'It's distressing for everyone': B.C. Gulf Island residents worry they'll be stranded if medical emergency strikes at night

Residents of Quadra Island are worried about being stranded ashore when medical emergencies occur at night because BC Ferries can't guarantee a crew for sailings to get ambulances across to the hospital in Campbell River.

A petition with close to 1,000 signatures is circulating in the community of 2,700 full-time residents calling on B.C.'s Transportation Minister Rob Fleming to work with BC Emergency Health Services (BCEHS) and BC Ferries to reinstate off-hour ferry service so ambulances can get patients to hospital in a timely manner.

One resident signing the petition said her dad had to wait in the back of an ambulance for five hours in incredible pain from a stomach aneurysm without access to pain medication before the air ambulance arrived.

Island paramedics have also urged residents on social media to call an ambulance before the last ferry at night if they feel unwell due to ongoing difficulties with getting patients evacuated off island.

Islanders shouldn't have their health outcomes compromised by being forced to wait till morning in the back of an ambulance for the first ferry, or for the extra time for a helicopter to arrive, when a hospital is just 15 minutes away across the water, said Quadra resident and Campbell River Hospital emergency room nurse Tessa Bingham.

“Time is precious in a lot of instances like heart attacks and strokes,” Bingham said, noting there's also significant pain and emotional distress with cases involving broken bones or mental health crises.

“It's just distressing for everyone, including the paramedics, to be held in the back of an ambulance for hours overnight.”

Part of the problem is that it's not the paramedics treating patients on Quadra who make evacuation decisions. That remains up to the dispatch centre on southern Vancouver Island.

Paramedics based on the island are fantastic, she said, but few, if any, are licensed advanced life support (ALS) paramedics able to treat acute emergency cases on the scene, make transport recommendations, or administer medications to patients if there's a delay in evacuations.

A lifelong resident of Quadra, Bingham said that for decades there hadn't been any problem getting ambulances and patients off island on the ferry system.

BC Ferries CEO Mark Collins said it isn't a question of willingness or cost on the part of the ferry service, but rather, less staff living on the island to crew the vessel - likely due to the price and availability of housing on the island.

“Quadra is a desirable place to live, and property values have gone up,” Collins said. “We've seen a steady decline in the number of crew that live on the island.”

Quadra staff are typically happy to crew a vessel for an overnight emergency, he said.

But if crew members slated for work the next day respond, they wouldn't be able to work due to mandatory rest requirements, which would disrupt regularly scheduled sailings.

As such, BC Ferries can't always guarantee the availability that BCEHS - the agency with the responsibility to provide emergency service - needs, he said.

BC Ferries informs BCEHS when vessels and crews are unavailable for after-hours service so that the ambulance service can source the best available transport options for patients, said BC Ferries spokesperson Astrid Chang.

Despite four separate requests to BCEHS for an interview on the issue of medical evacuations from ferry-dependent communities, Canada's National Observer was told no one was available for an interview.

The ambulance service uses the Canadian Coast Guard based in Campbell River for emergency evacuation after hours when a ferry is not available, and has contracted a water taxi service to bolster transport for patients needing emergency evacuations, said BCEHS spokesperson Cindy Leong in an email.

Depending on the seriousness of the patient's condition, an air ambulance may be dispatched, she added.

“When there is a delay in the provision of services due to weather, for instance, the crew consults with dispatch to look at all options for patient transport off the island,” Leong said in the email.

However, BCEHS did not respond to a request to clarify details about the water taxi - such as whether it had medical equipment aboard, or if it could run at night or in bad weather when BC Ferries or the air ambulance was unavailable.

The Canadian Coast Guard will assist with medical evacuations when requested by BCEHS or other provincial or federal agencies, spokesperson Michelle Imbeau said in an email.

However, the coast guard's primary role is marine search and rescue and marine pollution response, Imbeau wrote.

As such, coast guard vessels are only dispatched when there are no other options available, a suitable vessel and crew are free, and as long as the agency's ability to respond to search and rescue calls will not be compromised, she wrote.

Since March, there have been two BCEHS requests to the coast guard for medical evacuations from Quadra, but none since June 1 when the water taxi service reportedly started, Imbeau wrote.

Quadra Island regional director Jim Abram said he met with representatives from both BC Ferries and BCEHS last week to discuss the long-standing situation but no concrete course of action has been decided.

Rolling an equipped ambulance with gear and a patient onto a ferry is the gold standard of patient care, Abram said Wednesday.

“All the other options have drawbacks.”

Using a ferry is the best option for Quadra, given the ease of transport, patient comfort, reliability in poor weather and quickest response, Abram said.

Abram said he believed he could find rental space on the island for crew members close to the ferry terminal. Another option is to run crew members in Campbell River over in a water taxi for emergencies.

“It takes an extra half hour, but that's a lot better than waiting for an air ambulance for more than an hour,” he said.

BCEHS has contracted a water taxi service in Chemainus to run a purpose-built marine ambulance that allows a stretcher to be wheeled aboard and with space for paramedics to evacuate critically ill patients in the southern Gulf Islands.

Paul Brent, acting director for Southern Gulf Islands and a volunteer medical emergency responder on Saturna Island, says the marine ambulance is a good solution for getting patients off island to hospital if the air ambulance isn't readily available or necessary.

“I can attest this is a well-run and reliable service,” he said, adding it's especially important in the small community because there are no full-time paramedics based on the island.

Abram said a water taxi might work in some instances, but it would be cumbersome to transport stretchers down the ramps and load patients, and not all vessels in Campbell River have the equipment to run at night.

BCEHS did not respond to questions from Canada's National Observer on whether the water taxi service contracted to serve Quadra and other islands in the region was a medically equipped boat or a marine ambulance.

Abram said BCEHS and BC Ferries have said they will come back to him with proposals for a fix to the issue within a couple of weeks.

“I'm assuming that they will stick to their word,” Abram said. “This has to be fixed.”

BC Ferries is part of the highway and should be an essential service in an emergency, Bingham said.

But BCEHS' decisions to leave patients to wait until the first ferry falls into an ethical grey area, endangering people's equal access to emergency room care, she said.

A person who lives in other rural communities on Vancouver Island have the option of getting in their car and driving to an emergency room if they choose, even if just for a stubbed toe, Bingham added.

“You can't say BCEHS is denying service, but they're definitely delaying it,” she said.