8%) had another
episode. The reversal of these two percentages from the percentages
seen in the general population may reflect selection bias on behalf of
Neither a higher incidence of repeat hypoglycemic episodes nor an
increased recurrence of hypoglycemia in the over 65 population was
40 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
Repeat episodes of hypoglycemia are common, however recurrences within
48 hours are not. Admission to hospital is rarely required. There appears
to be no difference in the incidence of recurrences and repeat episodes
of hypoglycemia between transported and non-transported patients,
regardless of age. Given the high incidence of repeat episodes, paramedics
and physicians need to emphasize the importance of follow-up.
The results of this study may eventually lead to the development of a
‘treat and release’ policy for patients who are insulin dependent and have
Continuous Positive Airway Pressure (CPAP) Study
This study will continue in the Halifax Regional Municipality into 2003/
04. The purpose of this study is to determine whether pre-hospital
application of Non-invasive Positive Pressure Ventilation (NPPV) to
patients with Acute Respiratory Failure (ARF) reduces the need for
subsequent pre-hospital or in-hospital intubation. Secondary objectives
are to assess the impact of pre-hospital NPPV on Intensive Care Unit
admission rates, length of stay in hospital and survival. Patients will
be enrolled prospectively and randomized to receive either the current
standard of care or the standard of care plus NPPV. To detect a
significant difference in the proportion of patients in each group requiring
intubation, approximately 40 patients will be required to be entered into
The 2001 Medical Quality Performance Measure Report noted that
paramedics in Nova Scotia were able to intubate 75% of non-arrested
patients. Lacking in this report was the knowledge of the outcomes
of patients that could not be intubated. Information is required
regarding: (1) whether paramedics were able to oxygenate/ventilate these
patients, and (2) if these patients intubated in the Emergency
Departments, and if so, by what means and by who? To help determine
these outcomes an Airway Registry was developed in 2002. Since its
establishment it has been revised based on the National Association
of EMS Physicians’ Guidelines for Uniform Reporting of Pre-hospital
Airway Management. The first reports from this registry should be
available by the fall of 2003.
Evidenced Based Protocols
\h \r 1The updating of the Evidenced Based Protocols used by EHS
continues under the leadership of Dr. David Petrie and his assistant,
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 41
Ms. Corrine Burke, Division of EMS, Department of Emergency
Medicine at Dalhousie University. The following list of physicians also
act as section editors for updating these protocols:
Dr. Jeff Barnard, Dr. Edward Cain, Dr. George Kovacs, Dr. David Petrie,
Dr. John Ross, Dr. Chris Soder, Dr. John Tallon, Dr. Brett Taylor, Dr.
Andrew Travers, Dr. Natalie Yanchar
Provincial Advanced Care Paramedic (ACP) Exam
Paramedics applying for Advanced Care Paramedic (ACP) registration
in Nova Scotia, who have not graduated from a Canadian Medical
Association (CMA) accredited or EHS approved program must
successfully complete a Provincial ACP exam before registering for
employment. This exam combines the Dalhousie standardized patient
program at the Learning and Resource Centre with the EHS Atlantic
Health Training and Simulation Centre. The scenarios and their
evaluations are the result of a process called Angoffing by a group of experts
(EHS ACPs). Essentially, the group decides on a pass mark, critical actions
and the global rating scale used on each practical testing scenarios. Under
the guidance of Robert MacKinley, a third provincial ACP exam was
held during Spring 2003. The EHS Provincial Medical Director would
like to acknowledge the time, effort and expertise of all persons involved
with the ACP exam:
Robert MacKinley, Steve Baker, Leon Bootland, Thomas Borden, Gilles
Boudreau, George Carragher, Glenn Etsell, Ritchie Gilby, Bill Hill, Dale
Langille and Peter Simard, Brent Nicholson, Darryl Bardua, Mark
Wheatley, Phil Stewart, Chris Field, Tom Dobson, Derek LeBlanc, Linda
Mosher and Susan Love.
Continuous Quality Improvement (CQI)
The CQI process for the EHS ground ambulance system continues to
evolve, as there is more and more involvement of the Quality Control
Medics (QCM) and the Learning Department of EMC, Inc., as well as
more collaboration between QCMs, Medical Oversight Physicians
(MOP) and paramedic supervisors. The Medical Quality Performance
Measure Report continues to show excellent results for protocol compliance,
scene time, assessment and documentation as well as endotracheal
intubation and IV attainment.
For EHS, QCMs are an important component of the continuous quality
improvement process. QCMs are responsible for auditing patient care
reports. QCMs audit the following calls:
42 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
••• all calls where the patient is less than 16 years of age,
••• all advanced life support calls,
••• all calls where there is patient contact but no patient
is transported, and
••• a random sample of 10% of the remainder of calls.
The information gathered from these audits is used to continually
improve medical quality standards and care. In 2002, 29,770 audits were
performed. These audits provide reports that are the basis for the
evaluation of patient care in reference to targeted performance indicators.
The primary report is the Medical Quality Performance Measure Report
that measures how well the system is performing, from a clinical
During 2002/03, paramedics in the EHS system participated in a
number of educational sessions. These sessions covered:
••• vascular access devices,
••• Patient Care Report updates,
••• compliance reviews,
••• refusal policy review,
••• an airway review including practice,
••• nasogastric and other tubes monitoring,
••• pediatric scenario reviews,
••• Dopamine review for ACPs,
••• a Canadian Triage and Acuity Scale (CTAS) update
••• the introduction of the intubating bougie for
Intermediate Care Paramedics.
Also, a four hour program called Communicating Best Practices was
introduced in 2002.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 43
With the help of members of the Conduct & Competency Committee and
the Registration Committee as well as interested paramedics in Nova Scotia,
a working draft of governing legislation for paramedics in NS has been
developed and distributed to other health professions for input. EHS
plans to present the main issues of this document to small groups of
paramedics around the province in the fall of 2003, in order to solicit
feedback on the draft legislation.
