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					EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                      1




                                    Preamble

                    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




                     Dedication
    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


             August 2003


             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.
             Sincerely,

             Marilyn Pike
             Senior Director, Emergency Health Services
4   EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                                                                                                                                   5




                                                                     Contents

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




1
BRIEF OVERVIEW
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
                                                                                       husband’s
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,
                                                                                       George Carrigan
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.




                                  Figure 1.1




                                       DEPARTMENT OF HEALTH




                                               EHS Senior
                                                Director




    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:
                                                                                                  EHS
      Emergency                          QEII Health             IWK Health                 Canadian
                                                                                               LifeFlight
    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
                                                                              province.
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 system.


                          EHS LifeFlight
                            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
& AirMan.
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




2
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.


Vision
EHS is a centre of excellence known for highest quality, best cost,
sustainable emergency and mobile health care services.


Mission
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.
                                         •      funding
                                         •      monitoring, evaluating and reporting on performance
                                                and outcomes.


                              Strategic Directions:
                                         •      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
     comforting to
                              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
program.
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,
on scene.
16                                      EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003




       ERCEC
      EHS Research
     Consortium of
                              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
                             Canada.

                             Vision
                             The EHS Research Consortium of Eastern Canada is a leader in high quality
                             EMS research.

                             Mission
                             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.


Strategic Direction
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
Process
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
                                                                                2
                                                                                  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




                             Figure 3.2.1


     On behalf of
     our family I
     would like to
     thank the
     paramedics who
     responded to a
     call for my
     father. It takes
     a special kind
     of person to do
     the job you do.
     Your kindness
     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.
     Kevin Carey
                             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.



                             Table 3.2.1

                               Ambulance               Patient Transports
                               Region                  Per Service Inquiry
                               Central                 1860
                               Eastern                 1021
                               Northern                1964
                               Western                 921


                             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


Figure 3.2.2




                                                                             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.



Figure 3.2.2




  *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.

     Figure 3.2.3




                                                                 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
     their solution.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                                                        21




4
PROGRAMS
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
regions:



  Ambulance Region             Counties                                             District
                                                                                    Health Authorities
  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




                           4.2 Paramedics
                           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
                                                        Paramedics (CCPs).
                                                        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.
     splendid
     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.

Figure 4.3.1
                                                   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




                                             Figure 4.3.2
                                             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
                                                                         Education program.3
                                             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.

     3
      A detailed listing of the twenty key
     performance standards can be viewed
     at www.naemd.org/accred20pnts.html
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                                                      25


Services
                                                             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
     Dispatch
     (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
     paramedic arrival.

     Dictaphone
     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
EHS system.
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.


Strategic Direction
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.


     Facilities
     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
                                                                                 major difference,
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
in 2003/04.
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.


     Response Analysis
     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/
     03.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                                                             31


Figure 4.4.1




           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.

Figure 4.4.2




                                                                                            Source: EHS CAD
32    EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003




     The Fleet
     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.

     Table 4.4.1
         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
       Total                                                                      151
                                         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.



Table 4.4.2

THE AGE OF THE FLEET*
                                        2001/02                  2002/03
  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.



Quality Improvement

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




                                                                          Strategic Direction
                                                                          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
                                                                                   development.
        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

      4
        Survival is defined as a patient being
     discharged from hospital neurologically
     intact after having an out-of-hospital
     cardiac arrest.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                                                       35



  Figure 4.5.1




Figure 4.5.2

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
concern.
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
     ordered antibiotics
     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
     an appointment
     when I needed it.

     Kim LaMarche and
     Paula Prime
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                            37


Table 4.5.3

Month                 Number of patients                Percentage
                        received medical                   increase
                               treatment

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
following paragraphs.

Industrial Cape Breton 12 Lead ECG Project Study
PURPOSE
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




     RESULTS

       Challenges                          The most frequent problems
                                           encountered by paramedics
                                           in trying to attain a 12 lead
                                           ECG were attributed to the
                                           unileads.

