Re: Call prioritization (Alberta, Long)

[Ken Lawson-Williams <Macgyver@FlightMedicMail.com>]

Alberta:

Red = critical / unstable
Yellow = unstable
Green-priority 1 = stable emergent patient
Green-priority 2 = stable ER transfer / wait and return in case of tertiary centre admission 
White = transfer for scheduled tests
Blue = repatriation from tertiary centre to community hospital

All FW (all turboprop, mostly BE-200 a few 100's still and a J-31) have 30 minute launch window, RW (BK-117) with 10, may be scene or interfacility as criteria apply to both FW and RW, 95%+ of FW are interfacility and paved strips - only High Level & Ft. Vermillion will fly into gravel strips. RW is about 50% scene work. Ft. McMurray, Slave Lake and Peace River also will fly into isolated strips to meet ground units coming straight from the scene (no MD has yet seen patient so considered as a scene flight/ALS backup). Crews not commonly notified much more than 30 minutes prior to scheduled pickup time for transfers even when booked the previous day.

In general FW never pick up from the apron or turn over on the apron to ground EMS in tertiary city. Blue/white patients will sometimes be turned over to local EMS if final destination is not home base of crew - but must be within scope of ground (BLS) team and is at their discretion to accept or not. PFCC takes basic information using AMPDS and advises of vitals and attachments (IV's etc) if known by the unit clerk who calls for the flight. MD involvement is at sending when he says "get them out of here" which authorises Alberta Health payment for a transfer - and if more than 1 hour or so by road gets approved for flight no matter how BLS it is. Ground transfers come out of hospital budget, flights out of provincial budget. 

There are 2 flight medical directors who work for Alberta Health and carry a cell between them 24/7 that crew can call by 800 number to consult if differences between care sending wants and crew wants or crew - vs recieving etc. Don't usually get involved unless crew has already gone through (or tried to) their own medical director (each service has different protocols/gear/training/meds etc and only 1 or 2 have Flight Medical directors, most are local GP's who oversee local EMS/ER so flight crew may want something outside their protocols...)

All remotely based (non Calgary or Edmonton teams) maintain ground units stored for a fee in hangers in Edmonton or Calgary so on arrival they become a ground crew and continue to hospital. On rare occasions when unstable and cannot do so safely will cal for local ALS ground unit to pickup - but they retain care to the hospital. In this case the bill for that leg of the trip is paid by the medical contractor. As far as I know the medical crew contractors still bid q3yrs on "total cost per month" basis based on supplied historical response statistics (total system of 12 FW and 2 PW fly 24/7 at all bases and do 8500 trips a year or so - wait and return tests count as only one trip even though 2 loaded legs).

No hold allowed for late calls (6.5 hr average duration from Peace River up to full duty time of flight crew plus ground time pre/post flight = 16 hrs - not uncommon at all.) Few services still have crews on standard ground shifts as overtime racks up far to quickly - most are on 24 hr call times 3 to 8 days straight and respond to airport by pager same as flight crews. Overtime comes out of medical contractors budget. Penalty assessed by PFCC of $500 (against either flight contractor or medical crew contractor as appropriate) if 30 minute window missed - nay be waived at their discretion for extenuating circumstances.

R/Y/G/may also be interfacility transfers - as you know Grand Prairie, High Level and Peace river routinely fly into Northern BC when your aircraft are shut down for the night, and Calgary (FW and RW (STARS) does same in Southeastern B.C.). No matter what priority B.C. Provincial dispatch provides (most commonly red) ALberta Provincial Flight Coordination Centre will reassign priority depending on their criteria (not a lot of difference really). To the best of my knowledge their dispatchers are EMD + (mostly EMT basic), no medics or nurses, NONE with any frontline flight experience and mostly with little street experience.

All flight crews must have a minimum of one approved (by Alberta Health) expanded scope ALberta registered EMT-P (slightly below the new CCP level) to legally fly in ALberta. Most crews have EMT intermediate partner (no symptom relief so below new PCP or BC EMA-2 level) although Ft. McMurray, Calgary STARS (RW) and Edmonton STARS (RW) have RN's - no increase allowed in staffing at RFP/bid time so most services go EMT to lower overall costs and win bid / get more profit. 

EMT's get NO AEROMEDICAL OR SURVIVAL TRAINING IN SCHOOL and unless with a service that upgrades them stay that way and learn Propaq / 3-channel pumps / ventilators / ETT-CO2 / LP-12 or whatever on the job. High Level/Ft. Vermillion being one exception that I know of that does give survival training - but they are over pure bush so often that landing on a road in an emergency is not likely and crash/survival situation probable in -40 winters with minimum of 6 hours before SAR is overhead.

Wait and returns and scheduled tests are a real $ waster - I have seen 7 of the 9 Northern Alberta medevac aircraft in Edmonton with various angio's etc in progress. Really drives up crew duty days as on 30 minute notice to pick up patient (hospital rarely ready on time to recieve or discharge patient). Also means the Government's concept of remote basing to reduce response times to very rural areas is gone - can be 2 hours to fly back to Northern Alberta... 

Also means that you fly in with a W+R angio, an hour later are sent from Edmonton on a Red MVA somewhere, return to Edmonton, pickup up someone elses repatriation, then back on to another scheduled pickup in some other services area as they are holding in Edmonton still and you are mobile, back to Edmontno, yet another multi-leg repatriation to a different sevice area then home with some other crew having to bring your AM patient back after the angio...

Often thought a standardised standby fee (as is allowed ground EMS) past a certain point (say 1 hour for booked tests etc) should be charged by Aeromedical Team (flight and medical) for tying up resources unnecessarily - obviously be waived with cause. Say $30 per minute ($1800/hr for BE-200, two ATPL level flight crew plus medical crew and their equipment).....

Fly Safe. 
Ken L-W CCEMT-P/RN etc

PS: Always wondered how BCAS/the union/the dept of health views Alberta licensed Paramedics coming into B.C. and performing ALS at a different (higher) level than the B.C. protocols allow without any license or registration or waiver? Of ground units doing the same near Field / Ft. St John / Valemont? Or Alberta based long distance transfer companies bringing patients in or picking up within B.C.  See nothing to stop a service from basing near the border and actively seeking buisness in B.C..... If there is a document allowing reciprocity for mutual aid flight responses etc field providers are unaware and wondering our legal position if we provide care/meds that B.C. protocols disallow during the pickup or while still in B.C. airspace.


--- medicwest@shaw.ca wrote:
Currently we have a Priority One red call which is asap launch, Priority One green which can be delayed up to 2 hours to facilitate a shift change (some calls take 6 hours plus to complete) and Priority Two that can be dispatched within 12 hours

we only have two fixed wing aircraft (one jet, one turboprop) on night shift for a province the same size as Washington, Oregon and California.
If you have any criteria that you use for prioritizing your fixed wing flights and are willing to share, it would be very much appreciated.


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