Rural Manitoba health authority to temporarily dial back advanced care paramedic role, starting Saturday

Effective Saturday, advanced care paramedics in a rural Manitoba health region will no longer be allowed to offer certain procedures because of a shift to intermediate-care practice, in a move the province and the Interlake-Eastern Regional Health Authority say is temporary.

But the union and professional association representing paramedics call it a step backward.

"This is just going to exacerbate the lack of care in rural Manitoba," said Michelle Gawronsky, president of the Manitoba Government and General Employees' Union, which represents 1,100 paramedics in the province, including those in the Interlake-Eastern Regional Health Authority.

Advanced care paramedics in the health authority will no longer be able to practise in that capacity starting Sept. 1, said CEO Ron Van Denakker in an emailed statement Friday.

Instead, the seven people will practise as intermediate care paramedics, meaning they won't be allowed to offer some procedures they had previously delivered, despite having training and a national licence to do so.

Licensed advanced care paramedics can provide certain airway treatments and pediatric cardiac procedures, as well as delivering certain medications, Gawronsky said. 

No other EMS personnel in the region will be able to provide those services.

The compensation for the paramedics won't change.

The Interlake-Eastern Regional Health Authority had been the only rural health region that allowed advanced care paramedics to practise as such, said Eric Glass, administrative director for the Paramedic Association of Manitoba.

Winnipeg's Fire Paramedic Service includes a blend of advanced, intermediate and primary care providers.

Van Denakker said the move is intended "to ensure our seven [advance care paramedics] are receiving the support and integration they need to effectively practise to their full scope of practice."

"Interlake-Eastern RHA residents can remain confident in the abilities of the paramedics who respond to their calls in an emergency," he said in the statement.

A spokesperson for the health authority said the shift is temporary, but the timeline to switch back has not been determined.

Rural care already compromised: Gawronsky

Glass said the move was a surprise and a disappointment for his organization, which has advocated for the expansion of advanced care paramedics across rural regions for years.

"It will undoubtedly bring with it the possibility of minimizing some patient care," he said.

"Some of those advanced procedures that advanced care paramedics could perform and [intermediate care paramedics] can't will obviously not be available now."

Advanced care paramedics are nationally licensed and have to complete an additional year of full-time education in an accredited program, Glass said, which allows them to provide a more advanced level of care.

Gawronsky said rural health-care providers already face challenges, including long ambulance transport times, limited emergency room hours and an overall shortage of doctors and paramedics.

A spokesperson for the province said the move won't compromise care, adding intermediate care paramedics in other rural health regions are already providing good care to patients in their areas.

"Our government is focused on ensuring safe patient care and appropriate access and availability of services across rural and northern Manitoba," he wrote in an email.

"Recruitment efforts in IERHA have been successful, with 22 new doctors joining the region in 2017 and more starting this year. While there remain areas for improvement, this has made a significant dent in the region's vacancy rate, particularly in emergency departments."

Recruitment, retention concerns

Gawronsky and Glass both raised concerns about what the shift will do to recruitment and retention of paramedics in the region.

"When a decision like this is made, inevitably it's going to become more difficult to attract [advance care paramedics] and sustain those people once they have licensed and begin to practise," Glass said.

"If they're not going to be able to practise as ACPs in Manitoba, they may go elsewhere for work."

Paramedicine is evolving in Manitoba, he said, including recent steps to form a self-regulated college and the implementation of an advanced care program at Red River College in the past few years.

"These [advanced care paramedics], they have been formally educated through an accredited education program. They've received thousands of hours of education," he said.

"It's frustrating to see them not allowed to be able to practise at that level. It's frustrating to see this province move towards the inclusion of advanced care paramedics in terms of investing in education and now not utilising them."