Updated on May 16, 2024

Increasing pressure:

Demand for health care is ever increasing and this is evident through population growth and aging. The COVID-19 pandemic, toxic-drug crisis, extreme-weather events and more people on the roads create new pressures for ambulance service to overcome. In B.C., these pressures include:

• Since 2020-21, there has been an average year-over year increase in net Medical Services Plan (MSP) registrants.
  • In 2020-21 there were 5,317,706 people who registered for MSP.
  • That number grew in 2021-22 by 149,546 to 5,467,252.
  • In 2022-23, 188,145 people were added to the MSP to reach a total of 5,655,397. This represents a 3.4% growth in one year.
• In addition, the population of seniors continues to grow and has surpassed one million.
• Over the next 10 years, the number of seniors in B.C. will increase from 20% to 24% of the total population.
• B.C.’s population is increasing by 10,000 people every 37 days and 163,000 people were added in 2023 (3% growth). Prior to the COVID-19 pandemic, B.C.’s annual population growth ranged between 1% and 1.5%.
• Migration of individuals from outside Canada is significant, with B.C. experiencing a migration of 53,313 individuals from countries outside of Canada in the second quarter of this year, setting a new quarterly record.
• Since 2017, the number of people in B.C. living with at least one chronic condition has increased by 283,269.

All of this creates new demand for the ambulance service to meet — more calls to answer, more 911 events to attend and more patient transfers to complete. These challenges are unprecedented and require continuing transformation of the ambulance service.

Transforming the workforce:

Meeting demand has been achieved through the most significant staffing transformation in the history of BC Emergency Health Services (BCEHS). In 2023-24 there was a historic number of paramedics and dispatchers working for BCEHS. In part, this is because paramedics across B.C. now have the opportunity for regular permanent positions — an investment in staff that is transitioning BCEHS away from causal on-call staff and providing paramedics with a living wage and delivering more service for communities.

Progress:

• In 2023-24 there were 1,104 more paramedics working in B.C., a 28% increase compared to 2017-18.
• Of these paramedics, 62% now have regular permanent positions, a 51% increase compared to 2017-18.
• In 2023-24, there were 111 more dispatch staff working cross BCEHS’s three dispatch centres, a 42% increase since 2017-18.

Supporting the workforce:

Since 2017, government has been making investments and changes to service delivery to support a stronger ambulance service and a better working relationship with staff. This work began with the creation of a stand-alone bargaining association in 2018 for paramedics with focus on critical areas, such as response times, rural and remote staffing, and innovative ways of treating patients with non-emergency injuries and illnesses. Since then, two collective agreements have been reached between the Ambulance Paramedics and Ambulance Dispatchers Bargaining Association and the Health Employers’ Association of BC.

Progress:

• The most recent agreement was reached on Feb. 15, 2024, and includes a general wage increase, targeted hourly-rate increases for specific classifications, shift premiums and the most significant increase to on-call wages in BCEHS history, an increase from $2 to $12 per hour.

Paramedics are not immune to the pressures on the health-care system, which can take both a mental and physical toll. New resources have been invested in to keep paramedics healthy and engaged in their important work.

Progress:

• Use of the Critical Incident Stress Management Program, which provides access to mental-health services for front-line staff and their families, has increased by 121% since it started in 2018. In total, 4,148 connections with the program were made in 2023-24.
• Enrollment tripled in the Connect and Recover Program, which focuses on supporting employees who sustain minor injuries, such as strains and sprains, to recover faster and return to work. New resources allowed the program to support 98% of eligible cases, up from 35% in 2022.

BCEHS has embarked on the largest recruitment campaign in its history to increase paramedic coverage across the province.

Progress:

• Since 2017, BCEHS has added more than 1,800 new full-time and part-time permanent paramedic, emergency medical responder (EMR) and dispatch positions, with more than 900 of these paramedics working in rural and remote communities across the province.

• The new collective agreement provides for an expedited hiring process that shortens to eight weeks the time a paramedic has to rescind their acceptance of a position/posting. Previously, the window was 12 weeks. This change reduces the time it takes to hire paramedics.

BCEHS is also working to expand opportunities for career growth within the organization for better employee success, satisfaction and retention.

Progress:

• Increasing paramedics’ scope of practice across all levels. Training has begun, and 671 EMR and 104 critical-care paramedic (CCP) employees have completed their respective scope of practice expansion training, as of May 2024.

Transforming rural and remote service delivery:

BCEHS has made significant changes to improve service in rural and remote areas of the province.

