Controversial change in BC ‘first responder’ dispatch policy

Out for a walk on a sunny day, you pass a nearby yard and see your neighbour appearing to be in medical distress. She gasps that she has chest pains, and says her heart is fluttering wildly. You immediately call 9-1-1. 

But who will show up? And when? Paramedics? The Fire Department? 

Now, that depends. The BC Provincial Health Officer, Dr. Bonnie Henry, has recently directed some controversial changes to the process of dispatching first responders. 

When calls are made to 9-1-1, a dispatcher decides whether to code the call “purple” (life-threatening, time-critical), or “red” (less serious, patient is still breathing, heart is still beating). 

Both BC Ambulance Service (BCAS) paramedics as well as local Fire Rescue personnel can be dispatched to Code Purple emergencies. Both teams bring CPR skills plus an AED (automated external defibrillator), essential interventions in the case of cardiac or respiratory arrest.

However, Dr. Bonnie Henry has now ordered that firefighters be considered for a Code Red call ONLY IF paramedics are unable to arrive on scene within 20 minutes.

What if your call gets coded “red”, with an ambulance expected in 15 minutes or so? Maybe your neighbour is having a mild myocardial infarction, aka heart attack. But maybe not.  What if, 10 minutes later, she goes into full cardiac arrest? And what if, as happens occasionally, the ambulance on its way to assist your neighbour gets pre-empted and diverted to a more serious call? Then — and only then — will the Fire Department get a call.

Most people would prefer to have the quickest response to a 9-1-1 call, regardless of which agency responds. Fire Rescue personnel are often on the scene more quickly because, unlike ambulances, they are not busy transporting patients to a distant hospital. 

According to a recent Globe and Mail article, on April 3, fourteen Lower Mainland community Mayors co-signed a letter to BC Deputy Minister of Health Stephen Brown outlining their concerns, requesting that the directive be rescinded, and that Dr. Henry engage the BC Fire Chiefs COVID-19 Task Force in finding alternative solutions.

These communities are alarmed by the probable consequences of the unilateral directive from Dr. Henry. Here’s a too frequent practical example: Suspected opioid overdose, still breathing, gets coded “red”. But the risk is very high that the drug will further suppress the respiratory system – that’s what opiates do – and the patient may stop breathing within a few minutes. Timely response saves lives.

So, what exactly was Dr. Henry’s motive for changing the protocol? What problem is she trying to solve?

The Globe and Mail quotes a statement from BC Emergency Health Services (who operate the BC Ambulance Service and, along with the BC Centre for Disease Control, report to the Provincial Health Services Authority): “The order will protect firefighters from potential exposure to COVID-19 and limit the spread of disease within communities.” As well, “the changes are being made to maintain a reliable supply of personal protective equipment (PPE) for health-care workers, which includes paramedics.” 

Is Dr. Henry putting our access to timely response to medical emergencies at risk, in part because she doesn’t want to share “her” PPE supplies with our local Fire Rescue personnel?

A shout out to all of our local first responders, both the BC Ambulance Service paramedics and Qualicum Beach Fire Chief Marc Norris and his dedicated team.