EMS Vehicle Readiness Project Development Report

Vehicle Readiness Project – Evolution and Development
Don Sharpe – Paramedic
AHS EMS Calgary Team A44
Long before I was injured and assigned to Modified Duties by AHS EMS, I became
active in Process Improvement regarding our 5 EMS workspaces.

Regarding the Calgary Zone Equipment Readiness Project, I identified the issue and
suggested resolutions starting in 2012. The latest effort was prefaced with the
document below in an email to the EMS SLT through my Supervisor on June 29,
2020. I received no acknowledgement of this email.

Prior to that, in May 2020, I sent an offer to do a ‘Gemba Walk’ to the EMS SLT.
The offer was rejected. Deemed unnecessary by Chief Sandbeck.

SLT Gemba Walk
May 2020
A GEMBA WALK gives the SLT a chance to visit crews on the apparatus floor and see
how a specific operation, in this case shift change, is being done.
This in-person observation allows LEADERS to see what is actually happening.
It also gives them a chance to INTERACT with the people doing the job, right where the
work is being done.
It’s also an opportunity to INSPIRE… and we can take it one step further.
Would you consider showing up as the SLT one Friday morning at shift change and
helping the crews get ready for their day?
Their Supervisors already do a terrific job of ensuring they have radios, drugs and other
equipment.
What do the crews need? They need a CLEAN TRUCK.
Scenario: As the night crew pulls in they are met by the SLT, thanked for their work,
offered coffee and a muffin and then wished a good rest period and good days off?
What if that same SLT then went to work cleaning the truck for the day crew?
One vacuums, one does windows, one cavi-wipes the front and one/two cavi-wipe
down the back?
The SLT could then engage the crew as they checked their equipment and booked on
for the shift.
We could do a ‘test run’ of this idea and work out the kinks so that when the SLT
appeared that morning they were polished and professional!
Let’s discuss it, I have all the tools we need already, together in an ‘Ambulance Shine
Station’.
(403) 863-2598

Shortly after Curtis asked me to start, I submitted a ‘typical day’ document in an email
to Heather Doyle, as she had been identified as the Supervisor who was in charge of the
ERT project. I also asked for a meeting, which happened on Sept 28, 2020.
I received no acknowledgement or follow up email from Heather post that meeting.

Typical Day on Modified Duties – Aug 31, 2020
0700 – Start of shift - Check in w/ Supvs/VESST.
Assignments from Supv take priority. Check trucks for fuel, equipment, cleanliness.
Empty Garbage Cans on Apparatus Floor – this is an every Monday requirement.
Wash dirtiest unit, today that is 2997 – Assist VESST w/ repair of 2997 cabinet door.
Check email - prepare daily work and documents.
0800 - Meeting with Supv Sergio Espinoza. Clean 41 Stn - dishes/blankets / wipe surfaces.
0830 - Plan day with modified staff
0900 - Clean bike room - stock supplies - fix bike rack.
Start hospital rounds - Clean SHC lunchroom & microwave – wipe counters - Clean amb bay -
Check O2 tank racks – replace medical stock left on top of cabinets – sweep supply room floor.
1000 – Redeploy at request of VESST to bring green tagged unit from K Bldg to DB4 - stock w/
kits from VESST - check kits – clean cab – wipe down patient compartment.
1115 - Back to hospital rounds - Return IV pump to PLC - Clean PLC Amb bay – Clean
lunchroom/microwave -remove CFD VitalAire O2 tanks from EMS PraxAir rack.
1300 - Return Modified duty staff to DB4 for medical appt - Investigate PPE left strewn about
on apparatus floor – restock PPE with Gulf unit – organize bike room / washer fluid stock.
1400 - Resume hospital rounds - FHH - clean/sweep Amb bay, supply room, clean
lunchroom/microwave. Investigate Amb cot left since Aug 28 in Amb bay - investigate broken
supply cart drawer with VESST – remove CFD VitalAire tank from Praxair ‘D’ tank rack.
1500 - RGH - Clean/sweep Amb bay - empty garbages & laundry bags - clean lunchroom &
microwave – wipe down counters – return medication left on counter to Pyxis.
1600 - back at DB4 - shift end duties – clean out vehicle – put away supples.
Didn’t get to SCUCC Amb bay or K bldg today, will do so tomorrow.
If I get far enough ahead cleaning this week I’ll tackle the 5 Stn Apparatus floor.
If I get that accomplished I’ll head up to Airdrie South Stn and clean their equipment room.
If I had some help in the morning we could clean / make ready more peak units at DB4.
< Aug 31- Monday -Aug 24 >

I clearly had asked both Curtis and Heather for 3 things at these meetings.
Staff, Supply Chain and Support for Process Improvement.
The program remained largely unsupported with any of these.
It was clear I was on my own most days so I adapted by developing a priorities check
list that I could use to help crews get into service faster.

Since I was often alone trying to make ready 20 or more vehicles, this mattered.
AHS EMS LOGISTICS TECHNICIAN
Don Sharpe – Paramedic October 2020
AHS EMS Calgary - Logistics Team
TOP 10 PRIORITIES FOR TRUCK READINESS
1. Walk Around: body/windshield damage - lights – wheel indicators.
2. As you inspect the truck, look for Garbage / Sharps.
3. Cot O2 is properly secured.
4. Doffing Bags empty and ready for use.
5. M Tank O2 – D tanks – Entonox properly secured.
6. PPE - present in front and rear of truck including hand sanitizer.
7. Mobile radio/Speaker mics present, attached & secured properly.
8. Sharps Containers - empty and properly secured.
9. Wall Suction - all parts present and properly secured.
10. Cleaning solutions and wipes present.
3 Units Checked this morning. Oct 13, 2020
-Unit 2997 – 10 min – 3 pass, 7 fail.
Cot O2 not secured – Wall Suction not secured.
Wrong sharps container – Garbage ++ on floor
RED TAGGED FOR BADY DAMAGE
Door 5 not closing properly.
ALL Units checked had some garbage inside,
either on the floor or in pink bins not emptied.
One Unit had a sharp on the floor.
All had one wrong size or full sharps container.
2/3 of Units had missing mobile mics.
All Units were missing some required PPE.