Progress:

• In November 2023, BCEHS, Ambulance Paramedics of British Columbia (APBC, CUPE Local 873) and the Ministry of Health agreed to new staffing models for 60 rural and remote communities in B.C., providing more hours of in-station hours and better ambulance coverage.
• These new models added 271 full-time positions.
• This means that communities, such as Mackenzie, now have 24/7 ambulance coverage and an increase of seven paramedic positions.
• In 2022, BCEHS added 278 full-time positions in 31 rural communities, adding considerable capacity in rural British Columbia.
• This includes 18 advanced care paramedic (ACP) positions added to rural communities in 2022, marking the first time the commitment to improve service levels in rural and remote B.C. has been achieved.

Adding resources:

When people call 911, they know help is on the way, and often, that means an ambulance coming to their door or an air ambulance in critical situations.

Progress:

• There are 658 ambulances and 273 non-transport support vehicles supported paramedics responding to patients in 2023-24, a 26% one-year increase and an 88% increase since 2017-19.
• Five additional dedicated air ambulances have been added since 2017-18, an increase of 50%, bringing the total to 15.
• Air-ambulance responses increased by 19% to 8,290 in 2023-24 compared to 2017-18. This includes 2,113 helicopters rotary responses and 6,177 planes fixed-wing responses.

Innovating care:

The delivery of health care is changing rapidly to meet demand. This includes the delivery of ambulance service. In 2023-24, more than 212,000 purple and red calls, events which are life-threatening for people, were responded to by BCEHS. These calls have increased by 76% since 2017-18. In 2023-24, more than 391,000 yellow and orange calls were made to BCEHS, only 4% more than 2017-18. With an increasing number of life-threating events, BCEHS is adapting its response to non-life-threatening events to meet patients’ needs in new ways and to ensure staff are available for life-threatening calls.

Progress:

• Since Jan. 1, 2022, there were more than 14,000 events where the link and referral units arrived on scene and the event was resolved in a manner other than transporting a patient to an emergency department. 
• Four link and referral units were added in Victoria, Nanaimo and Prince George, with 18 units now in place across the province.
• Since Jan. 1, 2022, more than 9,000 patients who were assessed by secondary triage did not require an ambulance.
• Twenty-six urgent and primary care centres (UPCC) in B.C. accept BCEHS patients.
• Six new Assess, See, Treat and Refer (ASTaR) pathways for low-acuity patients with specific concerns have been developed. 

Meeting patient demand faster:

Meeting demand and improving response times is supported by the action taken to add more call-taking staff, paramedics and ambulances.

Progress:

• Calls to 911 are consistently answered in nine seconds or less.
• Median response times to purple calls that are the most life-threatening improved by:
  • 29 seconds over the past year and 21 seconds since 2017 in metro /urban communities;
  • 43 seconds over the past year and 93 seconds since 2017 in rural communities; and
  • 17 seconds over the past year and 20 seconds since 2017 in remote communities. 
• There were 596,014 911 events responded to by BCEHS in 2023-24, 15% more than in 2017-18.
• There were 71,198 inter-facility patient transfers completed by BCEHS in 2023-24, 4% more than in 2017-18.
• There were 8,290 patient transports completed by air resources in 2023-24 including 6,177 patient transports by fixed-wing aircraft and 2,113 patient transports by rotary-wing aircraft, a 19% increase over 2017-18 (4884 fixed-wing and 2085 rotary-wing patient transport). 

Building an inclusive culture:

BCEHS is building a culture that fosters anti-racism, diversity, inclusion and equity. These are actions that are tangible and measurable to ensure BCEHS is an employer of choice and that employees at BCEHS are healthy and well-supported.

Progress:

• 44% of staff have now completed the San’yas Indigenous Cultural Safety Core Health course and 59% have completed the Anti-Indigenous Racism Response training.
• 320 dispatch staff received culture, history and appropriate language education as part of their orientations.
• Implementing a dedicated phone line for employees seeking information on how to report bullying or harassment with trauma-informed employees staffing the line.
• Hiring a new chief, people diversity and culture officer to lead a dedicated team, which includes additional co-ordination of HR services; an executive director, employee experience; an executive director, Indigenous Health; as well as a director, diversity equity and inclusion; and a director, culture and leadership.
• 155 staff were recognized with Long Service awards for 25 or more years of service.

Investing more:

Since 2017, significant investments are working to improve BCEHS staffing and make access to ambulance services more equitable for people in B.C.

Progress:

• Since 2017, spending on emergency health services has increased by more than $475 million, reaching close to $1 billion in 2023-24.