Emergency services on the Prairies a chaotic dance

“As I got to the gate, I could hear the click of the emergency brake letting go (on the tractor),” said Chad Rogers in a video featuring his accident on the STARS website.

He is what the Shock Trauma Air Rescue Society (STARS) calls a Very Important Patient (VIP).

Rogers, who had been opening a gate, ran after the runaway tractor and the baler it had been towing.

The Assiniboia-area farmer almost reached the door, but his leg was dragged out from underneath him and the tractor and then the baler ran him over.

He texted his mom, who called 911. She also called a neighbour and a few friends who were local first responders to go to the scene.

A few of them stood beside the roadway to flag down the ambulance.

Rogers had a shattered pelvis and cracked vertebrae and was bleeding internally.

The local hospital didn’t have the pelvic brace needed to hold his injury together and stop the bleeding. Luckily for Rogers, a STARS helicopter arrived with the necessary device.

The helicopter also carried the blood needed to replace the nine units he had lost.

Rogers said he owes STARS his life. 

“I don’t know what we did without them before . . . it was a different outcome for sure for a lot of different people.”

As a paramedic for more than 15 years, Willem van Lankvelt already had a deep appreciation for STARS before becoming a VIP patient himself.

After a collision with a truck, while riding his bike on a family vacation, the crew that picked him up and stabilized him technically knew who he was through work, but due to the nature of his injuries, they didn’t recognize him.

“Even as an advanced care paramedic, I would have had a very difficult time managing myself, said van Lankvelt about the extent of his injuries in his STARS VIP video.

The medical attention he needed was beyond what the local medical facility could offer, but emergency dispatchers and coordinators, RCMP, and paramedics in rural Saskatchewan and Manitoba work every day to ensure that people receive the care they need.

If that care isn’t available locally, the patient is transported by air or ambulance to a larger centre.

According to the STARS website, 3,365 missions were carried out from six bases in Alberta, Saskatchewan, and Manitoba from April through March of the 2022-23 fiscal year, with trauma and vehicle incidents making up a combined 37 per cent of those calls.

“There are many more moving parts to this “chain of survival” than people realize,” said Andrea Robertson, a former STARS CEO.

“We rely on RCMP. We rely on city police. We rely on fire. So, when we’re coming, someone is securing the scene for us. Someone is out making sure that that scene is safe for us to land. That’s often EMS, fire, police, and RCMP. Don’t forget the small rural hospital that picks up the phone and says you know what, we need to get someone into Saskatoon or into Regina.”

Darcy McKay, the provincial director of STARS in Saskatchewan, calls it a “chaotic dance,” a logistical challenge that his team members have repeatedly overcome.

“All the logistics and coordination are remarkable.”

It starts with dispatchers

McKay said 911 dispatchers are invaluable in gathering the details and coordinating the services required to respond to a call.

From one central location, the Shared Health Emergency Medical Services and Medical Transportation Coordination Centre in Manitoba handles all emergency calls outside of Winnipeg and coordinates inter-hospital transfers.

“You’re stuck in that room, you’re hearing all that information,” said McKay. 

When an emergency takes place, Shared Health director Kyle Sneesby said his staff works closely with emergency services from across Manitoba, from EMS to STARS and other helicopter services, to get the right services to the right places.

While dispatchers are not on the scene, being involved in every rural emergency across the province takes a mental and emotional toll, even when they’re not directly responding to it. When someone calls, it is on the worst day of their lives when they or their loved ones are in pain, and Sneesby said his staff does an exceptional job in making sure patients get the right care when and where they need it.

“It’s a real unique environment and it takes a unique skill set to excel at it. I think the staff that we have are incredible at the work that they do in managing the stresses and the challenges with the job,” said Sneesby.

Part of the success of the response is also the information coming from the other end of the line. The best caller is one who is physically there, he said. However, people don’t realize the valuable information they have even if they can’t stay on the scene.

“They may be able to provide a lot more information than they realize. Just answering those questions as accurately as they can really help to ensure that the right resource, the right level of care, is sent as quickly as possible to that scene.”

Like many provinces and rural areas, Sneesby said the biggest challenge is geography.

“Not every community has its own ambulance, so part of the challenge is making sure that you maintain a real good response time, a reasonable response time to as many populated areas of the province as possible.” 

According to the Manitoba Association of Health Professionals, staffing shortages at the Medical Transportation Coordination Centre, which is based in Brandon, can sometimes mean callers in rural and northern areas can wait up to 10 minutes for a dispatcher to pick up the phone. 

