Whenever Stephanie Dunlop hears the sounds of sirens and sees the flashing lights of an ambulance speeding by her Metchosin fire hall, she immediately runs scenarios of emergency situations in her head—wondering why her crews aren’t being called, too. 

Heart attack, car crash, or drowning? “No. Couldn’t be. We usually get called for things like that,” the fire chief reassures herself.

Sprained ankle, herniated disk, or broken arm? “Possibly.” 

Most of the time, Dunlop assumes that it’s a transfer between hospitals and the ambulance is simply taking a detour through their quiet municipality to save some time—but sometimes Dunlop’s curiosity takes over. Is there someone who fell and broke their leg while hiking, who needs her help? She has no way of finding out what exactly BC Emergency Health Services (BCEHS) was responding to in that moment. For an emergency responder, dedicated to jumping in to help, it’s a frustrating question to be asking herself.

This has been a reality for the fire chief since May 2018, when the BCEHS introduced its new clinical response model (CRM). All first responders across the province were affected, including the Metchosin Fire Department.

A 2019 report by BC’s auditor general found that BCEHS didn’t consistently meet its targets for timely, quality care, and that BCEHS needed to strengthen its coordination with fire department first responders. Now those local departments are crying foul as they’re pushed out of their own municipalities by the province.

How 911 calls are responded to

When you dial 911 in BC, your call is answered by a dispatcher at E-Comm 911. The call taker asks several questions about your emergency situation to figure out your needs and the level of response required to take care of you. 

The current CRM system places callers into one of six coloured categories.

Previously, the BCEHS used a “you call, we come” system. But over time, BCEHS figured out that more people were calling for less serious conditions than before. In a video posted to their website, Neil Lilley, a senior executive director in charge of dispatch at BCEHS, explained that they would end up taking a non-urgent patient to hospital, where they would end up being triaged, just as they would if they walked into the emergency department themselves. 

BCEHS receives approximately 130,000 calls a year that don’t require transport to an emergency department. CRM was created to ensure there are alternative pathways for patients, such as advice on the phone to treat infection, a transport ride to a health service instead of a hospital, or treatment by a paramedic in the home. 

‘It’s not their job to dictate what we do’ 

Dunlop says when the CRM came into effect, “it rejigged the entire matrix.” Suddenly, BCEHS were the only ones who received all the calls, and only high-acuity calls (purple, red, and orange) would be given to Metchosin and local fire departments.

This was welcome news for busy fire departments, Dunlop explained—but not for Metchosin. 

Before the new model came in, fire departments could choose to not attend the lower acuity calls if they were having an exceptionally busy day—but Dunlop says in a small community of less than 5,000 people, Metchosin usually attends most calls. She adds that she wants to be able to respond to the needs of her residents “no matter the situation.”

As of September, 2020, firefighters were taken off from answering orange-coded calls to reduce the risk of COVID infection, as directed by the Provincial Health Officer. This leaves only purple and red calls in the system for Dunlop and her crew. Fire departments are always notified of fire-related calls, vehicle crashes, hazardous material sites, drowning or near-drowning incidents and other calls that land within the red and purple categories.

With a reduced spectrum of calls to respond to, Dunlop says she’s worried how residents will be affected. Their average response time is four-and-a-half minutes, compared to BCEHS time of 15 minutes and 58 seconds. Notably, there aren’t any BC Ambulance stations located in Metchosin—the closest is along Leigh Road in Langford.

Chris Moehr, who has lived in Metchosin for the past 35 years, recalls hearing of an incident near Matheson Lake a few months ago in which a hiker fell and broke her ankle. After the ambulance showed up, crews determined they couldn’t access the area as they didn’t have the keys to remove a post along the trail. Metchosin Fire Department then were notified about the incident and showed up on scene to unlock the post minutes later.

Dunlop confirmed that the incident took place, saying that it was a woman in her 70s. Frustrated, she says if her team had been notified about the call, they could’ve unlocked the post and reached the hiker side-by-side with paramedics instead of “wasting more time.”

“Since the decision to change the 911 callout system, it’s been extremely problematic for our community, especially when it comes to response time,” Moehr says.

Moehr is the vice president of the Association for Protection of Rural Metchosin, one of the groups that has started a petition to get BCEHS and the Ministry of Health to allow Metchosin to get access to all categories of emergency calls. The petition, launched in November 2020, has amassed more than 600 signatures.

“A huge amount of the residents in Metchosin are seniors,” Moehr says. “We need to know that when we call for help, we’ll get first responders out here quickly. It’s not rocket science. All we want is our calls back.”

Metchosin receives around 350 medical emergency calls a year, according to BCEHS. Of those calls in 2020, 30% were urgent, which means they were coded purple and red in the CRM. The call volume was 347 for 2019 and 308 for 2018. 

In 2020, the Metchosin Fire Department was notified of 127 calls, which makes 36 per cent of all medical emergency calls in the community. Although the majority—60%—of those calls were purple or red, BCEHS says there were a few times they notified Metchosin Fire Department to attend calls coded orange, yellow and blue. Capital Daily has asked BCEHS to explain why they would notify Metchosin about calls that aren’t purple or red if that doesn’t follow CRM protocol.

“The most frustrating part is that it doesn’t cost BCEHS anything to have us respond,” says Dunlop. “Why not let us be there too? We are all adults here and can make our own decisions as a fire department. It’s not their job to dictate what we do.”

What’s the solution?

With the bickering escalating into the public sphere, the Ministry of Health and BCEHS has agreed to virtually meet with Dunlop, Moehr, and several community organizations in early May.

Dunlop says she’s entering the meeting with a goal of receiving all levels of emergency calls, as she believes her crew needs to work together with BCEHS. 

She says her team’s knowledge of the area—such as the proper gates that need to be unlocked, the hidden driveways, or which home in a trailer part to go to—can help paramedics save precious time. During the winter, Metchosin Fire Department plows driveways for ambulances so they know where to go in an emergency. 

Dunlop remains optimistic although she herself has had conversations about the dispatching system with Premier John Horgan, head officials within the Ministry of Health and BCEHS since 2018, and those previous meetings have left her feeling like there is no wiggle room.

Shannon Miller, media spokesperson with BCEHS, says there are no communities within BC that have opted out of the CRM model or reinstated access to all calls, but there are a few fire departments around the province, like Metchosin, that have expressed their interest in wanting to attend more calls.

A group of 11 Metro Vancouver mayors have voiced their concern over recent long delays for BCEHS to emergency situations, which have been exacerbated by the growing opioid crisis and the pandemic. A letter the mayors released, addressed to the provincial government, cites a recent example in which fire crews arrived within four minutes of a 911 call about a suspected drug overdose while it took 50 minutes for BCEHS to arrive on the scene, as reported by CBC.

“People feel comfortable with familiarity,” Dunlop says. “There is community trust between us as a fire department more than BC Ambulance or RCMP. We need [the access to calls] to go back to what it was before.”

Moehr pointed out most of her neighbours have Dunlop’s cell number on them. She says this might cause a false sense of security, as the fire chief’s direct contact isn’t the answer in an emergency, and she doesn’t use it for emergencies because Dunlop “shouldn’t be placed in that position,” but it does underline the intimate connection Dunlop maintains with the community she serves. 

Dunlop notes that residents call her and the station for help from time to time. She encourages everyone to call 911 first when in an emergency, but admits that she gets requests for all kinds of things from septic tank breakdowns to serious injuries. 

At the end of the day, it’s not just the lack of emergency calls that frustrates Dunlop — it’s knowing that she could’ve helped a resident much sooner.