British Columbia Ambulance Service
Encyclopedia
The British Columbia Ambulance Service (BCAS) is the sole ambulance
service and provider of pre-hospital emergency care in the province of British Columbia
, Canada
. It operates under the Emergency and Health Services Commission (EHSC) and the Provincial Health Services Authority, and is tasked with the provision of ambulance response province-wide. Today, BCAS is the largest Emergency Medical Services
(EMS) provider in Canada and one of the largest services in North America. The BCAS has a fleet of over 480 ground ambulances operating from 187 stations across the province along with 47 support vehicles. It also provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities. While some private, for profit, transfer services exist, the vast majority of transfers are handled by BCAS crews. Dispatch centres in Vancouver
, Victoria
, and Kamloops provide call-taking and ambulance dispatching services to the entire province. In addition, BCAS operates an airevac program that utilizes both fixed-wing and rotary aircraft.
While the EHSC, and consequently the BCAS, are agents of the government and are able to operate independently, in practice they are closely linked to the BC government's Ministry of Health Services, which provides one-hundred percent funding for operations.
s in British Columbia, including three seasonal stations and the transfer fleet. Stations may be staffed with part-time paramedics, part-time and full-time paramedics, or only full-time paramedics, depending on where the station is located and the number of calls its crews are dispatched to. Each station is headed up by a Paramedic Chief, who acts as supervisor for the crew at the station. The Paramedic Chief also handles the day-to-day administrative duties required by the station, including payroll management, overseeing station and ambulance maintenance, and crew scheduling.
Each station falls under the responsibility of a District Superintendent. The District Superintendent has responsibility for the operations of all of the stations within a given district. The size of the district, and the number of stations it encompasses, varies depending on factors such as geography, station size and number of paramedics.
Each BCAS district is part of a larger region, which is headed by an Executive Director. Each District Superintendent is accountable to the Executive Director for that specific region. In some regions, a Director of Operations assists the Executive Director with day-to-day activities. The District Superintendents are accountable to the Executive Director of the region, who in turn reports to the Chief Operating Officer of the BC Ambulance Service.
The BCAS provincial headquarters is located in Victoria, BC. It is staffed by an executive management team, and other support services. The final responsibility for BCAS operations lies with the service's Chief Operating Officer. The Chief Operating Officer is accountable to the Executive Officer, Emergency & Health Services Commission, who in turn reports to the Board of the Emergency & Health Services Commission.
and the Gulf Islands
; the Lower Mainland Region Ambulance Communication Centre (LMRACC) deploys all ground ambulances in the Lower Mainland (i.e., Metro Vancouver & the Fraser Valley Regional District
), the Sunshine Coast
, as far east as Boston Bar
and as far north as Pemberton
; and the Interior and Northern BC Communications Centre (INBCCC) deploys resources to the remainder of the province, including the southern interior (Okanagan
, Cariboo
& Kootenays
) and northern BC (Skeena, Northern Interior & Peace Regions, representing west-central, east-central and northern areas of the province, respectively). The fourth Communication centre, the Provincial Air Ambulance Coordination Centre (PAACC), is located in Victoria
and has responsibility for coordinating and deploying of all air ambulance resources, whether they are used for scene responses, or for inter-facility transfers.
Each Communication centre is staffed with a mixture of Emergency Medical Call Takers (EMCT) and Emergency Medical Dispatchers (EMD). The Vancouver Communication system is the largest of the four Centres. A Communication Supervisor who is a barganing unit member, provides line supervisory support to Communication centre staff, with a Director and a Communication Superintendent managing the centre. Other centres have a Charge EMD in the role of Supervisor, with a Superintendent managing the Centre. Training for EMCTs and EMDs is provided in-house by the BC Ambulance Service.
The BC Ambulance Service utilizes the Advanced Medical Priority Dispatch System
(AMPDS) to triage calls and a customized Resource Allocation Plan (RAP) to allocate First Responders, Primary Care Paramedics, and Advanced Care Paramedics to calls as needed. Communication personnel are current, or former field paramedics, with few exceptions.
Within the Metro Vancouver region, BCAS utilizes the E-Comm
Wide-Area Radio Network for one-stop communication between police and fire agencies.
In larger Urban and Metro-designated posts, including stations in Metro Vancouver, the Fraser Valley Regional District
(i.e., Abbotsford
and Chilliwack
), Victoria
, Nanaimo, Kelowna
, Kamloops and Prince George
, ground ambulance service is provided by a mix of PCP and ACP-qualified paramedics. In smaller Urban-designated posts (such as Cranbrook
, Nelson
, Prince Rupert
, Terrace
, Fort St. John
, Vernon
, Salmon Arm
, Penticton, Campbell River
, Port Alberni, Squamish
, Whistler
, Powell River
, Sechelt
, Williams Lake
and Quesnel
) there is a core of four to eight full-time, regularly scheduled paramedics at the PCP level but there is also a heavy reliance on part-time, irregularly scheduled paramedics who are also trained to the PCP qualification. These auxiliary staff traditionally rely on paged call-outs and need not stay at the station but should remain in relatively close proximity in case of a call.
The first step toward a Metro designation (from Urban) requires a population base of 70,000 to 80,000 people. This will maintain a call-volume around 10,000 calls per year and will warrant the addition of Advanced Care Paramedic (ACP) resources to the station (e.g., Chilliwack
). Although this may be warranted, additions of Advance Care Paramedics have not kept up with population growth.
The next step would be to split the calls between two separate stations serving a single community (e.g., Kelowna
, Kamloops, Prince George
& Nanaimo). Finally, as in the case of Abbotsford
, when the call volume for the two stations combined reaches in excess of 20,000 calls, the station is re-designated as a Metro Post. When there are enough Metro Posts in a given region, they are reorganized into a larger, comprehensive post like Metro Vancouver or Greater Victoria.
The BC Ambulance Service air ambulance fleet consists of six fixed-wing aircraft, five Beechcraft Super King Air
350 turboprops and one Bombardier Learjet 31A jet. Additional aircraft are chartered on an as-needed basis. The BCAS also operates three dedicated air ambulance helicopters. Two Sikorsky S-76
helicopters are based in Vancouver, with a Bell 222
helicopter based in Prince Rupert
. Starting in 2011, there will be two Sikorsky 76c+ models in Vancouver and Prince Rupert. In addition, patient transfers are routinely performed by BLS crews in charter aircraft (e.g., Beechcraft King Air
100 turboprops).
Delta and Echo patterns differ in that they do not necessarily follow the standard platoon cycle of 'four and four'. Delta, for example, is on a 70-day cycle and provides a 35-hour work week, through various patterns. These shifts may me 12.5 hours long with a "four and six" pattern, a 7-hour shift on a standard Mon-Fri work-week or a 10-hour shift on a "four and three" alternating with "three and four" pattern. Lastly, a Delta pattern may be 10-hour shifts following the regular platoon cycle of "four and four". Delta patterns are almost exclusively reserved for Dispatch but are also used on two Transfer Fleet shift patterns (X-Ray and Uniform). An Echo shift, on the other hand, is 10 hours long and can start at any time during the day depending on the area's needs. If scheduled, it is usually a day shift at a smaller station and is reserved for a full-time Paramedic Chief and his partner. Echo is also the standard shift pattern for Transfer Fleet but these shifts are called different names according to start time. Echo patterns are typically Tuesday through Friday or Monday through Thursday, providing a 40-hour work week on a 56-day cycle.
None of Bravo, Charlie or Echo patterns provide 24 hour coverage so they are always supplemented by an Alpha car or, in the case of the lower call-volume stations, by Kilo and Foxtrot. Paramedics working these shifts are paid their regular wage regardless of how many calls they attend to. Further, overtime wages are paid when (and only when) a call takes a crew past their scheduled end-time, regardless of whether the shift is 7, 10, 11, 12, 12.5 or 14 hours long.
Kilo shifts are strictly on-call and paramedics respond to a pager. A kilo-responding paramedic must answer a page by calling dispatch within two minutes but there is no requirement to arrive at the station within a set time. However, most on-call paramedics carry their uniform with them and do not engage in any activity that they cannot drop at a moments notice (including other employment obligations). Each Kilo call-out generates a minimum of four hours of pay, as long as the crew returns to the station before each successive call. In busier Kilo stations, due to this tiering effect, paramedics can make more money in a shift than a full time employee working the same number of hours but it is still quite unreliable. The Kilo stipend, called "pager pay", is currently set at $2.00 per hour and is paid regardless of whether work is performed during the shift. There is no pager pay for working past the end of a shift, unless the same paramedic is scheduled for back-to-back kilo shifts. On-call paramedics are not expected to perform any duties and need not even be at the station until they receive a page out. For local residents who are hired as paramedics, this type of shift works well, as they can stay home during their shift or engage in other activities. For non-locals who have to commute, this can be quite problematic if it is a station with low call volume. This shift pattern makes it difficult to have a "life", since a long transfer mat be dispatched to a crew at the very end of their shift. There is no extra compensation for working past your scheduled hours, unless it is in excess of eight continuous hours.
Foxtrot is a compromise between a full-time shift and a Kilo shift. Paramedic crews on this shift pattern are said to be on "standby" and are required to be in their ambulance within 90 seconds of the page or phone call, just like a regular full-time unit. The Foxtrot stipend is currently $11.12 per hour and is increased to the full hourly wage for a minimum of three hours when a call is dispatched to the crew. As with Kilo, the crew is not expected to perform any duties while on standby. Should a call come in, the crew is considered to be "activated" for 3 hours and is under the direction of your dispatcher for that time. Unlike Kilo, if another call is dispatched to the crew within those three hours, no further pay is accumulated. After the three hour window or on returning to the station past the three-hour activation period, the crew returns to standby status until another call is dispatched.
Mike patterns are uncommon but they behave like Kilo cars that are pre-booked for transfers in busy regions or for event upstaffing so their shifts tend to be quite long and involve a lot of overtime. Scheduled Mike cars get $2.00 per hour Pager Pay.
Juliet shifts are 12-hours long and are normally prescheduled but may be authorized as a last-minute stopgap measure. They are staffed by part-time or irregularly-scheduled full-time paramedics and may begin at any time. Typically, Juliet shifts are used to up-staff a station or region in cases of expected high call-volume or to back-fill for a crew that has left on an airevac.
In smaller posts, Kilo is first choice for transfers so that the duty car (Alpha, Bravo, Charlie, Echo or Foxtrot) can be available for emergencies. In practice, the duty car may be used for short transfers within the normal response area, especially if Kilo (or Foxtrot) are occupied. While Sechelt's Mike car is a call-out transfer car, it is attached to station 235-Sechelt and not the B88-Transfer Fleet. This is the last remaining, scheduled Mike car (214-Hope had "14Mike" until the end of 2007 but the resource was reallocated to 206-Chilliwack for a Charlie car while the Foxtrot Nights went to 24 hours. Prior to the change, "06Bravo" would switch to "06Foxtrot" at the end of the shift.). "35Mike" shifts can be extraordinally long, due to the ferry trip at the end of their shift.
