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Northern BC patients dying 'at Third World rates'
Fraser Health pegs annual cost of trauma injuries in province at $2.8 billion
January 23, 2012
Ted CLARKE, Prince George Citizen

In a life-threatening accident, time is a killer.

In northern BC people who live in rural or remote regions and suffer serious trauma are dying at an alarming rates. In fact, unless you live close to a trauma hospital there's a good chance you will die before you get there.

Using data supplied by the BC Coroner, a trauma study presented to the Ministry of Health in 2002 revealed that of all people who die from trauma in our region, 75 per cent die before they get to a hospital.

It's even worse if you live in northwestern BC, where the pre-hospital death rate is 82 per cent. And if you don't get to hospital within that golden hour before treatment begins, the chances are even greater you will be left with a debilitating injury.

Those injuries might be serious enough to take you out of the work force permanently, creating even more of a strain on our already overburdened health care system. The Fraser Health Authority estimates lost productivity, long-term care and rehabilitation of accident victims costs the province $2.8 billion per year. Injuries such as motor vehicle collisions and falls are the leading cause of death for Canadians up to the age of 44.

Hans Dysarsz, a former pilot and aircraft manufacturer consultant who helped establish the STARS (Shock Trauma Air Rescue Society) air ambulance and rescue system in Calgary, says there is a better way to deliver more patients to medical help faster that will not only save more lives but help the province reduce its longterm healthcare costs.

"We've got that 59 per cent death rate for the Interior, 75 per cent for northern BC, and 82 per cent for the northwest - these are Third World death rate numbers," said Dysarsz.

"The Canada Health Act guarantees every person in this country reasonable access to the health care system. When people are arriving dead at the hospital, that's not reasonable access. The cost of running this mediocre system is far higher than the cost of world-class system, because the sooner you get people into hospitals, the quicker they come out, at less cost to the taxpayer. It is far more expensive for us to carry on as is than to spend $100 million more on pre-hospital care."

The high pre-hospital death rate in the North is attributed to the fact most northern communities are nowhere near the province's Level 1 trauma and neurosurgery centres, all of which are in Vancouver/Victoria areas. In Prince George, University Hospital of Northern BC, a Level 3 trauma centre, serves all of the northern half of the province.

In the event of a serious injury that can't be dealt with in Prince George, patients are flown by fixed wing aircraft to hospitals that have the ability to treat them.

"The faster you get a patient to a higher level of emergency care, typically at a larger hospital, the better the outcome for their longterm recovery and the better the chances of reducing complications in treatment," said STARS spokesman Mike Haska. "That's why rapid transportation is such a key aspect of the emergency medical system."

 

MORE CHOPPERS NOT THE ANSWER, OR ARE THEY?

The BC Ambulance Service has examined the STARS model and BCAS chief operating officer Les Fisher said the idea of putting more helicopters on the ground at more bases would not solve the problem of people dying in remote areas after trauma because choppers are for short-haul missions and in most cases are not suitable for delivering patients from the north to high-level trauma centres.

"The option of just putting helicopters everywhere to get them to the closest community hospital, that would shift where they die from pre-hospital to a community hospital, but the ultimate solution is to get them to the trauma centres," said Fisher. "In the north, that requires fixed wing because of the distances involved. A helicopter in Prince George may serve a small number of people [with major traumas] and get them to a facility but it won't get them to the facility they need to be sent to."

But Dysarsz said the two new Augusta Westlund AW139 helicopters STARS is getting this year can easily fly 280 kilometres per hour and have a range capable of delivering a Prince George-area patient to Vancouver in about two hours. The helicopters have a de-icing feature that allows them to be flown in moist cool conditions and pilots qualified for instrument flying can operate them at night using night-vision goggles while following low-altitude predetermined routes. Dysarsz also said pressured cabins, which those helicopters do not have, are not required for most accident victims.

Once they are in the air, the AW139s can take up to two patients who can be loaded on stretchers from the rear while the rotors are turning. They also come with winch systems that can pick up a patient in a stretcher without landing. BC air ambulance helicopters do not have that capability. They carry only single stretchers and can't load patients until the rotors are stopped, which can up to take three minutes.

