Call for Presenters: BCYPA 2019 Fall Education & Research Symposium

The British Columbia and Yukon Paramedic Association is seeking presenters for the fall education and research symposium. Ideal topics include competencies in the NOCP profiles to maximize CPD credits with the EMALB. Topics pertinent to clinical practice, education , research literacy, research that informs current practice and more.

If you have a topic, research or presentation idea we would like to hear from you. Presentations can be 30 or 60 minutes in length. We will be seeking to expand our venues this fall and would ask that you be available for two days to present in the lower mainland and interior. You will be kept in the loop for dates and planning.

Please send your expression of interest and a title with one paragraph description of your presentation to: admin@paramedicsbc.ca

BCPA Position Statement on Healthcare Regulation in BC and the Cayton Report

“It is the duty of a college at all times; To protect the safety of patients, to prevent harm and promote the health and well-being of the public.”

Health Professions in British Columbia are overseen by government within a variety of frameworks.  Currently, the most common framework is professional self-regulation under the BC Health Professions Act.

Paramedicine does not fall under a college based self governance model in BC and instead is overseen by a government appointed licensing board. The Emergency Medical Assistant Licensing Board (EMALB), oversees entry to practice and maintenance of licensure within BC. Paramedics are actually considered Emergency Medical Assistants (EMAs), within provincial legislation.  The title paramedic and its variations is not protected in BC which presents risk to the protection of the public.

The legislation under which BC paramedics are licensed and regulated has not kept up with modern evolutions of medicine. Skills, procedures and authorities in the Act are piecemealed together through a series of schedules that are confusing and fail to reflect current practice. Additionally, education standards have failed to keep pace with the rest of Canada for Paramedics; as a result the primary paramedic employer, BC Emergency Health Services (BCEHS), now bears a significant educational burden bridging knowledge gaps that have become entry to practice knowledge expectations in other canadian jurisdictions.

At the request of the Hon. Health Minister Adrian Dix, Mr. Harry Cayton has released a recent report on the status of regulated health professions in British Columbia.

It is the position of the British Columbia Paramedic Association (BCPA), that paramedics in BC should become a self-regulated health profession within the context of any new approach to regulating health professions. Should health regulatory reform come to pass, the BCPA would request a seat at the table designing the new regulatory structure and process.

Background

The Cayton Report, published April 2019, was commissioned at the request of the provincial health minister to address complaints about current self-regulatory colleges. This report breaks into two sections, each with a specific mandate.

Powerful beneficial ideals are frequently born of adversity. As a result of regulatory difficulties with the College of Dental Surgeons of BC (CDSBC), the Hon. Health Minister Adrian Dix commissioned Harry Cayton to investigate and report upon both the CDSBC and BC’s current health regulatory framework (as defined by the Health Professions Act). Mr. Cayton had the excellent foresight to clearly delineate the report into two sections: the first section being a comprehensive reflection upon the regulatory status of the CDSBC, the second section being a comprehensive reflection upon potential regulatory reform for BC’s health professions.

The first section of Mr. Cayton’s report is clear and does an excellent job of outlining issues found within the CDSBC. It has no direct bearing upon paramedic practice aside from serving as a cautionary tale with respect to the duties and obligations of a regulatory college.

The second section of Mr. Cayton’s report is one of the most relevant pieces of government commissioned literature with respect to paramedic practice from the last decade. It clearly outlines reasoning as to why a profession should be regulated for the protection of the public while laying out a potential new regulatory framework to both enhance protection of the public and reduce regulatory costs.

Section 9.14 of the Cayton report succinctly relays the core principles of health regulation reform:

9.14 The overall objectives of reform of health professional regulation should be:

• To protect the safety of patients, to prevent harm and to promote the health and well-being of the public

• To provide a framework for safe, competent and ethical professional practise

• To have the trust of the public and the confidence of regulated occupations

• To be able to adapt to change and respond to new risks and opportunities

• To be efficient and cost effective in the interests of all citizens

Each of these points deserves specific address with respect to the future of paramedic practice in British Columbia.

