February 8, 2013






Islanders remain dissatisfied with medevac service
 by Arlene Benham


     Residents of Grand Manan continue to be dissatisfied with their air ambulance service, despite ongoing efforts by the village to address the issue.
     After a new agreement was announced in August between Ambulance New Brunswick (ANB) and Atlantic Charters, the local air service, Mayor Dennis Greene says everyone "thought they had come to an amiable solution, which was that Atlantic Charters would be providing most of the medevacs from Grand Manan."
     However, problems continued. Greene describes a case in September in which a "high‑acuity" patient was ordered to be transferred by ANB. The ANB plane was unable to land due to weather, "and all of a sudden, he was not high acuity." Atlantic Charters took the man to Saint John, but only after he had waited two hours for the ANB plane to arrive and make a couple of passes over the airport. In October, another heart‑attack patient waited three hours for an ANB flight.
     Greene says that in January a local snowplowing contractor was asked by ANB in a series of phone calls to assess the conditions at the airport. "This is not his responsibility." By the time a decision was made, five hours had elapsed. "[The plane] took off at 3:30 a.m., but it was not ANB, it was Atlantic Charters. All I know is, ANB didn't come. So we have a five‑hour delay again. Come on -- let's get our people out of here."
     At the inception of air ambulance service in New Brunswick in the mid‑1990s, Grand Manan was an early experiment that didn't work very well. Health department authorities soon decided to revert to the previous system using Atlantic Charters. Patients were assessed by local healthcare providers in consultation with doctors at Saint John Regional Hospital.
     Ambulance New Brunswick, a Public Service Part III company, took over the management of services in 2007, consolidating all the provincial ambulance services; this led to the development of current protocols. An algorithm is used to assess high acuity patients, with input from a doctor in Moncton who decides whether the patient should be flown out, and with whom. Flight medics on the ANB plane can still overrule the local doctor.
     ANB's aircraft has equipment comparable to that in an ambulance, and the medical staff are "flight trained" regarding communication with pilots, in‑flight rules and the emergency safety equipment on board. High‑acuity patients are at imminent risk of losing life or limb, or are stable only because of medical intervention.
     If ANB cannot come due to weather, or their aircraft is occupied elsewhere -- both frequent occurrences -- Atlantic Charters can fly with a registered nurse and portable equipment such as a defibrillator.
     Councillor Jayne Turner feels that the "high acuity" loophole in the August contract has expanded. ANB leases an aircraft, and some members of council are now wondering whether the idea of acuity is being used to justify the use of that aircraft. They estimate ANB's Beech King Air likely costs several thousand dollars more per flight to operate than Atlantic Charters' Navajo, and they argue that using the local service makes more economic sense.
     Greene says, "Most people I've talked to don't care what the ANB protocol is. All they're concerned with is getting their relative to the regional hospital. And it sounds cruel, but they would much rather see them die in flight than they would [waiting] here in the hospital, knowing that they tried to get them the best possible care. And there have been a lot of people who have said to me, 'If it comes down to it, I'll hire [Atlantic Charters] myself to take me.'" But Atlantic Charters doesn't want to see people follow that route. And the ambulance will not take them.
     "In the transfer of patients, you hear about the 'golden hour' [for administering treatment]," says Greene. "Our golden hour is [frittered] away by ANB. Atlantic Charters can have patients at the regional hospital in 35 to 40 minutes. By using air, we are closer to the regional than St. George is to St. Stephen."
     The village asked the ministry of health for an investigation into last fall's delays. The reply indicated that proper procedures had been followed and that the service would continue to be monitored. "If you were doing a proper investigation," Greene says, "you would be contacting the hospital on Grand Manan, which we don't know whether they did, but we know they did not contact the families or the patients involved. How can you do a proper investigation without that information?" Greene says he and council believe that information about their concerns is not getting to the health minister, but rather being tied up by ANB.
     A source connected to the village says island healthcare workers wanted to meet with Atlantic Charters to bring all the key decision-makers together, but that they were not permitted by ANB to do so. Council members question why.
     Turner says the impression council got is that the health minister talked to Alan Stephen, ANB's CEO, to find out how those flights were handled. "It was a very blanket statement about what was taken into account. It seems odd that that is just taken at face value, where we have to struggle and prove every single point; and we still can't win."
     People have suggested that residents who are unhappy with the air service should live somewhere else. Turner says, "Who knows who might need an ambulance? You're basically saying, evacuate the island." She offers a mainland parallel: "Say I live outside of Saint John. I live up a steep hill. I have a heart attack, a family member calls [9-1-1], and they say, 'We have an ambulance we can send right away, but based on your symptoms it sounds like you need our best EMT.' But his shift doesn't start for four hours. So you wait, because you have no choice, for this other ambulance. It doesn't come, so they call and say, 'We forgot to tell you he's not good in the snow. He can't make it up your driveway. So we're going to send the guy who's been sitting ready for five hours.' And nobody on the mainland would ever accept that. And I think it's a very valid comparison. It sounds ridiculous, but that is what we are dealing with.
     "You can analyze this to death and there are parts that will never make sense. The fact is, there was a tried-and-true, proven care system that worked very well. You couldn't have asked for a better system. Why mess around with it? Trial and error has proved that that system worked. That's as scientific as their algorithm. [The old system] put patient care first, and everything that we're learning tells us that that is not the priority anymore," Turner says.
     Mayor Greene states, "We've had many people come to Grand Manan thinking, 'That is a good ambulance service if something happens to me.' And now they're having second thoughts."
     "It's very hard to grow a community and an economy when you cannot get people to buy into it because of things like this," Turner adds. "Who's going to want to come here? It's not just to retire; we want to bring businesses here, but they're going to deal with the same issues. They still want a stable system. We have a council that is showing a great deal of foresight [about future development]. To have something like this as a stumbling block is not just frustrating, it's disheartening. It's just too critical to let go of."
     Greene says Grand Manan contributes almost $100 million per year to the New Brunswick economy. "We're not asking for a gift; we're contributing a lot more money than is being returned."
     ANB's Alan Stephen was unavailable for comment. Media contact Sophie Cormier‑Lalonde said in an e‑mail, "On Grand Manan, as in communities across the province, Ambulance New Brunswick's priority is to ensure every patient receives the most appropriate care. ... The decision on the best means of transporting a patient from Grand Manan to the mainland is made by a provincially appointed Medical Control Physician (MCP) ... in consultation with the sending physician from the Grand Manan Hospital, to determine the safest and most clinically appropriate means of transportation. ... If the MCP determines that the patient's condition can be safely managed during flight by a paramedic or paramedic and registered nurse, Atlantic Charters is used to transport that patient. If the MCP makes the determination that the patient's medical condition requires an advanced level of care, the patient is transported by Ambulance New Brunswick's Air Ambulance or by Nova Scotia's LifeFlight aircraft.
     "Ambulance New Brunswick continues to work with administrators and physicians from the Grand Manan Hospital and the Saint John Regional Hospital to ensure the best care is provided to the residents of Grand Manan," Cormier-Lalonde's e-mail says.
     In late January, the village requested a meeting with Hugh Flemming, who replaced Madeleine Dubé as health minister in September. Greene would like him to come to Grand Manan for a dialogue with council and representatives of the nursing home and hospital. "We would be willing to come to Fredericton if he couldn't make it, and we are determined enough in this that we'll make his life miserable," he says.
     Turner concurs, "We're not going away. It's as simple as that."
     They await a reply.

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