Whenever a call comes in and STARS is needed, a helicopter is ready to take to the air as quickly and safely as possible while a team on the ground is already fighting against time, injury, and the elements.

While STARS has been an invaluable service for those living in areas that rely on air ambulances, the number of helicopter pilots in the country is on the decline.

Transport Canada issued 62 helicopter pilot licences in 2012. But in 2022, that number dropped by 80 per cent to just 12, raising concerns over what that means for air ambulance services.

Learning how to be a helicopter pilot can be prohibitively expensive. A student interested in such a career can pay up to $100,000 for the training.

One suggestion to attract new recruits is to increase pilot pay so they can pay off their student loans. But outreach is also needed, letting students know that there are a growing number of vacancies in aviation, which wasn’t the case even five years ago.  

Minding the weather and the utilities during an emergency

As the director of intelligence services with the Saskatchewan Public Safety Agency (SPSA), Brian Schafer manages many different emergency situations, from water rescues to large-scale accidents. His team is on the clock to gather information and make the calls on whether a situation needs local EMS, STARS, or even a Hazmat team. 

When a train derails, like the one that occurred near Macoun, Sask., in December 2022, information about weather and infrastructure is needed quickly.

“That information helps the incident commander on scene, make those types of decisions of what’s the next play and what’s our future plays? The weather can be calm right now, but come 11 o’clock tonight, those winds can be coming out of the west at 80 kilometres an hour,” said Schafer, causing the situation to change from hour to hour, even minute to minute.

Shifting wind could have forced the evacuation of Macoun, 2.2 kilometres away from the blaze, along tracks that ran just metres away from Highway 39.  

Emergency crews closed the highways, and some rural residents evacuated their farms.

The SPSA has meteorologists on staff and the ability to connect to Saskatchewan crown corporations at a moment’s notice to know how to deal with overhead and underground utility lines like gas and power.

Without that knowledge, utilities can worsen a disaster. For example, during Quebec’s 2013 Lac-Mégantic rail disaster, blazing oil flowed into the town’s sewer drains, causing flames to erupt from manholes, chimneys and basements further down the pipeline.

More rural emergency workers needed to meet 911 call demand

More boots on the ground are needed as many emergency service organizations in Manitoba and Saskatchewan agree there are too few ambulance staff for the high number of emergency calls and kilometres travelled.

According to Saskatchewan Health Authority documents obtained by the NDP, there were 1,132 instances of code NAA (no local ambulance available) recorded from Feb.14 to Oct. 2, 2023.

Most cases occurred in rural areas.

Regina reported 323 instances, Cut Knife 76, La Loche 70, Meadow Lake 58, and Buffalo Narrows 56. These documents exclude Saskatoon and other communities with different ambulance providers.

There is a significant shortage of paramedics nationwide, with Saskatchewan facing 150 vacant paramedic EMS positions, excluding those in fire services or private companies.

Meanwhile, in Manitoba, vacancies in rural areas have tripled since 2020, and ambulance response times have increased by roughly 30 percent since 2018.

In Saskatchewan, if you call 911, a dispatcher may tell you that an ambulance could take at least an hour, maybe more, to arrive.

The province’s paramedics travelled 11,789,634 km in the 2022-23 fiscal year with over 181,006 calls through 911 requiring an ambulance, said Steven Skoworodkov, who owns Wakaw and District Emergency Services. That is an average of 496 calls a day.

This is a concerning increase compared to the 470 daily calls reported as of November 2022, especially for small departments, where a busy night with limited crew, equipment, and vehicles could mean no one is available to answer a call.

Working in the Wakaw area for nearly his entire 27-year career, except for one year in Nipawin, Skoworodkov says calls to his ambulance business have increased every year by about 15 to 20 per cent for the last three years, and people and resources keep getting stretched thinner and thinner. Members of his team also pull double duty as volunteer firefighters.

At just under 1,000 people in Wakaw and more in the surrounding area, the community also lies at the intersection of Hwy 2 and Hwy 41, connecting Wakaw to Melfort, Saskatoon, Prince Albert, and Regina, making both very busy highways. 

Overcrowded emergency rooms cannot relieve overworked paramedics, who are unable to discharge patients until a bed becomes available, sometimes for up to eight hours, according to internal EMS logs released this fall.

In some extreme cases, ambulance crews have had to wait up to 26 hours before patients are placed in an ER bed.