“To protect the safety of patients, to prevent harm and to promote the health and well-being of the public”

As part of his recommendations for the enhancement of patient safety, Mr. Cayton proposes amendment of the Health Professions Act to state “It is the duty of a college at all times; To protect the safety of patients, to prevent harm and promote the health and well-being of the public.” This excellent statement of duty would apply to all health professions falling under the Health Professions Act. At present paramedics are separately regulated through the Emergency Medical Assistants Licensing Board (EMALB) under the Emergency Medical Assistants Regulation. As such, any changes to the Health Professions Act will not apply to paramedicine unless amendments to the regulation include the formation of a BC College of Paramedics.

By comparison the EMALB’s statement of purpose is as follows: “The board, under the authority of the Emergency Health Services Act, sets licence terms and conditions. In addition, the board investigates complaints and conducts hearings where necessary.”  The EMALB’s statement of purpose does not include the all important concept of purpose Mr. Cayton proposes for all regulated health professions: “to protect the safety of patients.”

Paramedics know the protection of patient safety must be at the forefront of practice, but a lay member of the public may ask why this concept should be embedded into the regulatory framework. The answer is surprisingly simple. Paramedics on a daily basis perform a tremendous number of controlled medical acts which, if performed incorrectly or inappropriately, have serious potential for patient harm. As healthcare providers performing controlled medical acts, paramedics must have patient safety minded regulation at the forefront of the professional lexicon. Inclusion of paramedicine within proposed changes to the health regulatory framework would ensure patient safety minded governance rose to a place of prime importance within paramedic practice regulation.

“To provide a framework for safe, competent and ethical professional practise”

Regulation governing the practice of paramedicine in BC, the Emergency Medical Assistants Regulation, consists of a 33 page, 5775 word single document. This, as compared to the scope of paramedic practice, miniscule document can not possibly be expected to encompass a framework for safe, competent, and ethical professional practise. By comparison, the allowed scope of practise document alone for BC’s registered nurses is 72 pages in length (professional responsibilities, code of ethics etc., are all separate documents). Current regulatory structure for the practice of paramedicine in British Columbia fails this test. Inclusion of a College of Paramedicine within a restructured health regulatory framework would serve to rectify this healthcare practise inequity.

“To have the trust of the public and the confidence of regulated occupations”

The paramedic profession by and large has the public’s trust, however it has no mechanism to earn the confidence of other regulated health professions. Consistently paramedics rank among the most publicly trusted healthcare workers yet they lack a regulatory college operated by an appropriate blend of subject matter experts and members of the public. The absence of a regulatory college robs the profession of the ability to professionally interact with other regulators for the betterment of patient safety and patient care standards. The formation of a BC College of Paramedics under proposed health profession regulations would alleviate this disparity by creating allowances for interdisciplinary information sharing.

“To be able to adapt to change and respond to new risks and opportunities”

The current paramedic regulatory framework completely fails in this important area. As medical evidence changes, so too does best medical practice for patient safety and best possible care outcomes. The current EMALB structure requires an act of legislation via the provincial health minister to adapt to changing medical evidence. This cumbersome and inefficient structure is neither quick in its ability to respond, nor guaranteed to be directed by appropriate subject matter experts. The formation of a BC College of Paramedics under an updated Health Professions Act would alleviate this impediment to best patient care by Paramedics.

“To be efficient and cost effective in the interests of all citizens”

At present the administrative costs of the EMALB are almost entirely borne by the BC taxpayer. Some degree of cost recovery is achieved through examination fees and licensing fees. Most regulatory college systems of governance impart the cost of operation directly to the regulated practitioner. As Mr. Cayton astutely points out, professional regulation “is a tax on work; a payment for the privilege of working.” What Mr. Cayton is proposing with respect to a health profession regulatory overhaul could include mechanisms for cost sharing amongst regulated health professions. The United Kingdom Health & Care Professions Council (HCPC) for example oversees sixteen separate regulated health professions which all share the regulatory costs associated with their various professions. Paramedicine is one of the sixteen health professions regulated under the UK HCPC. The formation of a similar health council in BC would ideally include Paramedicine.

Conclusion

As a significant stakeholder seeking improvement in paramedic professional regulation, the BC Paramedic Association (BCPA) seeks a seat at the table as health profession regulation is reformed and ideally a BC College of Paramedics is formed. Whether under an overarching health professions council or as a separate regulatory college, the time for more appropriate paramedic practice regulation in BC has come.