EMR training is available through a variety of instructional agencies throughout the province. EMR courses that are approved by the EMA Licensing Board include those offered by the College of the Rockies (http://www.cotr.bc.ca),Paramedic Academy of the Justice Institute of BC (JIBC), the Academy of Emergency Training, EMP Canada, Life Support British Columbia, First Aid Certified Training Systems , Malaspina University College Centre for Continuing Studies and Okanagan College Continuing Studies.
Primary Care Paramedic training is offered by College of the Rockies http://www.cotr.bc.ca, the Paramedic Academy of the Justice Institute of BC and the Academy of Emergency Training. Advanced Care Paramedic training is only available through the Paramedic Academy. All ITT and CCP training is conducted 'in-house' by BCAS Clinical Education Division in conjunction with BC Women's, Children's, Vancouver general, St. Paul's hospitals and the British Columbia Institute of Technology (BCIT).
The EMA Licensing Board maintains a list of approved training agencies available to potential students. Those students who do not complete one of the approved courses will not be permitted to apply for a licensing examination.
Clinical Education is the Division of BC Ambulance Service that provides Paramedic development once a Paramedic has been hired. The main goal of the Clinical Education Division is to support the delivery of quality patient care through curriculum development and course presentation. A new employee can expect to be offered about 11 courses of paid training in their first six months of service. These courses may include: Occupational Safety and Health (OSH) 1-5, CPR/AED Update, PEPP, Trauma 1, Child Abuse Recognition and Reporting, Driving Level 1, Introduction to Treatment Guidelines and Safety Awareness for Emergency Responders (SAFER). In addition, new employees must pass a driving preceptorship prior to being allowed to drive Code 3 (lights & sirens). BCAS fosters an environment of lifelong learning and offers a combination of face-to-face and online educational opportunities for Paramedic development.
EMR and PCP are Basic Life Support
(BLS) qualifications while ACP is an Advanced Life Support
(ALS) qualification; ITT has some pediatric advanced protocols; CCP has a whole different scope of practice. BCAS protocols are universal protocols which a qualified practitioner may employ at any time, up to his or her license qualification, within the provincial borders, given that the required equipment is at hand. Licencing qualifications and endorsements can be found in the EMA Regulations under Schedule 1 and Schedule 2.
(AED) and may monitor an existing IV line. Their protocols include Cardiac Arrest, Cardiac Chest Pain, Diabetic Emergencies and management of pain using Entonox. The "Schedule 2" endorsements appear as "Symptom Relief" and "IV Maint".
Schedule 1 - EMR Licence Qualifications:
Schedule 2 - EMR Licence Endorsements:
In addition to the EMR protocols, PCP licensees have protocols for Shortness of Breath (SOB), Anaphylaxis, Narcotic Overdose, an expanded Diabetic Emergencies and a catch-all for patients with a decreased level of consciousness Not Yet Diagnosed (NYD) that combines the Diabetic/Hypoglycemic and Narcotic OD protocols. PCP-qualified paramedics may also be endorsed for intravenous cannulation (PCP-IV) and will have an additional protocol for Hypovolemia as well as enhancements to the anaphylaxis, diabetic, narcotic OD and NYD protocols. Additional PCP-level medications include Salbutamol (Ventolin), Naloxone HCL (Narcan), Glucagon, Epinephrine HCL (Adrenaline), Diphenhydramine (Benadryl), Thiamine (Betaxin), Dextrose 10% (D10W) and Normal Saline. While 'protocols' were the old method of running medical calls, the service's medical oversight has recently introduced a new set of 'Treatment Guidelines', which is a more generalized framework within which paramedics can operate with more flexibility. For instance, the "Unconscious NYD" protocol no longer exists, as paramedics are expected to understand how to search for an etiology of a patient's decreased level of consciousness and intervene as necessary, instead of following through an algorithm like robots. In addition, chest pain patients can now be treated with the appropriate interventions in mind for those suffering from various forms of acute coronary syndrome, rather than a catch-all protocol for any ischemic-like episodes.
The "Schedule 2" endorsements appear on the PCP licence as "IV" or "ET". Normally, an ET endorsement is not awarded unless the paramedic practitioner has voluntarily downgraded from ACP to PCP and there were no previous issues with field intubations. At this point, the PCP-ET would simply have an adjunct to assist in Cardiac Arrest management. With increased labour mobility between the provinces, some paramedics from other jurisdictions will see restrictions such as for Narcan, Thiamine, Antihistamine or Entonox. Former EMA 2 Paramedics will also see an IM restriction since they were not technically trained how to perform an intramuscular injection.
Schedule 1 - PCP Licence Qualifications
Schedule 2 - PCP Licence Endorsements
In addition to the PCP protocols and medications, they may also administer Acetaminophen, Adenosine, Atropine Sulphate, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Gravol), Hemabate, Indomethacin, Lorazepam, Magnesium Sulphate, Midazolam (Versed), Morphine Sulphate, Ondansetron, Oxytocin, Sodium Bicarbonate and Out-of-Scope medications with orders from a CCTA. ITT paramedics have their own unique set of prehospital treatment guidelines that mirror ACP guidelines in the areas of pediatrics, having the ability to treat respiratory/cardiac arrest and disrhythmias. The ITT practitioner also has adult ACLS guidelines and intubation in the event they encounter an adult cardiac arrest.
Their additional training and skills include the use and monitoring of Incubators, Endotracheal (ET) Intubation, Intraosseous (IO) Access, nasogastric (NG) tube insertion and suctioning, manual defibrillation, cardioversion, chest decompression, Venous pressure monitoring, Arterial & Central Line Monitoring, Chest Tube Management, transthoracic pacing, Blood Product Infusion, IV Infusion Devices, 'IV with Medication' Maintenance, Mechanical Ventilation (using the LTV 1000 and 1200 and BMD CrossVent), Foreign body removal with laryngoscope, ET/IO/PR drug administration, Central & Parenteral Line Management, Venous & Arterial blood sample collection, point of collection analysis of ABG's and chemistry using the I-Stat, Lab & X-ray interpretation.
The ITT paramedics also transport pediatric and adult ECMO (Extracorporeal Membrane Oxygenation
) patients with a perfusionist from BC Children's.
Note that, while there are some areas of overlap between ACP and ITT, the additional ITT 'Airevac' class of skills that are not included in the standard ACP skill-set are Venous Pressure Monitoring, Arterial & Central Line Monitoring, Chest Tube Management, Blood Product Infusion, Mechanical Ventilation, nitric oxide delivery systems and Out-of-Scope Medications by orders.
Schedule 1 - ITT Licence Qualifications
Schedule 2 - ITT Licence Endorsements
ACP paramedics have protocols to administer all PCP plus Adenosine, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Gravol), Furosemide (Lasix), Heparin, Ipratropium Bromide (Atrovent), Lidocaine, Morphine Sulphate and Amiodarone (Cordarone). Their additional skills include synchronized cardioversion, airway isolation devices, endotracheal intubation, end-tidal CO2 monitoring, external jugular vein cannulation, transcutaneous pacing, IV colloid/crytalloid volume expanders, nasopharangeal airways, needle thoracentesis and surgical or needle cricothyrotomy.
Schedule 1 - ACP Licence Qualifications
Schedule 2 - ACP Licence Endorsements
To become qualified at this level, experienced ACP paramedics take further training consisting of a portion of the CCRN program through BCIT, followed by an intensive hospital-based program through St. Paul's Hospital. Next, there is a work experience portion, and finally, CCP licensure. Formerly, an ACP could take a much shorter course and receive a "Full Schedule 2" endorsement.
CCP's have standard operating guidelines for common critical patients; SIRS/Sepsis, RSI, Chest decompression, Ventilation strategies using the LTV 1000 and 1200, ACS and coronary care, etc. CCP paramedics sometimes take an intensivist with them, but consult with Critical Care Transport advisors.
CCP qualifications follow the NOCP guidelines as endorsed by the Paramedic Association of Canada. In addition to standard ACP protocols, the CCP can perform Schedule 2 ACP skills and procedures as well as administer virtually any medication following assessment and consult with the Critical Care Transport Advisor (CCTA). CCTAs are essential to both the air-evacuation and ground critical care transport programs.
Schedule 1 - CCP Licence Qualifications
Schedule 2 - CCP Licence Endorsements
(* D.O.H. may be adjusted if a part-time paramedic does not submit at least eight shifts of availability to their primary operator in a given month.)
Full time wages are salary-based but an hourly wage is often referred to as shorthand for calculation of overtime. Without getting into details, the hourly rate for a full-time, regularly scheduled employee on an Alpha pattern with three years experience at that license qualification is as follows;
EMR (i.e., Transfer Fleet): $27.86 per hour; PCP: $29.33; PCP-IV: $30.05; ACP: $36.40; ITT/CCP: $37.90.
Generally, part-time seniority does not count toward any full-time seniority or pay scale. The only exception is that a part-time paramedic who responds to 300 calls per year will receive one year's experience pay for each of (up to) three years when going full-time. That is to say, a part-time paramedic with at least 900 calls equally divided over three years will start at the 3-Year pay scale when accepting a full-time position. In the table below, for the ACP, ITT and CCP wage columns, it is assumed that the wage increments for 10, 15, 20 and 25 year marks are at the 3-year experience pay level. This is meant to show what an established paramedic at that licence qualification could expect in a full-time position. Once a paramedic reaches the third year of experience pay, further increments average $0.29 every five years; after 25 years, only $1.15 per hour ($2511.60 annually) is gained on top of the three-year experience pay. This reflects "years of service", rather than "experience" per se.
(* Regularly Scheduled; Three Years Experience; Alpha Pattern)
Although these wage scales reflect what a BCAS Paramedic will earn "on paper", these wages are "factored" through a complicted formula whereas the wages are reduced significantly.
At this time, EMR-qualified staff are only permitted to work in remote and rural stations and must upgrade to PCP if they wish to further their career with the BCAS, including lateral transfers to an Urban or Metro-designated station on a part-time basis or application for a full-time posting. The exceptions to this rule include applications to one of the Dispatch Centres or to the Metro Vancouver Transfer Fleet, both of which require only an EMR qualification; these are internal applications for current BCAS employees only.
Prospective employees are required to pay for their own training. EMR courses currently cost around $1,410, and a $450 charge for an EMA licensing exam. PCP training costs approximately $6,000, as well as the EMA licensing exam fee. PCP training also requires 6 months of full time classroom and on car practicum time, so applicants should be aware that they will also be out of work for 6 months while training, which could put total costs as high as $20,000 - $30,000.
If the above requirements are not able to be fully met, the applicant can still contact a paramedic chief in their local community for further information on applying. For example, in cases of extreme staff shortages, an attendant may be hired as a "Driver Only" if he or she holds only a Level 3 Occupational First Aid (OFA 3) Certificate or equivalent (OFA 3 is not a prerequisite for an EMR license but it is the current industry standard in BC for remote or high-risk workplaces).
