Nova Scotia

Union and province at odds over change to emergency call staffing

If someone in Nova Scotia calls 911 for a medical emergency, they may be connected to someone who is not a paramedic. The province says the change in the job description is necessary to deal with a staffing shortage, and is actually considered a best practice.

Use of paramedics on 911 phone calls is not the norm, says Emergency Health Services

Jeff Callaghan of the Canadian Union of Postal Workers says field experience is crucial when taking emergency phone calls from people in a crisis. (Robert Guertin/CBC)

The union that represents some paramedics says it's shocked that Nova Scotia is changing the way it staffs emergency medical calls.

Until recently, all 911 calls that needed medical support were routed to paramedics at the EHS medical communications centre in Dartmouth.

Two weeks ago, the provincial government gave its approval for Emergency Health Services to hire staff with no paramedic training. The union says it was caught off guard. 

"We don't really understand why the government is putting the lives and health and safety of Nova Scotians at risk," said Jeff Callaghan, the national director for Canadian Union of Postal Workers in Atlantic Canada, which represents the staff at the call centre.

Callaghan argued that the knowledge of the paramedics is critical, especially at a time when people can wait hours for an ambulance to arrive.

Both the company and the provincial government say the change is about filling staffing gaps and improving the service.

Until recently, anyone calling 911 for a medical emergency in Nova Scotia would be connected with a paramedic working in the call centre in Dartmouth. (Dan Taekema/CBC)

Jan Jensen, executive director of medical communications with EHS Operations, said it wasn't a decision that was made lightly. She said emergency systems across North America largely use civilians, not paramedics, to answer the calls for help.

"It's time to do this, to bring our communication centre in line with industry standards," she said. "It is an evidence-based decision, and no, we don't believe the quality of care of the emergency call taking process will change based on this."

The move comes nearly a year after it was recommended by the Fitch report, a comprehensive review of the provincial ambulance system from U.S.-based Fitch and Associates.

It estimated that "paramedics versus civilians can add approximately 50 per cent more labour costs." It pointed out that the software used in the communications centre is designed to be operated by people who are not paramedics.

The report added that the International Academies of Emergency Dispatch — a non-profit that provides training and certification for emergency dispatchers worldwide — "found that civilian call takers often performed better than paramedics as they are less likely to deviate from protocols and try to rely on past field experience."

Callaghan took issue with that point, and said experience is crucial to the job.

"They're able to listen for nuances," he said. "If you have laboured breathing, the person may be upset on the phone and kind of miss that part of it, but as a trained paramedic, you're trained to look for those types of signs that would not be picked up by somebody who is only reading a script."

180,000 calls a year

Callaghan is accusing the province of making the change for the sake of the bottom line.

"It was all about dollars and cents, but we really think that the service our members have provided over decades for Nova Scotians, that training means a lot more than a few dollars and cents on a budget."

There are currently 65 employees at the EHS medical communications centre, about 15 of whom are on leave. Jensen said ideally, there would be up to 75 employees to handle the 180,000 calls they receive every year.

"Our team members are working quite hard right now, so we need more members on the team," she said.

Any new hires who are not paramedics will receive about six weeks of training, she said. 

Jensen said the company now has a physician on shift around the clock, as well as an advance care paramedic. She said they are in place to provide backup if callers need additional medical support while they wait for an ambulance.

The health department initally sent CBC's request for comment to EHS, and followed up with a statement when CBC asked for more detail.

It reinforced the need for more staff at the call centre.

"It is crucial to look at all opportunities to increase the workforce and ensure that patients are receiving the care they need when they need it," the statement said.

"The practice of hiring non-paramedics for the Medical Communication Centre is now considered best practice."

While there is a shortage of paramedics in the province, Callaghan said the change won't free up those on the phone to work in the field. He said many of them are later in their careers, and cannot keep up with the physical demands of the job.

Others, he said, have been injured at work, but can continue to provide support over the phone.

"They're heroes, for one thing. They worked tirelessly through the pandemic, answering thousands of calls every year."

He's hoping people will fight this decision, and he has the support of the NDP. Susan LeBlanc, the NDP's spokesperson for health and wellness, was one of the first people to criticize the timing of the move.

"It seems to me a terrible time to make this change, when folks are waiting for ambulances," she said.

Leblanc said it would be one thing if ambulance wait times were reasonable, but she noted the entire system is struggling.

"The real folks at risk are the ones who are calling for an ambulance... It's really essential to have someone on the other end of the line who can help you through whatever is going on."

Jensen said all that's changing right now is the job posting, and paramedics can still apply.

"Certainly, that is an asset," she said of their experience.