Special Patient Survey
Some pediatric patients treated at the Izaak Walton Killam (IWK)
Health Centre, Halifax, Nova Scotia are identified as having very complex I would like to
and unique health care challenges. EHS recognizes that, given their commend your EHS
ages, these specific patients may not be adequately provided for, using medics. As a US
the current EHS protocols. In working with these patients’ families, visitor to Nova
physicians and nurses at the IWK (in particular Judy Chisholm, Clinical Scotia and
Nurse Specialist), EHS has developed individual protocols for particular requiring
emergency care, I
patients that take into account their unique patient care requirements.
These protocols are contained on laminated tags that accompany patients
at all times. The tags are“Robin Egg” blue and named for the first patient
However, I was very
registered in the program, Robyn McTague. In total, there are twenty-
five (25) patients in this program. surprised. Your
medics were very
Strategic Direction professional
During 2003, the Office of the EHS PMD hopes to become involved
in a national, multi-centre trial called the“WEST Study” to be conducted
in several centre in Canada, including Vancouver, Edmonton, and Paramedics: William Poole,
Montreal. This involves comparing three (3) management strategies Earle Sears
of ST segment elevation myocardial infarctions. The study will be
conducted in the Halifax Regional Municipality. This study will involve
all levels of paramedics. If this feasibility study is successful, a larger
study will be conducted in an attempt to develop a management strategy
for all patients suffering an ST segment elevation myocardial infarctions,
whether they are in rural or urban areas. The results of such a study
could lead to the development of a province-wide management program
for these patients.
44 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
4.6 EHS Provincial Programs
EHS Provincial Programs consists of the following four programs:
1. EHS LifeFlight—provides 24/7 rapid, high quality air medical
transport service for adult pediatric, neonatal and obstetric patients
2. EHS Nova Scotia Trauma Program—facilitates the provision of optimal
trauma care by providing leadership in injury prevention and control,
education, research and trauma system development
3. EHS Atlantic Health Training and Simulation Centre—provides training
and continuing education to health care professionals
4. EHS Medical First Response—a largely volunteer, rural based program
that serves as an enhancement to the patient care provided by the
EHS Provincial Programs integrate with all other aspects of the EHS system.
The EHS LifeFlight team comprises highly
qualified paramedics, nurses, and respiratory
technologists who provide care to the most
critically ill and injured patients that must be
transferred to regional and tertiary care facilities.
The air medical crew is supported by both
experienced pilots who fly the aircraft, and by
ground paramedics when missions must be
On behalf of integrated with ground ambulance. EHS LifeFlight is supported by the EHS
the entire staff Communications Centre, administration, engineering staff, and physicians who
of the Halifax provide expert clinical guidance and online support.
I want to thank EHS LifeFlight Team
you for the fine The EHS LifeFlight team is comprised of health care professionals in three
work you do and specialty crews: pediatrics, obstetrics, and adult.
looking after PEDIATRICS CREW
one of our The children’s component consists of specially trained critical care nurses and
extended family. respiratory therapists employed by the Izaak Walton Killam Health Centre
(IWK). They work in the pediatric and neonatal intensive care units when not
EHS LifeFlight team: on LifeFlight duty shifts.
Darlene Pertus, Bill OBSTETRICS CREW
Heys, Scott Morton, The obstetric service consists of an Obstetrical nurse and the pediatric crew.
All obstetrical nurses are employed by the IWK Health Centre in labour and
delivery. This arrangement allows this highly specialized group of nurses to
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 45
maintain their unique skills and knowledge thereby providing mothers to be and
their babies with the most current level of care and expertise available.
The adult component consists of specially trained nurses and paramedics. Flight
nurses are trained Intensive Care Unit and/or
emergency department tertiary care nurses with many
years of experience. The paramedics are Critical Care
Paramedics with many years of experience working
on advanced life support ambulances.
The Medical Oversight Physicians (MOPs), are also
part of the EHS LifeFlight team. In consultation with
a sending physician and based on specific criteria, they
make the decision as to whether or not a patient is
suitable for air transport. The MOPs consult with the sending facility to prepare I was very,
the patient for flight, and also brief the crew on the specifics of the mission. very
Throughout the transport, the MOPs are available to provide on-line medical impressed
advice to the team. At times, the MOPs may accompany the team on the mission. with the way
PILOTS the team
The helicopter and the pilots utilized by EHS LifeFlight are provided by Canadian worked.
Helicopters Limited (CHL). Both the captains and co-pilots have extensive flying Everything
experience with many of their flying hours being specific to air medical transport. you were
Captains have a minimum of 3,000 flying hours experience, while the co-pilots doing, yet
are required to have at least 500 hours experience. you made
time for the
During the year 2002/03, EHS LifeFlight completed 588 missions. Of those 513
(87%) were in Nova Scotia and 75 (13%) missions in other provinces. Figure 220.127.116.11
shows the distribution of missions by location. EHS LifeFlight
team: Peter Perry,
Canada or the
46 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EHS LifeFlight classifies missions according to response type5 . Figure
Response type depends on the place of 18.104.22.168 shows EHS LifeFlight missions by response type for the year
origin and destination of the mission
(i.e. health care facility, scene, etc).
You do great work—
expertise and your
kindness make a
patients and their
EHS LifeFlight team: Debbie Source: EHS LifeFlight
Enders, Bill Heys, Scott Inter-Facility: The patient is transported between two approved health care facilities.
Scene: Request for transport originates from scene of injury or illness and the patient is picked
Morton, Chris MacKay up directly from the scene.
Scene Inter-Facility: Request for transport originates from the scene of injury or illness and
patient is picked up from a health care facility.
EHS LifeFlight contracts Provincial Airlines Limited
(PAL) to provide a ‘King Air 200’ fixed wing plane, as
its backup. The fixed wing is activated when the
helicopter cannot fly due to weather and/or, if the
helicopter is out of service for maintenance. This is a
versatile airplane with a solid safety record.
FLYING TIMES FROM HALIFAX INTERNATIONAL AIRPORT
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 47
For Nova Scotia, the helicopter response standards are to: be airborne
within ten minutes by day (from 7:00am to 11:00pm) and within one
hour by night (from 11:00pm to 7:00am). While these are
the response time standards, more often the EHS LifeFlight
team are in the air in 7 minutes and 45 minutes, respectively,
therby exceeding this standard overall.