The occasional intermittent closures of rural emergency rooms in Manitoba and Saskatchewan have meant patients sometimes have to be taken farther down the road for care.

According to Freedom of Information requests filed by the NDP, 407 “distinct closures” of emergency rooms across the province have occurred since 2019.

In early 2023, the Galloway Health Centre in Oxbow, Sask., experienced at least a dozen emergency department closures over several weeks.

Even big Prairie cities aren’t immune from ER disruptions. Earlier this year, the emergency room at Saskatoon City Hospital experienced a partial closure and some patients were rerouted to other area hospitals.

Volunteer firefighters put mental health on the line

As deputy fire chief and Emergency Medical Responder in Martensville, Dean Brooman has seen a lot in his 28 years of service.

His volunteer firefighters work and train hard to provide a strong standard of care as first responders and college paramedic personnel.

When paramedics need to be called, they know that Martensville firefighters are treating the patient to the best of their abilities before they even get there.

With only eight career firehouses in Saskatchewan, the rest of the departments are volunteer-based with only a few paid full-time staff.

Louis Cherpin, president of the Saskatchewan Volunteer Firefighters Association, said there are around 400 fire departments with roughly 7,000 volunteers across Saskatchewan. SVFFA represents over 50 per cent of them.

According to the Canadian Association of Fire Chiefs, there were nearly 100,000 volunteer firefighters across the country in 2021, a sharp decrease from 126,000 in 2016.

Last summer, Manitoba’s rural volunteer firefighters raised concerns over a newly implemented training policy that tripled the hours of training needed to become a medical first responder.

New recruits will have to commit to 312 hours of training from the College of Paramedics. This does not factor in the commute time from remote rural areas, which is required to attend the training over several months.

The cost of training a new person is about $15,000, and there is always a risk that they will quit after just one traumatic accident.

Putting mental health on the line

Rural first responders are the first ones on a scene often just minutes from their homes.

After 30 years as a paramedic, Darcy McKay, the provincial director of STARS in Saskatchewan, still remembers his first call to his hometown in rural Saskatchewan.

The tears running down his face were not because of the call itself or the people involved but because he was proud to be serving his home community. 

But that level of care and service for communities across the province costs emergency staff time away from family and takes a toll on their mental, emotional, and physical health. That cost has been noted, especially in the last decade, and support for their well-being has greatly improved, said McKay.

Brian Schafer spent 20 years in emergency services before moving to emergency management with the Saskatchewan Public Safety Agency. He responded to emergencies in rural Alberta as a volunteer first responder and eventually as a firefighter and regional fire chief; he knows that feeling when the tone goes off.

“There’s a good chance there was always somebody that you knew, but honestly, your adrenaline kicks in, you do what you’re trained to do.”

Major events, like motor vehicle collisions, rarely go unnoticed in small communities like Wakaw, and when people want to know the intimate details of what happened on Hwy 2 on a Friday night, this can make it difficult to interact within your community or even seek help, said Steven Skoworodkov, who owns Wakaw and District Emergency Services.

“They want to know what’s going on with another community member but we can’t really say because of PIPEDA (Personal Information Protection and Electronic Documents Act)…even debriefs sometimes get difficult.”

So who can emergency workers talk to when things get rough?

In Martensville, Brooman looks for signs that his staff may need more support as they work through “bad calls.”

“There are many resources available to them that they can get a hold of and lean on. And then, of course, there’s always just even talking amongst ourselves, sitting down having a cup of coffee and debriefing.”

With each person having decades of experience, people like Skoworodkov, Brooman, Schafer, and McKay have seen how attitudes towards mental health support have changed, especially over the last five years, said Skoworodkov.

Based on 30 years of research into the International Critical Incident Stress Foundation model, the Saskatchewan Critical Incident Stress Management (CISM) Network was created as peer-to-peer support for public safety personnel and healthcare workers. It is made up of firefighters, paramedics, and mental health professionals, said Holly Schmidt, CISM instructor and team member.

Within 48 hours after an incident, a CISM team goes out and debriefs the members involved and offers their support.

“We provide them with tools for coping and explain what’s going to happen to them in the next little while, and then if they’re still struggling after that, we have resources that we can give out to them that they can utilize for further care.”

Through word of mouth and building awareness for their program, Schmidt has seen CISM grow as more departments ask for support and get involved in the program. Younger members are more accepting of it, she said, but she is also seeing older members get on board.

“They have seen how it’s affected them,” said Schmidt, “and don’t want their new firefighters being affected too.”