With the abolishment of mandatory retirement, paramedics may work past the age of 65 as part-time employees. Once they retire from full-time service, they must be off work for a period of one month after which they may reapply to become employed by the BCAS in a part-time capacity; it is the pension corporation that requires a formal severance of employment prior to the pension benefits being activated. The details of this process have yet to be fully fleshed out.
On average, it takes approximately 3 to 6 months before an applicant is granted an interview. The interview consists of a behavioural interview with a panel of two to three paramedic chiefs (and may include a Regional Superintendent or HR personnel) and is approximately 1 hour long. It may be held at a regional Human Resources office or at a given ambulance station where the applicant is under consideration. The interview follows the STAR (Situation, Task, Action, Result
) format. If the applicant has not yet completed a PCP program, there will also be a written exam based on OFA 3 knowledge of first aid and anatomy. After an applicant completes the interview he or she will not find out the results for another 1–3 months. If unsuccessful at the interview stage, the applicant may be told he or she cannot re-apply for a period of 6 months.
If the applicant passes the interview, they are entered into the hiring pool and ranked according to their score on the written exam and interview. From this point, the prospective employee may be contacted by a paramedic chief that is hiring. After passing the interview stage, a physical fitness assessment, a medical assessment and two criminal record checks will be conducted. Assuming all goes well, the applicant is then hired into the service at a specific ambulance station, called a 'primary operator'. Once issued an employee number, they are deemed eligible to work and the employee enters into a six-month probationary period. If the applicant is hired as underqualified (i.e., hired without a Class 4 driver's license or other specific training), conditions of probation may be imposed such that the person must obtain certain qualifications before their probation is up or they may be released from the service. During probation, a paramedic may not move to another station (called a lateral transfer) or work at any other BCAS station (often called working at a 'secondary operator'). The probationary period may be extended at the discretion of the Executive Director; this requires both the signature of the Paramedic Chief and the District Superintendent, as well as notification to the individual prior to the extension.
Getting hired in Vancouver as a PCP is the more common route taken to be hired as a full time employee. Once you are hired as a full time employee in Vancouver, you can also apply for a full time position elsewhere, however you will be competing for that position with every other full time employee who has applied. Full time positions are awarded based on the number of years worked as a full time employee. This means that it could be at least 2–3 years working in Vancouver before you have enough seniority to leave. Generally, this is a good thing as it gives new full-time paramedics ample opportunity to practice and hone their skills.
Current qualifications designated by collar dogs include EMR, PCP (formerly EMA1 and EMA2), ACP, ITT, EMCT and EMD. The EMR and PCP levels are shown on bronze and silver circles, respectively, forming the BCAS logo, along with a circumform bar below, denoting the EMR or PCP qualification. ACP (formerly EMA3/ALS) and ITT (Infant Transport Team) paramedics are recognized with gold cauducei, with either "ALS" or "Neonatology" imprinted upon them. CCP (Critical Care Paramedics) have a gold coloured shield with blue star of life and CCP on it. Within the Communication Centres, EMD (Emergency Medical Dispatcher) and EMCT (Emergency Medical Call Taker) are designated by gold and silver shields, respectively.
For rank insignia, Paramedics and dispatchers who hold the position of Paramedic Chief or Charge Dispatcher wear a black epaulette with three gold stripes. District Supervisors and Dispatch Supervisors wear the same coloured epaulette with four gold stripes while Dispatch Officers wear two gold stripes. Ranks above District Supervisor are management positions and are distinguished by a varying number of pips on their epaulette. District and Platoon Superintendents wear an epaulette with three pips, Managers wear one pip and one crown, Directors wear two pips and one crown and the Executive Director of a region will wear three pips plus a crown. Each station and dispatch centre has a staff member designated as its Occupational Safety & Health (OSH) representative. These paramedics and dispatchers are identified with a black epaulette with a single royal blue bar. Staff who are designated as OSH representatives hold no supervisory authority, but are available to assist staff with safe work practices. BC Ambulance instructional staff wear a black epalette with the word "INSTRUCTOR" embroidered in gold, facing laterally.
Shoulder flashes for field staff are royal blue with gold trim, and include the British Columbia Coat of Arms, with the words "Ambulance" above, and "British Columbia" below, both in white. Shoulder flashes for management personnel are navy blue with a navy blue trim. The layout of the shoulder flash is the same for both.
The collective agreement between the APBC and the EHSC expired on March 31, 2009. A strike vote was taken prior to the expiry of the prior collective agreement and the result was 97% of APBC in favour of a strike. Despite being legally on strike, the essential services order (ESO) handed down by the Labour Relations Board (LRB) stated that 100% of APBC's work was considered essential, and therefore could not withdraw any frontline work.
On November 2, 2009, the Minister of Health Services tabled Bill 21, titled the Ambulance Services Collective Agreement Act. Bill 21 was back-to-work legislation for APBC. This bill came under intense scrutiny, and is considered to be unprecedented in Canadian labour history. The reason for this is because the government began tabling the legislation while APBC was in the process of conducting a vote on the government's latest contract offer. The terms of Bill 21 were virtually the same as the contract offer being voted on.
The government's reasoning behind enacting Bill 21 was the H1N1 influenza pandemic
, stating they needed all branches of the healthcare service at 100% efficiency and operational levels. The government also accused paramedics of not working mandatory overtime shifts despite the terms of the ESO. The other reason provided was that the government had concern over BCAS managers required to work upward of 80 hours per week during the strike due to striking paramedics failing to carry out basic paperwork duties.
Further complicating the legislation is a leaked memo from the Medical Director of the Vancouver Organizing Committee for the 2010 Olympic and Paralympic Winter Games
(VANOC) sent to the government. In the memo is the following section: "VANOC Medical Services (and thus the IOC) requires definitive confirmation by Oct 1 2009 that all required ambulance services will be provided as planned. These services include the ability to engage the VCs and BCAS members in full venue planning as soon as possible. This confirmation must also include a guarantee that no services during the Games will be disrupted or reduced from what has been planned. If we are unable to obtain that guarantee (through either settlement of the strike or a legislated "detente" for the Games), then VANOC will be required to initiate contigency plans to avoid cancellation of the Games."
On November 7, 2009, the Ambulance Services Collective Agreement Act achieved Royal Assent
, after an overnight debate until the Act was passed. The terms of the Act specify a 3% general wage increase for APBC members, retroactive to April 1, 2009. None of the operational issues raised by APBC (staffing shortages, rural deployment issues, recruitment and retention challenges, longer response times) are addressed in this Act. The Act will expire on March 31, 2010, shortly after the conclusion of the Olympics. APBC and BCAS will be in a position to re-open negotiations for the next collective agreement in December 2009, a few weeks after being handed the legislated contract.
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
service and provider of pre-hospital emergency care in the province of British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
. It operates under the Emergency and Health Services Commission (EHSC) and the Provincial Health Services Authority, and is tasked with the provision of ambulance response province-wide. Today, BCAS is the largest Emergency Medical Services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
(EMS) provider in Canada and one of the largest services in North America. The BCAS has a fleet of over 480 ground ambulances operating from 187 stations across the province along with 47 support vehicles. It also provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities. While some private, for profit, transfer services exist, the vast majority of transfers are handled by BCAS crews. Dispatch centres in Vancouver
Vancouver
Vancouver is a coastal seaport city on the mainland of British Columbia, Canada. It is the hub of Greater Vancouver, which, with over 2.3 million residents, is the third most populous metropolitan area in the country,...
, Victoria
Victoria, British Columbia
Victoria is the capital city of British Columbia, Canada and is located on the southern tip of Vancouver Island off Canada's Pacific coast. The city has a population of about 78,000 within the metropolitan area of Greater Victoria, which has a population of 360,063, the 15th most populous Canadian...
, and Kamloops provide call-taking and ambulance dispatching services to the entire province. In addition, BCAS operates an airevac program that utilizes both fixed-wing and rotary aircraft.
History
Prior to 1974, ambulance services in British Columbia were generally uncoordinated. Service was provided by a mixture of volunteer ambulance brigades, fire departments, funeral homes, and private operators. As a result of recommendations made by the Foulkes Commission's report on health care, titled "Health Security for British Columbians" and released in 1973, the Government of British Columbia created the Emergency Health Services Commission (EHSC), which in turn, created the BC Ambulance Service on July 4, 1974.Governance
In British Columbia, responsibility for the provision ambulance services is granted to the Emergency and Health Services Commission (EHSC) under the auspices of the Emergency and Health Services Act. Under the terms of the Act, the EHSC is considered an agent of the government and as such, holds all responsibility for the provision of ambulance services across the province. The members of the Commission act as a Board of Directors to the BC Ambulance Service. The commission membership consists of health service administrators, medical professionals, and government representatives. The commission meets regularly to provide direction to the BCAS Executive Management Team. The EHSC is also responsible for the operation of BC Bedline, which assists physicians when it is necessary to transfer a patient to a higher level of care.While the EHSC, and consequently the BCAS, are agents of the government and are able to operate independently, in practice they are closely linked to the BC government's Ministry of Health Services, which provides one-hundred percent funding for operations.
Organization
There are 187 ambulance stationAmbulance station
An ambulance station is a structure or other area set aside for storage of ambulance vehicles, medical equipment, personal protective equipment, and other medical supplies. Most stations are made up of garage bays or a parking area, normally undercover...
s in British Columbia, including three seasonal stations and the transfer fleet. Stations may be staffed with part-time paramedics, part-time and full-time paramedics, or only full-time paramedics, depending on where the station is located and the number of calls its crews are dispatched to. Each station is headed up by a Paramedic Chief, who acts as supervisor for the crew at the station. The Paramedic Chief also handles the day-to-day administrative duties required by the station, including payroll management, overseeing station and ambulance maintenance, and crew scheduling.
Each station falls under the responsibility of a District Superintendent. The District Superintendent has responsibility for the operations of all of the stations within a given district. The size of the district, and the number of stations it encompasses, varies depending on factors such as geography, station size and number of paramedics.
Each BCAS district is part of a larger region, which is headed by an Executive Director. Each District Superintendent is accountable to the Executive Director for that specific region. In some regions, a Director of Operations assists the Executive Director with day-to-day activities. The District Superintendents are accountable to the Executive Director of the region, who in turn reports to the Chief Operating Officer of the BC Ambulance Service.
The BCAS provincial headquarters is located in Victoria, BC. It is staffed by an executive management team, and other support services. The final responsibility for BCAS operations lies with the service's Chief Operating Officer. The Chief Operating Officer is accountable to the Executive Officer, Emergency & Health Services Commission, who in turn reports to the Board of the Emergency & Health Services Commission.
Staff
As of January 10, 2010, the BCAS employs 2,163 part-time and 1,467 full-time paramedics for a total of 3,982. There are approximately 369 management and administrative employees in the BCAS.Emergency medical communication centres
The BCAS operates four Communication centres located throughout the province. The Vancouver Island Communications Centre (VICC), located in Victoria British Columbia is responsible for all ground ambulance deployment for Vancouver IslandVancouver Island
Vancouver Island is a large island in British Columbia, Canada. It is one of several North American locations named after George Vancouver, the British Royal Navy officer who explored the Pacific Northwest coast of North America between 1791 and 1794...
and the Gulf Islands
Gulf Islands
The Gulf Islands are the islands in the Strait of Georgia , between Vancouver Island and the mainland of British Columbia, Canada....