Flight and operational safety continues to be a primary goal
of EHS LifeFlight. Outreach programs include landing zone
officer training to community groups and first responder
agencies; assistance with selection of appropriate landing zone
sites; and information on how to safely land the helicopter
for scene missions. LANDING SAFETY
EHS LifeFlight has also partnered with the EHS
Communications Centre to provide dedicated air medical ‘Safety comes first’—This is the
communication support for all missions. Communication motto EHS LifeFlight lives by. The
Officers provide continuity of information from the beginning air medical crews, pilots and
of a call through to completion. This thereby, provides another engineers go through rigorous
layer of safety and continuity of care. Flight following, a safety training, believing that
sophisticated program utilized to confirm location, progress safety is a team concept. EHS
and arrival times of the aircraft ensures patient/crew safety. LifeFlight also continues to offer
safety training to all emergency
Quality Improvement services and hospital staff in the
province in the form of the
ACCREDITATION Ground Crew Safety and Scene
The main focus of EHS LifeFlight in the coming year will course, as well as, the Hospital
be to seek accreditation by the Commission on Accreditation Helipad Safety course. EHS
of Medical Transport Systems (CAMTS). CAMTS’ LifeFlight could not perform
accreditation standards address issues of patient care and these lifesaving missions if it were
safety in fixed and rotor wing services. not for the assistance of these
personnel. They provide a safe
and secure place for the
EHS LifeFlight strategic direction initiatives include:
helicopter to land, whether at the
••• Collaboration with users of the service to scene, community pad or at a
ensure their awareness of the full range of hospital helipad. To date, over
available resources 5000 personnel have attended
these certification courses. They
••• Attain CAMTS accreditation
are truly part of the EHS LifeFlight
••• Implementation of the EHS LifeFlight team and are to be congratulated
Balanced Scorecard Evaluation on a job well done.
••• Transition to a hospital based program.
48 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
The EHS Nova Scotia Trauma Program
The EHS Nova Scotia Trauma Program (EHS NSTP) facilitates the
provision of optimal trauma care in Nova Scotia through leadership in injury
prevention and control, education, research, and continuous development
and improvement of the trauma system.
In May 2002, the EHS Nova Scotia Trauma Program and the Department
of Emergency Medicine (Dalhousie University) released the Comprehensive
Report on Injury in Nova Scotia. This report provided a clear picture of the
magnitude and extent of injury in Nova Scotia, and highlighted the fact
that injury continues to be a significant societal and health care problem.
Sadly, we know that 95% of these injuries and predictable and therefore
preventable. They are not accidents.
While the EHS Nova Scotia Trauma Program and our many health care
and prevention partners continue to make inroads in reducing injury deaths
and disability, trauma is still the leading cause of death for Nova Scotians
under age 45 and the fourth leading cause of death overall. The anguish
and ongoing loss experienced by family and friends who are left behind when
someone is killed by injury is unimaginable. Far greater than the numbers
of those killed by injury each year, are those who survive. These people and
their families also experience incalculable suffering—some temporarily and
some for the rest of their lives. This suffering manifests itself in many ways,
including: chronic pain, disability, loss of income, loss of independence, and
In addition to its human toll, the direct and indirect costs of injury in Canada
are estimated at $14 billion annually. In Nova Scotia, it is estimated that
the annual cost of unintentional injuries is $370 million or $396 for every
citizen of NS. It is further estimated that the annual cost of intentional
injury is an additional $200 million. These staggering statistics demonstrate
the need for a comprehensive and integrated trauma system designed to
prevent injuries before they happen and to provide optimal treatment and
resuscitation when injuries do occur.
The EHS NSTP, through its various components, is working hard to prevent
injuries and to enhance the care provided to those who experience a traumatic
Nova Scotia Trauma Registry
The Nova Scotia Trauma Registry is a vital component of the EHS NSTP.
It collects data related to injury and performs this function from several
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 49
venues: the Minimal Data Set (MDS) and the Comprehensive Data Set
(CDS). The CDS also contains a subset of information known as the Death
Data Set (DDS). It should be noted that the Nova Scotia Trauma Registry
is unique in all of Canada in that it is the only trauma registry which houses
a Comprehensive DDS and MDS.
The CDS includes information specific to major injuries. Broadly defined,
a major injury is one that reaches a predetermined threshold of severity, as
defined by international standards. The information in the CDS includes
facts related to the injury event, the patient demographics, the types and severity
of injuries sustained in the event, the process of care, procedures and treatments
received, and discharge outcome. The DDS, captures the same information,
as the CDS, but is specific to injury-related deaths, including information
on those individuals who are pronounced dead at the scene of the injury and
are not hence transported to a hospital.
The MDS captures more general information on all injury-related
hospitalizations in Nova Scotia. While the MDS lacks the detailed information
contained in the CDS, it allows the Nova Scotia Trauma Registry to maintain
a more complete picture of the overall volume of injury in Nova Scotia.
The trauma registry data can be used for several purposes, including: (1) quality
assurance, (2) injury surveillance, (3) public policy development, (4) research,
and (5)injury prevention and control. Most importantly, it provides the
necessary data for evidence-based decision making. Information from the
registry is available to clinicians, researchers, and injury prevention
organizations by contacting the Nova Scotia Trauma
Nova Scotia Trauma Advisory Council
Established in April 2001, the Nova Scotia Trauma
Advisory Council (NSTAC) meets on a quarterly
basis. This past year meetings were held in June,
September, and March. The Advisory Council
continues to play a vital role in Nova Scotia’s trauma
system, ensuring that stakeholders have an
opportunity to provide strategic advise and input
to the system’s design and performance. Through this council a network for
information exchange on trauma systems and injury prevention issues has
There are three subcommittees within NSTAC. These are: the Injury
Prevention & Public Education Committee; the Trauma Registry &
Information Management Committee; and the Optimal Care Committee.
50 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
In 2002/2003 the EHS Nova Scotia Trauma Program continued to
play a key role in delivering learning opportunities to trauma care
providers across the province. These educational activities were designed
to increase trauma knowledge and skills for a multidisciplinary group
including: physicians, nurses, paramedics, and respiratory therapists.
There are three key components to this provider education program:
(1) coordination and management of the Advanced Trauma Life Support
program for the Maritime Provinces; (2)monthly Provincial Telehealth
Education Sessions; and (3) the Trauma Simulation Program.
