You will find the translation of the laws and by-laws that are applicable to Quebec's prehospital system. Please note that for brevity, the translation are not word for word, but are an acurate description of the each article of those laws and by-laws.
Law on Public Health Protection
By-law on Public Health Protection Law
How the emergency prehospital system works in Quebec
Comments on how the emergency prehospital system works in Quebec
Decrees, Interpretation guides, and other paperworks written/release for or by the Minsitry of Health and Social Services.
The Ministry
The Ministry of Health and Social Services is responsible for everything regarding emergency prehospital care by ambulance in Quebec. They establish the policies on how public funds are given to the ambulance system. It subsidizes the ambulances services through the Regional Health Boards ( RHB) . It establishes the training criteria for Ambulance Technicians, and of the Prehospital Protocols.
The Regional Health Boards
The RHBs gives the ambulances permits to each ambulance service for their respective territories. They also distributes the money authorized by the Ministry, in respect for the number of calls done on each territory covered by the ambulance service. The fewer the calls, the bigger the subsidies ( sp?), because the ambulance service will not be able to bill the customers enough to cover its expenses. Furthermore, ALL of the salaries of the Ambulance Technicians are subsidized at 100% by the RHB, through a seperate subsidie ( sp?), in relation to the type of schedule the RHB as authorize for each ambulance service.
The subsidized expenses ( other than the salaries) are gasoline, regular vehicle maintenance, fees for disposable equipment, fees for vehicle replacement, administration expenses, and dispatch fees to name a few. Those costs are estimated by the RHB at the beginning of the year, and the ambulance service receives fixed amount regularly. This is not a reimbursement for actual expenses. Note that in the fall of 1998, the ambulance owners association declared publicaly that they were making a 2-3 % profit every year.
The ambulance services
There is 3 types of ambulance service, by their administrative platform :
-Private ambulance services
-Ambulance Coops, such asl CETAM, CTAQM, CTAO, CAM
-Public ambulance corporations, such as CAMBI et Urgences Santé
All of these services receives their subsidies by the method mention earlier, except Urgences Sante, which receives its funding directly from the goverment. Urgences Santé is a crown corporation, as is Loto Quebec, Hydro Quebec, and the Liquor Board. It's covers the territory of the Island of Montreal and the Island of Laval).
Dispatch Centers
As of a few years ago, ambulance services were responsible for their own reception/dispatch of ambulance calls. When the goverment decided to implement province wide 9-1-1, they chose to regroup the different dispatch services into a few regional dispatch centers. Unfortunately, these regional dispatch centers are still in the infancy phase. For the moment, only 3 regional dispatch centers have been authorized and are operational: in Montreal ( Urgences Santé), in Quebec ( Centrale de Coordination de Québec) and in Monteregie ( CETAM ). The reasons for these regional dispatch centers are evident: increase performance, diminish treatment time of calls, better usage of ambulances by sending the closest available vehicule, no matter their area of coverage, and to reduce the costs of dispatch fees. ( A few services had already begun regrouping their dispatch centers, but on a local basis only).
Furthermore, these new dispatch centers will be able to keep more precise statistics on the number of calls, the response times, etc.. And this will make possible the installation of the Advanced Priority Dispatch Systme from Clawson in all the dispatch centers.
When somone calls 9-1-1 for an ambulance, the call is transfered to the dispatch center from the 9-1-1 municipal dispatch. The Emergency Medical Dispatcher ( EMD ) confirms the address with the caller, verifies if it is at this particular address the ambulance is needed, and asks a few questions to classify the call priority ( urgent or non-urgent ). And if applicable, the EMD will give precious pre-arrival instructions to the caller, so emergency care can start while the ambulance is going to the call. Following these instructions can make a difference between life and death.
While this is going on, the dispatcher will dispatch an ambulance to the specific address given on the phone, with pertinent detail of the medical problems on scene. If available in the municipality, a Medical First Responder unit ( usually the local fire department ) will be sent to the call to reduce the delays in emergency basic prehospital care. And if appropriate, the dispatcher will advise the ambulance crew of any change on the call.
Ambulance Technicians and their peculiar shcedules
Each ambulance must have 2 Ambulance Technicians ( AT ) on board. Those AT work according to a schedule pre-established by the Regional Health Board of their sector.
