Review of Haines Junction Pilot Program

Executive summary Review of Haines Junction Pilot Program Emergency response is a shared responsibility in Yukon. The Department of Community Services trains volunteers and provides the equipment needed to respond safely and effectively to fire and medical emergencies. The communities are responsible to help recruit volunteers and champion their programs. Yukon Emergency Medical Services (YEMS) has a mandate to support pre-hospital care and emergency patient transport services in cooperation with allied health care providers and community responders throughout Yukon. To do this, YEMS relies on community volunteers who work in close partnership with Health & Social Services Community Nursing to provide on-scene response in 11 Yukon communities. Since 2013, YEMS has been conducting an ongoing comprehensive review of the Emergency Medical Services program in an effort to improve service and program outcomes. Specific to Community Operations, this has meant giving consideration to the effectiveness of the rural community based program as measured by volunteer satisfaction, recruitment, retention, and volunteer availability to shifts and emergency calls. The Haines Junction pilot offered YEMS a timely opportunity to explore many of these considerations through a focused, community-based project. The Haines Junction pilot was designed to address a unique situation in which the majority of the community s volunteer responders were unavailable in summer months due to competing demands related to seasonal employment. Between May and September 2015, YEMS recruited and deployed six paid community responders to enhance volunteer coverage in Haines Junction. This pilot program was undertaken with one-time supplemental funding from Yukon government s Department of Community Services. The pilot program delivered consistent daytime coverage by paid responders and supplemented overnight standby during the summer volunteer shortfall. The pilot program was successful in providing seamless service throughout the period of deployment, augmenting the volunteer base, offering opportunities to new applicants and increasing engagement with the local First Nation. The Haines Junction Pilot Program ended in September 2015 when the temporary YEMS employees were released from service. Local EMS coverage once again relies on the volunteerbased service model. To evaluate the pilot program, all pilot program participants completed a survey hosted by the Yukon Bureau of Statistics. Community stakeholders and working group members were also asked to take a similar survey. The surveys focused on perceptions of the pilot program, its Review of Haines Junction Pilot Program 1

successes and what could be improved. In addition to the contributions from these two surveys, YEMS evaluated: The financial impact of the program; Coverage levels attained through the pilot program; Call volume and types of calls addressed during the pilot program response period; and Impact to on-going operational availability of volunteer team members. This report shares lessons learned with interested YEMS responders, community partners and working group members. Review of Haines Junction Pilot Program 2

Table of Contents YEMS Mandate... 4 Pilot Program Background... 4 Pilot Program Objectives... 5 Fast Facts... 6 Impact Analysis... 7 Table 1: Pilot project participants and their disposition at the end of the pilot program.... 8 Table 2: Shift and standby coverage provided by pilot program participants... 9 Table 3: Annual personnel cost per call estimation by Community... 13 Lessons Learned... 14 Opportunities... 14 Summary... 15 Review of Haines Junction Pilot Program 3

YEMS Mandate YEMS Community Operations supports pre-hospital patient care and inter-facility transportation to visitors and Yukon citizens in 15 communities outside of Whitehorse. To deliver this service, YEMS deploys paid health care practitioners and volunteer responders. YEMS is housed within the Department of Community Services and is funded by the territorial government. Although logistical support for community EMS teams is provided exclusively through YEMS Community Operations, the medical response model relies on collaboration between YEMS Medevac (air ambulance), YEMS Whitehorse Operations (ground ambulance), YEMS Clinical Operations (Communications) and Health and Social Services Community Nursing. YEMS does not deploy paid response staff outside Whitehorse, Dawson and Watson Lake where the presence of Yukon Hospital Corporation facilities require professional paramedic services. EMS response within the communities of Eagle Plains, Mayo, Pelly Crossing, Carmacks, Faro, Ross River, Marsh Lake, Haines Junction, Destruction Bay, Beaver Creek, Carcross, Tagish, and Teslin is provided by local volunteer responders. YEMS supports these volunteers with facilities, vehicles, maintenance, uniforms, training, specialized equipment, medical consumables and honoraria administration. In this service model, the volunteers come from the local community while resources, training and administrative support are provided through YEMS. Community response efforts are backed-up by YEMS Medevac (air ambulance) crews whenever local response capacity is unavailable. Medevac crews, based in Whitehorse, support local EMS, Community Nursing and Hospital Corporation operations throughout the territory. Pilot Program Background In December 2014, stakeholder groups in the community of Haines Junction approached the Department of Community Services in anticipation of a lack of available volunteer community responders for May through September. Issues with summer coverage in the community had been evident over three successive summers and had not been addressed previously. A multi-agency, community-based working group presented eight recommendations for summer coverage to YEMS in late March 2015. Following evaluation, YEMS determined that only two of the recommendations could be implemented in time to address coverage requirements for the summer months. YEMS implemented targeted measures to: facilitate increased volunteer recruitment; enhance the quantity and quality of EMS training available in the community; and fund six casual community responder positions between May and September 2015. Review of Haines Junction Pilot Program 4