During 2002/03, there were eight Advanced Trauma Life Support
Courses held in NS, NB and PEI. The ATLS course combines a series
of lectures and interactive skills stations, designed to teach a systematic
approach to trauma patient resuscitation and treatment. This past year
126 physicians received ATLS certification, and there was a marked
increase in the participation of nurses and paramedics.
There were six provincially broadcast Telehealth Education Sessions
held in 2002/03. Topics included:
••• Preparing the Trauma Patient for Transport
••• Preparation and Transport of the Pediatric Trauma
••• Early Management of the Burn Patient
••• Airway Management in Trauma,
••• Organ and Tissue donation in Trauma
••• Injury is No Accident.
This past year, the EHS Nova Scotia Trauma Program began
videotaping these sessions and making the tapes available for libraries
and individuals or groups who wish to view them. This has been an
extremely successful initiative and has significantly increased the benefit
of the Telehealth Sessions, allowing us to reach a greater audience.6
In partnership with the EHS Atlantic Health Training & Simulation
Centre, the EHS Nova Scotia Trauma Program has continued mobile
trauma scenario workshops. During this past year, trauma simulation
sessions were held in Antigonish, Truro, Yarmouth and Kentville.
Requests for copies of these Through Dr. John Tallon, EHS NSTP Medical Director, these sessions
sessions should be directed to Kathy
Hartlen at created an atmosphere for learning and discussion of best practice trauma
care. They also provided an opportunity to increase awareness and use
of the provincial trauma activation system.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 51
Continuous Improvements In Care
Once again under the direction and leadership of Dr. John Tallon, the EHS Nova
Scotia Trauma Program is continuously working to proactively improve the trauma
system. In 2002/03, two major projects were developed and implemented so as to
improve the care of trauma patients in Nova Scotia. These are described in the
The first initiative involved the development and release of the Provincial Head Injury
Guideline. This guideline, which is displayed on a large poster format, which can be
found in all Emergency Departments in Nova Scotia, and was designed in partnership
with the EHS NSTP, the Division of Neurosurgery (QEII HSC and IWK Health
Centre), and the Optimal Care Committee of the Nova
Scotia Trauma Advisory Council.
This head injury guideline was designed to standardize
the treatment of traumatic head injury in the province
and to ensure that patients who require tertiary
neurological care are identified early and receive rapid
referral and transport to a neurosurgical centre. This
initiative once completed, was formally recognized in the
Provincial Legislature by the Minister of Health during
the fall session.
The second project involved the development of a Provincial Trauma Patient Care Record.
This patient care record (PCR) was developed by the Nova Scotia Trauma Advisory
Council to aid in the care and documentation of critically ill trauma patients in the
province of Nova Scotia.
The PCR was designed to maximize simplicity, while maintaining comprehensive
indices for resuscitation, interventions, progression of the resuscitation, documentation
and utilization of areas for recording for all care providers. It was also designed so
that maximum information could be extracted by the Nova Scotia Trauma Registry.
Numerous health care providers participated in the design of this document and
in its final form it is compatible for both pediatric and adult resuscitations.
The EHS NSTP continued to play an active role in facilitating injury prevention
activities, and in developing partnerships with other injury prevention stakeholders.
Some of the highlights of this past year, include:
••• Continuation of the ‘Injury is No Accident’ Campaign.
••• Ongoing work with the Network for Preventing Falls in Nova Scotia
••• Continued provision of support and leadership to the Atlantic
Network for Injury Prevention (ANIP)
52 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
••• Membership on the Nova Scotia Road Safety Advisory
••• Membership on the Strategic Leadership Team for Safe
Prevent Alcohol and Risk-Related
Trauma in Youth (P.A.R .T.Y.) Program
The PARTY program is an injury prevention initiative for teenagers
developed by Toronto’s Sunnybrook Health Sciences Centre more
than 15 years ago, and is now licensed and administered by
SMARTRISK. The EHS NSTP continued its support of PARTY
in Nova Scotia through the development of a long term strategy
designed to sustain the initiative and reach as many teenagers as
INJURY IS NO ACCIDENT: AN AWARENESS CAMPAIGN
During the past year, the EHS Nova someone is ejected from a vehicle because
Scotia Trauma Program has been actively they were not wearing a seatbelt.
engaged in a campaign to educate the On the surface, this debate may seem
media, public, and trauma stakeholders trivial and may appear to be just another
regarding inappropriate usage of the word argument about political correctness.
“accident” Why, you might ask? An However, the Nova Scotia Trauma Program
accident is an event which takes place along with many others believe that
without one’s foresight or expectation; an without a change in the use of language
event which proceeds from an unknown around injury, efforts to prevent it will
cause; an event without an apparent cause; continue to be hampered. As long as people
is unexpected; is unexplained; is an act of believe that injuries cannot be controlled
God or the result of fate or bad luck. (as implied by the word accident), they
When it comes to describing injuries the won’t stop to think about the risks in their
facts make it clear that the word accident lives and the ways they can mitigate them.
is misleading and inappropriate. We believe that over time, changing the
Approximately 95% of all injuries result way people perceive injuries will have a
from predictable and preventable positive impact on our collective efforts to
circumstances. A good example of this is prevent them.
motor vehicle collisions. It is not an accident The EHS Nova Scotia Trauma Program
when someone who has been drinking asks that you consider striking the word
crashes into another vehicle. It is not an accident from your vocabulary of injury. For
accident when someone decides to drive suggestions regarding alternative
too fast for road or weather conditions and language, please visit the Trauma Program’s
hits a tree. It is not an accident when website: www.gov.ns.ca/health/ehs
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 53
The EHS Nova Scotia Trauma Program has a number of new
initiatives proposed for 2003–2004. These initiatives include:
••• Development of a provincial Cervical Spine (C-
••• Provision of leadership and the facilitation of the
development of a Provincial Injury Prevention
••• Exploration of strategies to link other injury-related
databases to the Nova Scotia Trauma Registry.
••• Implementation of the EHS Nova Scotia Trauma
Program Balanced Scorecard.
••• Participation in the Nova Scotia Brain
Injury Outcomes Study.