; the Lower Mainland Region Ambulance Communication Centre (LMRACC) deploys all ground ambulances in the Lower Mainland (i.e., Metro Vancouver & the Fraser Valley Regional District
Fraser Valley Regional District
The Fraser Valley Regional District is a regional district in British Columbia, Canada. The FVRD covers an area of 13,361.74 km²...
), the Sunshine Coast
Sunshine Coast, British Columbia
The Sunshine Coast is a region of the southern mainland coast of British Columbia, on the eastern shore of the Strait of Georgia, and just northwest of Greater Vancouver...
, as far east as Boston Bar
Boston Bar, British Columbia
Boston Bar is an unincorporated town in the Fraser Canyon of the Canadian province of British Columbia. It was not named for an organization of Massachusetts lawyers but dates from the time of the Fraser Canyon Gold Rush...
and as far north as Pemberton
Pemberton, British Columbia
Pemberton is a village north of Whistler in the Pemberton Valley of British Columbia in Canada, with a population of 2,192. Until the 1960s the village could be accessed only by train but that changed when Highway 99 was built through Whistler and Pemberton.-Climate:The climate of Pemberton is...
; and the Interior and Northern BC Communications Centre (INBCCC) deploys resources to the remainder of the province, including the southern interior (Okanagan
Okanagan
The Okanagan , also known as the Okanagan Valley and sometimes as Okanagan Country is a region located in the Canadian province of British Columbia defined by the basin of Okanagan Lake and the Canadian portion of the Okanagan River. As of 2009, the region's population is approximately 350,927. The...
, Cariboo
Cariboo
The Cariboo is an intermontane region of British Columbia along a plateau stretching from the Fraser Canyon to the Cariboo Mountains. The name is a reference to the woodland caribou that were once abundant in the region...
& Kootenays
Kootenays
The Kootenay Region comprises the southeastern portion of British Columbia. It takes its name from the Kootenay River, which in turn was named for the Ktunaxa First Nation first encountered by explorer David Thompson.-Boundaries:The Kootenays are more or less defined by the Kootenay Land...
) and northern BC (Skeena, Northern Interior & Peace Regions, representing west-central, east-central and northern areas of the province, respectively). The fourth Communication centre, the Provincial Air Ambulance Coordination Centre (PAACC), is located in Victoria
Victoria, British Columbia
Victoria is the capital city of British Columbia, Canada and is located on the southern tip of Vancouver Island off Canada's Pacific coast. The city has a population of about 78,000 within the metropolitan area of Greater Victoria, which has a population of 360,063, the 15th most populous Canadian...
and has responsibility for coordinating and deploying of all air ambulance resources, whether they are used for scene responses, or for inter-facility transfers.
Each Communication centre is staffed with a mixture of Emergency Medical Call Takers (EMCT) and Emergency Medical Dispatchers (EMD). The Vancouver Communication system is the largest of the four Centres. A Communication Supervisor who is a barganing unit member, provides line supervisory support to Communication centre staff, with a Director and a Communication Superintendent managing the centre. Other centres have a Charge EMD in the role of Supervisor, with a Superintendent managing the Centre. Training for EMCTs and EMDs is provided in-house by the BC Ambulance Service.
The BC Ambulance Service utilizes the Advanced Medical Priority Dispatch System
Advanced Medical Priority Dispatch System
The Advanced Medical Priority Dispatch System , is an Emergency Medical Dispatch system developed and marketed by Priority Dispatch Corporation. AMPDS is primarily used in the United Kingdom, where it is medically approved...
(AMPDS) to triage calls and a customized Resource Allocation Plan (RAP) to allocate First Responders, Primary Care Paramedics, and Advanced Care Paramedics to calls as needed. Communication personnel are current, or former field paramedics, with few exceptions.
Within the Metro Vancouver region, BCAS utilizes the E-Comm
E-Comm
' is the Emergency Communications for Southwest British Columbia.E-Comm provides 9-1-1 service for the Lower Mainland region of southwest British Columbia in Canada covering Metro Vancouver , the Sunshine Coast Regional District, south Squamish-Lillooet Regional District and the Whistler Howe Sound...
Wide-Area Radio Network for one-stop communication between police and fire agencies.
Operations
The current system designates a given station (or 'Operator') as either Metropolitan, Urban, Rural or Remote. A Remote-designated station typically has a call-volume of less than 500 calls per year and is staffed entirely by part-time EMR and PCP-qualified paramedics; Rural-designated stations usually have a range between 500 to 2000 calls per year and may have a full-time or part-time Paramedic Chief and might also have a full-time shift pattern for four full-time paramedics during daytime hours. Urban-designated stations generally have call volumes greater than 2000 calls per year and may range up to and over 10,000 calls. A 'Post' is a station with at least one full-time employee or a group of stations that are grouped together based on operational needs. The basic difference between Urban and Metro is that metropolitan posts consist of groups of neighbouring urban posts, each of which has a very high call volume; for example, every station in Vancouver Post is designated Metro. When a post incorporates more than one station, it functions as a unit for the purposes of irregularly-scheduled paramedic deployment (including part-time paramedics attached to the post).In larger Urban and Metro-designated posts, including stations in Metro Vancouver, the Fraser Valley Regional District
Fraser Valley Regional District
The Fraser Valley Regional District is a regional district in British Columbia, Canada. The FVRD covers an area of 13,361.74 km²...
(i.e., Abbotsford
Abbotsford, British Columbia
Abbotsford is a Canadian city located in the Lower Mainland of British Columbia, adjacent to Greater Vancouver. It is the fifth largest municipality in British Columbia, home to 123,864 people . Its Census Metropolitan Area, which includes the District of Mission, is the 23rd largest in Canada,...
and Chilliwack
Chilliwack, British Columbia
Chilliwack is a Canadian city in the Province of British Columbia. It is a predominantly agricultural community with an estimated population of 80,000 people. Chilliwack is the second largest city in the Fraser Valley Regional District after Abbotsford. The city is surrounded by mountains and...
), Victoria
Victoria, British Columbia
Victoria is the capital city of British Columbia, Canada and is located on the southern tip of Vancouver Island off Canada's Pacific coast. The city has a population of about 78,000 within the metropolitan area of Greater Victoria, which has a population of 360,063, the 15th most populous Canadian...
, Nanaimo, Kelowna
Kelowna
Kelowna is a city on Okanagan Lake in the Okanagan Valley, in the southern interior of British Columbia, Canada. Its name derives from a Okanagan language term for "grizzly bear"...
, Kamloops and Prince George
Prince George, British Columbia
Prince George, with a population of 71,030 , is the largest city in northern British Columbia, Canada, and is known as "BC's Northern Capital"...
, ground ambulance service is provided by a mix of PCP and ACP-qualified paramedics. In smaller Urban-designated posts (such as Cranbrook
Cranbrook, British Columbia
Cranbrook, British Columbia is a city in southeast British Columbia, located on the west side of the Kootenay River at its confluence with the St. Mary's River, It is the largest urban centre in the region known as the East Kootenay. As of 2006, Cranbrook's population is 18,267, and the...
, Nelson
Nelson, British Columbia
Nelson is a city located in the Selkirk Mountains on the extreme West Arm of Kootenay Lake in the Southern Interior of British Columbia, Canada. Known as "The Queen City", and acknowledged for its impressive collection of restored heritage buildings from its glory days in a regional silver rush,...
, Prince Rupert
Prince Rupert, British Columbia
Prince Rupert is a port city in the province of British Columbia, Canada. It is the land, air, and water transportation hub of British Columbia's North Coast, and home to some 12,815 people .-History:...
, Terrace
Terrace, British Columbia
Terrace is a city on the Skeena River in British Columbia, Canada. The Kitselas people, a tribe of the Tsimshian Nation, have lived in the Terrace area for thousands of years. The community population fell between 2001 and 2006 from 12,109 with a regional population of 19,980 to 11,320 and...
, Fort St. John
Fort St. John, British Columbia
The City of Fort St. John is a city in northeastern British Columbia, Canada. A member municipality of the Peace River Regional District, the city covers an area of about 22 km² with 22,000 residents . Located at Mile 47, it is one of the largest cities along the Alaska Highway. Originally...
, Vernon
Vernon, British Columbia
Vernon is a city in the south-central region of British Columbia, Canada. Named after Forbes George Vernon, a former MLA of British Columbia who helped found the famed Coldstream Ranch, the City of Vernon was incorporated on December 30, 1892. The City of Vernon has a population of 35,944 , while...
, Salmon Arm
Salmon Arm, British Columbia
-Climate:- Education :Public schools in Salmon Arm are part of School District 83 North Okanagan-Shuswap; within the city limits, there are currently five elementary schools , one middle school , and a secondary school with two campuses...
, Penticton, Campbell River
Campbell River, British Columbia
Campbell River is a coastal city in British Columbia on the east coast of Vancouver Island at the south end of Discovery Passage, which lies along the important coastal Inside Passage shipping route...
, Port Alberni, Squamish
Squamish, British Columbia
Squamish is a community and a district municipality in the Canadian province of British Columbia, located at the north end of Howe Sound on the Sea to Sky Highway...
, Whistler
Whistler, British Columbia
Whistler is a Canadian resort town in the southern Pacific Ranges of the Coast Mountains in the province of British Columbia, Canada, approximately north of Vancouver...
, Powell River
Powell River, British Columbia
Powell River is a city on the northern Sunshine Coast of southwestern British Columbia, Canada. Most of its population lives near the eastern shores of Malaspina Strait, that part of the larger Georgia Strait between Texada Island and the Mainland...
, Sechelt
Sechelt, British Columbia
The District Municipality of Sechelt is on the lower Sunshine Coast of British Columbia. Approximately 50 km northwest of Vancouver, Sechelt is accessible to the mainland of British Columbia via a 40 minute ferry trip between Horseshoe Bay and Langdale, and a 25 minute drive from Langdale...
, Williams Lake
Williams Lake, British Columbia
Williams Lake, is a city in the Central Interior of British Columbia, Canada. Located in the central part of a region known as the Cariboo, it is the largest urban centre between Kamloops and Prince George, with a population of 11,150 in city limits....
and Quesnel
Quesnel, British Columbia
-Demographics:Quesnel had a population of 9,326 people in 2006, which was a decrease of 7.1% from the 2001 census count. The median household income in 2005 for Quesnel was $54,044, which is slightly above the British Columbia provincial average of $52,709....
) there is a core of four to eight full-time, regularly scheduled paramedics at the PCP level but there is also a heavy reliance on part-time, irregularly scheduled paramedics who are also trained to the PCP qualification. These auxiliary staff traditionally rely on paged call-outs and need not stay at the station but should remain in relatively close proximity in case of a call.