In mid October, Curtis and Randy visited DB4. Afterwards, I sent an email to follow
up. I received no acknowledgement of this email.
From: Don Sharpe
Sent: Friday, October 16, 2020 11:41 AM
To: Randy Bryksa <Randy.Bryksa@albertahealthservices.ca>; Curtis Swanson
<Curtis.Swanson@albertahealthservices.ca>
Cc: Sergio Espinoza <Sergio.Espinoza@albertahealthservices.ca>; Rob Jabs
<Rob.Jabs@albertahealthservices.ca>
Subject: Logistics Technician Designation
Hi Randy / Curtis,
Good seeing you today at DB4.
My vision for the future of the Vehicle Readiness Project
is more than an 'Equipment Readiness Technician' title can accommodate.
Over the next 6 months, then on into the future, I'd like to see the scope of this role
expand. Let's not limit them right out of the gate to simply 'getting equipment ready'.

Very briefly, here are some of the reasons to use the term 'Logistics Technicians'.
• 'Logistics' by definition is:
The detailed organization and implementation of a complex operation.
It is managing the flow of work and materials to meet corporate requirements.
• There are multiple EMS workspaces in the Calgary Zone.
They include K Bldg, Hospital Ambulance Bays, Stand Alone Metro Stations, Rural
Stations.... I've made progress at all of these and submitted a draft 'Care & Cleaning of
EMS Stations' document. In future Logistics Technicians could assist with tasks and
process requirements at all of these sites.
• I'd like to 'twin' with the very successful Peel Region EMS Logistics Program.
Logistics Manager Daniel Maia has been very helpful and accommodating, even on short
notice.
We simply do not have staff here with the training, experience and knowledge that
Daniel and his team have.
He's provided answers to basic equipment movement questions as well as helped with
'bigger picture' solutions.
• Ideally, our fledgling Vehicle Readiness Program will someday absorb the
BSOS VESST role.
It's not too soon to plan an amalgamation of the two programs.
The BSOS VESST program is currently not meeting the needs of Operations.
The Logistics Technician/Logistics Team description
is both simple and flexible enough to accommodate future needs.

I hope this answers the question sufficiently.
Respectfully,
Don Sharpe - Paramedic
AHS EMS Calgary Logistics Team

By the end of November I had been working on the Vehicle Readiness Project for two full
months and sent a summary to the SLT. I received no acknowledgement of this email.

From: Don Sharpe <Don.Sharpe@albertahealthservices.ca>
Sent: Tuesday, December 1, 2020 10:40 AM
To: Curtis Swanson <Curtis.Swanson@albertahealthservices.ca>; Randy Bryksa
<Randy.Bryksa@albertahealthservices.ca>
Subject: Vehicle Readiness Project Meeting
Thanks for allowing me to assist with this vehicle readiness project.
For two months I've given it my fullest energy and attention, using my previous 10 years
of practice and advocacy for clean, efficient EMS workspaces.

The following summarizes activities of note, solutions proposed and some of the hurdles
we still need to overcome.

I hear there is a meeting this week that I may be invited to.
To date I have rec'd no confirmation of the meeting or if my attendance is required.

Early on I asked that the team be assigned collectively as 'Logistics'.
The document outlining my reasoning was sent to the Vehicle Readiness Project and
Senior Leadership Team... and it remains unanswered.
Regardless, we see obvious logistics workflow patterns here and priorities being clearly
established, despite the poor communication surrounding the project.

For instance, S4 or S5 will often ask me if there is someone who can take a radio, a
tablet or a spare ambulance to a rural crew. I use the flexibility I've created so as to
assign this task Top Priority, for reasons discussed and delivered in previous documents
to all of you.

Often Supvs are unaware of what resources are available to them for these tasks. Since
they're already busy doing their own jobs, I'm most often the one who knows who's
working, what modified staff are available, what they are currently doing and what their
restrictions are.

The inconsistency of who the modified duty staff are assigned to this project isn't a
problem. I have organized, meaningful work for as many as you need to assign. I've
learned ways to use modified duty staff's desire to provide service by offering them
meaningful work choices that play to their strengths.

From the beginning I've asked repeatedly for three things: Staff, Supplies and Support
for Process. Instead, I've been given check sheets and spread sheets that provide no
real assistance or value to the project. I've asked to meet regularly to discuss these
issues with a Supv or project lead and been rebuffed. I frequently have to interrupt my

work to go to hospital for supplies because there is no system in place (yet) to stock
them at DB4.

To date I've received minimal assistance, no supply chain and very little support for
process improvement. There are often people assigned to Logistics ERT who do NO
WORK AT ALL on vehicle readiness. While we are all busy, they're sitting doing
nothing. I understand that Supv have discretion when assigning all staff, I just don't want
a false picture painted of the work done based on the resources assigned (unjustifiably) to
an ERT position.

I've been told that I can't keep a small supply of PPE in the supply room because it 'isn't
secure', yet I do this partly to keep trucks parked on the apparatus floor (which aren't
secure either) from being pillaged. It's time consuming to constantly have to ask for
access from a Supv to the Commissioning area for the PPE storage room key and then
walk halfway down the building to get to the main PPE storage
room. Yesterday (Monday) the Supv blocked the door to Commissioning open... leaving
the entire Commissioning area unsecured just so we could access the key. I guarantee
that BSOS leadership will find this unacceptable. This morning (Tuesday) he tells me he's
blocked open the main PPE storage room. This is shared space with Commissioning
where they store $500 vehicle batteries and they won't be happy about this either. The
obvious answer, to allow a small amount of PPE to be kept in the supply room, is the
kind of support for Process Improvement which I'm asking for.

