Emergency services

When a person calls 9-1-1 in an emergency, the call triggers a response process that involves several players. All of the actions and interventions performed to assist a person in distress make up the prehospital centre intervention chain.

Although ambulance services are an essential component of the prehospital centre intervention chain, and undoubtedly the best known, the roles played by the other links of this chain are just as important to ensure an effective response in any emergency.

The various components of the prehospital centre intervention chain are:

• The first intervener or the designated first aider (if applicable)
• The 9-1-1 emergency service
• The Health Communication Centre (HCC)
• First responder services
• Ambulance services

First intervener or designated first aider

The first intervener is a witness, a passer-by or any other person on the scene of the emergency. According to Section 2 of the Charter of Human Rights and Freedoms , every person must come to the aid of a sick or injured person unless this involves danger to himself or a third person.

Thus, in an emergency, the first intervener is not necessarily obliged to provide care, but must at least call the prehospital centre emergency services. The first intervener must call 9-1-1 as soon as possible, because this may play a crucial role in a person's survival. You must not hesitate to provide assistance to a person in distress, because Québec laws protect first interveners when they provide assistance in good faith.

Several organizations offer training in first aid and cardiopulmonary rescuscitation (CPR). For more information, see the section "First aid training".

9-1-1 emergency service

In Québec, the 9-1-1 emergency services respond to over one million calls each year. When a person calls 9-1-1, the response is assured by the emergency call centre of the municipality concerned, and a few seconds is enough to determine whether the situation requires the assistance of the police, firefighters or ambulance services. When intervention by ambulance services is required, the call is then forwarded immediately to the Health Communication Centre.

Health Communication Centre

As the true nerve centre of the prehospital centre emergency system, the Health Communication Centre counts on the emergency medical dispatchers, who ask simple questions and apply a prioritization system to quickly determine the nature of the situation and the priority of intervention of the ambulance services. Therefore, in an emergency, it is very important to answer the dispatcher's questions as clearly and calmly as possible.

In urgent cases, the ambulance is notified within the first few seconds of the call. If necessary, the dispatcher will stay on the line with the sick person or the caller to give useful advice while waiting for help to arrive.

First responders

Complementary to the work of the paramedical ambulance technicians, the first responder applies the protocols to prevent the condition of the person in distress from deteriorating.

Since the first responders work for a municipality, they have the advantage of being close to the population. They can arrive very quickly on the scene of an emergency. Once the ambulance arrives on the scene, the first responders turn over responsibility for the intervention to the paramedical ambulance technicians.

The first responders are qualified to administer first aid, use an automated external defibrillator for patients in cardiac arrest, and administer epinephrine with an auto-injector in case of severe allergic reaction.

There are about 4,200 first responders divided among 206 municipal services, including 1,700 in Montréal's territory. Thus, not every Québec municipality has first responders. The municipal authorities are responsible for establishing this service in their territory, and new services are added annually. To find out whether a first responder service is offered in your municipality and to find out how it operates, contact the health and social services agency (ASSS) in your region .

Ambulance services

The paramedical ambulance technician is a fundamental component of the prehospital centre intervention chain, responsible for evaluating the patient's clinical condition, providing the necessary care and transporting the patient to a hospital centre. The paramedical ambulance technician also has the role of informing the hospital centre of the patient's condition with the assistance of the prehospital centre intervention report. This report brings together all the relevant information to give the patient appropriate care and is added to the patient's medical file.

Over the past few years, the nature of the acts that paramedical ambulance technicians can perform during an intervention has evolved greatly. In particular, they are qualified to:

• use a semi-automatic defibrillator when a patient is in cardiac arrest;
• intubate a patient in cardiac arrest or respiratory insufficiency (with a Combitube);
• perform an electrocardiogram to diagnose acute infarctions rapidly;
• ventilate a patient who needs ventilatory support.

In addition, paramedical ambulance technicians can now administer five types of medications:

• glucagon for hypoglycemia (low blood sugar);
• nitroglycerine and aspirin for chest pain;
• salbutamol (Ventolin) for respiratory difficulty;
• epinephrine for severe allergic reaction.

Rigorous training and continuing education

So that paramedical ambulance technicians can intervene effectively with people in distress in any emergency, they are given precise and rigorous training in ambulance techniques. This training is ensured by several colleges of general and vocational education and by some private colleges. In addition, all active paramedical ambulance technicians must take an annual continuing education program to keep their competencies up to date and learn new professional techniques.

Ambulance services are ensured by private companies, by worker cooperatives, and by Urgences-santé, a public sector enterprise covering the territories of Montréal and Laval. These 98 enterprises employ over 4,400 paramedical ambulance technicians and manage a fleet of nearly 800 intervention vehicles.