The first step toward a Metro designation (from Urban) requires a population base of 70,000 to 80,000 people. This will maintain a call-volume around 10,000 calls per year and will warrant the addition of Advanced Care Paramedic (ACP) resources to the station (e.g., Chilliwack
Chilliwack, British Columbia
Chilliwack is a Canadian city in the Province of British Columbia. It is a predominantly agricultural community with an estimated population of 80,000 people. Chilliwack is the second largest city in the Fraser Valley Regional District after Abbotsford. The city is surrounded by mountains and...
). Although this may be warranted, additions of Advance Care Paramedics have not kept up with population growth.
The next step would be to split the calls between two separate stations serving a single community (e.g., Kelowna
Kelowna
Kelowna is a city on Okanagan Lake in the Okanagan Valley, in the southern interior of British Columbia, Canada. Its name derives from a Okanagan language term for "grizzly bear"...
, Kamloops, Prince George
Prince George, British Columbia
Prince George, with a population of 71,030 , is the largest city in northern British Columbia, Canada, and is known as "BC's Northern Capital"...
& Nanaimo). Finally, as in the case of Abbotsford
Abbotsford, British Columbia
Abbotsford is a Canadian city located in the Lower Mainland of British Columbia, adjacent to Greater Vancouver. It is the fifth largest municipality in British Columbia, home to 123,864 people . Its Census Metropolitan Area, which includes the District of Mission, is the 23rd largest in Canada,...
, when the call volume for the two stations combined reaches in excess of 20,000 calls, the station is re-designated as a Metro Post. When there are enough Metro Posts in a given region, they are reorganized into a larger, comprehensive post like Metro Vancouver or Greater Victoria.
Airevac response
The BCAS is responsible for the delivery of air ambulance services throughout the province of British Columbia. There are four dedicated Critical Care Paramedic air bases in BC, located in Richmond, Kelowna, and Prince George at their respective airports (YVR, YLW, & YXS). Additionally, there is often ground based team in Kamloops that has access to a medivac helicopter. Each team is composed of two CCPs who transport all Adult patients and some pediatric patients. The Infant Transport Team (ITT) based out of BC Children's Hospital in Vancouver handles the critical care infant, child, and maternity transports.The BC Ambulance Service air ambulance fleet consists of six fixed-wing aircraft, five Beechcraft Super King Air
Beechcraft Super King Air
The Beechcraft Super King Air family is part of a line of twin-turboprop aircraft produced by the Beech Aircraft Corporation . The King Air line comprises a number of model series that fall into two families: the Model 90 series, Model 100 series , Model 200 series and Model 300 series...
350 turboprops and one Bombardier Learjet 31A jet. Additional aircraft are chartered on an as-needed basis. The BCAS also operates three dedicated air ambulance helicopters. Two Sikorsky S-76
Sikorsky S-76
The Sikorsky S-76 is an American medium-size commercial utility helicopter. The S-76 is powered by two turboshaft engines, which drive both the main and tail rotors, each with four blades...
helicopters are based in Vancouver, with a Bell 222
Bell 222
The Bell 222 is a twin-engined light helicopter built by Bell Helicopter. The Bell 230 is an improved development with different engines and other minor changes. A cosmetically modified version of the 222 was used as the titular aircraft in the US television series Airwolf.-Development:In the late...
helicopter based in Prince Rupert
Prince Rupert, British Columbia
Prince Rupert is a port city in the province of British Columbia, Canada. It is the land, air, and water transportation hub of British Columbia's North Coast, and home to some 12,815 people .-History:...
. Starting in 2011, there will be two Sikorsky 76c+ models in Vancouver and Prince Rupert. In addition, patient transfers are routinely performed by BLS crews in charter aircraft (e.g., Beechcraft King Air
Beechcraft King Air
The Beechcraft King Air family is part of a line of twin-turboprop aircraft produced by the Beech Aircraft Corporation...
100 turboprops).
Shifts
There are four different part-time shifts, and five main full time shifts used at BC Ambulance stations. The two main part-time shifts are designated Kilo and Foxtrot, but Juliet and Mike are also used. The five full-time shifts are Alpha, Bravo, Charlie, Delta and Echo.Full-time shift patterns
An Alpha shift pattern provides continuous coverage with one ambulance and is divided into two 12-hour shifts (0630-1830 & 1830-0630), or a 10-hour day-shift plus a 14-hour night-shift (0800-1800 & 1800-0800), depending on the station. Both Bravo and Charlie shifts are 11 hours long, with Bravo starting in the morning (e.g., 0730-1830) and Charlie starting in the afternoon (e.g., 1300-0000). At busier stations, paramedics may standardly work a Bravo/Charlie pattern where the first two days of the block are on Bravo and the final two days of the block are on Charlie; Charlie patterns are always supplemented by Bravo for peak coverage in the afternoon. Alpha, Bravo and Charlie patterns operate on a platoon cycle of four days on and four days off in a 56-day cycle. This means a 48 hour block for Alpha but, since it is over a period of eight days, averages out to a 42-hour work week. Similarly, for Bravo and Charlie, the block may be 44 hours in duration but the average work week is 38.5 hours.Delta and Echo patterns differ in that they do not necessarily follow the standard platoon cycle of 'four and four'. Delta, for example, is on a 70-day cycle and provides a 35-hour work week, through various patterns. These shifts may me 12.5 hours long with a "four and six" pattern, a 7-hour shift on a standard Mon-Fri work-week or a 10-hour shift on a "four and three" alternating with "three and four" pattern. Lastly, a Delta pattern may be 10-hour shifts following the regular platoon cycle of "four and four". Delta patterns are almost exclusively reserved for Dispatch but are also used on two Transfer Fleet shift patterns (X-Ray and Uniform). An Echo shift, on the other hand, is 10 hours long and can start at any time during the day depending on the area's needs. If scheduled, it is usually a day shift at a smaller station and is reserved for a full-time Paramedic Chief and his partner. Echo is also the standard shift pattern for Transfer Fleet but these shifts are called different names according to start time. Echo patterns are typically Tuesday through Friday or Monday through Thursday, providing a 40-hour work week on a 56-day cycle.
None of Bravo, Charlie or Echo patterns provide 24 hour coverage so they are always supplemented by an Alpha car or, in the case of the lower call-volume stations, by Kilo and Foxtrot. Paramedics working these shifts are paid their regular wage regardless of how many calls they attend to. Further, overtime wages are paid when (and only when) a call takes a crew past their scheduled end-time, regardless of whether the shift is 7, 10, 11, 12, 12.5 or 14 hours long.
Part-time shift patterns
Part-time shifts have their advantages and disadvantages. The main disadvantage is that pay is entirely dependent on the number of calls received, as wages are only paid when a call is dispatched. This is true for Kilo, Foxtrot and Mike shift patterns. The main advantage to being part-time is flexibility, as part-time staff need only submit availability for eight shifts per month but may submit full availability or anywhere in-between, if they wish. The other advantage, when working Kilo, Foxtrot or Mike patterns, is that overtime wages are paid after eight hours of continuous work; overtime is paid only after twelve hours on a Juliet shift. In past years, the majority of paramedics in the smaller communities were local residents who essentially volunteered their time to be on-call as a service to their community. In exchange, they were provided with paid training positions to upgrade their qualifications. Now, the number of locals has decreased significantly and small communities have to rely on long-distance commuters to staff the ambulance stations. The low call volume of these stations, now compounded by the cost of commuting, licensing requirements and the initial cost of training, makes it cost-prohibitive for many new recruits who want to break into the career. Most smaller stations see a "revolving door" of new recruits who stay just long enough to pass their probation so they can transfer to a busier station or to one near their home. Community-based stations like Toad River and Pink Mountain have been forced to close due to a lack of staff. It is not uncommon for paramedics at stations with lower call volumes to have to have a second job and/or submit only minimal availability. Alternatively, paramedics may choose to submit "full availability", to maximize the number of shifts alloted and organize their life around their schedule. Some stations will schedule paramedics for up to 90% of their sunbmitted availability; others will require 10% or less.Kilo shifts are strictly on-call and paramedics respond to a pager. A kilo-responding paramedic must answer a page by calling dispatch within two minutes but there is no requirement to arrive at the station within a set time. However, most on-call paramedics carry their uniform with them and do not engage in any activity that they cannot drop at a moments notice (including other employment obligations). Each Kilo call-out generates a minimum of four hours of pay, as long as the crew returns to the station before each successive call. In busier Kilo stations, due to this tiering effect, paramedics can make more money in a shift than a full time employee working the same number of hours but it is still quite unreliable. The Kilo stipend, called "pager pay", is currently set at $2.00 per hour and is paid regardless of whether work is performed during the shift. There is no pager pay for working past the end of a shift, unless the same paramedic is scheduled for back-to-back kilo shifts. On-call paramedics are not expected to perform any duties and need not even be at the station until they receive a page out. For local residents who are hired as paramedics, this type of shift works well, as they can stay home during their shift or engage in other activities. For non-locals who have to commute, this can be quite problematic if it is a station with low call volume. This shift pattern makes it difficult to have a "life", since a long transfer mat be dispatched to a crew at the very end of their shift. There is no extra compensation for working past your scheduled hours, unless it is in excess of eight continuous hours.
Foxtrot is a compromise between a full-time shift and a Kilo shift. Paramedic crews on this shift pattern are said to be on "standby" and are required to be in their ambulance within 90 seconds of the page or phone call, just like a regular full-time unit. The Foxtrot stipend is currently $11.12 per hour and is increased to the full hourly wage for a minimum of three hours when a call is dispatched to the crew. As with Kilo, the crew is not expected to perform any duties while on standby. Should a call come in, the crew is considered to be "activated" for 3 hours and is under the direction of your dispatcher for that time. Unlike Kilo, if another call is dispatched to the crew within those three hours, no further pay is accumulated. After the three hour window or on returning to the station past the three-hour activation period, the crew returns to standby status until another call is dispatched.
Mike patterns are uncommon but they behave like Kilo cars that are pre-booked for transfers in busy regions or for event upstaffing so their shifts tend to be quite long and involve a lot of overtime. Scheduled Mike cars get $2.00 per hour Pager Pay.
Juliet shifts are 12-hours long and are normally prescheduled but may be authorized as a last-minute stopgap measure. They are staffed by part-time or irregularly-scheduled full-time paramedics and may begin at any time. Typically, Juliet shifts are used to up-staff a station or region in cases of expected high call-volume or to back-fill for a crew that has left on an airevac.