I've also asked more than once, in writing, for managers to support the project by
coming to the floor at shift change, seeing for yourselves what the challenges are... and
participating in trial solutions. So far not a single one of you has agreed to do so.

I'm concerned that there's no paper trail and no accountability between myself and
those overseeing this project. I've received no acknowledgement that I'm assigned to
this project other than my telestaff, I'm not invited to any planning meetings and 90% of
my emails / phone calls go unanswered.

I've been experimenting with a Process 'TEST CONTROL' Truck - assigning it to specific
crews for 12 hr day shifts, two days at a time. I track issues with repairs, restocking,
cleaning and reporting. This effort gives me insight into what obstacles we're facing
with reporting and accountability.
A summary is attached and leads me to conclude that:
1. Problems with vehicle maintenance, expired and missing medications and supplies
will continue as long as we rely on crews to be the primary caretakers of these
assignments.
2. A 'Crew to Logistics' postcard size communication tool will provide some measure of
safety and accountability, much safer and easier to collect than some of the suggestions
I've heard, such as a laminated sheet and a grease pencil.

So over the past 2 months we've cleaned Ambulances, Supv vehicles, PPE vehicles, NAT
vans, Rural spares, Supv spares, Metro halls, Rural stations, firehall EMS dorms, DB4
supply rooms, VESST area, PPE supply storage, K Bldg, cleaned out vacuums at multiple
stations, medical supply rooms, etc. Some of the vehicles and workspaces we've
cleaned hadn't been cleaned in YEARS. Drugs and supplies from 2016 were discovered
in the cabinets of a PPE truck which had been working out of DB4 for months and
desiccated dead mice were cleaned out of the PPE storeroom. We can speculate
together how all of this happened.

K Bldg: We need people to get work done at K Bldg on a regular basis, at least 3 - 4
times a week. If anyone doesn't understand why and how trucks get dirty there I can
explain it to them, or take them down there and show them. This important work has
been described to me by a Supv as, 'that squirrely stuff you do' illustrating just how
ignorant some are.

I've also asked for a company phone and been denied, even after explaining that my
personal cell phone bill was $50 higher last month directly related to the work I'm doing
now. I won't change the way I do business, I'll continue to eat the extra cost in order to
get the job done.

Full Time VESST at DB4: It's time. Not only is there plenty of work to be done during the
day but from 4 pm to 8 pm there are ++ minor truck repairs to be made before evening
shift goes into service. What's really required at DB4 from BSOS is two shifts of VESST
covering 5 am to 8 pm. If I can assist communicating this information in a meeting with
BSOS I'd be delighted.

Rural Spare Cleanliness: Rural spare readiness is every bit as critical as front line
cleanliness. We've made a commitment here to keep the Rural Spares assigned to DB4
immaculate. Crews need to start in a clean truck, whether it's a spare or not, in order to
have respect for the process of keeping it clean. This is the same commitment we've
made for K Bldg.

Station Cleaning Projects: I've made remarkable progress on these station workspaces
in the Calgary Zone, you've had my DRAFT EMS Stn Care and Cleaning document for two
months now. Until it's approved and implemented I'll continue operating a station
cleaning routine based on priorities, staff assignments and time available.

Pathway Mapping DB4 Shift Change: I hear that someone had decided that clean trucks
will park there and dirty ones over there... without considering access to supplies and
crew traffic flow. I've worked with AHS Human Factors in the past, doing pathway
mapping in the Foothills Hospital Ambulance Bay. It is essential to understanding
workspace flow prior to making decisions... especially such as the movement of large
vehicles in a crowded pedestrian area.

District Base Volunteers: I hesitate to even bring this up... there's such little appetite
for innovation or change here. There are PCP students who would LOVE to work 4 hour
volunteer shifts checking/filling kits, cleaning vehicles, etc. These are good jobs for
them that absolutely need doing. These are simple jobs around the station that would
also teach them good habits prior to their practicums. Blaine Barody - AHS Mgr in
Edmonton - has details on the results of a six month secondment looking at a EMS
volunteer business plan.

If there is a meeting this week that you would like me to attend, please let me know.

Respectfully,

Don Sharpe - Paramedic
AHS EMS Calgary Logistics Team.

I added pictures to support the work and ideas for better communication with crews.

ß This is K Bldg – CLEAN!

I also added the results of a two week study we did at District Base 4
to determine patterns of use and care for Ambulances assigned to specific crews.

All issues were documented to illustrate and track where we needed to improve.

TEST CONTROL TRUCK - UNIT 3193
This immaculate Ambulance was given to specific crews for two 12 hr day shifts each,
with instructions to check/report any deficiencies - no matter how minor, to DB4 Logistics.
AHS EMS Calgary Logistics Team
NOV 16/17, 2020
EXTRA IV BAG AND MED BAG / BACK CABINET w/ IO KIT
STICKY SPILL IN PASSENGER SIDE DOOR POCKET
NOV 18/19
UNMARKED WIPES FOUND IN BACK CAB
NO MIC FOR RADIO (SAFETY ISSUE)
NOV 20/21
MISSING NITRO/ASA X2
o REPLACED FROM STOCK AT DB4
MONITOR PAPER LOW
FLOOR NOT MOPPED AT END OF DAY ON 20TH
o MOPPED MORNING OF 21ST
TRUCK UNWASHED
NOV 22/23
DOFFING BAGS FULL
GARBAGE LEFT INSIDE AMBULANCE
OUT OF PT MASKS IN BACK
NOV 24/25
AM/FM RADIO NOT WORKING
BGL KIT
Nov 26/27
REMOVED OVERSTOCK ++
PED KIT MISSING 4.0 ETT X 2 – OBTAINED FROM VESST
Nov 28/29
COT O2 NOT SECURED PROPERLY
NO PED PADS IN MONITOR
MONTH END DRUG CHECK NOT DONE ON 25TH
MISSING BVM – FORGOTTEN TO RESTOCK AFTER CODE ON 28TH
.
NOV30/DEC1
SIREN SWITCH LOOSE
CABINET DOOR 5 MISSING OUTSIDE RUBBER STOPPER
EXPIRED AMIODARONE – MISSING PPE (GOWNS)

I wrote one incident up as a children’s story.
This is page 1 of a 6 page PDF send as an addendum to this document.