The BCAS fleet consists of six fixed-wing planes (two turboprops and one jet in Vancouver, two turboprops in Kelowna and one turboprop based in Prince George (operated by Northern Thunderbird Air), and four helicopters (two in Vancouver, one in Kelowna, one in Kamloops).

Operating on a budget of $41 million, the BCAS transported 8,217 patients in 2009-10 (2,269 aboard helicopters, 5948 on fixed wing aircraft) at a cost of $4,989 per patient. About 40 commercial and charter carriers in B.C. and Alberta are used to fly patients to hospitals. Depending on where a critically-injured patient is, they could be sent to Vancouver, Calgary or Edmonton, whichever is quicker.

"The big advantages to our service is the quality of service we provide because we have an integrated system of our ground and air services," said Fisher.

"We can put a critical care paramedic crew on a jet in Vancouver, fly them to our helicopter in Prince Rupert to go up to Stewart and pick up a patient to come back, then put them into a ground ambulance in Vancouver and get them into hospital."

Dysarsz said B.C. needs to hire more paramedics who have flight capability to reach trauma victims in remote areas and allow access for doctors to fly on helicopter rescue missions. In Europe, on-board emergency doctors fly with helicopter ambulances in Switzerland and Germany, while in Alberta doctors are on-call to join STARS rescue missions. Dysarsz suggests having five or 10 doctors available to fly in the choppers would be equivalent to having 100 additional paramedics on the ground.

The BC Ambulance Service now has 3,650 paramedics who operate out of 186 ambulance stations across the province. There are 137 advanced care paramedics and 56 critical care paramedics, most of whom are based in the Lower Mainland, where the pre-hospital death rate of trauma victims is 12 per cent. In Prince George, there are 15 advanced care paramedics and five with critical care qualifications to serve all northern B.C. communities.

Alberta, with about 900,000 less people than BC and 300,000 less square kilometres to cover, has 2,100 paramedics with advanced care skills. Many of them are employed by municipalities or regions.

"We have completely different systems," said Fisher. "In Alberta, people can go and get their advanced care paramedic licence and then operate wherever. We only have the advanced care paramedics working in areas where there's sufficient call volume to maintain their skills. It is a big investment to put an advanced care paramedic in place. At this point, we have them only in the larger areas."

STARS provides a dedicated air ambulance service to 95 per cent of Alberta residents, while only 45 per cent of BC residents have that coverage. To cover a country one-third the size of BC, Germany's non-profit air rescue system has a fleet of 100 helicopters, all of which are within range to reach high-level trauma hospitals. A third of those trips were to pick up traffic accident victims. Since emergency room doctors replaced paramedics to lead those missions in 1970, Germany estimates it has saved an additional 800,000 lives. The number of traffic accident deaths dropped from 27,000 in 1970 to 3,657 in 2010.

Part of the reason for that is the response times. German choppers are typically in the air within two minutes of receiving the emergency call, while STARS helicopters average three minutes. Although BC air ambulance helicopters in Vancouver are mandated to be airborne within 10 minutes of being notified, the mean average time is 28 minutes.

Wayne Drysdale knows why it might take so long for BC to scramble a chopper rescue crew. Now the Alberta MLA for Grande Prairie-Wapiti, until STARS arrived in Grande Prairie five years ago it was Drysdale's job to assemble flight crews for rescue missions as part of the Grande Prairie Regional Emergency Medical Services board.

"We supplied the paramedics and could hire a helicopter to go do those rescues but it wasn't a dedicated helicopter and it wasn't a dedicated crew on site so it was a lot slower response," said Drysdale. "It was not the best service but it was all we could do at the time. We were originally against STARS coming to town because they were our competition, but in the end we invited them to come to Grande Prairie.

"STARS is a very good service and we're happy to have them. It's the remote people and people in highway accidents 50 to 100 kilometres away from the city who notice it more. If there's a life-threatening accident they will send a helicopter and land it right on the highway."



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