Pilot Program Objectives This one-time program offered support to the local volunteer community responder team within the existing territorial volunteer service model. The desired result of the targeted measures was to give the Haines Junction volunteer team a booster shot. The objectives were to: i. Offer comprehensive training in the community to get new volunteers certified quickly and working with existing community responders. ii. Increase the overall number of trained, experienced and trusted community responders in order to increase shift coverage. This reduced pressure on individual volunteers who felt over-burdened by coverage pressures in previous years. iii. Increase the amount of information about YEMS in the community, and streamline the recruitment processes to encourage participation from previously under-represented areas of the community. To support the program s objectives, YEMS hosted a two-day recruitment drive at the Haines Junction EMS station in mid-april 2015. New volunteer candidates identified through the recruitment drive were immediately provided with certification training in Emergency Medical Response (EMR), emergency driving (CEVO III) and professional driving (Class IV). Volunteer training took place over successive weekends between April and June 2015. In addition to volunteer recruitment, the Department of Community Services advertised employment opportunities to staff a one-time, summer pilot program. Recruitment processes identified a number of initial candidates suitable for casual employment as well as an eligibility list to support program contingencies. Coordinated liaison between YEMS, the Council of Yukon First Nations (CYFN), the Aboriginal Recruitment and Development Program (ARDP) and the Champagne-Aishihik First Nation (CAFN) identified candidates of aboriginal descent to participate in the pilot program. Once the team of six pilot program participants had been recruited, YEMS hosted an intensive education program in Haines Junction to facilitate the on-boarding, certification and on-the-job training of all. A total of eight employees were trained during this four-week process. Review of Haines Junction Pilot Program 5

These recruitment and training strategies brought a total of 10 individuals into contact with the Haines Junction EMS team. Of this number, 7 have remained with YEMS: Two pilot participants have joined other community EMS teams; One pilot participant is now employed by YEMS in Whitehorse; and The Haines Junction team now benefits from four new volunteer members. Overall, the pilot program raised the number of active volunteers in Haines Junction from 13 to 17, making this crew the largest community volunteer team in Yukon. Fast Facts The period of operational deployment was 29 June to 30 September, 2015. Pilot program participants were deployed operationally in two-person teams for 94 shifts of 10-hour days, totaling 1880 regularly scheduled hours. Off-duty pilot program participants also covered overnight standby when volunteers were not available (for 2950 standby hours). During the period of the pilot program there was 100% EMS coverage in Haines Junction. Pilot program participants responded to 32 daytime calls and 5 standby calls between 29 June and 30 September. 10 new EMS candidates were trained between April and September, 2015. 7 participants remained with YEMS. 4 pilot project participants continue to work with the local Haines Junction EMS team in a volunteer capacity. The current Haines Junction team consists of 17 volunteer community responders. Historically, the annual personnel costs to support the Haines Junction volunteer EMS team (on average) have been $88,556. Overall costs to support the pilot program alone was $150,860. Total YEMS support costs for Haines Junction this fiscal year are forecast to be $209,172. Review of Haines Junction Pilot Program 6

Impact Analysis 1. Increase training in the community Successful. Over a three-month period in Haines Junction, YEMS ran five courses to train new YEMS recruits. This was over and above the annual training commitments maintained in a number of other communities. s who received this new in-community training were so positive in their response that YEMS is adjusting its centralized training model to focus on providing more in-community training. Feedback from active volunteers identified that offering in-community training is linked to higher levels of recruitment and engagement. First Nations participants, in particular, suggested that offering training within the communities was essential to encouraging further EMS participation by aboriginal community members. The pilot project also demonstrated that inexperienced community volunteers can be trained to a deployable level in about five weeks. In the future, this intensive development process could be implemented anywhere that YEMS has access to training facilities and interested candidates. 2. Increase number of active volunteers Successful. The pilot program recruited and trained 10 participants. As a direct result of the pilot program, Haines Junction now has four additional trained and experienced volunteer community responders. Three other communities also benefit from EMS volunteers who gained training and experience through the pilot program. In addition, YEMS hired one of the pilot program participants as a permanent employee and another as a casual employee to assist with fleet maintenance during the off-season. Review of Haines Junction Pilot Program 7

