Analysis: Chronic and worsening issues with EMS have reached a crisis point—and the Smith government is making it worse

The emergency medical services crisis in Alberta is a labour crisis: there are too many calls and not enough paramedics to answer them. On the campaign trail, Danielle Smith promised to fix it all within 100 days, but local paramedics say we’ve arrived at the opposite, a system “in shambles.

According to Alberta College of Paramedics data, Alberta has nearly 7 per cent fewer registered paramedics now than it did in 2017 and there doesn’t seem to be any plan to address this decline. By contrast the College of Registered Nurses of Alberta shows a more than 4 per cent increase in nurses with one less year of data. Alberta’s population has grown by more than 7 per cent since June 2017. 

Image via HSAA.

Mike Parker, president of the Health Sciences Association of Alberta (the union that represents AHS paramedics), didn’t hold back when I asked him how EMS workers are doing.. 

“We don’t have enough people working in EMS to meet demand that has been rising, and not just because of the pandemic, for a decade now. Governments have made the situation worse through decades of neglecting the system and the people who keep it running.”

The UCP government has talked a lot about the emergency medical services crisis and has focused on marginal solutions around the edges like diverting non-emergency calls to 811 or trying to privatize and contract out parts of the EMS system like inter-facility transfers or so-called “non-ambulance transport.” Of the 53 recommendations made in the Alberta Emergency Medical Services Advisory Committee report that was recently released only one substantially addresses training new paramedics. And it’s pretty vague: “work with partners to expand the availability of student practicums in the EMS system.” 

It turns out new paramedics can’t get the work placements necessary to join the profession because existing paramedics are getting worked off their feet. While provisions exist in collective agreements for nurses to get a premium when training students on work placements no such language exists for paramedics.  

Roughly 20,000 metro area paramedic shifts went unstaffed in 2022. Paramedics are getting worked into the ground and either quit, burn out, or become casual or part-time paramedics because working for AHS is so unpleasant. A recent report in the Breach shows that 73 per cent of new AHS paramedic hires are casuals with no benefits or sick days. The 89-day contract is a fixture of the AHS paramedic human resources strategy. AHS is treating its paramedic workforce like an Amazon warehouse. 

“I’m not surprised that the number of paramedics has gone down. It’s a difficult job and Alberta is a lousy place to work. So why would anyone as skilled as a paramedic want to work here,” said Bob Barnetson, a professor of labour relations at Athabasca University, when I asked him to explain the situation. 

“I’m not sure AHS can be an employer of choice while the UCP is controlling the organization. But, changes that could improve recruitment and retention are better wages, better working conditions and more permanent full time jobs,” said Barnetson. 

The UCP government does not seem to have the same changes in mind.. AHS and the government have talked about recruiting paramedics from Australia where they allege that it “currently has more qualified graduates than available jobs.” And even that is a distraction: last year only 11 paramedics that transferred to Alberta internationally, the year before that only 13. Interprovincially there is not a lot of movement either. There were only 85 applicants to the Alberta College of Paramedics from other provinces in 2021/2022 and only 77 the year before. According to a ministry of health spokesperson the Australian recruitment campaign is still in its early stages.  

So with international and interprovincial recruitment not going to cut it, it falls to the various educational institutions that train paramedics to do the heavy lifting when it comes to replacing paramedics who leave the profession. Unlike nursing training, which is only done through public universities and colleges, paramedic training is done by a mix of both public and private institutions. 

The college of paramedics tracks paramedic graduates and over the past three years Alberta has graduated an average of 292 primary care paramedics a year (they used to be called Emergency Medical Technicians or EMTs) and 137 advanced care paramedics a year. Graduate numbers dipped during the pandemic but the six-year decline in registered paramedics precedes the pandemic. 

Not only is Alberta not training enough paramedics to replace the ones who quit or leave, but Alberta Health Services is universally reviled as an employer. While they are the single largest employer of paramedics in Alberta, with 42 per cent of registered paramedics working for them, a majority of registered paramedics are choosing to work with fire departments, private ambulance services, in industrial settings or literally anywhere else. 

When you treat paramedics like just-in-time gig workers, don’t listen to their concerns about work conditions and don’t pay them what they’re worth, it's not really a surprise that there aren’t enough paramedics to respond to calls. 

The UCP government disputes that there even is a crisis. A ministry of health spokesperson said that as of December 2022 AHS employed 3,075 paramedics compared to 2,763 in December 2019, an increase of 11.2 per cent. But according to Brett McKay’s reporting in the Breach, 73 per cent of all new AHS paramedic hires in 2022 were casuals. Parker, the union president, finds the government denials frustrating.

“For them to say so is to deny the reality our members on the frontline are still dealing with every day. It has done incredible damage to morale. To minimize the current situation by just saying it is fixed, does not fix anything,” said Parker.

According to Parker this is a solvable crisis but it’s not something that can happen in 90 days or during an election period. 

“We need to improve working conditions for EMS professionals to keep them resilient and on the job. Better working conditions will also make becoming an EMS professional in Alberta more attractive to people considering the career and those currently working elsewhere.”

“We need more training spaces open in Alberta post-secondary institutes. Alberta needs to set itself up as a preferred employer to attract professionals. This requires a culture change at AHS EMS. It means better wages and benefits. Stop relying on casuals and offer full-time positions with benefits and pensions to those that want them,” said Parker. 

“Until Alberta starts treating its dedicated health-care professionals better it will continue to have problems growing the ranks of paramedics and emergency communications officers.”

Image from the HSAA Facebook. Take on Sept. 26, 2022 on the steps of the Alberta Legislature.