Volunteer firefighters a lifeline in rural Alberta with EMS system under strain

When the fire crew arrived at the crash, they knew it would be a difficult day: the woman trapped inside was the wife of a firefighter rushing to the scene.

"My heart sunk," said Glendon, Alta., firefighter Derek Cote about the call, "I [still] didn't know how bad it was."

On a blustery winter morning, volunteer firefighters tore the roof off the pickup truck with the jaws of life.

Her truck had rolled over into a ditch along Highway 28 in northeastern Alberta. The driver was pushed against a smashed door buried in 60 centimetres of fresh snow.

Firefighters arrived first on scene about 16 minutes after receiving the call. Next were RCMP, and finally, paramedics, about 25 minutes after the initial call.

The ambulance drove away with the patient on a stretcher, her husband by her side. Luckily, her injuries were minor. 

In a small town like Glendon, population 448, firefighters are accustomed to waiting for an ambulance as EMS dispatch is 40 kilometres away in the town of Bonnyville. But the pressure on volunteer crews has grown in recent years.

From 2017 to 2022, the number of EMS emergencies in Alberta grew by 39 per cent, according to a report released in January, with rural areas seeing even higher growth. In that same five-year period, the average response time for an ambulance rose by 18-and-a-half minutes.

That takes a toll on volunteers, said Glendon station chief Dan Amalia.

"There are times we might be doing CPR for 15, 20 minutes and that's just physically exhausting," Amalia said. "[If it's] somebody you know that can have quite a mental strain while you're waiting, and waiting, for EMS to arrive."

Close to 80 per cent of all firefighters in Canada are volunteers, according to the Canadian Association of Fire Chiefs census.

A long road for rural paramedics

One of the biggest problems tying up local paramedics is that rural ambulances are regularly travelling long distances in non-emergency situations, said Dan Heney, Bonnyville Regional Fire Authority chief.

On a typical day, one of the three ambulances available in Bonnyville is driving someone to Edmonton for medical care. It typically takes about six hours round trip, but if there's a hospital delay or another call  for them within the city, the trip can last an entire 12-hour shift.

"An ambulance that is transferring from here into Edmonton means one less ambulance that's here to respond to emergencies in the community," Heney said.

EMS inter-facility transfers require fully-trained paramedics to drive long distances often for non-emergency health needs like a specialist appointment, a CT scan or a surgery.

EMS performed over 176,000 inter-facility transfers in the last fiscal year, according to Alberta Health Services. The province has recently announced several measures to reduce the number of non-emergency transfers for ambulances.

A request for proposals to offload some of those transfers from paramedics to private contractors went out on Feb. 2. The province said once in place, that could divert 44,000 transfers from paramedics. But it would only assist with inter-facility transfers within the Calgary and Edmonton regions, not rural communities.

In Bonnyville, approximately 50 percent of EMS calls are non-urgent transfers, according to Heney.

The issue is just one symptom of an already overburdened system, said Jason Stedman, a paramedic in Lac La Biche and who is also a councillor on Lac La Biche County Council.

"Rural EMS and rural fire needs attention because I've never seen the system like this," said Stedman.

In his 22-year career, Stedman said he's never experienced so many daily EMS shortages before.

The EMS report said Alberta's growing population and health concerns like the opioid epidemic are contributing to a rising number of trips for paramedics. It also cites COVID-19 and hospital wait times for longer ambulance response times.

Paramedic staff shortages have become so severe in Lac La Biche that ambulances no longer have capacity to provide inter-facility transfers, Stedman said. That means patients who need non-urgent medical attention outside their community, are left to find their own transportation or travel via the local medevac airplane.

"There are things happening to address it," he said, "but realistically it's going to take a while before it resolves itself - and the public should be aware."

Support for firefighters

While the province continues to develop its plan to tackle EMS shortfalls, some initiatives have aimed specifically at helping rural firefighters handle the rate of medical emergencies.

An Alberta program called Before Operational Stress has enabled more first responders to access psychological services, since it received federal funding in 2022. A study found that trauma and workplace stress injuries are the main reason firefighters have to take time off.

Heney said since mental health resources have become more available, he's seen first responders who had left the service return to work again.

"When I look back across my career, we were just barely scratching the surface of post-traumatic stress and we didn't do a good job of making people aware."

Heney said he's heartened to see firefighters don't face the same stigma they once did when it comes to trauma.

"Now, nobody looks at you sideways when they find out you reached out for help," he said.

A growing number of Alberta communities also have Medical First Response programs in local fire departments.

The training allows firefighters to be more prepared to keep someone in stable condition until paramedics show up or they reach a hospital. Those skills can cover a wide range of training and as the EMS report noted, those services provided by MFR vary from community to community.

Paul McLauchlin, president of the Rural Municipalities of Alberta, said the province needs to recognize that volunteers are doing more medical work.

Last fall, the RMA passed a resolution to lobby the government to compensate rural municipalities that have firefighters with MFR training.

McLauchlin said as the reeve in Ponoka County it's frustrating to have seen situations where volunteer firefighters are called on to keep someone alive when an ambulance isn't there.

"If [the province] ends up having to pay for it they would quit using our medical first responders as a stop gap for inefficiencies in the emergency medical system," he said.