In 1989, the Ministry decided to stabilise the ambulance work-force by creating certain types of subsidized working schedules, and by garantying a salary equivalent to a 40-hour week for full-time AT. There is 6 types of schedules for AT, depending on where they work in Quebec:
- 14/21
- 8/14
- 7/14
- 12-hours
- 9-hours
- 8-hours
The 14/21 means 14 days of work over a 21-day periode. The Ambulances Technicians are on duty 24 hours a day for 14 strait days, then are off ( or on recuperating time according to the Ministry's terminology) for 7 days. So they are on duty for 336 hours on a 21 day period. But the AT are only paid for 120 hours ( remember the 40-hours a week equivalency) of work. Following provincial union negotiations, this type of schedule is bound to disappear to be replaced by 8/14 schedules.These schedules do not exists anymore, as of 1998
The 8/14 means 8 days of work over a 14 -day period. The AT are on duty 24 hours a day for 8 days, and are off ( or on recuperating time according to the Ministry's terminology) for 6 days. So they are on duty for 192 hours on a 14-day period. But the AT are only paid for 80 hours ( remember the 40-hours a week equivalency) of work. This type of schedule is, according to the Ministry, temporary. That was the same for the 14/21, that had become permanent.
The 7/14 means 7 days of work over a 14-day period. The AT are on duty 24 hours a day for 7 days, then are off ( or recuperating according to the Ministry's terminology) for 7 days. So they are on duty for 168 hours over a 14-day period. But the AT are only paid for 80 hours of work ( remember the 40-hours a week equivalency ).
The reason for the Ministry saying they are recuperating is simple: Because they are paid by the week, if there is training to be given, the AT must receive this training during their recuperating time, so not to cause problems with ambulance coverage. And without any more aditionnal money paid to the AT. The 12-hours are paid hourly, and are located in urban centers like Montreal, Quebec City, Longueuil, Brossard. On these shifts, the AT works 7 days over a period of 14 days, and work every other week-ends, Usually, the schedule is 3-2-2-3-2-2, alternating work-days and off-days.
The 9-hours exists only in Montreal, and are paid by the hour. They work 21 days over a 35-day period. The Montreal Police Department has this kind of schedule, but has in addition a day/evening/overnight rotation, which the AT do not have. The AT works 3 W/E out of 5, and has a schedule looking like 7-6-5-3-3-2-2-2, alternating work-days and off-days.
The 8-hours are identical to those you see in the Public Health Sector in Quebec. They are paid hourly, 5 days a week, every other W/E off, except a few localized shifts where they do not work any W/E.
Ambulance vehicles
The ambulances are operated by the ambulance services, but it is the Ministry, through the Regional Health Boards ( RHB ), that pays for the vehicles. The ambulance service choses the type of ambulance it wants, in compliance with the BNQ standards ( somthing like CSA or KKK standards). Once bought, the RHB reimburse the costs of acquisitions to the ambulance service, on an instalment basis, over 4 years.
The ambulance system is still seen in 1998, as a transport service for the sick, and the goverment policies toward its EMS system reflect thes views.
Everywhere in the civilized world ( France, Great-Britain, Switzerland, Australia, United States of America, and even the rest of Canada) the ambulance services are part of the chain of survival, by providing advanced prehospital care ( like giving medication for allergic reaction, cardiac arrest, heart attacks and asthma attacks). Iu Quebec , it is stll required by Ambulance Technicians to rapidly transport sick people to the hospital, while nothing else is done while going to said hospital.
It is not a bad idea as such, but certain things can be done to the patients by Ambulance Technicians WHILE the ambulance is going to the hospital, to stabilize the patients, diminish their suffering, their anxiety, the moribidity and mortality of these patients. Studies from all over the world are unanimous: the faster the patient is stabilized, the less severe the consequences of the disease will be. And on cardiac arrest or allergic reaction patients, it is in minutes that these advanced life support measures must be initiated, not hours. And that is what Paramedics do.
Then, there is the Ministry who spends millions of dollors ( 194 at the last count) subsidizing PROFITS for ambulance services in Quebec, at the expense of patient care. Money that could easily be redirected to improve the quality and the quantity of emergency prehospitali care given by Ambulance Technicians. It is however relevant ot note that efforts are made improving the ambulance system by the Ministry, but it is a long, tedious process, that has a tendency to be derailed by political agendas of lobby groups.
A few indicators to know if your ambulance service is up to the task:
1)- Ambulance response time ( timed from the moment the call comes in to the dispatch center to the arrival to the ambulance at your door):
------ 8 minutes in urban areas ( Montreal, Laval, Longueuil, Quebec City, Hull, Sherbrooke, Trois-Rivières )
-------15 minutes in semi-urban areas( Cities of less 25 000 inhabitants)
-------30 minutes in semi-rural areas ( the rest of the province except the Far North, and certain parts of the Lower St-Lawrence River east of Sept-Iles, and of the Gaspésie).
2)- The fact Ambulance Technicians asks a few qestions ( a minimum of 10 to be precise) and that they check your vital signs ( pulse, blood pressurel, breathing rate ) is a GOOD THING, and are generaly required by the different protocols under which Ambulance Technicians work under. Those protocols have been written by Doctors for Ambulance Technicians.
Updated on 14 February 1999