Transfer Fleet patterns
The Transfer Fleet that operates out of many Vancouver Post and Fraser Valley stations is used for routine and stat transfers. It is its own separate post, called B88 (B = 2, for Region 2). In principle, these units are meant to ease the workload of the Emergency Fleet and ensure those are available for emergency calls. At the inception of the Transfer Fleet, all units were designated Tango but they are currently called by different names, depending on their start time. With some exceptions, their shifts follow the Echo pattern, as outlined above. Notably, Papa imitates the Bravo pattern, as it is an 11-hour shift on a platoon cycle.In smaller posts, Kilo is first choice for transfers so that the duty car (Alpha, Bravo, Charlie, Echo or Foxtrot) can be available for emergencies. In practice, the duty car may be used for short transfers within the normal response area, especially if Kilo (or Foxtrot) are occupied. While Sechelt's Mike car is a call-out transfer car, it is attached to station 235-Sechelt and not the B88-Transfer Fleet. This is the last remaining, scheduled Mike car (214-Hope had "14Mike" until the end of 2007 but the resource was reallocated to 206-Chilliwack for a Charlie car while the Foxtrot Nights went to 24 hours. Prior to the change, "06Bravo" would switch to "06Foxtrot" at the end of the shift.). "35Mike" shifts can be extraordinally long, due to the ferry trip at the end of their shift.
| Transfer Fleet Shift Patterns |
||||||||
| Pattern | Lima | Mike | Oscar | Papa | Romeo | Uniform | Victor | X-Ray |
|---|---|---|---|---|---|---|---|---|
| 0600-1300 | Weekday | |||||||
| 0600-1600 | Echo | |||||||
| 0700-1800 | 7 Days | |||||||
| 0700-1700 | Echo | |||||||
| 0800-1900 | Platoon | |||||||
| 0900-1900 | Echo | |||||||
| 0900-1600 | Weekday | Weekday | ||||||
| 1000-2000 | Echo |
Training
Paramedics in BC obtain their initial training before employment by pursuing either their EMR or PCP License at their own cost.EMR training is available through a variety of instructional agencies throughout the province. EMR courses that are approved by the EMA Licensing Board include those offered by the College of the Rockies (http://www.cotr.bc.ca),Paramedic Academy of the Justice Institute of BC (JIBC), the Academy of Emergency Training, EMP Canada, Life Support British Columbia, First Aid Certified Training Systems , Malaspina University College Centre for Continuing Studies and Okanagan College Continuing Studies.
Primary Care Paramedic training is offered by College of the Rockies http://www.cotr.bc.ca, the Paramedic Academy of the Justice Institute of BC and the Academy of Emergency Training. Advanced Care Paramedic training is only available through the Paramedic Academy. All ITT and CCP training is conducted 'in-house' by BCAS Clinical Education Division in conjunction with BC Women's, Children's, Vancouver general, St. Paul's hospitals and the British Columbia Institute of Technology (BCIT).
The EMA Licensing Board maintains a list of approved training agencies available to potential students. Those students who do not complete one of the approved courses will not be permitted to apply for a licensing examination.
Clinical Education is the Division of BC Ambulance Service that provides Paramedic development once a Paramedic has been hired. The main goal of the Clinical Education Division is to support the delivery of quality patient care through curriculum development and course presentation. A new employee can expect to be offered about 11 courses of paid training in their first six months of service. These courses may include: Occupational Safety and Health (OSH) 1-5, CPR/AED Update, PEPP, Trauma 1, Child Abuse Recognition and Reporting, Driving Level 1, Introduction to Treatment Guidelines and Safety Awareness for Emergency Responders (SAFER). In addition, new employees must pass a driving preceptorship prior to being allowed to drive Code 3 (lights & sirens). BCAS fosters an environment of lifelong learning and offers a combination of face-to-face and online educational opportunities for Paramedic development.
Licensing and qualifications
Paramedics qualified in British Columbia are broadly referred to as Emergency Medical Assistants and are licensed by the Emergency Medical Assistants (EMA) Licensing Board (EMALB), a government agency, under one of five categories:- Emergency Medical Responder (EMR)
- Primary Care Paramedic (PCP)
- Infant Transport Team Paramedic (ITT)
- Advanced Care Paramedic (ACP)
- Critical Care Paramedic (CCP)
EMR and PCP are Basic Life Support
Basic life support
Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by...
(BLS) qualifications while ACP is an Advanced Life Support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
(ALS) qualification; ITT has some pediatric advanced protocols; CCP has a whole different scope of practice. BCAS protocols are universal protocols which a qualified practitioner may employ at any time, up to his or her license qualification, within the provincial borders, given that the required equipment is at hand. Licencing qualifications and endorsements can be found in the EMA Regulations under Schedule 1 and Schedule 2.
Emergency medical responder (EMR)
An EMR licensee is qualified to deliver a limited number of medications, under the class of 'symptom relief', including ASA, Nitrous Oxide, Nitroglycerin SL and Oral Glucose. They are also qualified in the use of an Automated External DefibrillatorAutomated external defibrillator
An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of...
(AED) and may monitor an existing IV line. Their protocols include Cardiac Arrest, Cardiac Chest Pain, Diabetic Emergencies and management of pain using Entonox. The "Schedule 2" endorsements appear as "Symptom Relief" and "IV Maint".
Schedule 1 - EMR Licence Qualifications:
- scene assessment;
- assessment of level of consciousness, skin colour and temperature, pulse, and respiration;
- rapid body survey to identify and attend to any life threatening injuries followed by a secondary assessment consisting of a physical examination, medical and incident history, and vital signs;
- cardiopulmonary resuscitation;
- basic wound and fracture management;
- maintenance of airways and ventilation.
- use of airway management techniques including oropharyngeal airways, oral suction devices and oxygen-supplemented mask devices to assist ventilation;
- use of an automatic or semi-automatic external defibrillator;
- cervical collar application and spinal immobilization on a long spine board;
- administration of oxygen;
- administration of oral glucose;
- emergency childbirth;
- ventilation using pocket mask and bag/valve/mask devices.
- occupational first aid;
- lifting/loading, extrication/evacuation and transportation;
- cervical collar application and spinal immobilization on a long spine board;
- blood pressure assessment by auscultation and palpation;
- emergency fracture management/immobilization;
- oropharyngeal airway suctioning;
- oxygen administration and equipment;
- administration of semi-automatic or automatic external defibrillator;
- soft tissue injury treatment.
Schedule 2 - EMR Licence Endorsements:
- maintenance of intravenous lines without medications or blood products while transporting persons between health facilities;
- use and interpretation of a pulse oximeter;
- administration of the following oral, sublingual or inhaled medications;
- anti-anginal;
- anti-hypoglycemic agent;
- analgesic;
- platelet inhibitors;
- use and interpretation of a glucometer;
- chest auscultation.
Primary care paramedic (PCP)
The vast majority of Paramedics in BC practice at this level.In addition to the EMR protocols, PCP licensees have protocols for Shortness of Breath (SOB), Anaphylaxis, Narcotic Overdose, an expanded Diabetic Emergencies and a catch-all for patients with a decreased level of consciousness Not Yet Diagnosed (NYD) that combines the Diabetic/Hypoglycemic and Narcotic OD protocols. PCP-qualified paramedics may also be endorsed for intravenous cannulation (PCP-IV) and will have an additional protocol for Hypovolemia as well as enhancements to the anaphylaxis, diabetic, narcotic OD and NYD protocols. Additional PCP-level medications include Salbutamol (Ventolin), Naloxone HCL (Narcan), Glucagon, Epinephrine HCL (Adrenaline), Diphenhydramine (Benadryl), Thiamine (Betaxin), Dextrose 10% (D10W) and Normal Saline. While 'protocols' were the old method of running medical calls, the service's medical oversight has recently introduced a new set of 'Treatment Guidelines', which is a more generalized framework within which paramedics can operate with more flexibility. For instance, the "Unconscious NYD" protocol no longer exists, as paramedics are expected to understand how to search for an etiology of a patient's decreased level of consciousness and intervene as necessary, instead of following through an algorithm like robots. In addition, chest pain patients can now be treated with the appropriate interventions in mind for those suffering from various forms of acute coronary syndrome, rather than a catch-all protocol for any ischemic-like episodes.
The "Schedule 2" endorsements appear on the PCP licence as "IV" or "ET". Normally, an ET endorsement is not awarded unless the paramedic practitioner has voluntarily downgraded from ACP to PCP and there were no previous issues with field intubations. At this point, the PCP-ET would simply have an adjunct to assist in Cardiac Arrest management. With increased labour mobility between the provinces, some paramedics from other jurisdictions will see restrictions such as for Narcan, Thiamine, Antihistamine or Entonox. Former EMA 2 Paramedics will also see an IM restriction since they were not technically trained how to perform an intramuscular injection.
Schedule 1 - PCP Licence Qualifications
- all EMR Skills and Endorsements;
- administration of the following intravenous, intra-muscular, subcutaneous, oral, sublingual, inhaled or nebulized medications:
- narcotic antagonist
- bronchodilator
- anti-histaminic
- sympathomimetic agent
Schedule 2 - PCP Licence Endorsements
- initiation of peripheral intravenous lines;
- administration of the following intravenous fluids and medications:
- anti-hypoglycemic agent,
- isotonic crystalloid solutions, or
- vitamin B1;
- King extra-glottic device (rescue airway).
Infant Transport Team (ITT)
ITT paramedics are specifically trained for critical care of perinatal, neonatal and pediatric patients. They respond as an equally qualified team of two and sometimes take a physician with them for critically ill patients. When dispatched on street calls these are targeted response ambulances that often assist or intervene when necessary, but can hand a more stable patient off to a layered or co-responding PCP ambulance. The team currently consists of only 26 specially trained paramedics for the entire province.In addition to the PCP protocols and medications, they may also administer Acetaminophen, Adenosine, Atropine Sulphate, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Gravol), Hemabate, Indomethacin, Lorazepam, Magnesium Sulphate, Midazolam (Versed), Morphine Sulphate, Ondansetron, Oxytocin, Sodium Bicarbonate and Out-of-Scope medications with orders from a CCTA. ITT paramedics have their own unique set of prehospital treatment guidelines that mirror ACP guidelines in the areas of pediatrics, having the ability to treat respiratory/cardiac arrest and disrhythmias. The ITT practitioner also has adult ACLS guidelines and intubation in the event they encounter an adult cardiac arrest.
Their additional training and skills include the use and monitoring of Incubators, Endotracheal (ET) Intubation, Intraosseous (IO) Access, nasogastric (NG) tube insertion and suctioning, manual defibrillation, cardioversion, chest decompression, Venous pressure monitoring, Arterial & Central Line Monitoring, Chest Tube Management, transthoracic pacing, Blood Product Infusion, IV Infusion Devices, 'IV with Medication' Maintenance, Mechanical Ventilation (using the LTV 1000 and 1200 and BMD CrossVent), Foreign body removal with laryngoscope, ET/IO/PR drug administration, Central & Parenteral Line Management, Venous & Arterial blood sample collection, point of collection analysis of ABG's and chemistry using the I-Stat, Lab & X-ray interpretation.
The ITT paramedics also transport pediatric and adult ECMO (Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation
In intensive care medicine, extracorporeal membrane oxygenation is an extracorporeal technique of providing both cardiac and respiratory support oxygen to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function...
) patients with a perfusionist from BC Children's.
Note that, while there are some areas of overlap between ACP and ITT, the additional ITT 'Airevac' class of skills that are not included in the standard ACP skill-set are Venous Pressure Monitoring, Arterial & Central Line Monitoring, Chest Tube Management, Blood Product Infusion, Mechanical Ventilation, nitric oxide delivery systems and Out-of-Scope Medications by orders.