       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.


     Hypoglycemic Study
     PURPOSE
     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.
     RESULTS
      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
                                   hypoglycemic episodes
                                   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
                                     respectively).

  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%
                                                                          paramedics who
                                     for transported patients and
                                     6 – 9% for non transported           provided
                                     patients).                           professional and
                                                                          empathetic care
  No significant difference in                                            to my daughter.
  intervals between
                                                                          It is very
  hypoglycemic episodes              There was no statistically
                                     significant difference in the
                                                                          comforting to
                                     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
                                                                          whenever
                                     episode (40.7 days +/- 53.5)         needed.
                                     (p=0.6).
                                                                          Paramedics: Robert
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
the paramedics.
Neither a higher incidence of repeat hypoglycemic episodes nor an
increased recurrence of hypoglycemia in the over 65 population was
discovered.
40    EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003




     CONCLUSIONS
     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
     hypoglycemic episodes.

     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 study.

     Airway Registry
     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
     perspective.


     Education
     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
                       and
                •••    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


Paramedic Legislation
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.
                                                                              was somewhat
These protocols are contained on laminated tags that accompany patients
                                                                              apprehensive.
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-
                                                                              pleasantly
five (25) patients in this program.                                           surprised. Your
                                                                              medics were very
Strategic Direction                                                           professional
                                                                              knowledgeable and
During 2003, the Office of the EHS PMD hopes to become involved
                                                                              courteous.
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 system.
                            EHS Provincial Programs integrate with all other aspects of the EHS system.


                             EHS LifeFlight
                                                               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.
     Control Tower,
     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.
     especially for
     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.
     Chris MacKay
                                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.
ADULT CREW
     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.
MEDICAL OVERSIGHT
     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
                                                                                           family with
Missions
                                                                                           such care
During the year 2002/03, EHS LifeFlight completed 588 missions. Of those 513
                                                                                           and concern.
(87%) were in Nova Scotia and 75 (13%) missions in other provinces. Figure 4.6.1.1
shows the distribution of missions by location.                                            EHS LifeFlight
                                                                                           team: Peter Perry,
                                                                                           Grace MacConnell
Figure 4.6.1.1




Other: Other
provinces of
Canada or the
United States
Source: EHS
LifeFlight
46                                                 EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003




                                                  EHS LifeFlight classifies missions according to response type5 . Figure
       5
         Response type depends on the place of    4.6.1.2 shows EHS LifeFlight missions by response type for the year
       origin and destination of the mission
       (i.e. health care facility, scene, etc).
                                                  2002/03.

                                                  Figure 4.6.1.2


     You do great work—
     your clinical
     expertise and your
     kindness make a
     difference to
     patients and their
     families.

     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.
                                                    Other: Repatriation



                                                                       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.

                                                  Figure 4.6.1.3
                                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.

Safety
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
Strategic Direction
                                                                  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
     depression.
     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
     injury.

     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
Program.

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
been created.
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




                                            Professional Education
                                            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
                                                              Patient
                                                       •••    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.
     6
       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
     Kathy.Hartlen@cdha.nshealth.ca
                                            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
following paragraphs.
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.

Injury Prevention
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
                                             Committee
                                      •••    Membership on the Strategic Leadership Team for Safe
                                             Communities.


                                       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
                                       possible.

     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


Strategic Direction
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-
                 Spine) Protocol.
           •••   Provision of leadership and the facilitation of the
                 development of a Provincial Injury Prevention
                 Strategy.
           •••   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 &
Simulation Centre
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 4.6.3.1, the programming delivered
                                                to these practitioners has been equally as diverse. The number of courses
                                                and participants is also presented in Figure 4.6.3.1.

     Table 4.6.3.1
     EHS ATLANTIC HEALTH TRAINING & SIMULATION CENTRE
     Course Type                                           Total       Participant Type                                   Total
                                                          Hours                                                   Participants

     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
                                                                                                                      Source: AHTSC
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 4.6.3.1 shows the number of students for each month
of the last two fiscal years:

Figure 4.6.3.1




                                                                               Source: AHTSC



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




     EHS LifeFlight
     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
     competition.

