Eight years ago, when Brian McNamara decided he wanted to become a critical care paramedic, the training he needed was not available in Prince George.
Vancouver was the only place in BC where Emergency Health Services offered the program he needed to advance his training to the highest level. He made the difficult decision to leave his pregnant wife and he spent the better part of the next two years away from his family to earn his credentials.
Since then, the COVID pandemic spurred the provincial government to invest more money in northern B.C.’s pre-hospital care system and with that came the resources to develop a made-in-Prince George critical care paramedic training program. In December it produced its first three graduates.
“I’ve always said if you want to keep people in the North you have to train people from the North,” said McNamara.
“It’s absolutely huge, the first time ever offered outside of the Lower Mainland. It’s not just growing the base and the effects on recruitment and retention, but also relationships we’ve built in the North because we’re training here. We have a lot of instructors at UHNBC teaching how they like things done and there’s huge buy-in from everyone.”
Planning for the CCP program started in late 2019, and in response to a predicted surge of COVID patients, BCEHS added staff and based a dedicated medical helicopter and additional fixed-wing aircraft at Prince George Airport.
The first intake of candidates - advanced care paramedics (ACPs) Spencer Ovenden, Eric Konkin and Joseph Balfour - began their training two years ago, working closely with medical staff at University Hospital of Northern B.C.
The program involves 18 months of training, starting with completion of a post-graduate nursing program, then working in a hospital alongside doctors and nurses trained in intensive care interventions, trauma surgery, respirology, anesthesiology, emergency medicine and infectious diseases. Once licensed to CCP level, the paramedics are eligible for a six-to-nine month residency overseen by a group of UHNBC doctors headed by Floyd Besser, who also holds a CCP certification.
A critical care paramedic responding to call has the ability to bring the life-saving interventions of a hospital intensive care unit to the patient and their ability to travel in a helicopter or fixed-wing plane to rural and remote locations drastically reduces response times.
In consultation with hospital physicians, a CPP determines a treatment plan for each patient to stabilize their condition and prepare them for transport. They have the authority to administer almost every drug a physician would and can perform procedures to restore heart rhythms or to clear an obstructed airway. If needed, a CCP can insert a breathing tube to intubate a patient to immobilize them and keep them safe and stable for the time it takes to get to a hospital.
“We go to these remote areas where sometimes there are no physicians or we go into a place where sometimes the physician hasn’t intubated for a long time and they may ask us to do it,” said Konkin.
Konkin, a 48-year-old Grand Forks native, worked as an ACP for 11 years in Kelowna. Throughout his 25-year paramedic career he always wanted to become a CCP but it wasn’t feasible until and how he’s using his CCP training to save lives in central and northern B.C.
“I honestly look forward to coming to work every day, being able to help more people in better ways than what I previously could,” said Konkin. “Just being able to go into the small rural remote hospitals it’s just tremendous when you see the relief on the faces of the staff there, that they’ve got some support and can take a breather.
“It’s more the rural and remote (staff) that appreciate us. We keep hearing about hospitals being shut down by a lack of staffing and with us being here now we can keep those nurses and physicians there and keep those hospitals open.”
Having those flights available to bring definitive critical care keeps ambulance crews and medical staff in outlying communities from having to leave their facility to accompany a patient in a ground ambulance. Considering how vast the northern half of the province is, one road trip there and back can take an entire shift for a small-town medic.
Ovenden, 33, was working ACP shifts in the Lower Mainland when the opportunity to train in Prince George was offered to him late in 2020. He considered medical school when he was 18 but didn’t like the idea of committing to at least eight years of university before he could start helping sick and injured people. He’s made Prince George his permanent home, like Konkin and Balfour, and that’s nearly doubled the city’s CPP ranks.
“I feel more like I’m more a member of the health care team,” Ovenden said. “I’m a paramedic but I don’t feel like an outsider in that circumstance.”
The new recruits allowed the Prince George station to expand its CCP shifts around the clock, rather than just day shifts.
CCPs fly in tandem with another critical-care paramedic to retrieve a patient. BCEHS has two fixed-wing planes and one helicopter based at Prince George Airport. Two daytime crews and one nighttime crew are assigned to the planes, while the helicopter is crewed for one daily 12-hour daytime shift.
Their hospital training in operating rooms and intensive care teaches CCPs how to maintain that level of care once the patient leaves the hospital so they can be transported to a receiving hospital.
Ovenden says the balance between classroom instruction and clinical training in the two-year program prepared him for just about every situation he’ll encounter away from the hospital and he knows he will save more lives as a result.
“Our job seems boring because all you see is this calm cool flight, and that’s the goal,” Ovenden said. “You want to get that patient as managed as possible on the ground and then you want a nice calm flight to your destination. The training prepares you do that.”
The vast terrain he covers in northern B.C. means long flights with one patient, sometimes as long as four hours if the call in in Fort Nelson, in sharp contrast to the 15-minute interfacility flights that are common in the Lower Mainland.
Ovenden knows CCPs who trained at Vancouver General Hospital and they had to get in line with other medical students waiting to practice procedures. At UHNBC, a teaching hospital with fewer students, the wait times were much shorter.
“The numbers are nowhere near the same, so you get to know all the staff, you get to participate in all these things,” said Ovenden. ‘We were running rounds, going up and consulting patients on the floor and things like that.
“Not only does it help at this hospital but we integrated with some of the residents teaching here and some of the medical students, so when they go to these small communities they know what our capabilities are and we’re all on the same page. It makes for a much more cohesive path for patients.”
Balfour, 42, moved to Prince George in 2019 after his wife got pregnant with their second child and they knew they were about to outgrow their one-bedroom Vancouver apartment. The chance to become a homeowner and work as an ACP is what brought him to Prince George and he jumped at the chance to learn critical care.
“I felt very welcomed as a team as soon as we came here,” said Balfour. “We were a growing base and the guys that were already here wanted everyone’s input and that helps with morale. It’s been a good experience and that’s what kept me here, I didn’t plan on staying initially.
“This is a great program and for paramedics curious about it, it’s worth investigating. I think having more paramedics able to do these transports for people up north who need specialty care to get them down to a bigger centre, there’s no negatives to having this program.”