Schedule 1 - ITT Licence Qualifications
- all PCP Skills and Endorsements;
- nasopharyngeal airway;
- insertion and maintenance of advanced airway devices which do not require laryngoscopy;
- direct laryngoscopy and endotracheal intubation;
- electrocardiogram rhythm interpretation, cardioversion, external pacing and manual defibrillation;
- initiation and maintenance of intraosseous needle cannulation;
- administration of colloid and non-crystalloid volume expanders;
- use and interpretation of end tidal CO2 monitoring devices;
- maintenance of intravenous routes using intermittent infusion devices;
- mechanical ventilation - adult, pediatric and neonatal;
- maintenance and monitoring of arterial and central venous catheters;
- gastric intubation and suction;
- management of chest tubes and chest drainage systems;
- intravenous blood product administration;
- management of parenteral feeding lines and equipment;
- use of incubators for thermoregulation;
- administration of the following intravenous, oral, nebulized, endotracheal, intraosseous, intramuscular and rectal medications:
- anti-arrhythmic
- bronchodilator
- anti-pyretic
- anti-cholinergic
- anti-hypoglycemic agent
- sedative (anti-epileptic)
- anti-emetic (anti-nauseant)
- histamine antagonist
- anti-convulsant
- alkalizer;
- administration of virtually any medication on consult with a Transport Advisor.
Schedule 2 - ITT Licence Endorsements
- None
Advanced care paramedic (ACP)
Although there are relatively few ACP-staffed ambulances compared to PCP, the majority of the population is covered by ALS service. These are targeted response units with two ACP-qualified paramedics. They are able to defer transport of a more stable patient to a layered or co-responding PCP ambulance. This ensures that most patients have access to ACP but that the resource is not tied up on a call they are not needed on. It also ensures that ACP-qualified paramedics treat a "critical mass" of the most acutely ill patients, thereby maintaining their high skill level.ACP paramedics have protocols to administer all PCP plus Adenosine, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Gravol), Furosemide (Lasix), Heparin, Ipratropium Bromide (Atrovent), Lidocaine, Morphine Sulphate and Amiodarone (Cordarone). Their additional skills include synchronized cardioversion, airway isolation devices, endotracheal intubation, end-tidal CO2 monitoring, external jugular vein cannulation, transcutaneous pacing, IV colloid/crytalloid volume expanders, nasopharangeal airways, needle thoracentesis and surgical or needle cricothyrotomy.
Schedule 1 - ACP Licence Qualifications
- all PCP Skills and Endorsements;
- electrocardiogram rhythm interpretation, cardioversion, external pacing and manual defibrillation;
- initiation and maintenance of intraosseous needle cannulation;
- nasopharyngeal airway;
- maintenance of intravenous routes using intermittent infusion devices, including IV pumps;
- initiation of external jugular vein cannulation;
- cricothyrotomy and needle thoracentesis;
- gastric intubation and suction;
- maintenance of intravenous lines with medications;
- insertion and maintenance of advanced airway devices which do not require laryngoscopy;
- use and interpretation of end tidal CO2 monitoring devices;
- administration of colloid and non-crystalloid volume expanders;
- administration of the following intravenous, oral, nebulized, endotracheal, intraosseous, intramuscular and rectal medications:
- anti-arrhythmic
- electrolyte (calcium therapy)
- diuretic
- anti-coagulant
- narcotic
- anti-pyretic
- anti-cholinergic
- sedative
- anti-emetic (anti-nauseant)
- histamine antagonist
- anti-convulsant
- alkalizer.
Schedule 2 - ACP Licence Endorsements
- mechanical ventilation;
- administration of drug therapy on the direct order of a Transport Advisor;
- urinary catheterization;
- arterial line management and central venous pressure monitoring;
- infusion of blood products;
- point of care testing using capillary, venous or arterial sampling;
- collect arterial and venous blood samples;
- interpret laboratory and radiologic data;
- perform and interpret 12-lead ECGs;
- chest tube management;
- central line management;
- management of parenteral feeding lines and equipment;
- provide trans-venous pacing.
Critical care paramedic (CCP)
CCPs are paired in British Columbia.To become qualified at this level, experienced ACP paramedics take further training consisting of a portion of the CCRN program through BCIT, followed by an intensive hospital-based program through St. Paul's Hospital. Next, there is a work experience portion, and finally, CCP licensure. Formerly, an ACP could take a much shorter course and receive a "Full Schedule 2" endorsement.
CCP's have standard operating guidelines for common critical patients; SIRS/Sepsis, RSI, Chest decompression, Ventilation strategies using the LTV 1000 and 1200, ACS and coronary care, etc. CCP paramedics sometimes take an intensivist with them, but consult with Critical Care Transport advisors.
CCP qualifications follow the NOCP guidelines as endorsed by the Paramedic Association of Canada. In addition to standard ACP protocols, the CCP can perform Schedule 2 ACP skills and procedures as well as administer virtually any medication following assessment and consult with the Critical Care Transport Advisor (CCTA). CCTAs are essential to both the air-evacuation and ground critical care transport programs.
Schedule 1 - CCP Licence Qualifications
- All ACP Skills and Endorsements
- arterial line placement.
Schedule 2 - CCP Licence Endorsements
- None
Wages and benefits
Wages are paid according to license qualification, years of service and supervisory status. For full-time employees, there is also a difference based on whether the paramedic is regularly or irregularly scheduled. As of April 1, 2009, the starting wage for an Emergency Medical Responder (EMR) is $19.29 per hour; for a Primary Care Paramedic (PCP), it is $20.57 per hour or $21.19 per hour with an IV endorsement (PCP-IV); and the call-out wage for an Advanced Care Paramedic (ACP) starts at $27.91 per hour. For the first 6 years of employment, part time employees are given 11% in lieu of benefits and 6% vacation pay on top of their wage. After their six-year employment anniversary, part time employees are given some medical and dental benefits which start at the beginning of the next fiscal year and they lose the 11% in lieu of benefits. The first (and only significant) wage increase for part-time employees is at five years of service and brings the respective qualifications up to $23.91, $25.15, $25.78 and $31.20 per hour.| Part Time Wage Scale | ||||
| Adjusted D.O.H.* | EMR | PCP | PCP-IV | ACP |
|---|---|---|---|---|
| Base = D.O.H. | $19.29 | $20.57 | $21.19 | $27.91 |
| Adj. D.O.H. +5 Years | $23.91 | $25.15 | $25.78 | $31.20 |
| Adj. D.O.H. +10 Years | $24.16 | $25.41 | $26.03 | $31.45 |
| Adj. D.O.H. +15 Years | $24.38 | $25.63 | $26.25 | $31.67 |
| Adj. D.O.H. +20 Years | $24.67 | $25.91 | $26.54 | $31.96 |
| Adj. D.O.H. +25 Years | $24.90 | $26.14 | $26.77 | $32.19 |
(* D.O.H. may be adjusted if a part-time paramedic does not submit at least eight shifts of availability to their primary operator in a given month.)
Full time wages are salary-based but an hourly wage is often referred to as shorthand for calculation of overtime. Without getting into details, the hourly rate for a full-time, regularly scheduled employee on an Alpha pattern with three years experience at that license qualification is as follows;
EMR (i.e., Transfer Fleet): $27.86 per hour; PCP: $29.33; PCP-IV: $30.05; ACP: $36.40; ITT/CCP: $37.90.
Generally, part-time seniority does not count toward any full-time seniority or pay scale. The only exception is that a part-time paramedic who responds to 300 calls per year will receive one year's experience pay for each of (up to) three years when going full-time. That is to say, a part-time paramedic with at least 900 calls equally divided over three years will start at the 3-Year pay scale when accepting a full-time position. In the table below, for the ACP, ITT and CCP wage columns, it is assumed that the wage increments for 10, 15, 20 and 25 year marks are at the 3-year experience pay level. This is meant to show what an established paramedic at that licence qualification could expect in a full-time position. Once a paramedic reaches the third year of experience pay, further increments average $0.29 every five years; after 25 years, only $1.15 per hour ($2511.60 annually) is gained on top of the three-year experience pay. This reflects "years of service", rather than "experience" per se.
| Full-Time Wage Scale* | ||||||
| Experience Pay | EMR | PCP | PCP-IV | ACP | ITT | CCP |
|---|---|---|---|---|---|---|
| Base | $22.48 | $23.95 | $24.68 | $32.56 | $34.06 | $34.06 |
| 1 Year | $24.21 | $25.68 | $26.41 | $34.34 | $35.84 | $35.84 |
| 2 Years | $25.94 | $27.41 | $28.14 | $35.90 | $37.40 | $37.40 |
| 3 Years | $27.86 | $29.33 | $30.05 | $36.40 | $37.90 | $37.90 |
| 10 Years | $28.15 | $29.62 | $30.34 | $36.69 | $38.19 | $38.19 |
| 15 Years | $28.43 | $29.91 | $30.63 | $36.97 | $38.47 | $38.47 |
| 20 Years | $28.72 | $30.19 | $30.92 | $37.26 | $38.76 | $38.76 |
| 25 Years | $29.01 | $30.48 | $31.21 | $37.55 | $39.05 | $39.05 |
(* Regularly Scheduled; Three Years Experience; Alpha Pattern)
Although these wage scales reflect what a BCAS Paramedic will earn "on paper", these wages are "factored" through a complicted formula whereas the wages are reduced significantly.
Labour Mobility
With the introduction of the Trade, Investment and Labour Mobility Agreement (TILMA), the process of transferring one's licensure between provincial jurisdictions has been streamlined.Hiring process
The basic requirements to become employed by the BCAS as of August 15, 2007 are:- A valid EMR, PCP, ITT, ACP or CCP license issued by the Emergency Medical Assistants Licensing Board;
- A valid Class 1, 2 or 4 BC Driver's License. If Class 4, then 'unrestricted' is preferred.
- Proof of a 'safe and competent' driving history as demonstrated by a Driver's Licence Abstract;
- A CPR Level 'C' (or HCP) certificate, valid within one year, also known as "BCLS";
- Legal entitlement to work in Canada;
- At least 19 years of age;
- Grade 12 Graduation diploma or equivalent;
- Satisfactory Criminal Record Search and Criminal Record Review Act Search;
- Fit to safely perform the duties of a paramedic as measured through a medical and physical pre-employment assessment;
- Be of good character;
- Be available on a regular basis for ambulance duty.
At this time, EMR-qualified staff are only permitted to work in remote and rural stations and must upgrade to PCP if they wish to further their career with the BCAS, including lateral transfers to an Urban or Metro-designated station on a part-time basis or application for a full-time posting. The exceptions to this rule include applications to one of the Dispatch Centres or to the Metro Vancouver Transfer Fleet, both of which require only an EMR qualification; these are internal applications for current BCAS employees only.
Prospective employees are required to pay for their own training. EMR courses currently cost around $1,410, and a $450 charge for an EMA licensing exam. PCP training costs approximately $6,000, as well as the EMA licensing exam fee. PCP training also requires 6 months of full time classroom and on car practicum time, so applicants should be aware that they will also be out of work for 6 months while training, which could put total costs as high as $20,000 - $30,000.
