Wednesday, April 15, 2009

EMS Review: Saskatchewan Health censors committee meeting minutes; SEMSA and health regions “will directly shape” final report

Saskatchewan Health has disclosed the minutes to four meetings held earlier this year by the Emergency Medical Services (EMS) Review Committee. The unfortunate thing is they’re heavily censored.

In February a freedom of information request was made to the health ministry for copies of any briefing notes or memorandums from Dec. 16 to Feb. 19 regarding the EMS review along with copies of the minutes to any meetings conducted by the review committee since its inception.

In its Mar. 23 response the ministry provided partial disclosure of the minutes to review committee meetings held Nov. 28, Dec. 11, Jan. 8, and Feb. 12. No briefing notes or memorandums were included. Health officials said that none were created during the time frame requested.

The province-wide EMS review was announced at a news conference in Regina on Dec. 11, 2008.

The committee is mandated to review pre-hospital and interhospital EMS in Saskatchewan and provide recommendations for a strategic vision and 5 year plan for EMS. The review was completed March 31, 2009.

Don Cummings, an Edmonton-based consultant, was appointed chair of the 7 member review committee. Other members include:

Mike Redenbach, Regina Qu’Appelle Health Region
Rod MacKenzie, Saskatoon Health Region
Duncan Fisher, Saskatchewan Health
Patrick O’Byrne, Saskatchewan Health
Ron Dufresne, president of SEMSA
Trevor Dutchak, vice president of SEMSA

The ministry’s Mar. 23 cover letter notes that the EMS Review Final Report could be published by Apr. 30.

The minutes to the four meetings show that information regarding the following agenda items is being withheld from the public:

– EMS Review Committee Chair’s suggestions on approach (Nov. 28)
– Road ambulance issues for considerations (Nov. 28)
– Minister’s announcement debrief (Dec. 11)
– EMS Review Committee working document (Dec. 11)
– Opening remarks (Jan. 8)
– Committee report document (Jan. 8)
– Further Developing the EMS Review Report draft (Feb. 12)
– Other items (Nov. 28, Dec. 11, Feb. 12)

At its first meeting held on Nov. 28, the chairperson suggested that the committee meet approximately 7 or 8 times.

“The focus will be on aligning visions regarding solutions to known challenges within EMS,” the minutes state.

The chair suggested that the content of the committee report document would need to be developed by Mar. 15, with the remaining 2 weeks until Mar. 31 left for handling the logistics of submitting the report.

The minutes reveal that the “primary stakeholders” of the review committee will be the Saskatchewan Emergency Medical Services Association (SEMSA) members and the health regions.

Secondary stakeholders will include:

Saskatchewan Association of Rural Municipalities
Saskatchewan Urban Municipalities Association
– Saskatchewan Institute of Applied Science and Technology
Saskatchewan College of Paramedics
– First Responders
– Provincial Emergency Services Practices Committee
Saskatchewan members of the EMS Chiefs of Canada
Saskatchewan Medical Association
– Saskatchewan Registered Nurses Association (possible)
– Saskatchewan Association of Licensed Practical Nurses (possible)

“The Chair suggested that the above two “rings” of stakeholder groups, along with a third, will have distinct roles in shaping the work of the Committee. The primary stakeholders will directly shape the final document. The secondary group will provide input that validates the work of the Committee on provincial issues. A third group of stakeholders will be called upon to deal with select, specific issues discussed by the Committee,” the minutes state.

Conspicuously absent from the list are labour unions that might have an interest in the review, such as the Health Sciences Association of Saskatchewan, Canadian Union of Public Employees (Saskatchewan), Service Employees International Union and Saskatchewan Government Employees Union. It would appear that input from these groups was not much of a priority.

At its Dec. 11 meeting the committee determined that it would meet on Jan.8, Feb. 12, Feb. 26, Mar. 5 and Mar. 26. According to the minutes the chair “supported connecting the Committee to work from the EMS Chiefs of Canada including a scan of what Chiefs are doing following the release of the EMSCC white paper.”

The reference to the white paper is important since it appears to confirm the significant influence the EMS Chiefs and SEMSA had on the direction and outcome of the review process.

It should be noted that Cummings, according to an Oct. 28, 2008, health ministry briefing note released earlier this year, “was instrumental in the development” of the white paper.

The Future of EMS in Canada (Sept. 2006) report is a strategic policy framework. It describes six strategic directions and provides 11 recommendations that the EMSCC say will help enhance community-based EMS across Canada.

The EMSCC envisions EMS “as a mobile health care service” and believes “that the future of EMS in Canada is at the centre of the community, providing primary health care in a mobile setting.” It feels EMS’ role must be broadened beyond the traditional model of providing pre-hospital emergency care.

Page eight of the white paper explains a bit of this stating: “EMS has the potential to increase the level of care it provides through greater training and enhanced technology. In addition, EMS has significant resources and knowledge that should contribute more to health care reform by easing staffing and emergency department space shortages. Expanding EMS’ scope of practice, using its reserve capacities, and increasing the amount of mobile health services such as augmenting home care and other primary care areas are part of this contribution.”

A Dec. 2, 2008 briefing note indicates that during the afternoon of December 11, 2008, members of the SEMSA board were scheduled to have a separate, private session with Mr. Cummings to highlight their viewpoints regarding the development of a strategic vision and prioritized recommendations within the review. It will be interesting to see how much of what they and the white paper had to say appears in the review committee’s final report.


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