Community paramedicine: Paramedic retention may keep seniors in their homes

Low pay and long hours are juxtaposed with flexible scheduling and job security for B.C. Ambulance Paramedics

Trisha Shanks

Arrow Lakes News

Low pay and long hours are juxtaposed with flexible scheduling and job security for B.C. Ambulance Paramedics. Working as a paramedic in a small town is not nearly as glamorous as it is for city medics. Sure they’re serving a noble purpose and saving lives, but this combines with plenty of idle time before extremely high stress when the calls come in. In a rural station such as Nakusp, there might be a period of days without even one call to 911, or a non-emergency hospital transfer to a larger centre. The ambulance remains parked, but must be ready to roll into action at any moment. The people who man it have to drop what they are doing to get to the station and race off to the call.

The argument is that there isn’t enough call volume to justify full-time staffing so most of the area’s paramedics are part time, working on call carrying a pager as they go about their daily business. This also means having immediate child care in place for those who are parents. For anyone who lives further than a few minutes from the station, they must remain close by and even sleep there during the night to be available if their pagers go off, despite the pager pay rate being a paltry $2 per hour.

The Ambulance Paramedics of British Columbia (APBC) suggests paramedic recruitment and retention in rural areas is challenging because the low number of emergencies does not justify full time employees.  A way around this is to create more work for the paramedics while waiting for emergency calls, in addition to making some of those positions full time.

Nakusp Unit Chief Barb Miller says, “Any time the government creates jobs in rural B.C., it’s a good thing, but at what cost?” She is referring to union considerations such as hierarchy of seniority, full time versus part time and the question of location of the 80 positions being recommended. While this concept is just in the development phase, the new model of community paramedicine is in use in many communities across Canada with a noteworthy amount of success.

A recent APBC publication presented at the 2014 UBCM conference talks about the concept in practice in Pugwash, Nova Scotia. “This program uses Paramedics to supplement local physician shortages. The result is keeping the local healthcare facility open, while keeping costs under control.”

Community paramedics could help to bridge the gap of fewer doctors and an aging population. The APBC website states that the program called Community Referrals by EMS (CREMS) is being used to identify seniors at risk of losing their independence or suffering a serious medical event at home. The focus is on identifying patients at risk and then referring those patients to the specific type of care needed to ensure they stay healthy in their own home. Having a paramedic visit the home of an aging patient and providing basic medical services instead of transporting to hospital is saving the Ontario healthcare system $1 million annually, according to a February article in the Globe and Mail. “Frail seniors with multiple chronic conditions” are one of the fastest growing consumers of emergency health care, and the launch of a pilot program providing community paramedicine has seen “a 50 per cent reduction in calls to 911 and a 65 per cent drop in ER visits by so-called frequent fliers.”


The provincial government is responsible for providing emergency ambulance services to every citizen, therefore with the growing demand on the health care system, APBC hopes that changes such as this are implemented as soon as possible. It is seeking buy-in from the various levels of government, the union members and the community. For further information, visit