MSDSB, Health Centre disagree on ambulance non-emergency transfers

by Alicia McCutcheon

MANITOULIN—There’s a debate going on between the Manitoulin-Sudbury District Services Board (DSB) and the Manitoulin Health Centre (MHC) over non-urgent patient transfers and the role ambulances should play in this daily function.

Considering the MHC’s rural designation and the ever-increasing role high tech diagnostics has to play on a patient’s diagnosis and treatment, trips to the Sudbury Regional Hospital (SRH) are a must to access services such as magnetic resonance imaging (MRI) and CT scans.

However, Fern Dominelli, chief executive officer of the DSB, says his board is not in the business of providing non-urgent transfers, but rather in the business of saving lives.

“Right now, all of these transfers are being paid for 50/50 (the province and the member municipalities),” Mr. Dominelli explained.
He noted that at any given time, there are seven ambulances available for the LaCloche-Manitoulin area.

“There’s a 25 minute delay, best time scenario, after an ambulance leaves,” Mr. Dominelli explained. “Ambulances should be kept in the area for true emergencies, and I understand that, in the hospital’s mind, people waiting for tests are considered emergencies, but that’s just not our role—emergency medical services is our role.”

The CEO said that often, when the hospital will call for an ambulance to request a transfer, staff will list the priority as a code 3 or 4—the highest priorities. When paramedics arrive at the hospital, he continued, they will often reassess the situation and knock the code down to a 1 or 2, which is deferrable. “Then they’ll have a conversation with hospital staff, then the field superintendent at the communication centre who will make the final call.”

“That’s the game were playing,” Mr. Dominelli said. “They (the MHC) see us as challenging staff and the hospital, but the reality is are we really the ones to do this?”

The CEO thinks the answer to the problem is to create a two-tier system—the DSB-run ambulance service and a privately run medical transport service, such as the service Platinum used by the SRH in Sudbury. In fact, the DSB has created a business case model to be presented to the Minister of Health after the October 6 election, requesting full support and full funding for such a service. All of the DSB area hospitals, as well as the North East Local Health Integration Network are on board too, including the MHC with a letter of support from CEO Derek Graham.

“These small hospitals don’t have a budget for this and I understand this, but somebody has to pay for that ride and that’s the issue for the DSB,” Mr. Dominelli added.

This issue was also debated during last Thursday’s MHC board meeting in Little Current with Mr. Graham apprising the board of the situation.

“EMS is looking at that (non-urgent transfer protocols) as not really their business any more,” he told the board, noting that 18 percent of the transfers from the two Manitoulin hospital sites are classified as non-urgent. “Being a rural facility, this is absolutely crucial for us.”

Both CEOs noted that this topic has been is discussion for upwards of a year and admitted the first meeting was a heated one, but they are trying to find common ground.

Starting October 16, the same day the Mindemoya ambulance service becomes staffed 24 hours, the amount of time an ambulance will wait for a transfer patient at the SRH will be 90 minutes. Before, Mr. Dominelli explained, the wait time was based on the distance traveled. If it took one hour for the ambulance to transfer the patient, the paramedics would wait one hour. After the 90 minutes, the staff will speak with their field superintendent to see if they can wait any longer, but once the EMS hits four ambulances out of the area, that crew will have to leave Sudbury and come back.

“Again, are we really the right vehicle for this?” Mr. Dominelli asked, noting that the DSB would run the transport service and even donate two ambulances to be transformed into the less-equipped version of ‘bus.’

“Both sides are advocating for patients, but I’m advocating for the residents of the area,” he added.

The DSB CEO noted that the Ministry of Health is setting new standards on response time with questions to be answered such as, ‘how many times out of 100 will an ambulance get to a heart attack victim in six minutes?’ He expects this to “go live” in the next couple of years.
“We’ve got to make sure we’re doing the best we can considering the resources,” Mr. Dominelli added, noting that while transfer numbers have stayed the same, total calls have doubled in the last six years. “That’s the real issue,” he said.

Both Mr. Dominelli and Mr. Graham say they are hoping for positive feedback from the ministry after the election and will continue to work side-by-side.