HUGE underlying problems with the BC Ambulance service contributed to this mess - they were so overwhelmed that it took over 2 hours to respond to super high priority calls (e.g. heart attacks, strokes). I copied this from an anonymous poster off reddit (and I'm no expert so I cannot verify):
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I've worked with the BC Ambulance Service / BCEHS for somewhere between 10 to 20 years. In that time I've worked at essentially every license level you're likely to encounter on car. I've served in rural stations, I've worked in busy centres, I've staffed advanced resources, and I've worked in specialist programs. I know my way around a laryngoscope and a LifePak. I've spent my time with Sue and the Columbian Zoo. Basically, I've seen stuff.
Whether you live in a remote reserve, a rural farm community, or a busy metro region, BCEHS is essentially the only organization legally permitted to provide you with 'paramedic' level care and emergency medical transport. Jammer in Fort St. John? BCEHS. Water on the lungs in Fort Ware? BCEHS. Lacerated liver in Fort Langley? Believe it or not, BCEHS. So, if you ever plan to get sick or hurt outside of a hospital in BC, you're likely to need the services of the BCEHS. God help you.
BC Ambulance was once awesome. Like actually a world class ambulance service used as a model for several other ambulance services across the world.
It was awesome because the government believed in the idea of a provincial ambulance service with a decent standard of training, equipment, and governance serving the entire population of BC. They invested training, planning, and most importantly, cold hard cash into building the service. They advocated standard training levels, they supported a nascent targeted ALS program which was a revolution in prehospital care in Canada. They invested in building an air ambulance program built on some of the highest trained paramedics on the continent.
And this was all done within a reasonably-sized organization called the Emergency Health Services Commission which reported directly to the Ministry of Health. The organization was run as an 'Emergency Service' by and for paramedics who saw themselves first and foremost as 'Emergency Responders'--the culture was somewhat similar to a fire department or police department, with a reasonable esprit de corps and a narrow but clear focus and purpose.
It should be noted that during this era full-time paramedics were paid at approximate parity with other emergency services. Training was funded by the ambulance service, allowing paramedics to move up the ranks like their police/fire brethren. Dispatch work was seen as some of the most important in the ambulance service, with stringent training standards and a high degree of clinical latitude given to dispatchers and call takers. The culture was largely oriented towards patient care with little concern given to liability and management CYA.
Was the Commission and BC Ambulance Service perfect? Absolutely not. But it understood what it was, and was small and nimble enough to at least have a chance of achieving its mission. So what happened?
This part is multi-factorial and poorly understood. Essentially though, the BC Liberals never quite liked BCAS--they saw it as an NDP project, as a difficult union shop, as a needless draw on provincial coffers. Apparently they shopped around privatization in the early 2000s under Campbell (Laidlaw Waste and Ambulance Services anyone?) but had no takers. So, they just let the service stagnate with under-funding and falling wages relative to cost-of-living and other emergency responders. (It should be noted that this trend of stagnation did not originate with the Liberals but with Clark's NDP.)
Paramedics, angered about a service they saw stagnating and wages remaining effectively flat, sought job action. So they called a strike which just so happened to coincide with the 2010 WINTER OLYMPICS. Needless to say, the Liberals were pissed. Back to work legislation was drafted. Paramedics fought back by refusing to attend to non-essential duties en masse. Olympic services were threatened. Paramedic fought paramedic over accusations of scabbing. It was bad.
The strike was effectively broken, and any goodwill between the Liberals and the paramedics was gone forever. And now the redheaded step child of the emergency services was the redheaded step child of government organizations. Having had enough of the Commission and BCAS, the Liberals did two things which crushed whatever spirit was left in the ambulance service.
The government pushed paramedics into a bargaining unit with hospital janitors and facilities staff (the Facilities Bargaining Unit) leaving paramedics as the only clinically-oriented, emergency professionals in a much larger group of maintenance-oriented staff. Because all bargaining was conducted by this bargaining unit and not the paramedic's union (APBC 873), and because the rest of the FBU saw paramedics as a small bunch of outsiders, paramedics were given very, very raw deals at subsequent contract negotiations. And because of the structure of the FBU/APBC merger, paramedics couldn't strike or take any job action separate from other FBU staff.
In effect, this led to the complete stagnation of wages and professional progress for the better part of a decade. The FBU situation, coupled with arguably weak-kneed leadership from the union, made a career as a paramedic look like a terrible idea, creating constant staffing shortages, and frankly, a 'bottom-of-the-barrel' 'meat-in-the-seat' hiring culture. In addition, it killed any esprit de corps and created a staff culture bordering on death row levels of joy.
Second, the Liberals eliminated the Emergency Health Service Commission / BC Ambulance as a separate entity, instead rolling it into the Provincial Health Services Authority. This meant that BC Ambulance was no longer an emergency service of ~4000 employees which could advocate for itself and dictate its future to some extent. Instead, BCAS was now a small part of an organization of nearly 20,000 employees with a mandate to manage services as disparate as the BCCDC, BC Children's Hospital, and business support services for all health authorities under BC Clinical and Support Services.
The PHSA had no emergency services background, no paramilitary culture, and certainly had no interest in supporting a paramedic-led ambulance service. All it took was some management shenanigans circa 2014 and the last paramedics to lead BCAS was ousted. The organization was completely taken over by accountants, healthcare management, and nursing management types who had little interest in 40+ years of emergency service history.
Under PHSA, BC Ambulance was managed like a backwater hospital. The organization lost the ability to plan its own future, procure its own equipment, hire/fire/discipline its own staff, set its own staffing levels and schedules. Since 2014, leadership has been a revolving door. We've had a new Chief Operating Officer almost every year. Some have fought for adequate funding and lost, others have quickly taken leadership positions in far flung parts of PHSA. None have stayed long enough to get a reign on things. The top position of the largest ambulance service in Canada has become either a short-term stepping stone or a poisoned chalice. All the while, the ship drifts rudderless, failing to response to crisis after crisis.
An 'emergency service' should rarely be operating in an 'emergency mode'. The everyday cardiac arrests, car accidents, and overdoses should be handled gracefully and without excitement. Yet, BCEHS has been operating in a 'crisis' mode for years. Before the opiate crisis, before COVID, there were often periods where scores of ambulances went totally unstaffed, where patients waited hours to be seen by paramedics, where morbidity and mortality occurred as a direct result of a failing system.
Then the opiate crisis hit and paramedics were now attending to thousands of more overdose calls which pushed an already strained system to the edge of collapse. Then COVID hit. Calls took twice as long due to PPE, cleaning, etc. The system regularly failed, scores of cars were regularly down and morale spiraled to all-new lows.
Then a once in a lifetime (hopefully...) crisis hit. It was predicted days in advance. It might have even been mitigated by upstaffing, emergency planning, and deft leadership. But the once great BC Ambulance Service had nothing more to give. So it fell apart and patients died. Family members, firefighters, police officers, taxi drivers, and family physicians were left holding the pieces. If an inquiry is ever struck, I suspect there will be scores of patients who are identified as experiencing serious harm because of our failures.