Hospital centre

The patient's preference is usually taken into consideration by the emergency medical dispatcher and the paramedical ambulance technicians when choosing the hospital centre to which the patient will be transported. However, it is possible that the choice of hospital centre will be determined by other factors, such as the patient's condition, the distance to be travelled, the specialize services offered by the hospital centre and the accommodation capacity of the institution's emergency room.

Emergency triage

It is important to know that in the hospital centre emergency room, priority of treatment of all patients is evaluated by triage according to the severity of their health problems. Thus, a person who goes to the emergency room by ambulance but whose condition is stable will not be treated faster than a person who got there by another means but whose health status requires immediate care.

Call priority is established by the emergency medical dispatchers who ask simple questions and apply a prioritization system to quickly determine the nature of the situation and the priority of intervention of the ambulance services. Therefore, in an emergency,it is very important to answer the dispatcher's questions as clearly and calmly as possible.

High priority calls

For a high priority call, the ambulance is notified in the first few seconds. It proceeds to the scene, using the siren and the emergency flashers if necessary. When a first responder service exists in the municipality concerned, it is dispatched to the scene at the same time as the ambulance.

Lower priority calls

Depending on the evaluation of the call, if the emergency medical dispatcher recognizes that there is no immediate danger to the life of the person concerned, the ambulance proceeds to the scene, but usually does not put on the emergency flashers and the siren. Also, if a high priority emergency is received during this time and no other vehicle is available, the ambulance can be reassigned to the most urgent call. A person whose condition does not present an immediate danger then might have to wait for another ambulance to be free.

Over 650,000 ambulance trips are made each year. However, this is not a free service. Every ambulance trip to a hospital centre is normally charged to the person transported, even if another person made the call to the 9-1-1 emergency service to request an ambulance. Some government exceptional measures may apply.

The basic cost of transport by ambulance is established at $125 for pick-up, plus $1.75 for each kilometre travelled to the hospital centre. A fee of 35 $ is charged for any additional patient. The cost for a non-resident of Canada is $400 for pick-up, plus $1.75 for each kilometre travelled. These rates, in force as of July 30, 2010, may be indexed annually. No additional charges are billed for a person accompanying the person transported.

The Québec government assumes most of the funding of the prehospital emergency system; the costs billed to the user only cover a fraction of the actual costs of the patient's transport by ambulance.

Government exceptional measures

The Gouvernement du Québec, through its departments and public bodies, assumes the entire cost of transport by ambulance for the following clienteles :

• persons injured in a traffic accident
  Société de l'assurance automobile du Québec 
• persons injured in an industrial accident
  Commission de la santé et de la sécurité du travail 
• persons transported between two institutions of the health and social services network
  Coûts assumés par les établissements concernés
• persons age 65 and over and persons receiving Income Security
  Costs assumed by the admitting hospital centre or the Ministère de l'Emploi et de la Solidarité sociale, conditional on approval by the responsible physician

Important
Even if they are eligible for a government exceptional measure, persons whose transport is not considered medically required could be billed for the service.

The federal government pays the costs of transport by ambulance in certain cases, in particular :

• members of the Canadian Forces
  National Defence 
• veterans
  Veterans Affairs Canada 
• On-reserve First Nations and Inuit populations
  Health Canada 
• Inmates of a correction centre
  Correctional Service of Canada 

Private insurance

Group or individual insurance policies often cover all or part of the costs of transport by ambulance. Ask your insurer to find out if your insurance policy includes this coverage.

Paramedical ambulance technicians cannot oblige a person to be transported by ambulance. When they consider that a patient's condition requires transport by ambulance and the patient refuses, the person will have to sign the Formulaire de refus de transport (Refusal of transport form). The paramedical technicians then will be released from all legal liability concerning the person's health status. No charges will be billed to a person who has refused the service.

The Act respecting the protection of persons whose mental state presents a danger to themselves or to others  allows police officers, on certain conditions, to take persons to a hospital centre against their will to receive the care required by their health status. Thus, the police may request the ambulance services to transport the person concerned.

The Act respecting health services and social services  provides for a complaint examination procedure that allows any persons who consider that their rights have been infringed to express their dissatisfaction regarding the ambulance services received and to file a complaint on this matter. This procedure not only makes it possible to ensure respect for the users' rights, but helps improve the quality of ambulance services.

To file a complaint, you can contact the Regional Service Quality and Complaints Commissioner at the health and social services agency (ASSS) in your region .

Several organizations offer training in first aid and cardiopulmonary resuscitation (CPR). These easy-to-learn techniques can save lives. The Ministère de la Santé et des Services sociaux encourages the public to take CPR training.

Several recognized organizations offer this training, particularly :

• Canadian Red Cross 
• Heart and Stroke Foundation of Quebec 
• St. John Ambulance 
• ACT Foundation 

For more information on ambulance services in Québec, you can contact the health and social services agency (ASSS) in your region 

For the Montreal and Laval regions, consult Urgences-santé (French only) .

Useful link:

• Mobility of Ambulance Technicians