EMS North of the Border

On June 16, I visited the Montreal EMS Agency (Urgences-Sante) in Canada-the sixth-largest EMS agency in North America.

     When my French-speaking companion and I arrived at the building, we were immediately joined by Division Chief Jocelyn Caron and other staff supervisors. As pleasantries were exchanged in French, I nodded politely (as I had become accustomed to doing during my visit) and then proceeded to exhaust my French linguistic skills with "bonjour." Michael Harding, Special Unit supervisor, arrived shortly and was introduced as the best "anglophone" (as opposed to "francophone") tour guide in the department. He is a recent transfer from the southern region of Quebec, where English is more commonly spoken.

     After a brief rundown of the size and area covered by the department, we moved into the check-in area, where three computer screens allow EMTs to "punch in" on a computer system called SAAV (an automated arrival and departure system). Behind those screens are more computer screens and keyboards where medics can order clothing and personal gear from the company store.

     Beyond the lockers is a vending machine that does not dispense candies, but rather gloves, masks, stethoscopes and other supplies. Instead of requiring coins, this vending machine reads the barcodes on paramedic badges as a way to control the previously unchecked flow of medical supplies. Items in the vending machine include:

• Hand disinfectant
• Pocket masks
• Filter pocket masks
• Cold packs
• Stethoscopes
• Penlights
• Safety glasses (two models) to wear with or without glasses
• Triangulars
• 6" cling
• 4 X 4s (10)
• Earphones for portable radio
• Clamps
• Insta-Glucose
• Ambulance keys
• Universal scissors
• Gloves-mostly nitrile, some oversizes, and latex for those with a prescription.

     Next to the vendo-medic was a picture of three medics in SWAT gear. I asked Michael if they were moonlighting or just got into the wrong vending machine. "These are my guys," he told me, then explained how the agency runs two tactical units every day, 24-7. These units operate in the "warm zone," while the police, bomb squad and fire operate in the "hot zone," he said. Other EMS units stay clear of harm in the identified "cold zone."

     Another specialized unit of Urgences-Sante is the bariatric unit, which rides in an ambulance equipped with a bariatric gurney system and other lifting devices like the agency's unique stair chair developed in collaboration with Universite du Quebec a Trois-Rivieres (University of Quebec Three Rivers). The development team began with a safe dolly fitted with a chair and seat belt, which allowed two medics to safely move bariatric patients up or down stairs with minimal strain.

     Another innovative product was introduced when the agency's Michel Turgeon teamed up with Whelen Engineering and Federal Signal Corp. to develop a lighting system that provides constant illumination at all four corners of the agency's Demers ambulances, allowing them to work without darkness between flashes. This was accomplished by inserting an LED light into the strobe to maintain uninterrupted brightness without diminishing the intensity of the flash.

     Continuing our tour, we walked into the vehicle garage, which is designed to house up to 46 ambulances at a time. This doesn't include the four stalls equipped with lifts for vehicle repair, or the spaces for the command post, bariatric ambulance and two service vehicles. The two mass casualty vehicles with trailer hookups for the command post trailers are parked outside.

     At the stall closest to the offices, an ambulance team was just starting its end of shift check-in routine. At the end of each shift, the ambulance is gassed up, inventoried and washed.

     The quality control technician is responsible for stocking the ambulance, and each compartment is "sealed" with a badge number. If any items are missing from the vehicle in the field or at check-in, responsibility can be assigned to the appropriate person. At check-in, batteries and missing supplies are replaced from the nearby storeroom as part of the process.

     By law, medics have to inspect their vehicles prior to leaving the garage at the start of their shift. In addition to the end-of-shift cleaning, once a month, the ambulance is completely emptied, cleaned top to bottom and then reloaded.

     Because these vehicles and teams are constantly on patrol, a GPS system has been employed to track and position each team strategically through-out the island city. In a city with limited access (similar to New York), traffic is a significant consideration, and both vehicle position and location of the nearest trauma centers are important factors. Only one trauma center has a helicopter pad on the roof; the other centers use nearby school sports fields.

     At any given moment during the daytime, there are 85 Dermers ambulances in the field. There are 56 during evening hours and 34 overnight, which does not include the four full-time bike patrols from June through September.

     By government regulation, each ambulance has a mandatory retirement mileage of 300,000 km (186,000 miles), at which time the vehicle is donated to another city. To keep the vehicles and equipment in use up to that point, a team of maintenance technicians has been trained and certified by Stryker and Ferno to work on their products, including bunker helmets, BP cuffs, cervical collars and more. Motor and transmission work is sent to the Ford or GM dealer for service.

     Another daily occurrence for this agency is hospital "recuperation," which involves sending a biohazard vehicle to each hospital in the area to pick up used, but reusable, medical supplies, such as sheets, blankets, pillowcases, backboards, head immobilizers, straps, c-collars and vacuum mattresses. This equipment is then cleaned and sterilized as needed in an environmentally controlled area, then re-entered into the agency's inventory.

     At the conclusion of the tour, I thanked my hosts for their extreme hospitality, especially those who labored to converse with me in their second language, while my only reply was a simple "merci."