The British Columbia Paramedic Association (BCPA), is an independent, non-partisan, not-for-profit, member supported society that represents the profession of Paramedicine in BC.  The BCPA advocates for the best out-of-hospital medical care for patients in British Columbia by establishing professional standards of practice, continuing professional development opportunities/education, creating original research, and providing knowledge translation for paramedic practice in British Columbia. BCPA membership is voluntary and the association is not a labour representative.

CERN-RCRSP 2019 AGM & Paramedic Research Symposium in Vancouver – May 6, 2019

The 2019 CERN-RCRSP will be held on the afternoon of Monday, May 6, 2019 at UBC Robson Square in Vancouver, BC. The Symposium runs from 1230 to 1800.


Highlights of the CERN-RCRSP Symposium agenda are the following:


 Key note address exploring key concepts and trends in Big Data, and how these can inform EMS and paramedicine research in Canada
 Presentations describing current data-related research initiatives in Canadian EMS and paramedicine
 Poster presentations from researchers across Canada
 Updates on EMS- and Paramedic-related research from across the country
 Presentation of this year’s Canadian EMS Research Mentorship Award
 CERN-RCRSP Annual General Meeting


Registration is free and open to anyone interested in Paramedic research! Click here to register. Participate in the 2019 CERN-RCRSP Symposium: Call for Abstracts and Research Updates
Poster Abstracts


CERN-RCRSP is now accepting abstracts that explore both the Symposium theme of Big Data and Paramedicine and research in EMS and Paramedicine broadly.


An abstract review committee will invite a limited number of abstracts for poster presentation or an oral presentation at the 2019 CERN-RCRSP AGM and Symposium. Abstracts should include:


 Primary presenter’s name and contact information
 Title
 Short description (maximum 350 words) summarizing your research and/or its key points


Please submit your EMS and Paramedicine Research Abstracts to admin@cern-rcrsp.ca NOW!

SPECIAL ANNOUNCEMENT: BCPA Education & Research Symposium – Live Webinar Access

The British Columbia is pleased to announce that thanks to our partnership with the Justice Institute of BC we are now going to be able to provide live webinar access to those members that are not located in the lower mainland.

As with regular tickets, webinar access is FREE to all members or available for purchase online.

PRESS RELEASE – British Columbia Paramedic Association Supports Auditor General’s Report on BCEHS

For Immediate Release
February 28, 2019

British Columbia Paramedic Association Supports Auditor General’s Report on BCEHS

Vancouver, BC — The British Columbia Paramedic Association (BCPA), an independent body representing paramedic clinical and professional practice in British Columbia, supports the findings of the BC Auditor General’s Report on the British Columbia Emergency Health Services (BCEHS). Executive Director, Scott Ramey a Critical Care Paramedic says “It appears to be a well balanced report; emphasizing the positive improvements well underway, while outlining within the recommendations some areas BCEHS has already identified for on-going enhancement.


In particular BCPA shares the view expressed within the auditor’s report that a comprehensive clinical quality assurance and improvement program would serve to improve overall patient care standards. In the interest of public safety such a program would encompass the full emergency health services response profile, ranging from first responder through paramedic treatment and transport. Quality assurance practices previously only applied to paramedic levels of care would serve to enhance patient safety once applied across all levels of care, including first responders. BCPA President, Edward Peters, a Critical Care Paramedic, shared that “The BCPA strives to continually improve patient care through the enhancement of paramedic education and by supporting sound clinical oversight.”


The auditor general made particularly valid recommendations regarding several areas of clinical practice and patient care in British Columbia. The expansion of advanced levels of paramedic care to suburban and rural areas should be further explored and is long overdue.


All levels of responders contribute greatly to the emergency health system. There are areas the BCPA sees opportunities to rapidly and significantly enhance patient care. Of note, the Auditor General emphasized the ST Elevation Myocardial Infarction (STEMI) program in the report. The BCPA supports the addition of Primary Care Paramedic (PCP) 12-lead ECG acquisition, 12-lead interpretation and STEMI bypass. These skills and procedures have to date been restricted to Advanced Care Paramedics (ACP) in BC while other provinces have proven the effectiveness of a PCP STEMI program in broadening accessibility to life saving STEMI care in a timely and safe manner.