Volunteer Recruitment Drive Paid Casual Employment Opportunity Table 1: Pilot project participants and their disposition at the end of the pilot program. s Background Program Participation Untrained Volunteer Recruit # 1 Untrained Volunteer Recruit # 2 # 3 # 3 # 4 # 5 # 6 # 7 # 8 # 9 # 10 Untrained Untrained Untrained Untrained Trained Trained Out-of- Territory Paramedic Untrained Untrained Volunteer Recruit - Transferred to Pilot Employee Volunteer Recruit Transferred to Volunteer Recruit Transferred to Volunteer Recruit Transferred to (Eligibility List) (Eligibility List) (Eligibility List) Disposition at end of Pilot Active EMS Volunteer Inactive did not complete training Active EMS Volunteer Active EMS Volunteer Active EMS Volunteer Active EMS Volunteer Active EMS Volunteer Active EMS Volunteer Active YEMS Communications Officer Inactive did not complete training Inactive did not complete training Current Location Haines Junction Haines Junction Haines Junction Haines Junction Haines Junction Haines Junction Beaver Creek Whitehorse / Watson Lake Whitehorse Haines Junction Lake Laberge Review of Haines Junction Pilot Program 8

3. Increase volunteer interest from under-represented segments of the community Partially Successful. The pilot program created a unique opportunity for YEMS to work with CYFN, CAFN and the Aboriginal Recruitment Development Program (ARDP). First Nations representatives assisted YEMS to disseminate information, identify suitable aboriginal candidates and to develop elements of cultural sensitivity during the training and deployment phases of operation. Five people of aboriginal heritage participated in this program; three continued their association with YEMS at the end of the pilot program. YEMS and ARDP are collaborating on a proposal to use YEMS resources and the Community Responder model as a developmental opportunity and seasonal employment stream in other Yukon First Nations. Other community groups did not provide the same level of support for this pilot program. Although there was a significant amount of public interest, few allied agencies offered assistance, work opportunities, funding or resources. Although the Community Working Group was charged with looking at community-based solutions to address the forecasted summer service shortfall, all eight recommendations required Community Services to provide the resources and personnel. For there to truly be a community solution for community response coverage, all elements of the community will have to come together to collaborate on services. This cannot and should not be a single agency responsibility. 4. Increase operational coverage Partially Successful. Table 2: Shift and standby coverage provided by pilot program participants June Days (2 days) June Standby (2 nights) July Days (31 Days) July Standby (31 nights) August Days (31 Days) August Standby (31 nights) September Days (30 Days) September Standby (30 nights) Total Shifts 4 62 62 60 Hours per Shift 10 10 10 10 Regular Hours Assigned 40 620 620 600 Standby Hours Assigned 48 659 850 840 Total Pilot Coverage Hours 54 48 692 659 692 850 670 840 Scheduling The three days on, six days off (Three-on, Six-off) schedule adopted during the Haines Junction pilot program differs from other employee deployment patterns currently in place in Whitehorse, Dawson and Watson Lake. This shift pattern was implemented on a trial basis to determine the optimal number of responders required to provide consistent and flexible operational coverage. This Three-on, Six-off rotation provided two on-duty responders each day while reserving four off-duty responders to fill last minute vacancies, overnight standby or to Review of Haines Junction Pilot Program 9

