N.L.'s public road ambulance service is a year old, and it still has that new-car smell
About 2 new ambulances arriving monthly, but staffing remains a challenge
It's now been a year since Newfoundland and Labrador transitioned to a fully integrated road ambulance service managed — at least for now — by the province's health authority.
And those who run the service say it's been a positive move for health care in the province.
"I can guarantee you we are far ahead in the quality of our system," said Cassie Chisholm, the Newfoundland and Labrador Health Services vice-president in charge of emergency transport.
And the paramedic managing the fleet, Zack Parrell, said "we've found a lot of efficiencies within the system."
In a move that stoked some controversy, the mishmash of public, private and community-based road ambulance services ended on June 1, 2024, with NLHS launching a new public system linked to an expanded medical communications centre in St. John's, which receives 911 calls and dispatches emergency response.
The move was one of the calls-to-action from the Health Accord, and it saw NLHS swallow up more than 60 private operators and their fleet of ambulances, including some providers that had been under contract for decades. About 500 workers from those companies were also welcomed into the public service.
For most of those workers, the transition came with higher salaries, and better benefits and working conditions, said NAPE president Jerry Earle, whose union represents the province's roughly 800 paramedics and emergency medical responders.
"Many of these people that worked for a private entity didn't even have a group insurance plan," said Earle.
For now, the service is operated by NLHS, but a 10-year management contract for a new integrated air and road ambulance service is expected to be awarded this fall to a company called Medavie Health N.L.
Negotiations are currently underway, said Chisholm.
"It's our objective to get it right and we don't want to go so fast that we missed something, so we're taking our time," she said.
Union leaders gives new service an A
Now, on any given day, these specialists are staffing just under 150 ambulances stationed at dozens of locations throughout the province, and responding to an average of 275 calls.
"I'd certainly have to give it an A from a grading perspective," Earle said of the new service.
The bill for the first year of operation? Nearly $100 million. That's more than the old, disjointed system, but not by much, said Chisholm.
"A higher quality system is always a cheaper system. It always provides more return on investment," she said, describing a well-run ambulance service as "fundamental" to the health system.
As for response times, Chisholm said that information didn't exist before the consolidation, so data is still being compiled as the service matures.
An expensive effort to modernize the ambulance fleet is ongoing, with about two new vehicles entering service each month.
By the end of this year, 40 per cent of the fleet will comprise vehicles that are less than two years old, said Parrell, and all-wheel drive models are being procured to ensure enhanced safety and reliability during winter driving conditions.
The health authority is also investing in new equipment such as power stretchers to help reduce back injuries among paramedics and EMRs, and there's a new radio system and a steady shift toward electronic patient records.
Like many specialized job categories, there are challenges with recruitment and retention of staff, and the health authority is trying to address that by increasing salaries and benefits, offering financial support for EMRs to upgrade their skills at training institutions in the province, working closely with the union on issues such as mental health support, and providing the best equipment available.
In-house repair centres being planned
Paramedics can encounter many challenging situations. Earle, who once worked as a paramedic, has first-hand experience.
"It's a very rewarding career where you get a chance to make a difference in somebody else's life," he said.
Chisholm said NLHS needs more people in the role, and that paramedics are finally taking their rightful place alongside nurses, physicians and other specialists as key players in the health system.
"They are unsung heroes. They add untold value to the delivery of health care," she said.
Parrell, meanwhile, said more changes are coming.
Currently, NLHS spends about $3.5 million in repair costs for the fleet at private service centres, and a similar amount in fuel, while travelling about five million kilometres annually.
Parrell said work has well advanced on a plan to establish two dedicated fleet centres operated by the health authority. One will be located in the St. John's region, and a second in a location yet to be decided.
Parrell said the plan is to hire about 30 people — mechanics, logistics staff and other specialists — to work at the two centres. The first centre is expected to be operational in about six months, he said.
"We will work with our central medical dispatch to ensure that we rotate ambulances across the province to get that maintenance done in a timely manner and as scheduled," Parrell said.
When asked if the service is better than in the past, Parrell replied: "I think the people of the province need to understand that when they call 911 and they need an ambulance, that we are there."
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