POOR 3324
Don Sharpe - Paramedic / Ben Rempel - Paramedic
This is the story of Poor 3324.
It wasn’t always a poor unit, in February of 2020 it was a brand new unit.
On May 7, 2020 – Poor 3324 was ‘Green Tagged’ on the floor at Southgate.
A green tag means the unit is ready to go to work and save lives.
However, this morning Poor 3324 wasn’t ready to go to work.


I was still liaising with the PPE modified staff and working on Hospital EMS issues.
Several documented issues illustrate serious OHS violations not being managed.

FHH O2 tank storage – For OHS Review
This was the state of the O2 cylinder storage
in the EMS Supply Room at the Foothills Hospital on March 9, 2020.
The ‘D’ cylinders were unsecured on top of the O2 tank rack.
Several of these are Vitalaire property which they refuse to pick up.


I had multiple examples of Ambulances ‘Green Tagged’ at K Bldg after mechanical
service that were absolutely not ready to go into service without extensive rehab.

3 Trucks on 3 Different Days in September.
AHS EMS Southgate District Base 4.
Three Days in a Row DB4 had a green tagged Truck w/ serious deficits.
Missing Meds/Equip from Unit 3214 Expired meds from Unit 3275
Expired Pediatric Airway Supplies from Unit 3321

We were now routinely discovering issues with damaged equipment during our Vehicle
Readiness Duties. These were passed on to the VESST manager for investigation and
resolution.
- Below – Several toddler masks size 3 found crushed in different Paediatric Kits.

- Below – Stretcher Monitor Arm securement near failure.

I sent two emails to Emergency Health Services, as they are responsible for the
regulation governing EMS Operators cleaning, maintaining and readiness for use.

Sent: Tuesday, September 15, 2020 9:16 AM
To: Amy Langridge <Amy.Langridge@gov.ab.ca>
Cc: calgary.currie@assembly.ab.ca
Subject: EMS isn't Ready
Hi Amy,

I'd like to talk about AHS EMS and some of the reasons we are failing.
Attached are two of dozens of similar reports I've submitted to EMS Leadership.

AHS Ambulances are filthy, the Paramedics are exhausted, our Patients are not being
served. Many Ambulances moving about the Province right now do not meet the AHS
Policy level 3 standard for cleanliness and are missing critical equipment and
medications.
Response times to critical emergencies are unacceptable, both urban and rural. I've sat
in the Office of the Chief with possible solutions to these issues on more than one
occasion. I've also seen many managers turn a 'blind eye' to the problem of vehicle
readiness.
You may be aware that I'm also an advocate for eliminating EMS Hospital hallway waits.
I believe they are certainly a factor in our shift start/stop issues. I'm not even going to
talk about them here other than to say they're an abomination of Health Care.

I don't believe our standards for truck readiness are unreasonable, yet they're
consistently not being met.
You are aware this area of professional practice is governed by the Alberta Ground
Ambulance Regulation.
I don't mean to insult you by quoting the relevant parts here, it is for lay persons who
may read this email.
(https://www.qp.alberta.ca/documents/Regs/2020_110.pdf)

Here are what I view as the three most applicable sections to this discussion:
- Equipment and supplies
26(1) An ambulance operator shall ensure that every ambulance is equipped with the
equipment and supplies required by the Provincial Medical Protocols.

26(2) Ambulance operators and ambulance attendants shall ensure that all equipment,
supplies and medications used to provide emergency health services that have a
specified shelf life are removed from the ambulance on or before the expiry date.

- Ambulance defects
30(3) An ambulance operator shall immediately address any defect or mandatory repair

of which the ambulance operator is aware so that the ambulance may be operated
safely.

This is the MINIMUM regulatory standard and I have mountains of evidence this
standard is not being maintained.
If the Registrar and AHS Leadership want to download this responsibility and the
associated accountability to Paramedics, they need to keep some of the items we're
discussing in mind.

The Alberta College of Paramedics who registers me also has Standards of Practice that
are applicable to this circumstance.

- 3.5 Maintaining high standards of personal and professional conduct.
- 3.12 Ensuring vehicles and equipment are maintained and in compliance with
regulations.
- 3.13 Operating vehicles and equipment in a safe manner with appropriate education
and ongoing proficiency.
- 3.14 Complying with emergency medical response and transport vehicle operations,
required certifications and best practice.

- 5.6 Preventing or minimizing adverse events through identification, reporting and
monitoring.
- 5.8 Incorporating risk management strategies to ensure safe practice.
- 5.9 Responding to human and system factors in practice to minimize medication
errors and unsafe practice.

- 6.2 Guiding, directing and seeking feedback from stakeholders in the planning,
delivery and evaluation of the provision of health and public safety to ensure safe
practice.
- 6.3 Incorporating appropriate evidence for quality and safety improvements in health
care and public safety.
- 7.6 Taking appropriate measures to ensure prevention of infection between patients,
providers and the public.

Paramedics would prefer to simply 'Check The Ambulance' and book into service at the
beginning of the shift and get to work. However, since we clearly have a professional
and legal obligation to ensure the Ambulance and equipment/supplies are in order...
and since they so often ARE NOT EQUIPPED as per Section 26(1) of the Regulation
Paramedics have two choices.
1. Book in service and check/replace/repair missing equipment/medications or
delay booking into service and risk the wrath of management. The first option
exposes my patients to unnecessary risk and my license to practice Paramedicine
to investigation and termination.

