Better pre-hospital care could save treatment costs in long run

Critical Condition

Better pre-hospital care could save treatment costs in long run

The yearly cost of injury exceeds $2.8 billion according to Provincial Health Services Authority.

Fifth in a series looking at serious issues with emergency health services in British Columbia.

If you have a story to share with us about your experiences, send an email to newsroom@castlegarnews.com.

Advocates of an improved pre-hospital care system argue that the overall costs of adding more ambulances, paramedics, helicopters and fixed-wing aircraft to British Columbia’s emergency health-care system would be countered by the savings generated from shorter hospital stays, less time spent in rehabilitation facilities, lower disability claims, etc.

“From a cost perspective alone, all the politicians from all of the parties should be tripping over themselves to put together a vastly more capable pre-hospital care system,” said Hans Dysarz, executive director for the advocacy group BC HEROS. “It is literally bleeding our health system out.”

What is often referred to as the golden hour — the first hour following a traumatic injury or illness in which prompt treatment is most likely to make a difference in preventing death or dire outcomes — is often used up in rural B.C. before a patient ever reaches a hospital.

Missing that golden opportunity for treatment can result in extended hospital stays, need for long-term care and permanent injuries leading to disability claims — all which cost the medical system.

According to the Provincial Health Services Authority, the yearly cost of injury exceeds $2.8 billion in B.C.

Over 700,000 people are injured yearly in B. C. Of these, approximately 1,800 die, 9,000 suffer permanent disability, 27,000 are hospitalized and an estimated 41,000 potential years of life are lost. (Trauma Services BC)

The Public Health Agency of Canada reports that in 2010 the total economic burden of injury across the country was $26.8 billion, of those costs, $15.9 billion was health-care expenditures and $10.9 billion was associated with reduced productivity from hospitalization, disability and premature death.

The costs of injuries have been climbing each year, so current numbers are likely a lot higher. These figures are only for injuries and do not include other urgent medical issues such as strokes or heart attacks — two situations where timely treatment is of utmost importance.

So the question many are asking is: “Wouldn’t an investment in better pre-hospital care reduce those figures — lowering costs, permanent disabilities and lives lost?”

When transportation is primarily done by ground ambulance, more than one million rural B.C. residents are so far from a trauma centre that transportation time alone takes so many hours that sometimes opportunities for improved outcomes are lost.

This is combined with the fact that almost all of the ambulances transporting those patients are Basic Life Support ambulances which are limited in equipment and not staffed with paramedics at the highest level of certification.

All three of B.C.’s Level 1 trauma centres are located in the Vancouver area. The Level 2 trauma centres are located in Kelowna, Kamloops and Victoria. Three of the Level 3 trauma centres are located in the Lower Mainland, one in Nanaimo and one in Prince George. That leaves a vast swath of B.C. residents with a very long way to travel to reach the help they need.

“Yet all of B.C.’s rural residents help to pay for these facilities and highly skilled staff year after year,” stated Dysaryz. “That is a form of taxation without representation — or in this case, taxation without timely access. And rural residents are dying and ending up with permanent injuries as a result,” said Dysarsz.

The long distances to hospitals designated as trauma centres are one of the reasons why BC Forest Safety Ombudsman Roger Harris called for the province to add more air ambulances to its emergency health care system in a recent report.

In Harris’s report “Will it be there? A report on helicopter emergency medical services in B.C.” he says, “When all factors are considered, HEMS (Helicopter Emergency Medical Service) may, in fact, be more cost-effective than ambulances in the total overall cost to the health-care system when you factor in patient outcomes to the equation; and second, if you apply the logic of using low call volumes as a determinant of allocating emergency medical resources to an area, then conceivably a community with little or no crime or fire could find themselves without those services as well. It simply is not a reasonable argument to make.”

The report continues, “There are no technical, or infrastructure barriers to the delivery of helicopter emergency medical services within that critical first hour to each and every resident of B.C., regardless of where they live. The decision by government not to provide those services is a choice.”

“Faster care results in less overall health care costs,” states Harris. “It is an accepted fact the quicker an accident victim can access medical care, the better the medical outcomes, the shorter the period of time for rehabilitation resulting in an overall lower cost to the health-care system. As emergency response is one component of the cost, investing more in ensuring patients receive timelier treatment, could result in overall savings to the cost of moving a patient through the system.”

Alberta’s air ambulance service STARS estimates that: “Timely treatment of stroke, heart attacks or brain injuries can save more than $1 million per patient. The economic benefits of helicopter ambulance missions are six times higher than the costs.”

Every time an outcome is improved, the costs go down. A regular hospital stay costs less than an ICU stay, a temporary or partial disability costs less than a full disability and every day shaved off of a hospital stay saves thousands of dollars.

An out-of-province perspective

The Castlegar News heard from an Ontario paramedic leader with over 30 years of experience who is very concerned about the state of pre-hospital care in British Columbia.

He shared that he has many friends in the British Columbia Emergency Health Service that are afraid to speak out about their concerns due to potential repercussions, so he has made a commitment to his B.C. paramedic friends to advocate for better service for B.C. residents.