If the above requirements are not able to be fully met, the applicant can still contact a paramedic chief in their local community for further information on applying. For example, in cases of extreme staff shortages, an attendant may be hired as a "Driver Only" if he or she holds only a Level 3 Occupational First Aid (OFA 3) Certificate or equivalent (OFA 3 is not a prerequisite for an EMR license but it is the current industry standard in BC for remote or high-risk workplaces).
With the abolishment of mandatory retirement, paramedics may work past the age of 65 as part-time employees. Once they retire from full-time service, they must be off work for a period of one month after which they may reapply to become employed by the BCAS in a part-time capacity; it is the pension corporation that requires a formal severance of employment prior to the pension benefits being activated. The details of this process have yet to be fully fleshed out.
On average, it takes approximately 3 to 6 months before an applicant is granted an interview. The interview consists of a behavioural interview with a panel of two to three paramedic chiefs (and may include a Regional Superintendent or HR personnel) and is approximately 1 hour long. It may be held at a regional Human Resources office or at a given ambulance station where the applicant is under consideration. The interview follows the STAR (Situation, Task, Action, Result
Situation, Task, Action, Result
The STAR format is a job interview technique used by interviewers to gather all the relevant information about a specific capability that the job requires...
) format. If the applicant has not yet completed a PCP program, there will also be a written exam based on OFA 3 knowledge of first aid and anatomy. After an applicant completes the interview he or she will not find out the results for another 1–3 months. If unsuccessful at the interview stage, the applicant may be told he or she cannot re-apply for a period of 6 months.
If the applicant passes the interview, they are entered into the hiring pool and ranked according to their score on the written exam and interview. From this point, the prospective employee may be contacted by a paramedic chief that is hiring. After passing the interview stage, a physical fitness assessment, a medical assessment and two criminal record checks will be conducted. Assuming all goes well, the applicant is then hired into the service at a specific ambulance station, called a 'primary operator'. Once issued an employee number, they are deemed eligible to work and the employee enters into a six-month probationary period. If the applicant is hired as underqualified (i.e., hired without a Class 4 driver's license or other specific training), conditions of probation may be imposed such that the person must obtain certain qualifications before their probation is up or they may be released from the service. During probation, a paramedic may not move to another station (called a lateral transfer) or work at any other BCAS station (often called working at a 'secondary operator'). The probationary period may be extended at the discretion of the Executive Director; this requires both the signature of the Paramedic Chief and the District Superintendent, as well as notification to the individual prior to the extension.
Full time vs. part time
All employees hired start as part time employees. You will generally start at a Remote or Rural-designated station until you have passed your 6 month probation period and have enough seniority to transfer to another station. Sometimes it can take up to a year and a half before another position becomes available for you to fill. As a part time employee, you work as much or as little as you like, with a minimum commitment of being available to work eight shifts per month at your home station. This can be advantageous as it allows you to schedule what days you like to work, or if you want to go on vacation without worrying about asking for time off. To become a full-time employee, you have three options. The first option is to continue working as a part time employee in the field, until you attain sufficient seniority (currently around four years), in order to transfer directly to Vancouver Post (Emergency or Transfer fleet). Secondly, you could or apply to transfer into Dispatch after completing your initial probation. The last option is to gain your ACP qualification and bid on a full-time position in one of the major centres.Getting hired in Vancouver as a PCP is the more common route taken to be hired as a full time employee. Once you are hired as a full time employee in Vancouver, you can also apply for a full time position elsewhere, however you will be competing for that position with every other full time employee who has applied. Full time positions are awarded based on the number of years worked as a full time employee. This means that it could be at least 2–3 years working in Vancouver before you have enough seniority to leave. Generally, this is a good thing as it gives new full-time paramedics ample opportunity to practice and hone their skills.
Rank and qualification insignia
The BC Ambulance Service is a uniformed organization and as such, has a similar rank structure to most police or fire departments. The medical qualifications of a uniformed member are denoted with collar insignia, commonly known as 'collar dogs', while rank is denoted using epaulettes. Excluded management and administrative employees in regional offices and provincial headquarters do not wear uniforms, generally preferring a 'jeans day' clothing policy throughout the week.Current qualifications designated by collar dogs include EMR, PCP (formerly EMA1 and EMA2), ACP, ITT, EMCT and EMD. The EMR and PCP levels are shown on bronze and silver circles, respectively, forming the BCAS logo, along with a circumform bar below, denoting the EMR or PCP qualification. ACP (formerly EMA3/ALS) and ITT (Infant Transport Team) paramedics are recognized with gold cauducei, with either "ALS" or "Neonatology" imprinted upon them. CCP (Critical Care Paramedics) have a gold coloured shield with blue star of life and CCP on it. Within the Communication Centres, EMD (Emergency Medical Dispatcher) and EMCT (Emergency Medical Call Taker) are designated by gold and silver shields, respectively.
For rank insignia, Paramedics and dispatchers who hold the position of Paramedic Chief or Charge Dispatcher wear a black epaulette with three gold stripes. District Supervisors and Dispatch Supervisors wear the same coloured epaulette with four gold stripes while Dispatch Officers wear two gold stripes. Ranks above District Supervisor are management positions and are distinguished by a varying number of pips on their epaulette. District and Platoon Superintendents wear an epaulette with three pips, Managers wear one pip and one crown, Directors wear two pips and one crown and the Executive Director of a region will wear three pips plus a crown. Each station and dispatch centre has a staff member designated as its Occupational Safety & Health (OSH) representative. These paramedics and dispatchers are identified with a black epaulette with a single royal blue bar. Staff who are designated as OSH representatives hold no supervisory authority, but are available to assist staff with safe work practices. BC Ambulance instructional staff wear a black epalette with the word "INSTRUCTOR" embroidered in gold, facing laterally.
Shoulder flashes for field staff are royal blue with gold trim, and include the British Columbia Coat of Arms, with the words "Ambulance" above, and "British Columbia" below, both in white. Shoulder flashes for management personnel are navy blue with a navy blue trim. The layout of the shoulder flash is the same for both.
Other pins and insignia
- Service Bars - issued one for every five years service with BCAS or combined time with another bona fide EMS agency.
- Line of Duty Death Pin - worn only in the event of a BCAS line-of-duty death or during Paramedic Appreciation Week, the first seven days of July.
- 25, 30 and 40-year Service Pins - issued after the designated years of service, full and part-time inclusive.
- Union Pins - permitted one on a uniform at any given time.
- Stork Pin - awarded when a BLS crew performs a pre-hospital delivery in the absence of ITT or ALS.
Uniform Colour
As of Thursday, August 4, 2011 the BCAS has officialy changed from the traditional white and blue uniform to an all blue uniform. The gold trim on the shoulder flash was also lost. Some paramedics are concerned about being mistaken as police or firefighters. The new uniforms are said to be more durable and stain resistant.Labour relations
Ambulance paramedics, emergency medical call-takers, and emergency medical dispatchers are members of the Ambulance Paramedics of British Columbia (APBC) Local 873 of the Canadian Union of Public Employees (CUPE). Provincial headquarters and administrative staff are members of the British Columbia Government Employees Union (BCGEU).The collective agreement between the APBC and the EHSC expired on March 31, 2009. A strike vote was taken prior to the expiry of the prior collective agreement and the result was 97% of APBC in favour of a strike. Despite being legally on strike, the essential services order (ESO) handed down by the Labour Relations Board (LRB) stated that 100% of APBC's work was considered essential, and therefore could not withdraw any frontline work.
On November 2, 2009, the Minister of Health Services tabled Bill 21, titled the Ambulance Services Collective Agreement Act. Bill 21 was back-to-work legislation for APBC. This bill came under intense scrutiny, and is considered to be unprecedented in Canadian labour history. The reason for this is because the government began tabling the legislation while APBC was in the process of conducting a vote on the government's latest contract offer. The terms of Bill 21 were virtually the same as the contract offer being voted on.
The government's reasoning behind enacting Bill 21 was the H1N1 influenza pandemic
2009 flu pandemic
The 2009 flu pandemic was an influenza pandemic, and the second of the two pandemics involving H1N1 influenza virus , albeit in a new version...
, stating they needed all branches of the healthcare service at 100% efficiency and operational levels. The government also accused paramedics of not working mandatory overtime shifts despite the terms of the ESO. The other reason provided was that the government had concern over BCAS managers required to work upward of 80 hours per week during the strike due to striking paramedics failing to carry out basic paperwork duties.
Further complicating the legislation is a leaked memo from the Medical Director of the Vancouver Organizing Committee for the 2010 Olympic and Paralympic Winter Games
Vancouver Organizing Committee for the 2010 Olympic and Paralympic Winter Games
The Vancouver Organizing Committee for the 2010 Olympic and Paralympic Winter Games was the non-profit organization responsible for planning, organizing, financing and staging the 2010 Winter Olympics and 2010 Winter Paralympics...
(VANOC) sent to the government. In the memo is the following section: "VANOC Medical Services (and thus the IOC) requires definitive confirmation by Oct 1 2009 that all required ambulance services will be provided as planned. These services include the ability to engage the VCs and BCAS members in full venue planning as soon as possible. This confirmation must also include a guarantee that no services during the Games will be disrupted or reduced from what has been planned. If we are unable to obtain that guarantee (through either settlement of the strike or a legislated "detente" for the Games), then VANOC will be required to initiate contigency plans to avoid cancellation of the Games."
On November 7, 2009, the Ambulance Services Collective Agreement Act achieved Royal Assent
Royal Assent
The granting of royal assent refers to the method by which any constitutional monarch formally approves and promulgates an act of his or her nation's parliament, thus making it a law...
, after an overnight debate until the Act was passed. The terms of the Act specify a 3% general wage increase for APBC members, retroactive to April 1, 2009. None of the operational issues raised by APBC (staffing shortages, rural deployment issues, recruitment and retention challenges, longer response times) are addressed in this Act. The Act will expire on March 31, 2010, shortly after the conclusion of the Olympics. APBC and BCAS will be in a position to re-open negotiations for the next collective agreement in December 2009, a few weeks after being handed the legislated contract.
See also
- E-CommE-Comm' is the Emergency Communications for Southwest British Columbia.E-Comm provides 9-1-1 service for the Lower Mainland region of southwest British Columbia in Canada covering Metro Vancouver , the Sunshine Coast Regional District, south Squamish-Lillooet Regional District and the Whistler Howe Sound...
, 9-1-1 call and dispatch centre for Southwestern BC - List of EMS Services in Ontario
- HealthLink BC
External links
- BC Ambulance Service Official Site
- British Columbia Paramedics at Work - a photo/video chronicle of British Columbia's Paramedics on the job
- Ambulance Paramedics of BC, CUPE Local 873 Official Site
- Ambulance Paramedics of BC Save Our Paramedic site
- http://www.bcas.ca/assets/About/PDFs/Annual%20Report.pdf