2. The second option exposes my career to possible risk of discipline, suspension or
even termination... unless my Supervisor again turns a 'blind eye' to a delay
booking into service that sometimes exceeds an hour.
This is occurring daily. There is overwhelming proof that this practice weakens AHS
EMS. Our current fleet is not being replaced quickly enough, so it's critical that we take
good care of the vehicles we are currently using. Worst of all, patient care is being
adversely affected. How do we fix it?

Paramedics will 'keep their head down' and keep working for a whole bunch of reasons.
They'll thrash the horses and do their best until something breaks - many of them are
broken already.
The fact that what is happening is wrong and CAN BE CORRECTED is the reason I'm
writing this email.

One possible solution may lie in section 9 of the act:
'The Registrar may, in writing, delegate any power, duty or function of the Registrar
under the Act or the Regulation to a qualified employee of the Department'. Whether
that means EHS or AHS I'm not qualified to say.

What I can tell you is that there is a position for a Strategist in AHS EMS BSOS. I've
spoken with the manager, that position is currently unfunded however it is may be
exactly what this organization needs to move forward on this issue.

Regardless, Paramedics need more help. In the past it was possible to keep up with
restocking, cleaning and IT demands. Now call volumes, late trips, hallway waits and
COVID issues have made the job of the a front line Paramedic unmanageable. One
immediate solution is to get them some help preparing vehicles for service.

Many younger Paramedics who care very much about their patients are struggling to
make sense of this unworkable situation. They have young families and great careers
ahead of them, senior staff like myself have a responsibility to take on tasks related to
process improvement. There are answers to this problem that will provide
accountability, help protect Paramedics and most importantly, serve the needs of our
patients.

I look forward to discussing solutions with you and your team.

Don Sharpe - Registered Paramedic.
403 863-2598

This first email failed to prompt any action that I was aware of.
Notice I also sent it to my MLA and followed up with a phone call to discuss.

I sent a follow up email after learning there was to be an EMS Operators Meeting.
Sent: Wednesday, December 16, 2020 9:26 AM
To: Amy Langridge <Amy.Langridge@gov.ab.ca>
Cc: calgary.currie@assembly.ab.ca <calgary.currie@assembly.ab.ca>
Subject: Re: EMS isn't Ready

Hi Amy,
Thank you for taking my call yesterday.
Here's the information we discussed for the meeting regarding vehicle preparedness
tomorrow. I've redacted the names however you are always welcome to use mine, I do
nothing anonymously.

Here is the body of the email:
--------------------------------
Hi XXXX,
Some significant concerns regarding the condition of unit 2997 today.
Equipment/Vehicle Related:
• missing wind shield washer fluid in compartment 3
• missing wrench in compartment 2
• fire extinguisher in compartment 2 expired in 2017
• car auxiliary power outlet charging cord for the portable suction unit broken
• electrical outlets in the patient compartment non operational, though power to
other devices in the back in working order (we have been unable to resolve this,
will create a ticket and tag the truck at the end of the shift tonight)
• truck had less than 3/4 tank of fuel
• main O2 tank just under 500psi - low enough that the oxygen alarm was
sounding (...perhaps this was left as there was no wrench?)
Truck Cupboards:
• IV Cupboard/Drawers:
o D5W expired (Aug. 2020)
o only one 1000ml NS bag
o only one 10 drop set
o expired IV supplies
o Insufficient number of 10ml NS
o insufficient number of 3ml syringes
• Monitor:
o Expired Pediatric Defib Pads
o BGL kit VERY low on supplies
• Truck Cupboard IO Kit:
o expired 10ml NS (Sept. 2020)
o expired iodine swabs (Sept. 2017)
• Airway Cupboard/Drawer:
o expired LMA size 1&2 (March & Aug. 2020)

o expired intubation stylet
o intubation kit missing a MAC 4 blade
o intubation kit had expired mucos
o no entonox mouth piece attachments
o BVM was not set up correctly (all pieces were accounted for)
o 2 expired decompression needles, 2 non expired, however one was not in
the correct location
o some stock in the wrong locations
• HAM Drawer:
o expired D50W
o expired epi preload
o missing 1 anaphylaxis kit
• Black Medication Kit:
o ALL epi expired
o ALL atrovent nebs expired
• Pediatric Kit:
o expired IV catheter
o expired ET Tubes size 4, size 2.5 two size 3
o expired intubation stylet
o BVM not set up - missing end title, peep and peep diverter
o BVM masks deflated
• Secondary Bag:
o missing D5W
o expired D50W
o IO kit iodine swabs expired, missing 20ml syringe
Don had directed us to take this unit today (and to clarify these concerns are not
directed at him or his vehicle readiness team) I do believe that Don mentioned that the
unit came from the IFT side of DB4 as they were short units today due to some red tag
issues.
Don advised us on what he and the VRTs had already addressed, and everything
checked out in line with this later: the unit was washed, PPE and cleanliness issues
addressed, the primary bag had been switched to a newly stocked zip tagged one and
he was in the process of checking the other items in the equipment tree (problems
found and addressed by him are included in the list above). I spoke to Don regarding the
other issues found after we discovered them later while at the hospital. He is CCed on
this email for continuity.

The monitor had 2 days worth of self tests hanging from the printer, and its last use in
the archives was on Dec 12th. The CAD was already open to the MPS log in screen, and
all the log in information for a BLS IFT crew was pre-entered. Based on this I suspect this
is an 'IFT' truck, if that helps direct your search for resolution into this matter.
Thanks in advance for addressing this, your support on matters such as these is
always appreciated!

This second email did generate a written response. I was never contacted as promised.
Only because the email contained that ‘promise of action’ is it included here.
From: Amy Langridge <Amy.Langridge@gov.ab.ca>
Sent: Tuesday, December 22, 2020 1:25 PM
To: Don Sharpe <Don.Sharpe@albertahealthservices.ca>
Cc: Brent Tario <Brent.Tario@albertahealthservices.ca>; EHS <ehs@gov.ab.ca>
Subject: RE: EMS isn't Ready
Dear Don,
Firstly, thank you for taking the time and initiative to reach out to the EHS unit to address your
concerns. We appreciate that these are sensitive and unprecedented times for all in EMS and I
thank you for allowing us some time to consider the information you have provided during our
telephone conversations and emails.

