It's 8 a.m. on Wednesday, time for shift change at St. Albert's second fire hall on Boudreau Road, and Medic-2 is missing.
The ambulance, one of St. Albert's two 24/7 advanced life support (ALS) units, is still at the Sturgeon Community Hospital, waiting for a patient to be admitted. Just because the team on board was supposed to be finished at 8 a.m. doesn't mean their work stops when their shift ends. It's a part of the job — you stay with the patient until they're admitted or you're relieved.
Paramedic Vincent Pashko and EMT Adam Colameco, ready to take the 8 a.m. to 6 p.m. shift, were in the same situation Tuesday night, waiting three hours at hospital until the night crew came to relieve them. That crew waited an additional two hours before the patient was admitted.
At 8:34, Medic-2 rolls in and the crews switch over. Pashko, a nine-year EMS veteran, hops into the driver's seat for a look at the Mobile Data Terminal (MDT), a hardened laptop in the ambulance that shows the locations of all ambulances in Alberta. Each unit and its status are displayed in real-time, thanks to GPS. Different colours indicate what each ambulance is doing — green trucks are available, red ones are on a call and pink units are at a hospital. At the moment, Edmonton and St. Albert are awash in green.
"For the beginning of the day, it looks pretty good," Pashko says.
Colameco, now in his seventh year in EMS, paws through their supplies and equipment, keeping an inventory of what they need and re-arranging equipment to his and Pashko's liking.
"It's hard to have everything the way you want it," Colameco says.
Pashko and Colameco sign on for the day and dash over to fire hall three to stock up on supplies. Upon return to hall two, the pair finish off paperwork from their last shift. Even though some EMS crews can now type up reports in the ambulance on a laptop, Pashko and Colameco must still finish the first form by hand, then re-enter the data on computer.
First call
A call comes over the radio, but it's in Medic-1's territory.
"We'll be going in about five to 10 minutes, I think," Colameco says.
At about the 10-minute mark, both their pagers light off, and the radio crackles to life. It's a vehicle collision at St. Albert Trail and Mark Messier Trail. The ambulance is ordered to come in hot, meaning lights flashing and siren blazing. After almost colliding with two drivers who try to beat them through intersections, Pashko and Colameco arrive where St. Albert Trail and Mark Messier Trail connect.
But there's no accident in sight.
Pashko whips the ambulance around, heading back into St. Albert, looking for the crash. Suddenly an Edmonton Fire rescue truck blows past. Pashko falls in behind, then follows the truck as it pulls a u-turn. The radio crackles — the accident is actually at 137 Avenue and Mark Messier Trail.
"These are the kinds of complications we deal with every day," Colameco says.
Two Edmonton fire trucks are already on scene, cutting a patient free from one vehicle. As the first paramedic on scene, Pashko is responsible for triage. He ducks his head into both cars, with Colameco checking into one when Pashko dashes off to the other. An Alberta Health Services (AHS) ambulance arrives moments later. Pashko assigns them the patient being cut out of the car while he and Colameco take the second patient, who is complaining of neck and back pain. They transfer her to a spine board, to their stretcher and into the ambulance. A quick check of her vitals reveals she is in good shape, which is good because both are having problems starting an IV. Colameco keeps talking to her in an upbeat, almost joking fashion as Pashko drives, no lights or siren, to the Royal Alexandra Hospital.
As the ambulance pulls into the bay, one problem becomes apparent — the truck parked in front is Medic-1, meaning the only ambulance covering St. Albert is the mysterious peak-hour car, operating out of the Sturgeon.
Contrary to what many think, ambulance patients do not "jump" waiting room patients in emergency rooms — the most serious, no matter how they arrived – are admitted first. Colameco heads over to admitting while Pashko stays with the patient in the hallway. Surprisingly, she is admitted within 20 minutes. Start to finish, the call has taken one hour and 15 minutes.