EHS Atlantic Health Training &
The EHS Atlantic Health Training & Simulation Centre
(AHTSC) has been in operation since January of 1999,
providing acute care training and continuing clinical
education opportunities to a broad spectrum of health care
practitioners. The centre utilizes leading-edge simulation
technology, such as the METI® Human Patient Simulator
and the Laerdal® SimMan & AirMan to assist in the
development and enhancement of practitioners’ critical-
thinking abilities and interventional skills.
Although the technology employed in the centre is
remarkable, it is the subject matter expertise of the
facilitation staff that is truly the foundation of the program.
Program Medical Director, Dr. J. Adam Law, along with
facilitators Dr. John Ross and Dr. Kirk MacQuarrie, provide
the bulk of the curriculum development and content
delivery in the centre. Supported by the Program Manager,
Derek LeBlanc, and coordinators Rob MacKinley and
Brent Nicholson, the staff of the centre strive to provide an intense
and enjoyable learning experience to each group that participates in
the various courses that the centre offers.
54 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
In 2002/03, the centre provided training to a wide variety of acute care
providers. As evidenced in Table 22.214.171.124, the programming delivered
to these practitioners has been equally as diverse. The number of courses
and participants is also presented in Figure 126.96.36.199.
EHS ATLANTIC HEALTH TRAINING & SIMULATION CENTRE
Course Type Total Participant Type Total
Advanced Care Paramedic Registry Exam... 15 ACP Paramedics .......................................... 17
Advanced Care Paramedic
Simulation Session ....................................... 56 ACP Paramedic Students .......................... 100
Crisis Resource Management (CRM) ............. 8 Anesthesiologists ......................................... 6
Critical Care Competition Preparation ......... 8 EHS LifeFlight Adult Crew ............................ 4
Airway Management/CRM ............................ 8 Emergency Dept. Physicians ......................... 8
Airway Management/CRM ............................ 8 Multi-disciplinary ........................................ 18
CRM/ Trauma Management .......................... 8 Emergency Dept. Physicians ......................... 8
CRM/ Trauma Management .......................... 8 Multi-disciplinary Acute Care ..................... 18
Association Education Day ............................ 5 Emergency Dept./ Operating Room Nurses 28
Emergency Medicine Simulation Sessions .... 8 Emergency Medicine Residents ................. 12
Family Medicine Simulation Sessions ............ 8 Family Medicine Residents ......................... 12
ICU Simulation Sessions ............................... 96 ICU Residents ............................................ 144
Med 1 Pharmacology .................................. 18 Med 1 Students .......................................... 42
Medical English ............................................. 5 International Medical Students ................... 4
Mega Code Re-certification ........................ 20 Central Region Paramedics ........................ 38
Mobile Mega Code ...................................... 12 Central Region Paramedics ........................ 24
Mobile Trauma Education ........................... 24 Multi-disciplinary Acute Care ..................... 34
PGY2 Advanced Airway Workshop ............. 40 PGY2 Anesthesia ........................................ 72
Rapid Sequence Intubation ......................... 44 EHS LifeFlight Adult and Pediatrics Crews . 43
RT Airway Workshop ..................................... 8 Respiratory Therapists .................................. 8
SAR Airway Workshop ................................ 16 SAR Technicians ............................................ 4
MH Tele-health Session ................................. 8 Perioperative Nurses .................................... 8
Transition to Clinical .................................... 16 PCP Paramedic Students ............................. 24
Trauma Team Leader-CRM Sessions .............. 4 Trauma Team Leaders .................................. 4
Total Hours: ....................... 451 Total Participants: ................ 680
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 55
Since March 1999, almost 2500 people have participated in courses at
the EHS AHTSC. In 2002/03, the centre hosted a total of 680
participants. Figure 188.8.131.52 shows the number of students for each month
of the last two fiscal years:
Below is a brief explanation of each of the courses delivered in 2002/
03 by the staff of the centre:
Paramedic Education and Evaluation
In 2002/03, the centre was involved in many aspects of paramedic
education and evaluation. Advanced Care Paramedic students from
the Holland College / NS Community College program participated
in a total of seven full-day sessions in the centre, focusing on advanced
airway management, ACLS and Rapid Sequence Intubation (RSI). In
addition, AHTSC staff traveled to le College de L’Acadie for their
Transition to Clinical sessions, with an emphasis on medical assessment
and critical intervention techniques.
Paramedics in the Central Region have also had a number of
opportunities to demonstrate their skills in the simulated setting through
their annual Mega Code Re-certification requirements. In 2002/03,
a total of five sessions were offered in the centre, as well as three in the
mobile setting. The centre has also provided support to the evaluation
of Advanced Care Paramedic registry candidates who have trained
outside of the province.
56 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
All new clinical staff hired by LifeFlight are required to participate in
Rapid Sequence Intubation (RSI) training, which takes place in the
EHS AHTSC. Medical Directors, Dr. John Tallon, Dr. John Ross and
Dr. Chris Soder facilitate each of these scenario-based sessions, utilizing
actual cases as the basis for their training. These, along with current
staff ’s annual RSI and Airway Management refresher requirement,
resulted in six full-day sessions delivered in the centre.
During this year, EHS LifeFlight paramedic Dale Traer and Flight Nurse
Darlene Pertus competed in a critical care aero-medical transport
competition held in the United States. As the competition was
conducted on a METI® Human Patient Simulator, the team utilized
the centre to prepare. They placed 2nd overall in the North American
Crisis Resource Management
This program, delivered in a full-day course and half-day workshop
format has been adapted for delivery to a variety of clinicians. Though
2002/03 saw limited delivery due to a pending study on the program,
the centre expects to see a significant increase in the numbers of
physicians, residents and multidisciplinary teams taking this training
in the coming year.
Beyond the paramedic sessions delivered in the Central Region and
Meteghan, the centre also delivered a number of training courses around
the province. In conjunction with the EHS NS Trauma Program, staff
from the centre traveled to Yarmouth, Kentville and Antigonish to deliver
Mobile Trauma Education Sessions at the regional hospitals in each
location. Facilitated by Trauma Medical Director, Dr. John Tallon, the
sessions were delivered to multi-disciplinary groups with an emphasis
on acute management and early system activation.
The centre also delivered sessions in Truro and CFB Greenwood,
including a combination of airway management techniques, trauma
scenarios, and Crisis Resource Management education.
