2024-01-16 15:51:54
The CEO of Urgences-santé, François Charpentier, pleads in favor of a “nationalization” of pre-hospital services in Quebec. He estimates that with the billion dollars invested annually by the Quebec government in the sector, the system could “do much better and be much more efficient”. According to him, we must also create a professional order for paramedics in order to give them expanded power.
At the head of Urgences-santé for almost two years, François Charpentier shared his vision of the prehospital system with Le Devoir during an interview last week. He deplores the lack of coordination between the province’s health communication centers (CCS), which receive and process emergency calls that require the intervention of ambulances. Currently, everyone assigns the ambulances in their territory — belonging to a cooperative, a private company, a non-profit organization or the public company Urgences-santé — without knowing if a vehicle from the neighboring CCS is closer to the patient than his.
“There are ten health communication centers in Quebec, which work in approximately ten different ways,” says François Charpentier. CCS computer-assisted ambulance dispatch systems are not interconnected. You must contact a neighboring CCS to find out if one of their vehicles can get to a patient more quickly. For a year, Urgences-santé has not hesitated to pick up the phone to ask for help if necessary.
“Our neighbors, we don’t ask ourselves: is this private? A coop? The whole government pays for that. When the estimated arrival time is too long, we call on colleagues. They are remunerated. They are waiting,” said the CEO of the public company. The patient’s interest comes first, he emphasizes.
François Charpentier believes that the government should set up a national operational management center, which would coordinate the CCS and ensure monitoring of the entire territory. A single computer-assisted ambulance dispatch system would be used. “If you see that you have a vehicle available in a particular location, you no longer have the boundaries of CISSS, CIUSSS, private or public company,” he explains. A CCS could switch its calls to another in the event of an outage or overflow. This is how the 11 call management centers of the Sûreté du Québec operate, according to François Charpentier, who spent his career there.
Centralize in Montreal?
The CEO of Urgences-santé, which operates in the territories of Laval and Montreal, denies wanting to centralize operations in the metropolis, where its operational center is located — the only one in Quebec. His organization will implement a new computer-assisted ambulance dispatch system in the fall, which he believes could be extended across Quebec.
“The goal is not to manage from here,” assures François Charpentier. The national operations management center, you can put it anywhere in Quebec. Sometimes, it’s easier to fill positions in the regions. It’s more and more complicated to attract people to Montreal. »
François Charpentier believes that CCS should be, at the very least, “interoperable”. He recalls that a billion dollars is spent in the prehospital sector, public funds coming from taxpayers. “We don’t quite use 200 million to make about 38% of pre-hospital calls in Quebec. I won’t hide that from you [le milliard] mainly goes into the pockets of individuals, coops, whatever you want to call them, NPOs, all that. » According to the Ministry of Health and Social Services (MSSS), 53 ambulance companies are present in Quebec.
Reactions from Quebec
Questioned about a “nationalization” of the prehospital system, the office of Minister Christian Dubé responds that the government “has already undertaken a major transformation” by adopting a new national policy for the prehospital sector in 2022, “with, among other things, 30 million more to improve ambulance coverage.” Announcements on ways to “optimize the work” of paramedics and “improve access to services” will be made in the coming weeks. “In the new contract with ambulance companies, we are now setting conditions of transparency, in addition to including financial penalties for those who do not deliver the services,” adds the firm.
The MSSS specifies that the national policy provides that “ultimately, Quebec will have to equip itself with a universal computer-assisted dispatch system”. “With the adoption of Bill 15, modifying the composition of the boards of directors of health communication centers is a first step which will facilitate the deployment of this universal system,” writes the ministry.
From 2019 to 2021, Michel C. Doré chaired the National Committee for the Transformation of the Emergency Prehospital System, which led to the adoption of government policy. He does not believe that a national operations management center is necessary to coordinate the 10 CCSs. But he advocates a common computer-assisted ambulance dispatch system and a “limited number” of CCSs – two to four would be enough, according to him.
“When we think that there are large American centers – Chicago, New York, Los Angeles – which are capable of managing a prehospital fleet with a single dispatch center for as many ambulance vehicles as we have overall of the province, are we really right to increase the number of dispatch centers and computer-aided dispatch systems? asks the senior civil servant, on the eve of retirement. This seems inappropriate or suboptimal to me. »
An order for paramedics
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