provide supplemental surge capacity. This shift pattern proved sustainable for the duration of the pilot program and demonstrated its suitability for future applications within Community Operations. From a coverage perspective, Three-on, Six-off is a superior schedule to the weekday schedule practiced in Watson Lake and Dawson as it allows for improved holiday, weekend and after-hours coverage while still encouraging volunteer involvement. In the future, implementation of this shift pattern should be considered in any community where call volumes exceed the capacity of standby coverage but where service demand does not justify round-theclock, full-time staffing. In addition to the Three-on, Six-off shift rotation, the hours of work (08:30 18:30) were also proven successful. The Pilot Program was designed to offer EMS coverage that overlapped with the working hours of the Community Nursing Health Centre. This proved to be an appropriate decision as the Pilot Program responders were in place to address 32 of the summer s 48 calls during the scheduled shift period. This means that 67% of the calls in Haines Junction were addressed by the pilot program. Co-scheduling day-time EMS coverage to align with the operating hours of Community Nursing s health centres enabled Community Responders to partner with Community Nurses to address the majority of this community s emergency calls. Scope of Practice Several themes of public interest emerged during the pilot program that advocated a different EMS service model be offered in Haines Junction. Specifically, the pilot program s design was criticized for not deploying Primary Care Paramedics (PCPs) in the community. PCPs are trained to deliver medications and delegated medical acts in pre-hospital environments. They are typically deployed within a 30-minute range of a health care facility and are capable of emergency interventions that are similar to what is offered in the first six minutes of care at a hospital emergency room. Where teams of PCPs are deployed, there are no requirements for physicians or nurses to attend the scene. Emergency Medical Responders (EMRs) do not receive the same training as PCPs and must be supported by health care practitioners with more advanced scopes of practice when patient needs exceed the EMR skill-set. EMRs were intentionally recruited, developed and deployed in Haines Junction to complement the existing volunteer team and the Community Nursing model that exists within that community. At no time was the pilot program s purpose to change the existing level of care available in Haines Junction. The purpose of the pilot program was to support community response while providing a reprieve for the existing volunteers and increasing community engagement. A review of the calls addressed during the pilot program period reveals that the Community Responder (EMR) scope remains an effective adjunct to the emergency care provided by Community Nursing. Appropriate patient care was delivered to all of the patients attended to by the pilot program teams and Community Nursing practitioners. Responder Utilization Although Haines Junction did benefit from continuous operational coverage throughout the operational period of the pilot program, the community responders were under-utilized. There Review of Haines Junction Pilot Program 10

was simply not enough EMS-related work in Haines Junction to support sustained employment. Despite repeated conversations with community stakeholders and local allied health care agencies, very few community-based work opportunities were put forward to occupy the program participants. Other than daily duties and 32 daytime emergency calls, YEMS was only able to identify 28 hours of additional project work to occupy the casual employees. For the most part, YEMS kept the pilot program participants busy training and participating in community outreach. Even with these outlets, only 14% of scheduled hours were allocated to operational duties. The remainder (86%) of the 1880 paid service hours were spent standing-by. By comparison, paid YEMS responders in Whitehorse are occupied with operational tasks for 67% of their working hours and in Watson Lake and Dawson, paid paramedics are engaged in operational duties for about 45% of their duty days. Until the combination of call volume and operational duties can fill a reasonable portion of the working day, government sponsored positions (FTEs) are not recommended in this capacity. Job-Sharing Work as a community responder could, however, supplement existing government or municipal positions. Employees in other positions in the community could be trained to the Community Responder level in addition to their substantive duties. The call volumes experienced in Haines Junction should not hinder core business provided that the nature of the substantive work is such that it can be deferred when an emergency response is required. For agencies looking to create new employment opportunities (or to justify existing positions), the Community Responder skill set could be used up to 0.2 or 20% of an FTE. This employment model is already in place in industry where on-site medical responders commonly hold blended positions such as cook, safety officer, administrative assistant, etc. Agencies within the community that may be able to take advantage of cross-trained community responders include Community Nursing (administrative positions), Home Care, Social Workers, Parks and Recreation, facilities management, Highways and/or Public Works. Should a First Nation, municipality or allied government department be interested in developing employees in this manner, YEMS has the capacity to provide training and support to responders under existing infrastructure. Review of Haines Junction Pilot Program 11

Program Cost The Haines Junction Pilot Program consumed $150,860 in one-time, supplemental funding. This funding was required in addition to annual YEMS expenditures to support the volunteer Haines Junction EMS team. Cost per Call Training and on-boarding costs: $23,426 Participant Training Wages: $29,563 Operational Wages & Benefits: $88,827 Standby and Overtime: $19,366 Budget Offsets (un-used Volunteer Honoraria) - $10,324 Total Program Cost $150,858 From a cost-per-call perspective, the coverage gained through the pilot program was prohibitively expensive. By using a formula that focuses specifically on the personnel costs associated with call response, each of the 37 calls addressed during the pilot program cost $4,077. By way of comparison, calls addressed by paid teams in Whitehorse average $475. In Teslin and Carmacks the communities with call types, call volume and volunteer crew composition most like Haines Junction the average costs per call are $925 and $1,163 respectively. Review of Haines Junction Pilot Program 12