Whilst the issues you have raised are of great concern, there are many factors that realistically
lie with the operations department and supervisory personnel within your organisation. I
appreciate that you stated the concerns you addressed have already been presented to your
leadership team without a satisfactory resolution, however, it would be remiss of me to proceed
in escalating this matter without attempting to signpost this to the most appropriate
department within AHS as a primary course of action.

I have reached out to the leadership team within AHS EMS to discuss your concerns and have
copied Brent Tario into this response for your records. I have been assured that this matter will
be investigated by AHS EMS and that they will be in contact with you to discuss further
actions. Both AHS EMS and the EHS unit will track the course of this enquiry, however should
you feel that further input from EHS is required, I ask that you maintain the channels of
correspondence you have already previously taken with us.

Please rest assured that the specialist team has not dismissed the seriousness of the information
you have provided to us and we will be following this up within our department and seeking
escalation where appropriate. With the implementation of the new Ground Ambulance
Regulation (GAR) there is now a greater opportunity to instigate change within the EMS system,
to which the EHS unit is actively working hard to achieve with the cooperation and assistance of
all licenced ambulance operators within the province. A working group has been formed to
provide operator feedback, discussion and recommendations to the Registrar on how best to
implement the GAR. Part of the issues you identify with the equipment and maintenance of
ambulances is a key focus of this group and whilst I am afraid I cannot divulge the details of
what has been discussed, I hope that you will appreciate that there is anticipated action coming
regarding the areas of focus in your correspondence.

Once again, I would like to thank you for providing all the information you have in you emails
and phone calls. Furthermore, as a fellow experienced paramedic I do understand your
frustration and concern, however it is so encouraging to hear that you continue to act as a
mentor and advocate to the profession, especially for those just staring their careers in EMS.

Kind regards,
Amy Langridge

We also dealt with complaints from crews in a responsible manner,
without excessive use of time taken away from the job at hand.

From: Don Sharpe
Sent: Wednesday, December 2, 2020 9:37 AM
To: Sergio Espinoza <Sergio.Espinoza@albertahealthservices.ca>
Cc: Christopher John Socholotuk <ChristopherJohn.Socholotuk@albertahealthservices.ca>
Subject: Complaint about Vehicle Readiness from M425
HI Serge,
I dug into this issue right away.

3045 was used the previous night shift by Twaddle/Knittle.
They're both pretty reliable, so it seemed strange there'd be a complaint about their
truck. They had to park outside, which currently limits the first check we do.

0530 to 0730 is our busiest time, after that 3045 was brought in and parked in bay 33.
No one touched it... 3045 sat there until Kubat/Jamison came in at 1300.
At 1300 hrs there were 4 other trucks in the bay.
3221 was in bay 31, we had taken it to Quarry Park earlier in the day to have the CAD
replaced. I had removed the red tag from the vehicle but didn't erase it off the white
board by the VESST office.
When they saw the note on the white board they assumed 3221 was still OOS.
This was my fault as I was the one who took it to Quarry Park and brought it back again.
2958 was RED TAGGED - however 3164 and 3162 were both GREEN TAGGED.

So, when at 1100 hrs M-424 was booked down I knew I had enough trucks ready for the
day. Teisha asked me to move Claresholm 2 regular truck 3022 from AFAB in Vulcan to
Claresholm and switch it out with the spare 3018 and bring the spare back to DB4.

If I'd had two people on ERT I could have sent them with a driver to AFAB but I only had
the one - he has restrictions to one hour of driving so I drove him down to Vulcan, he
drove back while I went to Claresholm and then back to DB4.

I did talk to Bryce and their complaints about the truck were really not very specific.
Sounds more like they were tired and frustrated that 3221 was OOS (again, my fault)
and unhappy there was only 3045 on the Metro side (ignoring the two 3100 trucks on
the IFT side). So, in closing I'm glad you called me about this!

It illustrates some existing process problems we knew we had.
We're working on them and I have every confidence we'll get them fixed.
Overall, a little deal.
See you tomorrow!
Don


We dealt with FEMS IT issues by contacting the appropriate Fleet Staff for resolution.

Hi Teshia

Can you help with a FEMS history?
One going back until at least August 1, 2020.

I spoke with Will this morning and he suspects it was swapped with a unit from
Southgate that needed an ASI sometime between Dec 10 - 14, 2020.

Thanks, Don

We discovered and corrected many of the discrepancies created within FEMS.

You’ll recall supplies were number two on the list of three things I needed to make this
program work. We found shelving, we carefully added stock from the destocking of
vehicles and hospital EMS supplies and slowly built a supply room with 90% of what an
EMS crew was generally missing at the start of the shift.
No more, “You’ll have to go and get that from the Hospital.”
Our goal: EMS Vehicles will book into service clean and fully stocked at shift change.

Having these supplies ready to help crews book into service with all of their gear gives
them confidence. Confidence that someone cares about them, so they can care for
their patients. It lowers their shift start anxiety and it show RESPECT.
- - - - - - - - - - - - -
Here’s a link to a short video about Peel Region Paramedics and how Geenard cares for
them. It’s one minute in length but it speaks volumes to the great attitude this young
EMS Logistics Technician has about the work he does.

https://youtu.be/eMkqmuwsH3g

Why was stocking sand at both District Base Stations such a big deal?
I encountered vocal opposition to this basic requirement from some managers.
“They can go to a Fire Station and fill their sand containers, like they’ve always done!”
This isn’t 1990, if it’s on the list of required items, we should stock it. Period.

At the same time I’m trying to build a Vehicle Readiness Program, I’m dealing with poor
cleaning and building maintenance issues at Southgate EMS District Base 4.