The centre has identified as one of its strategic directions, research into
the educational validity of simulation-based medical training. To this
end, there are several studies either pending or in progress that the centre’s
staff are involved in. For example, the centre is involved in a multi-centre
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 57
study with the University of Toronto and the Sunnybrook Hospital
looking at the effect of Crisis Resource Management (CRM) training
on human error. Additionally, there are studies underway looking at
the effect of simulation-based training on the learning curve for novice
intubators, as well as the effect on experienced practitioners such as
Resident and Medical Student Education
The past year saw a great deal of physician-resident education conducted
in the centre. Anesthesia residents participated in an eight-session
program at the beginning of the year, focusing on routine and complicated
inductions. The Intensive Care Unit residents participated in a three-
session program at the beginning of their rotations that included airway
management, Advanced C Life Support and CRM. Residents from
both the Department of Emergency Medicine and the Department of
Family Medicine attended sessions in CRM principles in acute care
management as well.
As well, Med. 1 Pharmacology Tutorials saw a total of 42 first year
medical students come into the centre to administer and witness the
effects of a variety of common classes of medications in a simulated
Summer Institute for Medical English
A unique program, conducted this past year was the addition of the
Summer Institute for Medical English, administered by the Dalhousie
International Health Office. Three Brazilian students in their final year
of medical school, and one practicing physician, visited Halifax to learn
English in a medical setting. This program incorporated a full-day session
in the centre, facilitated by Dr. John Ross and English instructor, Roetka
Search and Rescue (SAR) Technicians
Each year, the centre delivers advanced airway training to SAR
technicians from across the country in association with the departments
of Emergency and Anesthesia, as well as the Justice Institute of British
Columbia. This year, two sessions were conducted in the centre to
prepare the SAR Techs. for their Operating Room and Emergency
Members of the Nova Scotia Emergency Nurses Association, and
members of the Capital District OR Nurses Association took the time
58 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
to include sessions in the simulation centre in their meeting agendas this
past year. In addition, the Capital District Health Authority’s Perioperative
Nursing Program videotaped a“Malignant Hyperthermia” case in the centre
that was delivered as part of a provincial telehealth presentation last fall.
In the coming year, the staff of the EHS AHTSC are committed to placing
a strong emphasis on program evaluation in addition to research activities
that will continue throughout the year.
Also planned for 2003-04 are some exciting new initiatives in airway
management education, acute-care nursing and Medical First Response, to
be delivered in collaboration with a variety of Emergency Health Services’
EHS Medical First Response Program
The EHS Medical First Response (MFR) program is a largely volunteer,
rural-based program that serves to enhance the patient care provided by
the EHS system. Beyond the lifesaving instructions
provided by the EHS Communications Officer, a
first responder is often the first physical contact that
the patient has with a person who can offer some
form of medical assistance. This assistance can
range anywhere from a person who knows first aid
and CPR to an organization that is certified as a
medical first response agency. Because much of
Nova Scotia is rural, assistance by volunteer agencies
that wish to provide first responder services in their
communities is a welcome adjunct to the EHS pre-
MFRs are individuals in the province trained to provide advanced medical
first aid to the residents of their communities. In addition to this, some
agencies also have defibrillators so that they can provide early defibrillation
before the paramedics arrive on scene.
In 2002/03, the EHS MFR Strategic Advisory Committee was established.
This committee developed the following vision and mission:
The EHS MFR program is a provincial network of volunteer, community
supported medical first aid teams adequately resourced and competently
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 59
Enhance a community’s ability to provide safe, effective, reliable advanced
first aid through participation in the provincial medical first responders
In 2002/03, the strategic advisory committee worked together to develop
a strategic plan for the EHS MFR program. This plan
allows for the provision of an effective MFR program that
meets the needs of Nova Scotians. This plan identifies five
key strategic directions. These are:
1. An infrastructure that supports a
province-wide volunteer MFR program
2. A training plan that ensures competent
3. A communications plan that fosters community
4. EHS sponsored MFR agencies that are strategically
5. Appropriate funding levels that ensure program
EHS would like to formally recognize the hard work of the Strategic
Advisory Committee. Each of the members’ names can be found in
The Logistics Committee for the EHS MFR Program continued its
work in 2002/03. This group deals with the day-to-day operations of
the program, such as the approval of potential MFR agencies. This
group is comprised of members from EHS, Emergency Medical Care,
and MFR providers.
As of April 2003, there are 156 EHS sponsored MFR agencies in Nova
Scotia. Through the sponsorship of EHS, these agencies received
medical first response training and supplies, consistent with equipment
carried on ambulances in the system. Training of these agencies is
provided by EHS approved organizations, such as the Canadian Red
Cross, St. John Ambulance and Active Canadian.
Medical First Responders are dedicated to the well-being of their
communities and are prepared to answer a call at any hour of the day
or night. EHS would like to publicly recognize the dedication of each
of the Medical First Responder agencies in the province. These names
can be found in Appendix D.
60 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
MFR…A COMMUNITY SUCCESS STORY
For the past few years, high school students in Kings County
have been participating in a important and unique course
– Medical Technology 12 Academic. In this course, students
are provided with the knowledge and skills necessary in an
emergency to help sustain life, reduce pain and minimize
the consequences of injury or sudden illness until paramedics
Under the leadership of James Lindh, a teacher at Central
Kings High School who developed the program, the course
is delivered at full capacity to 25 students, each semester.
To help make this program a success, local paramedics and
their supervisor help train the students in medical first
response. As well, a review of the equipment found on
ambulances in the province is conducted with the students.
Students who successfully complete the course become
members of the school’s ‘response team’. This team provides
medical assistant at local events at the school and within
their community. EHS, through the MFR program, hopes
to encourage more programs like this one. To the Central
Kings High School response team—keep up the great work!
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 61
F I N A N C I A L S U M M A RY
The Nova Scotia Department of Health provides EHS with the
resources to run emergency health services in the province. Figure 5.1
shows the actual expenditures for the last four fiscal years and the budget
Note: Other includes Medical Oversight, Trauma Program, Simulation Centre and Medical First Response Source: EHS
The Department of Health’s budget for 2002/03 was $1.98 billion, of
which the EHS budget comprises 3%. Figure 5.2 demonstrates that
the EHS budget for 2002/03 was $56.9 million.