Table 3: Annual personnel cost per call estimation by Community Annual Calls Annual Support Cost (per Community) $ / Call Beaver Creek 22 $ 65,470.80 $ 2,975.95 Carcross 71 $ 77,403.00 $ 1,090.18 Carmacks 66 $ 76,746.00 $ 1,162.82 Destruction Bay 12 $ 64,336.80 $ 5,361.40 Eagle 4 $ 31,776.00 $ 7,944.00 Faro 45 $ 68,727.00 $ 1,527.27 Haines Junction 64 $ 60,040.00 $ 938.13 Marsh Lake 14 $ 65,694.00 $ 4,692.43 Mayo 71 $ 71,675.40 $ 1,009.51 Pelly Crossing 31 $ 68,835.00 $ 2,220.48 Ross River 84 $ 73,149.60 $ 870.83 Tagish 40 $ 99,504.00 $ 2,487.60 Teslin 86 $ 79,518.00 $ 924.63 Whitehorse 5328 $ 2,533,740.00 $ 475.55 ** Cost-per-call calculations consider only the personnel costs associated with call response. Infrastructure and equipment costs vary widely from community to community and were not included in calculations. At current call volumes, response work does not justify full time positions in Haines Junction. Standby coverage remains the most fiscally responsible deployment model to address call volumes that do not average at least one call per shift period. Should paid community responders be deployed in the future, this is an area where collaboration with allied community stakeholders is essential: by cooperating with other contributors to community health care, community responders may be used to compliment and augment the work pools of other local work units. Community responders could be trained from existing staff members within these other work units and released to provide pre-hospital response when required. YEMS-trained community responders could be imbedded within allied health care operations to justify their full-time wages. Review of Haines Junction Pilot Program 13

Lessons Learned The call volumes experienced by Haines Junction are most appropriately addressed by a standby deployment model. A full-time staffing model is not financially advisable in any community where call volumes average less than one call per work day. There is not enough EMS-related work to support permanent employment of this type in Haines Junction. Call volumes that exceed 100 calls per year, however, tax volunteer responders and may overwhelm a small (less than 10 member) team of active volunteers. The call types evident during the deployment period of the pilot program indicate that the Community Responder (EMR) scope of practice remains the most appropriate level of care to support Community Nursing s Primary Health Care Nurses in providing scene response and inter-facility transport. YEMS can develop an effective team of community responders in as little as five weeks through targeted, intensive training. This training model can be implemented in any community where YEMS has facilities and team members. The Three-on, Six-off deployment schedule maximizes consistency in operational coverage with a minimal number (6) of responders. This offers an alternative to the 24-hour operations in Whitehorse and the business day operational schedule in Watson Lake and Dawson. A community-based solution to address coverage shortfall must involve all community partners not a single agency or service provider. Volunteer local EMS response is only possible in community settings when allied community partners actively support the volunteer teams. These supports must include contributions of personnel, resources, shared training opportunities and professional development opportunities. Opportunities The in-community training program and seasonal employment model is an effective, although cost-intensive, method for developing trained, experienced community responders to supplement existing community EMS teams. This type of program may provide developmental opportunities in conjunction with municipal summer employment incentives, government student employment programs and the Aboriginal Recruitment and Development Program. Proposals to take advantage of such collaborative funding arrangements are under investigation for the future. The nature of community EMS response is such that community responder duties could be blended into an existing job description or used as partial justification for new, community-based Review of Haines Junction Pilot Program 14

positions. In communities where EMS call volumes do not justify stand-alone employee positions, community response training could be provided by YEMS to incumbents of other municipal or government-funded positions. Summary The Haines Junction Pilot Program was successful in meeting its objectives. New volunteer responders were trained and made available to local EMS teams in Haines Junction and several other communities. Working relationships between YEMS and CAFN, CYFN and ARDP were established and future collaborations are being considered to support aboriginal development and YEMS volunteer operations. A new YG job description Community Responder was developed and tested as was the Three-on, Six-off shift rotation. Each of these enhancements holds promise for future application within the YEMS service model. Finally, the pilot program was able to provide continuous coverage throughout its duration. Although expensive when implemented as a single-agency solution, the successes of the pilot program demonstrate that a community solution is possible if more community stakeholders engage and contribute personnel, funding and resources. Review of Haines Junction Pilot Program 15