DB4 Detritus & Building Management
October 2018

I don’t think there is any argument
that EMS District Base 4 is not as
clean or organized as it could be.
Over the past month I’ve consistently
removed and discarded soiled and
broken equipment, garbage and
expensive medical stock, from the
apparatus floor, offices and
equipment storage area.

It appears that we need an attendant
whose job it would be to daily
review, sort and straighten up in the
many separate areas of the building.
Clean, well-organized workspaces
are an asset to any busy organization.
When work areas are clean and
efficient, staff knows they are valued
and can relax, performing their tasks
with increased efficiency and safety.

Every Monday morning I came in ½ hour early to empty the garbages and clean the
bathroom. Because it needed to be done. Because no one else would do it.

Monday Mornings - DB4
October 5, 2020
Monday Morning has regular tasks that need to be done, as well as a few surprises.
The main floor bathroom, last cleaned on Friday, never on Weekends. Same with the Garbage.
A ‘green tagged’ Unit had a broken IV tray left in the patient compartment.
There were two broken mobile radio mics – both found disconnected from the radio.
These are examples of how we simply aren’t looking after our facilities or equipment.
I could show anyone another dozen examples.

OK, Let’s talk more about K Bldg.
This is important to the Vehicle Readiness Project because the dirtiest, most under-
stocked, uncared for EMS Vehicles I see at DB4 come directly from K Bldg.
This is the transitional space where EMS vehicles stage for two reasons. They’re either
waiting for maintenance or waiting to be put back into service.
Hospital Ambulance Bays are also transitional spaces, albeit for different reasons. All
EMS transitional spaces need specific attention and procedures.
“Whose Job Is It, Anyway?”
There is a story about three people named Everybody, Somebody and Nobody.
There was an important job to be done and Everybody was sure that Somebody would do
it, but Nobody did it.
Nobody took responsibility, nothing got accomplished.
It’s a story that plays out most often in organizations that lack accountability.
Who is supposed to clean K Bldg? Nobody.
In Spring of last year K Bldg was so dirty I asked Fleet Staff if they knew anyone who
could send a street sweeper through the building. 20 minutes later there was one parked
outside waiting. We moved all of the Vehicles, tables and equipment outside and 20
minutes later it was done. Then I brought my power washer from home and finished the
floor and walls up to the 5 ft. mark.
Who provides equipment to clean Vehicles in K Bldg? Nobody.
I purchased a 6.5 hp vacuum and acquired tables, lockers, a cart, linen bag/supplies.
Who is supposed to clean Vehicles in K Bldg? Well, that’s a tricky question. Because it’s
not just EMS Crews dropping Vehicles off there... I’ll explain.
When EMS Crews drop a vehicle off in K Bldg it’s their responsibility to:
- Switch all of their equipment and personal gear over to a ‘Green’ tagged vehicle.
- Remove all garbage from the cab, the patient compartment and doffing bags.
(There are garbage cans and a linen cart there for you to use)
- Wipe down the cab of the Vehicle they’re dropping off.
(This is to protect our Fleet Services Teammates, the Mechanics)
(Washing the exterior of the Vehicle is nice if there’s time, but not necessary)
- Red tag the vehicle with a clear, concise description of the problem.
Can I get a AMEN if you like getting into a clean Vehicle at K Bldg?
- Do a vehicle check sheet in FEMS on their new Vehicle. (Safety)
However, it’s not just EMS crews dropping off EMS Vehicles there.
Here are four examples of where else Vehicles can come from:
1. Back from regular service at Fleet. *NB* - Fleet staff will usually wipe down the cab
when it’s returned to K Bldg however… we wipe it down again for safety.
Mechanics will not mop their boot prints out of the back and I’ve found grease marks,
garbage, vehicle parts and tools left in Vehicles. Right now, unless I get to it before you
go to switch into that ‘Green’ tagged vehicle, it’s up to you to find and clean that mess
up. To me, that’s simply unacceptable.

2. Towed in from an the Field. This happens often, after an accident or mechanical
problem disables the vehicle. Sometimes this happens during a call and after transferring
care to a backup crew, a Supervisor will pick up the first crew and take them
to K Bldg for another Vehicle. Here’s where it gets interesting… It’s my opinion that the
crew has absolutely no responsibility at all for cleaning a disabled vehicle at the roadside.
NONE. Funny enough, there are some in Leadership positions who disagree. I sent an
email earlier this month asking to be notified when a vehicle was towed to K Bldg so I
could go down and clean it before Fleet worked on it. I got an email from BSOS that
states even during a RED ALERT it is the crews responsibility to wipe down the unit and
remove (some) of the garbage. I’m paraphrasing here but the tone (deaf) is accurate. This
is typical of our organization that a recommendation of doing half a job is sufficient.
3. Vendors drop off Vehicles. Often EMS Vehicles are both picked up and dropped off,
primarily by Shaw GMC and Range Mobility, for specific service or warranty work that
Fleet doesn’t perform. I have picked up a Green tagged Vehicle from K Bldg to move to
Southgate that had almost no fuel; the needle was right on empty. Turns out, Range
Mobility had been testing the charging system and had left it outside running overnight,
declared it ready to go and then dropped it at K Bldg. Certainly it’s not the Vendor’s
responsibility to fuel our vehicles and maybe they did tell someone it needed gas but the
message wasn’t delivered and NOBODY did anything about it.
4. Returned to K Bldg after Major Work. An EMS Vehicle that’s been in a serious
accident may remain at Fleet for months, having various repairs done by different
departments. THESE VEHICLES COME BACK FILTHY. Much of the stock left in
the Vehicle will expire during this time and have to be replaced. In our current system,
these Vehicles are ‘Green’ tagged at K Bldg and you may be asked to switch into it
without any effort to restore it to actual in service status being done by any EMS
employee. Again, absolutely unacceptable.
For months it’s been my practice to go to K Bldg daily for a couple of hours after the rest
of my work is done. IMO, this is not sufficient to ensure Crew and Fleet Safety.
I believe:
Every EMS Vehicle needs to be assessed by the Vehicle Readiness Team when it arrives
at K Bldg, whether it’s going in for maintenance or heading back into service, regardless
of who brings it in. We need to know where it’s been, what happened, what’s been done
and where it’s going.
Rural Vehicles present an additional challenge. It’s my belief that we need to be taking
replacement vehicles out to the Rural Crews whenever possible, keeping them in service
in their home communities as much as possible.
I do value the work our VESST's do, they have the responsibility of ensuring that we
have enough vehicles at Southgate for every Crew. Almost daily I'm asked to move 1 or
several vehicles to assist them. They do no standard work cleaning our Vehicles.
Lastly, I have hundreds of pictures and dozens of reports that I've submitted regarding
cleaning of EMS Vehicles, at District Bases, at K Bldg and in the Hospital Ambulance
Bays. Now that the Vehicle Readiness Project is DEAD, what happens next is
predictable. Everybody wants to see Somebody working on Vehicle
Readiness. Nobody wants to have to deal with the alternative.