BCPA would be delighted to see greater evaluation of the rural and remote inter-facility transport system in future system status reports. BCEHS is a lifeline for rural and remote patients requiring referral to specialty care; often in urgent and emergent conditions far from where these patients reside. The evaluation of these critical care transport services was excluded from the report and is not on the current BCEHS list of active projects outlined within.


The British Columbia Paramedic Association is committed to the translation and application of pre-hospital clinical research for the enhancement of patient care through paramedic derived evidence based medicine. Any opportunity for the BCPA to work with BCEHS toward the enhancement of paramedic education, clinical practice, quality, risk, safety and improved patient outcomes is welcomed.

— 30 —

Contact:
Scott Ramey, CCP
Executive Director
Scott.Ramey@paramedicsbc.ca
(604)801-9696

Letter of Support for Paramedic Higher Education & Research, BCPA Advisor Dr. Yoon


RE: University Education and Research Programs in Paramedicine


To Whom It May Concern:


I am a Clinical Professor within the Department of Emergency Medicine at the University of British Columbia. As an Emergency Medical Services (EMS) physician, I have been involved in the operations, education, research and promotion of paramedic practice for the last 20 years. It has been my privilege and honour to have worked and to continue to work with numerous talented, dedicated, and inspiring paramedics. I am an enthusiastic supporter of paramedics and a stalwart advocate for advancing paramedicine as a profession. I strongly assert that the need for university level academic programs specific to paramedicine is vitally important to not only the profession, but to the quality of out-of-hospital medical care.


Paramedicine has evolved relatively quickly as a distinct body of knowledge and skills that continue to play a critical role in health care around the globe. University level degree paramedicine programs have been well established in several other countries including Australia, New Zealand, Ireland, South Africa, the United Kingdom, and the United States. Numerous medical schools internationally have recognized EMS as a distinct and major subspecialty of emergency medicine with academic divisions and centres that specialize in out-of-hospital care education and research. Paramedicine is an essential and prominent discipline for virtually all military forces of the world. In this context, the British Columbia Paramedics Association is championing an effort to persuade universities and other organizations to initiate and sustain academic programs specific to paramedicine. We are fortunate to have a critical mass of paramedics who are keenly dedicated and passionate about formalizing paramedicine as an academic discipline. In order to achieve that, university administrations must recognize that our BC paramedics require an organizational vehicle that can establish degree programs, research infrastructure, and an academic milieu that supports excellence in paramedic practice for not only the health care demands of today, but beyond.


We all acknowledge that quality in health care stems from support and achievement in clinical delivery, education, research, innovation and community engagement. We have witnessed paramedic practice in the province move beyond 911 emergency responses and inter-facility patient transfers and into community paramedicine, special operations (including mass gatherings, event medicine and tactical support), disaster management, environmental medicine, HAZMAT management, public health and many other areas of health care. We rely on paramedics to be the front-line providers for mass casualty incidents, pandemics involving substance use and infectious diseases, and time-sensitive life-saving procedures. It is abundantly clear that paramedics are playing a highly prominent and important role in the delivery of health care, but in this province and generally in this country, they are insufficiently supported by our academic institutions.


Paramedics are highly motivated and passionate health care professionals who possess a dedication to life-long learning, inter-disciplinary collaboration, research and clinical excellence. It is long past due for academic institutions and other decision-makers in this province to provide these professionals a formal academic environment to enable them to strengthen and sustain their profession, just like other health professions. Our society takes it for granted that in any person’s moment of medical need, paramedics will be there to use their knowledge and skills to render immediate aid and comfort. I ardently argue that all of us who benefit daily from the security, safety and clinical care that paramedics are always ready to provide us should be doing our best to support paramedicine.
Sincerely,


Philip Yoon, MD, MBA, CCFP(EM), FCFP
Clinical Professor, Department of Emergency Medicine, University of British Columbia
Emergency Physician, Royal Columbian & Eagle Ridge Hospitals, Fraser Health
Reserve Medical Officer, 1 Canadian Field Hospital – Ottawa Detachment, Canadian Armed Forces Medical Director, EMS Physician Online Support, British Columbia Emergency Health Services
Vice-Chair, Emergency Medical Assistants Licensing Board, Ministry of Health, Province of British Columbia

CPD Opportunity (EMALB Credit): Viewing, Falling Through the Cracks: Greg’s Story

You are invited to attend a viewing of Falling Through the Cracks: Greg’s Story

Hosted by: Douglas College Faculty of Health Sciences

Monday February 25, 2019

11:00-12:30

A1470 Lecture Theatre

Douglas College, David Lam Campus

Coquitlam, BC

1100-1230

Registration can be found here.

