No 'silver bullet' to fix ambulance response times, CEO says

Ambulance New Brunswick says there's no easy solution to chronically poor response times in many rural and remote communities around the province.

Officials appearing at a committee of MLAs for the second time this month said the problems require changes in the broader health-care system that would, for example, reduce the time ambulances are stuck at hospitals waiting to offload patients.

"There is not a silver bullet solution to these challenges," said Craig Dalton, the CEO of EM/ANB Inc., a provincial government-owned company that contracts with Medavie Health Services New Brunswick Inc. to operate the ambulance service.

"It's really an attempt to do as many things as we can to reduce pressure on the system, and not just the emergency health system but the health system in general."

Dalton said a growing population, with a fast-expanding share of older people, will mean more calls for ambulances while at the same time, recruiting paramedics is a challenge.

"The level of service decreases as those pressures increase," he said.

Dalton and Ian Watson, the chair of EM/ANB and also the assistant deputy minister in the provincial Health Department, confirmed Sept. 6 that they are talking to Medavie about changing the contract before it expires in 2027.

Under that agreement, Medavie must be on time for calls 90 per cent of the time.

"On time" is defined as within nine minutes in urban areas and 22 minutes in rural areas.

A 2020 auditor-general's report found that low on-time response rates in rural areas do not count against bonus payments to Medavie.

The formula in the contract allows those calls to be averaged into broader regional numbers that include a far greater number of on-time responses in urban areas producing an overall regional number that hits the target.

Watson said Thursday that formula, which allowed Medavie to scoop up $2.7 million in bonuses last year, is on the table as part of a possible renegotiation of the contract.

"The short answer is 'yes,'" he said.

But Dalton rejected the auditor general's finding that the formula creates a disincentive for ANB to improve by rewarding them for overall numbers so they don't need to hire more paramedics to address local shortfalls.

"My comment would be there's no internal disincentive to have the absolute best performance that we can have," he said.

"I understand the perception, which is why we're really keen to sit down and look at those as well. But I can assure you inside the organization, the only incentive is doing the best we can on each and every call."

Dalton and Watson were at the legislature's public accounts committee for the second time this month because MLAs from all parties agreed they wanted more answers than what they got during their first appearance Sept. 6.

Last year's numbers showed 19 rural and remote communities, out of 67 in total, having on-time ambulance responses far below 90 per cent of the time.

They were the same 19 that the auditor-general identified in 2020, including:

• Belledune, whose calls did not hit the target of 90 per cent on-time response in any month of 2022, and which had an on-time rate of just 29.2 per cent in December.

• Port Elgin, where the on-time response rate ranged from 55.6 per cent in July to 15.8 per cent in September.

• Fords Mills, in Kent County, with a 57.1 per cent rate in May of last year as its best result, and a 23.1 per cent rate its lowest in August.

Dalton said some new pilot projects are working, including a "pre-alert" system that allows paramedics to assess a patient on-site and divert them from a hospital emergency department in some cases.

That diverted 10,000 calls in which paramedics helped patients arrange to get care elsewhere.

New rapid response units with a single paramedic who can provide care before an ambulance arrives also free up some ambulances for other calls.

But Green MLA Kevin Arseneau questioned why there's no such unit in Kent County, given Fords Mills and other communities have had such poor response times.

Dalton said the units were placed in areas with the highest need, and ANB will likely look at putting one in Kent County when the next service review happens. Those reviews take place every two years.