This paramedic has worked at the primary care and advanced care levels, in ground ambulances and on helicopters and in both urban and rural areas.

He is advocating for more ambulances and paramedics, more helicopters and planes and more equipment on board, especially ECG monitors.

In B.C. primarily only Advanced Life Support (ALS) ambulances staffed with Advanced Care Paramedics (ACP) have ECG monitors on board. The total of ALS ambulances in the province is less than 30. Other provinces utilize ECGs much more extensively in ambulances staffed at the Primary Care Paramedic (PCP) level.

“Equipping PCP crews with the tools that every other province does makes financial and moral sense,” explained the Ontario paramedic. “The rest of the country considers [ECG] a staple tool required to do the profession.”

“Cover the province with a net of well-trained paramedics in both fixed wing and helicopters and survivors will be lining up to say thanks,” he added.

He also stressed that paramedics should not be looked at as just a means of conveyance — they should be treated as a huge part of the medical team.

In his experience in Ontario, PCP paramedics daily diagnose patients having critical cardiac arrhythmias, treat the patient with oxygen and ASA and then based on a 12 Lead ECG either redirect the patient to a cardiac center for emergency surgical intervention — bypassing emergency rooms — or in the absence of a cardiac centre, alert the hospital of an inbound patient with clinically significant 12 lead changes so that the “door to drug” time can be reduced.

“This in no way is meant to disparage the hardworking staff at BCEHS,” he said. “But it is time that the government look at what the rest of Canada is doing and start being a leader instead of bringing up the rear.”

Critical Condition Investigation

Get local stories you won't find anywhere else right to your inbox.
Sign up here

 

Better pre-hospital care could save treatment costs in long run

Better pre-hospital care could save treatment costs in long run

Just Posted

Const. Allan Young. Photo: Abbotsford Police Department
Manslaughter charge laid in Nelson death of Abbotsford police officer

Allan Young died after an incident in downtown Nelson last summer

Forty-seven vaccination clinics will open across Interior Health beginning March 15. (Canadian Press)
48 COVID-19 vaccine clinics to open across Interior Health

Select groups can book appointments starting Monday

Seniors in the Interior Health region can book their COVID-19 vaccinations starting Monday, March 8, 2021 at 7 a.m. (File photo)
Seniors in Interior Heath region can book COVID-19 shots starting Monday

Starting March 8 the vaccination call centre will be open 7 a.m. to 7 p.m. daily

.
Eight weeks with no new COVID-19 cases in Castlegar

The latest localized BCDCD COVID-19 numbers

Jasper after he was reunited with his owners Mary and Brent Hummel. Photo: Steve Smith
New children’s book features lost Castlegar dog who swam the Columbia multiple times

Brent and Mary Hummel and Jasper tell their dramatic story

Elvira D’Angelo, 92, waits to receive her COVID-19 vaccination shot at a clinic in Montreal, Sunday, March 7, 2021, as the COVID-19 pandemic continues in Canada and around the world. THE CANADIAN PRESS/Graham Hughes
‘It’s been a good week’: Tam hopeful on vaccines as pandemic anniversary nears

Tam says the addition of two new vaccines will help Canadians get immunized faster

(The Canadian Press)
‘Worse than Sept. 11, SARS and financial crisis combined’: Tourism industry in crisis

Travel services saw the biggest drop in active businesses with 31 per cent fewer firms operating

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Pictures and notes in from friends and classmates make up a memorial in support and memory of Aubrey Berry, 4, and her sister Chloe, 6, during a vigil held at Willows Beach in Oak Bay, B.C., on December 30, 2017. THE CANADIAN PRESS/Chad Hipolito
Mother of slain daughters supports recent changes to Canada’s Divorce Act

Sarah Cotton-Elliott said she believed her children took a back seat to arranging equal parenting

Victoria man Brett Andersen is asking for people’s help to secure him one of eight free tickets to the moon. (Screenshot/@brettandersen Instagram)
Victoria man wants your help securing a free ticket to the moon

Japanese billionaire offering eight people a trip to the moon

The Conservation Officers Service is warning aquarium users after invasive and potentially destructive mussels were found in moss balls from a pet store. (BC Conservation Officers Service/Facebook)
Aquarium users in B.C. warned after invasive mussels found at pet store

Conservation officers were told the mussels were found in a moss ball from a Terrace pet store.

Hockey hall-of-fame legend Wayne Gretzky, right, watches the casket of his father, Walter Gretzky, as it is carried from the church during a funeral service in Brantford, Ont., Saturday, March 6, 2021. HE CANADIAN PRESS/Nathan Denette
Walter Gretzky remembered as a man with a ‘heart of gold’ at funeral

The famous hockey father died Thursday at age 82 after battling Parkinson’s disease

Donald Alan Sweet was once an all star CFL kicker who played for the Montreal Alouettes and Montreal Concordes over a 13-year career. Photo courtesy of Mission RCMP.
Ex-B.C. teacher who was CFL kicker charged with assault, sexual crimes against former students

Donald Sweet taught in Mission School District for 10 years, investigators seek further witnesses

Most Read