It’s been four years since he lost his leg, but Esko Saarinen still replays that day in his mind at night.
Saarinen was working as a tree faller in Haida Gwaii when he slipped and his leg was crushed under a huge Sitka Spruce. But it’s not just the accident itself that causes him to lose sleep—it’s the 11-hour journey he had to take to the hospital.
The trip could have been a short trip in an air ambulance, but instead it was taken entirely by ground ambulances, included two separate ferry trips and a bumpy ride in a mechanic’s vehicle over an unfinished resource road.
“It was freezing cold. The whole leg was totally crushed, bones were sticking out from the socks,” Saarinen recalled. “I’m in the middle of nowhere there. We don’t even have a road. And there’s all this time we’re wasting.”
Eleven hours later, when Saarinen finally arrived to hospital in Vancouver, his leg was “black,” he said, and it had to be amputated below the knee. He cannot go back to his career in forestry, and will forever wonder whether he would still have a leg if he would have arrived at a hospital sooner.
“It’s devastating to lose your leg like that. It changes everything really fast,” he said. “It’s really hard, I’ve been in the bush all my life.”
If you live in a major urban centre such as Vancouver or Victoria, you can expect that if an accident happened, you would be taken to a hospital almost right away. But if you’re more than 10-minute drive away from a hospital—“you’re in deep trouble,” according to experts.
Convoluted service delivery, lesser-trained paramedics, and outdated provincial rules are all factors that leave rural patients to face dangerously long wait times.
There’s no shortage of horror stories, nor is there a shortage of reports calling for change.
But despite ongoing attempts to put a Band-Aid on the problem, critics say the layered method by which BC has been providing ambulance care for more than four decades remains “deeply systemically flawed.”
It’s a hard pill to swallow, one critic says, when the province of Alberta, just next door, not only has a non-profit helicopter ambulance service that serves rural areas, but 10 times more highly-trained paramedics who are distributed throughout the province. With an opioid crisis killing hundreds and a new provincial government in power, advocates say now is the time for change to happen.
In BC, Saarinen’s case was one of many that prompted a report earlier this year from the province’s Forest Safety Ombudsman demanding change in the way service is delivered to rural areas. Roger Harris said in his February 2017 report titled “Will It Be There?” that the BC government has made a “choice” not to provide adequate care to rural communities.
The report argues that BC could easily change its mandate so that everyone has access to emergency response that doesn’t involve hours of arduous travel, and that it has all the equipment and technology to do so, but has decided not to.
“It’s not gone unnoticed that BC Ambulance Service concentrates all its assets in the major urban centres,” Harris said in an interview. “When you live in rural BC and the primary method of dispatching an ambulance is land-based, that’s not equitable service.”
Under the current system, he said, if a child in Vancouver breaks their arm playing soccer, they can get to Vancouver General Hospital within 15 minutes. If a child breaks their arm in Dease Lake, a northern interior community of 300, they’re probably facing an uncomfortable eight-hour ambulance trip that includes gravel roads.*
Currently, Harris’s report states, nearly three quarters of all people who die of trauma-related conditions in northern BC do so before they can even be brought to a hospital, compared with just 12 percent in Metro Vancouver.
However: “At the end of the day, nothing is going to change,” Harris said.
“Those in charge of creating equitable ambulance service across the province, in my interviews with them, have told me clearly that if you don’t live in a large urban setting, you can’t accept the same level of service. They’ve already conceded that they can’t do it.”
Linda Lupini, executive vice president of the Provincial Health Services Authority and BC Emergency Health Services, acknowledged that the issue is complex.
Lupini said in an interview that the ambulance service itself is restricted on what it can do by various rules. Paramedics, for example, aren’t allowed to put themselves into dangerous situations in order to retrieve an injured person from a hard-to-access ravine or a steep cliff.
“The rural and remote issue is very complicated because there are obligations on three or four parties,” she said.
She said that in Metro areas, service is straightforward because there is almost always somewhere the patient can be taken to get the exact type of treatment needed. In rural areas, patients often need to be taken to smaller hospitals for assessments before being transferred to a larger centre for specialized care.
She explained that ambulances also must often wait on third parties such as search and rescue or the employer to bring patients to them, which can take time.
“We’re in situations every single day where we have to wait for patients to be brought to us,” Lupini said. “We do our best to save lives but we’re actually not allowed to do the things that paramedics want to do sometimes.”