62 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
Total $1.98 Billion
5.1 Service Fees
The cost of ambulance services is not and has never been an insured
service. Each province determines the amount and the circumstances
under which it will subsidize its services.
For Nova Scotia residents, that is, individuals with a valid Nova Scotia
Health Card, the government covers all costs associated with the care
given by paramedics during an ambulance transport between approved
facilities i.e. between hospitals.
For medically essential transports, with a valid Nova Scotia Health Card,
from place of residence to approved health facility or scene to approved
health facility a service fee of $105 is charged.7
In those instances where an individual does not have a valid Nova Scotia
Health Card; is eligible for third party payment (insurance); or the
ambulance trip is not medically essential, an unsubsidized rate is charged.
The following fee schedule outlines the service categories and
The revenue collected for service fees during the fiscal year 2002/03
was $7.09 million.
If Non-Canadian, the cost
is $900.00; If third party
insured, the cost is
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 63
GROUND AMBULANCE SERVICE FEES YEAR 2002/03
Category Service Fee
Between two approved facilities with a valid NS health card * .................................... $0.00
Scene to hospital with valid NS health card * ............................................................ $105.00
Hospital to place of residence with physician approval * ......................................... $105.00
Home to doctor’s office if mobility challenged ......................................................... $150.00
Non-Nova Scotian; Canadian citizen .......................................................................... $600.00
Third party insured, e.g., motor vehicle collision, work related injury ..................... $600.00
Non-Canadian ............................................................................................................. $900.00
* If Non-Canadian, the cost is $900.00; If third party insured, the cost is $600.00 Source: Ambulance Fee Regulations
Service Fee Advisory Council and
Service Fee Appeal Board
An Advisory Committee consisting of a variety of stakeholders i.e.
Senior’s Secretariat, Worker’s Compensation, Insurance Bureau of
Canada meets quarterly to advise on policy issues
regarding service fees.
In addition to this Committee, a Service Fee Appeal
Board meets quarterly to review individual invoices
using the Ambulance Fee Regulations. Persons wishing
to appeal an invoice are asked to submit an appeal
in writing to the board. The board reviews the appeal
letter, the invoice, and if necessary, the patient care
report to assess whether or not the service fee was
appropriate. In 2002/03, the appeal board reviewed
a total of 79 invoices. In 96% of these appeals, the board found that
the service fee was appropriate. In these cases, the appellants were given
the opportunity to negotiate a flexible payment plan with the ambulance
contractor, Emergency Medical Care, Inc. In three cases, after reviewing
the circumstances of the invoice, the board waived the service fee.
64 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
6C O N TA C T S AT E H S
EHS Senior Director: Joseph Howe Building, 10th Floor, 1690 Hollis
Marilyn Pike Street, PO Box 488, Halifax, NS B3J 2R8
Tel: (902) 424-8902 Fax: (902) 424-0155
Director of EHS Provincial Programs:
Paula Poirier Tel: (902) 424-2346
Acting Director of EHS Communications:
Director of EHS Ground Ambulance Services: Bedford Tower, Suite 600,
Tony Eden 1496 Bedford Highway
e-mail: email@example.com Halifax, Nova Scotia B4A 1E5
Tel: (902) 424-3916 Fax: (902) 424-1781
EHS Medical Director:
e-mail: firstname.lastname@example.org Tel: (902) 424-1729
EHS Medical First Response Program Coordinator:
Wayne LeMoine Tel: (902) 424-4654
EHS LifeFlight Program Manager: 693 Barnes Dr., Halifax International Airport
Bud Avery Enfield, Nova Scotia B2T 1K3
e-mail: email@example.com Tel: (902) 873-3657 Fax: (902) 873-3987
EHS Nova Scotia Trauma Program: Room 004, 13th Floor, Victoria Building, 1278
Julian Young Tower Road, Halifax, Nova Scotia B3H 2Y9
e-mail: Julian.Young@cdha.nshealth.ca Tel: (902) 473-7157 Fax: (902) 473-5835
EHS Atlantic Health Training & Simulation Centre: Room 097, Centennial Building, 1278 Tower Road
Derek LeBlanc Halifax, Nova Scotia B3H 2Y9
e-mail: firstname.lastname@example.org Tel: (902) 473-3199 Fax: (902) 473-7309
Web page: www.gov.ns.ca/health/ehs
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 65
EHS Communications Centre Staff
Adams, Michael Lent, Matt
Baxter, Sharon Langille, Amber
Belanger, James Lillies, John
Bell, Martin Mack, Carol
Bezanson, Kristie MacKinnon, Greg
Brenton, Debbie Mancini, Robert
Brown, Bob Martell, Rick
Campbell, Rick May, Cindy
Connors, Heidi Mills, Alison
Conohan, Sean Mooy, Neil
Cooper, Jamie Murphy, Gary
Cox, Bruce Murphy, Sean
Eld, Chris Pollock, Melissa
Elias, Joey Porter, Chuck
Faulkner, Darryl Porter, Phil
Ferguson, John Rose Jennifer
Fitzgerald, Denise Shaw, Don
Goulet, Rick Standen, Andrew
Gravel, Michel Stewart, John
Greene, Wayne Stockdale, Brian
Hamer, Danny Sullivan, Kerry
Hughes, Glen Warrne, Donna
66 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EHS Medical Oversight Physicians
Maureen Allen Martin MacLennan
Mark Bennett Bruce McLeod
Kenneth Buchholz Gerry Morash
Bernard Buffet Eoghan O’Sullivan
Michelle Dow David Petrie
Andrew Holmes George Sutherland
Michael Howlett Andrew Wawer
EHS LIFE FLIGHT
Victoria Allen Heather Scott
Anthony Armson Chris Soder
Alexandra Howlett Dora Stinson
Krista Jangaard John Tallon
George Kovaks Michiel Van den Hof
Constance LeBlanc Michael Vincer
Dorothy Sharon Litz Robyn Whyte
Brian MacManus Natalie Yanchar
David Petrie Dave Young
*This includes all full time, part time and casual medical oversignt physicians
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003 67
Members of the Medical First Response
Strategic Advisory Committee (as of
NAME ............... ORGANIZATION
Tom Bremner ........... Chief, Amherst Fire Department
Ed Cain ..................... EHS Medical Director
Robert Cormier ....... Fire Marshall of the Province of Nova Scotia
John Craig ................. President of the Fire Officers’ Association
Mike Eddy ................ Chief Director, Halifax Regional Fire and
Mike McKeage......... Director of Operations, Emergency Medical Care,
Bernie McKinnon.... Director of Fire Services, Cape Breton Regional
Fire and Emergency Services
Doug MacLean ........ Chief, Lawrencetown and District Fire
Marilyn Pike ............ Senior Director, Emergency Health Services
David Rippey ........... Executive Director, Quality, Emergency Health
Services and Health Protection Branch, NS
Department of Health
Arnold Rovers .......... Chief Executive Officer, Emergency Medical Care,
Julia Stick .................. Chairperson, Sheila Christian Emergency
Paula Poirier ............. Director, EHS Provincial Programs
68 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EHS Medical First Responders Agencies
Abercrombie Fire Five Islands Fire Mabou & Dist. Fire Sheet Hbr. Fire
Advocate & Dist. Fire Florence Fire Maitland Fire Shubenacadie & Dist. Fire
Annapolis Royale Fire Fox River-Port Greville- Margaretsville & District Smith’s Cove Fire
Dept. Wards Brook Fire Volunteer Fire Dept. Southampton Fire
Aylesford Fire Framboise-Forchu Fire Marion Bridge Fire Dept. Southside Boularderie
Baker Settlement & Dist. Freeport Fire Dept. Martins River Vol. Fire Fire Dept.