     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.

     Mobile Training
     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.

     Research
     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
Respiratory Therapists.

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
setting.

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
Gradstein.

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
Department experiences.

Nursing
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.

     Strategic Direction
     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’
     partners.


     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-
     hospital system.
     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:

     Vision
     The EHS MFR program is a provincial network of volunteer, community
     supported medical first aid teams adequately resourced and competently
     staffed.
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                             59


Mission
Enhance a community’s ability to provide safe, effective, reliable advanced
first aid through participation in the provincial medical first responders
program.
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
                  MFR personnel
           3.     A communications plan that fosters community
                  support
           4.     EHS sponsored MFR agencies that are strategically
                  located.
           5.     Appropriate funding levels that ensure program
                  sustainability
EHS would like to formally recognize the hard work of the Strategic
Advisory Committee. Each of the members’ names can be found in
Appendix C.
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
     arrive.

     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




5
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
for 2002/03.

Figure 5.1




  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




                                       Figure 5.2


                                             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
                                       corresponding fees.
                                       The revenue collected for service fees during the fiscal year 2002/03
                                       was $7.09 million.
     7
         If Non-Canadian, the cost
          is $900.00; If third party
          insured, the cost is
          $600.00
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                                                                                          63


Table 5.1
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
     e-mail: pikema@gov.ns.ca
                                                         Tel: (902) 424-8902       Fax: (902) 424-0155
     Director of EHS Provincial Programs:
     Paula Poirier                                       Tel: (902) 424-2346
     e-mail: poiriept@gov.ns.ca

     Acting Director of EHS Communications:
     Deborah MacKay
     e-mail: mackaydr@gov.ns.ca

     Director of EHS Ground Ambulance Services:          Bedford Tower, Suite 600,
     Tony Eden                                           1496 Bedford Highway
     e-mail: edent@gov.ns.ca                             Halifax, Nova Scotia B4A 1E5
                                                         Tel: (902) 424-3916       Fax: (902) 424-1781
     EHS Medical Director:
     Ed Cain
     e-mail: cainej@gov.ns.ca                            Tel: (902) 424-1729

     EHS Medical First Response Program Coordinator:
     Wayne LeMoine                                       Tel: (902) 424-4654
     e-mail: lemoinww@gov.ns.ca

     EHS LifeFlight Program Manager:                     693 Barnes Dr., Halifax International Airport
     Bud Avery                                           Enfield, Nova Scotia B2T 1K3
     e-mail: bavery@ehsairmedical.ca                     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: ahtsc@qe2-hsc.ns.ca                         Tel: (902) 473-3199       Fax: (902) 473-7309

     Web page:                                             www.gov.ns.ca/health/ehs
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003   65




APPENDIX A
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
Humes, Jon
Jackman, Elaine
66    EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003




     APPENDIX B
     EHS Medical Oversight Physicians


     GROUND AMBULANCE

     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
     Paul Legere
     Peter Loveridge
     Donald MacDonald



     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
     John Ross
     *This includes all full time, part time and casual medical oversignt physicians
EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003                           67




APPENDIX C
Members of the Medical First Response
Strategic Advisory Committee (as of
April 2002)

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
                           Emergency Services
Mike McKeage......... Director of Operations, Emergency Medical Care,
                      Inc.
Bernie McKinnon.... Director of Fire Services, Cape Breton Regional
                    Fire and Emergency Services
Doug MacLean ........ Chief, Lawrencetown and District Fire
                      Department
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,
                         Inc.
Julia Stick .................. Chairperson, Sheila Christian Emergency
                               Response Association
Paula Poirier ............. Director, EHS Provincial Programs
68                                          EMERGENCY HEALTH SERVICES ANNUAL REPORT 2002/2003




     APPENDIX D
     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.

				
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