Lupini could not comment on Saarinen’s case specifically because of privacy reasons, but pointed out that the service is also reliant on people at the scene to give first responders accurate information. The service will send an air ambulance when a call is “high-acuity,” meaning the patient is in immediate danger.
“If we get the wrong information in, we may not be responding correctly,” she said. “If it’s a medium or low-acuity issue, the system is set up so you may have to wait so the system is available for high-acuity calls.”
She said that BCEHS has gradually been making improvements to the system and is now working with the provincial government on future changes.
After the air ambulance service was subject to a scathing audit several years ago, the service has implemented every single recommendation that came from that report, Lupini said.
Currently, BC has seven fixed-wing aircrafts, four helicopters, and the service has access to more than 45 air ambulances owned by contractors. There are 585 ground ambulances.
“If we keep layering enhancements to our services in rural and remote … we will improve service,” she said.
“Some of it is just beyond our control. We look at what is in our control.”
But Hans Dysarsz, newly appointed executive director of the BC Helicopter Emergency Rescue Operations Society (HEROS), said the small changes aren’t enough, and the system needs a full overhaul.
His group BC HEROS was formed in Prince George in 2012, after 24-year-old Jackie Inyallie’s seemingly preventable death—she was in a car accident near Bear Lake and suffered a punctured lung and broken arm, but it took paramedics five hours to get her to a hospital and she died during the wait.
Dysarsz himself, a former air ambulance co-pilot who helped start the helicopter non-profit STARS in Alberta, has been advocating for better prehospital care in BC for three and a half decades.
“I’ve heard ‘we’re working on it’ for 30 years,” he said.
“It’s systemically so deeply flawed, that if you’re more than 10 minutes away from the hospital, you’re in deep trouble in BC.”
Dysarsz said problems in the ambulance service can be traced back to the outset, when it was formed in 1974. Before then, services were provided jointly by various groups such as fire departments, volunteer ambulance crews and private operators.
Recommendations stemming from a Foulkes Commission report on health care a year earlier created the BC Ambulance Service, but Dysarsz said a quick scan of the document reveals that many of the suggestions were “completely ignored,” he said.
“The NDP created this system 43 years ago and no subsequent government has decided to touch it,” he said.
“It’s a chosen system. It doesn’t have to be this way. When you compare the truth to what other provinces have and what other jurisdictions have internationally, we are so far behind.”
Dysarsz recently filed a freedom of information request which revealed that Alberta has 10 times as many Advanced Care Paramedics—who are some of the most highly trained and capable workers in the field—as BC does.
BC has 240 Advanced Care Paramedics centred around urban areas, while Alberta has 2,668 that are distributed province-wide.
In total, BC has 6,786 EMS attendants while Alberta has 9,377. Of the licensed attendants in BC, almost half aren’t even allowed to treat the general public, Dysarsz said, because they work for private companies and not BCEHS.
“Because of the seniority system, the most junior workers go to the most remote locations where the longest return to hospital times exist,” he said. “That means patients with urgent care needs suffer or die the most.”
BC HEROS is now calling on the BC government to strike a royal commission that’s made up of a panel of EMS experts to create a new “made in BC” model. The group is also calling on a universal cost-benefit analysis of all aspects of prehospital care.
BC Health Minister Adrian Dix, a former opposition health critic, said in an interview that his concern about something like a royal commission is that it could take several years.
“If people are saying we need to improve service, I would agree with that,” Dix told VICE. “I think some steps need to be taken right now. And that’s what we’re doing.”
Dix said one of the biggest ongoing challenges has been staffing ambulance crews in rural areas. There’s also the issue of navigating BC’s large and difficult terrain. But he said some things have improved in the past year.
He said he is hopeful about a community paramedicine program that started in 2016 and involves offering more regular employment to rural paramedics instead of keeping them on-call.
A new air ambulance was also recently added in Fort St. John.
He said the province will keep working with the ambulance service and paramedic’s union to make improvements. “We have significant issues that weren’t dealt with for more than a decade,” Dix said. “I think it’s time to get on with some things.”
Saarinen said he hopes to see some significant changes happen soon, so that other people won’t lose their limbs—or their lives.
“So the ambulance will get there,” he said.
“It’s an emergency situation. You’ll be dead if you don’t get help.”
Follow Cara on Twitter.
*Story updated November 28, 3:00 PM.