Be Prepared to hear from Fleet Services when a vehicle is dropped off without being
cleaned. It’s happened before, they’ll simply refuse to work on it until someone from
EMS cleans it. Good for them.

Help Protect Our
Fleet Services Teammates!
Please Wash / Wipe Down Your Unit.
Leave a Red Tag / Specific Info.
Take all of your personal gear.

I have several documented incidents of Fleet rightly refusing to work on contaminated
EMS Vehicles. The issue is one of neglect by leadership, blaming crews isn’t the answer.

Cleaning Ambulances to a Standard – Policy Level 3
Providing Covid19 Pandemic Safety for CoC Fleet Staff
On March 16 I arrived at MSD with Unit 2881 for a rear door handle repair. I was
asked by the Fleet intake staff if the vehicle was cleaned to a Level 3 Standard and
I said that I could not confirm that.
They showed me a memo, I called S4 and then took 2881 to 3 Stn and cleaned it.
Fleet also showed me their new washroom policy.

This document was sent to leadership on June 2, 2020.

AHS EMS Unit 3022 – ‘Green Tagged’ but not ready for Service
Unit 3022 was ‘Green
Tagged’ in K Bldg today.
I don’t know why it was
there or what work had
been done on it.
What I do know is that it
was filthy, inside and out.
The attached pictures show
the door pockets and under
the front passenger seat.
As I cleaned it, I discovered
the side step was broken.
3022 now gets a red tag.
Then I opened the back
doors to remove and clean
the cot and they doors
weren’t closing properly.
Another note to the red tag.
What does a ‘Green Tag’
actually mean? In this case,
it appears to mean very
little. 3022 wasn’t clean, it
wasn’t stocked, it wasn’t
capable of being used as an
Emergency Ambulance.
Perhaps we need to be a
little more definitive about
what ‘Green Tagged’ means.


AHS Calgary Metro EMS – Unit 2916 - June 14, 2019
WHAT WILL IT TAKE TO SOLVE THIS PROBLEM?
Hi Serge,
Ben and I chose 2916 that day for several reasons.
2945 was red tagged for an ASI.
2865 was red tagged for A/C repair and 2,000 km over for a B Check.
There was one other unit there supposedly ready for the 0900 crew to use.
2916 was really dirty but that’s par for the course at DB4.
We knew we could clean it in an hour or so… this is how our day usual starts.
Then we found no oil on the dipstick during our Vehicle Check.
2916 was also less than 500 km from the next scheduled B Check.
We put in two liters of oil and decided to go to MSD and get the B Check done.
Then we found the right inside dual tire was very low, <30psi.
We pumped it up to 65psi using the VESST compressor.
We got approval to be OOS from S44 to MSD.
Being OOS allowed us to also help Ian (VESST) out and take 2865 to MSD.
There were several missing screws in both back door panels of 2916. Ian (VESST)
tried to fix them but they were stripped so we put the Body Shop on our list as well.
At MSD the truck was assessed as having either a fuel leak or disabled fuel vents.
There were now too many issues with 2916 so we red tagged it and left it with the
Mechanic in the Body Shop. Well, at least it was clean for the next crew to use…
We walked over to K Bldg and of several units there only 2914 was green tagged.
2914 was very dirty and missing equipment like the Med Bag and Intubation Bag.
I phoned Will (VESST) and he said they had removed some kit to supply other units.
We drove back over to the Body Shop and put together a complete set of equipment.
So it took us almost 4 hours that morning to become available to do calls…. WHY?
A Calgary Metro Ambulance that was supposedly green tagged and in-service at DB4
was not only unacceptably dirty, it had several DANGEROUS DEFICIENCIES.
NO OIL ON THE DIPSTICK. A FLAT INSIDE DUAL TIRE. A FUEL LEAK/VENT ISSUE.
Who’s accountable for this?
If we had gotten a call right at the start of the shift, this is the unit we would have
responded in. This is the unit we would have put our patient into for transport to
hospital. This unit was UNSAFE FOR USE AS AN EMERGENCY VEHICLE.
We’re continually disappointed with the state we find our Ambulances in.
We’ve filled out vehicle check sheets, written occurrence reports and complained
loudly to anyone who would listen yet this appalling situation still exists.

But the Sun Shines Brightly in Peel Region, Ontario.
There, Paramedics NEVER get into a dirty truck to start their shift.
They NEVER are missing equipment, their medications are NEVER expired.
Once a year, the Paramedic Crews host a BBQ to celebrate their Logistics Technicians.
I met Danny Maia, their Manager, several years ago and keep in touch with him.
His program is the example we were following.

I could post a dozen more pictures like this, however it’s just as easy for you to follow
Danny Maia on Twitter. He regularly praises his Logistics staff and the work they do.

So that’s a summary of some of the work done building a Vehicle Readiness Program
here at AHS EMS. Some might say there’s still a program in place… but is there?

EMS Vehicle Readiness Project Development Report

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EMS Vehicle Readiness Project Development Report