Fire Gore Dist. Fire Dept. Dept. St. Berneard Fire
Barrington Fire Dept Grand River Fire Meagher’s Grant Fire St. Peters Vol. Fire Dept.
Barrington Passage Greenwich Fire Dept Middle Musquodoboit Stewiacke Fire Dept.
Bass River Fire Brigade Hammonds Plains Fire Fire Summerville & District
Beaverbank-Kinsac Fire Department Middle River Vol Fire Fire Dept.
Berwick Fire Hantsport Fire Dept. Dept. Sydney River Vol. Fire
Big Bras d’Or Vol. Fire Harbour Fire Dept. Middleton Fire Dept.
Dept. Harbourview Fire Milford Fire Tangier Fire
Big Tancook Island Harrietsfield / Sambro Moser River Fire Dept Thorburn Fire Dept.
Emergency Response Fire Dept. Mushaboom Fire Uniacke & Dist. Fire
Association Havre Boucher Fire Dept. Musquodoboit Hbr. Fire United Communities Fire
Black Point Fire Dept. Hebbs Cross Fire New Minas Fire Dept. Upper Musquodoboit
Blandford Fire Dept. Herring Cove & District New Ross Fire Fire Dept.
District 1 Fire Dept. Nicteaux Fire Upper Stewiacke Fire
Blockhouse Fire Dept. Howie Centre Fire Dept. Nine Mile River & Dist. Valley Kemptown Fire
Blue Mountain Fire Dept. Hubbards Fire Dept. Fire Dept. Valley Mills Volunteer
Boisdale Fire Indian Brook Fire Noel Fire Fire Dept.
Bridgetown Volunteer Ingomar Roseway Fire North Queens Fire Assoc. Walden Fire
Fire Dept Dept. North Shore & Dist. Fire Waterville & District Fire
Brookfield Fire Ingonish Beach Vol. Fire Dept. Dept.
Department Dept. Oakhill & District Fire Waverly Station 41 Fire
Brooklyn Fire Isle Madame Volunteer Dept. Dept.
Cabot Fire Dept. Fire Dept. Onslow Belmont Fire Wellington Station 42
Canning Fire Italy Cross / Middlewood Ostrea Lake / Pleasant Fire Dept.
Caribou Dist. Fire & District Fire Dept. Point Fire Dept. West Bay Rd. Fire
Chapel Island Fire Joggins Fire Dept. Oyster Pond Volunteer West River Fire
Chelsea & Dist. Fire Judique & Dist. Fire Dept. Fire Dept. Western Queens First
Chester Basin Kennetcook Dist. Fire Parrsboro Fire Dept. Responders
Chezzetcook Volunteer Dept. Pictou Isl. Fire Dept. Western Shore Fire
Fire Dept. Kentville Fire Pleasant Bay Fire Dept. Westport Fire Dept.
Cobequid Fire Dept Kingston Fire Dept. Plymouth Fire Dept. Westville Fire
Conquerall Bank Fire Lahave & District Fire Port Hood Volunteer Fire Weymouth Fire
Cook’s Brook & District Dept. Dept. Whycocomagh Fire Dept.
Fire Dept. Lake Echo Fire Port LaTour Windsor Fire Dept.
Cornwall & Dist. Fire Lakeside Fire Dept. Port Medway Fire Wolfville Fire
Dayspring & Dist. Fire Lantz Fire Port Morien Fire Dept. Wood’s Harbour
Dept. L’Ardoise Fire Port Williams Fire Dept. Volunteer Fire Dept.
Debert Fire Larry’s River & Dist. Fire Prospect Rd. & Dist. Fire Valley Mills Volunteer
Digby Fire Lawrencetown & Dist. Pugwash District Fire Dept.
Dutch Settlement Fire Fire Dept. Volunteer Fire Dept. Walden Fire
Dept. Lawrencetown Beach Fire Rawdon Dist. Waterville & District Fire
East River St. Mary’s Fire & Emerg. Red Isle Fire Dept.District Dept.
Dept. Little Dover Fire 10 Waverly Station 41 Fire
East River Valley Fire Little Tancook Island First River John Fire Dept. Dept.
Dept Response Riverport Fire Dept Wellington Station 42
Ecum Secum Volunteer Liverpool Fire Ross Ferry Vol. Fire Dept. Fire Dept.
Fire Dept. Lockeport Fire Dept. Scotsburn Fire Dept. West Bay Rd. Fire
Elmsdale Fire Louisbourg Volunteer Seabright Fire Dept West River Fire
Enfield Fire Ambulance Association Shag Harbour / Bear Western Queens First
Fall River / Windsor Louisdale Vol. Fire Dept. Point Volunteer Fire Responders
Junction Station 44 Lunenburg Fire Dept.