A look at the MDT reveals St. Albert is still covered by the Sturgeon ambulance, but Morinville is in rough shape. Its other ambulance is also at the Sturgeon, but coded as delivering a patient. The only unit available from Morinville north to Redwater, east to Fort Saskatchewan and west to Alexander First Nation is a "PRU" car — an SUV carrying ALS equipment and a single paramedic. They can respond to calls but can't transport patients.
System flaws
It is immediately obvious where some of the inefficiencies in the system lie, and that stems not from Medic-2's call, but Medic-1's patient — an elderly woman complaining of abdominal pain. Medic-1 is an ALS unit, but the patient is in no imminent danger. Similar situations arise for others in assisted living who need to be transported to hospital for testing or treatment. ALS cars, including St. Albert's, are tasked with these transfers when a basic life support (BLS) unit would suffice.
It's also obvious some of that testing could be done in-house, as it is mostly routine blood work. Increased home care would likely remove some of the burden from an already stressed EMS system. So too would increasing long-term living spaces, which would equate to more available beds at hospital and faster admissions, freeing up ambulances more quickly. More ambulances would be great, but without more beds, they would still spend hours waiting.
No lunch
On Tuesday, Pashko and Colameco were just pulling up for lunch when their pagers buzzed. Today, they at least get into line at Subway when a call comes in.
It is at Youville Home. The patient has numerous issues and appears to be bleeding internally. Pashko and Colameco spend a little extra time with her in the ambulance, joking gently with her, starting an IV and making sure she is comfortable before driving to the Sturgeon.
"This could be where we end our day," Colameco says, recalling the previous day's three-hour wait.
Again, Medic-1 is also at the Sturgeon with a patient, leaving the city in the hands of the peak-hour unit, which is nowhere in sight. Surprisingly, Medic-2's patient is admitted within 30 minutes.
Pashko says it would be easy to be consumed by the stresses of the job, but considers himself an optimist. "If you start getting cynical, you need to take a break or something. It's about the patient."
Both he and Colameco chose an EMS career because of the excitement and unpredictability of every workday. Whether they are on a fire shift or on ambulance, they never know what the day could hold.
"I can be scrubbing the floors in the bathroom and I'm thinking, 'there could be a fire right now,' or some other kind of emergency," Colameco says.
Cleared from the Sturgeon, the pair finally get an uninterrupted lunch — at 4 p.m. Ambulance coverage in Edmonton, however, is dropping off, according to the MDT. There are few units in the north and west of the city available for calls. Colameco predicts they'll be heading into the city before their shift is over.
Another call comes in at 5:35 p.m., but it's local. Even though it's 25 minutes to shift change, Pashko and Colameco roar off to a report of a woman having hit her head on the ice. There is an RCMP officer waiting.
The woman did hit her head — three days ago. There are multiple other issues at play. She has, throughout the day, taken nine doses of powerful narcotics. She also has a loud, wet cough and refuses to go to the hospital. Her young child is in the living room watching TV with a "friend" no one can identify. The officer believes she is incapable of caring for her daughter and asks the woman to go to the hospital one last time. She finally agrees. In the ambulance, one listen to her lungs reveals a likely case of pneumonia. By the time she is taken to the Sturgeon, she is fast asleep. It is 6:10 p.m.
Red alert
Medic-1 is also at the Sturgeon with a patient, as is the peak-hour unit. At 6:20 p.m., it is obvious St. Albert is in a "red alert" or "code red" situation — there are no ambulances in the city.
"This is a bad situation," Pashko says, looking at the MDT. The only available unit from west Edmonton to Redwater is that SUV in Morinville. There are no signs of any units on the way into town.
Colameco stays with the patient while Pashko takes the ambulance back to the hall to hand it over to the evening crew. They will relieve both Medic-1 and Colameco at the hospital and wait with both patients to free up one ambulance for the city. It is 7 p.m. — an 11-hour shift and Pashko is tired, but he has few complaints.
"I worked an hour over. I deal with it. It happens," he says. "I just go in and do my job, one call at a time.
"I'm not going to fix the system."