Falling Through the Cracks: Greg’s Story is a short film on Greg Price’s journey through the healthcare system. The film gives a glimpse of who Greg was and focuses on the events of his healthcare journey that ended in his unexpected and tragic death.   In spite of the sadness of Greg’s Story, the message of the film is intended to inspire positive change and improvement in the healthcare system. We believe the film will resonate with the audience and create a platform for further dialogue. We hope people will feel empowered and challenge the status quo of the current healthcare system so we all end up with better care and outcomes.

Watch the trailer:

CPD Resource: Neuro Anatomy UBC

Our friends at University of British Columbia have created a wonderful learning resource that we wish to share with our members. Open to the public and licensed through Creative Commons they have created a virtual anatomy lab on Neuroanatomy. We are sure all paramedics will find this useful and interesting.

http://neuroanatomy.ca

For instance, check out the stroke model: http://neuroanatomy.ca/stroke/aca.html

Longer prehospital time was not associated with mortality in major trauma. A retrospective cohort study.

(Photo Credit: Surrey Now-Leader)

Just released in the Journal of Pre-Hospital Emergency Care:

https://www.tandfonline.com/doi/abs/10.1080/10903127.2018.1551451?journalCode=ipec20&

Commentary:

As more and more research presents on the previously perceived validity of the “Golden Hour” of trauma, this research article provides opportunities to consider a balanced approach of critical interventions versus a purely “load and go” approach.  After many years of research showing reduced scene times are the defining factor, much of what is happening with advanced critical interventions with programs such as London HEMS and others, there seems to be a new trend toward advanced practitioners being the defining factor.  This is something that we need to watch closely and participate in further research.

An example of an important question; Would advanced critical care practitioners in rural environments capable of treating severely life threatening conditions in the absence of a local trauma centre be better than rapid transport alone to a local emergency department?  Recent Helicopter EMS (HEMS) studies have shown that advanced practitioners are perhaps the defining factor in those that are survivable and have not already  declare themselves unviable.

Does this support the direction for the future of paramedic practice in British Columbia?

Quote from the study offers some thoughts:

“Our finding of an association between longer on-scene times and longer LOS in those who survived at least 30-days could be attributed to these patients being those who had their immediate life threats corrected in the additional time spent on-scene and thus were less
likely to die.”

Objective: To determine the association between prehospital time and outcomes in adult major trauma patients, transported by ambulance paramedics.

Methods: A retrospective cohort study of major trauma patients (Injury Severity Score >15) attended by St John Ambulance paramedics in Perth, Western Australia, who were transported to hospital between 1st January 2013 and 31st December 2016. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to limit selection bias and confounding. The primary outcome was 30-day mortality and the secondary outcome was the length of hospital stay (LOS) for 30-day survivors. Multivariate logistic and log-linear regression analyses with IPTW were used to determine if prehospital time of more than the one hour (from receipt of the emergency call to arrival at hospital) or any individual prehospital time interval (response, on-scene, transport or total time) was associated with 30-day mortality or LOS.

Results: A total of 1,625 major trauma patients were included and 1,553 included in the IPTW sample. No significant association between prehospital time of one hour and 30-day mortality was found (adjusted odds ratio 1.10, 95% confidence interval (CI) 0.71-1.69). No association between any individual prehospital time interval and 30-day mortality was identified. In the 30-day survivors, one-minute increase of on-scene time was associated with 1.16 times (95% CI 1.03-1.31) longer LOS.

Conclusion: Longer prehospital times were not associated with an increased likelihood of 30-day mortality in major trauma patients transported to hospital by ambulance paramedics. We found no evidence to support the hypothesis that prehospital time longer than one hour resulted in an increased risk of 30-day mortality. However, longer on-scene time was associated with longer hospital LOS (for 30-day survivors). Our recommendation is that prehospital care is delivered in a timely fashion and delivery of the patient to hospital is reasonably prompt.

Disclaimer

As a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also.