Crestline Coach Ltd. Breaks Ground for New Headquarters Building Continuing its rapid business expansion, Crestline Coach Ltd., a... ...more on Press Releases

Crestline Coach Ltd. Breaks Ground for New Headquarters Building Continuing its rapid business expansion, Crestline Coach Ltd.,... ...more on New Features

Crestline Coach Ltd. Breaks Ground for New Headquarters Building Continuing its rapid business expansion, Crestline Coach... ...more on New Products

When a massive explosion at a propane plant rocked the city of Toronto’s north end in August, sending huge fireballs high into the sky and thousands fleeing their homes, 34 ambulances and support vehicles were sent to the rescue, including Toronto Emergency Medical Service’s multi-patient emergency response vehicles (referred to as Emergency Support Buses).

“These Emergency Support Buses are used any time there is a chance of multiple casualties,” says Paul J. Harris, Operations Supervisor assigned to Special Operations, Toronto EMS. “We send the bus to the scene, and release ambulances back into the system to do regular calls.”

With 5.5 million people in the greater Toronto area, and a lot of tall buildings and highways, the potential for a mass casualty incident is high. Harris says the city has used multi/patient vehicles for 30 years. “In 1975, a local bus made contact with a train during rush hour. We had multiple patients requiring transport to hospital, and we realized that we couldn’t transport quickly enough. So, the commissioner at that time purchased an old transport bus which was retrofitted in-house.”

The makeshift model worked so well that Toronto EMS began buying professional models. They currently have three Emergency Support Buses in the fleet, the newest of which is a fifth generation vehicle built in collaboration with the engineers and production staff at Crestline Coach. “Every time we get a new bus,” explains Harris, “we change it according to things we learn over the years.”

The latest Emergency Support Bus is a customized model on a 40-foot low floor El Dorado National AXESS bus built in Riverside, California. Designed by Crestline to seat 13 patients or transport eight stretchers with access to oxygen outlets, 12-volt and 110-volt power, a diesel generator, a suction system and area lighting, the bus can also carry three wheelchairs, safely tied down.

Three custom-made seat bunks can be raised or lowered independently and quickly. Harris says it takes about 30 seconds to vary the seating arrangements. “At a recent apartment fire, the entire building was evacuated. We used the bus to treat on scene, for transport, and we also used it for days as an on-site walk-in medical centre.”

This versatility allows Emergency Support Buses to be used as public immunization clinics, briefing rooms, standby support at public events, holding centers, and even mobile command centers.

Harris says the vehicles often function as intensive care units for long-distance transport. “It’s not unusual for us to transport a sick child 120 miles from Toronto to London (Ontario). We need 110 volt power, specialized equipment, a large staff, and room to treat a patient in an incubator or on a heart-lung machine. With this bus, that’s no problem.”

The Emergency Support Bus has a Cummins ISL 8.3L Turbo Diesel 280 HP engine, and Allison B400R five-speed automatic transmission, air ride suspension, all-wheel ABS brakes and a 275-inch wheel base with four-corner kneeling capability which, Harris says, has taken the strain off the medics, who can now load a stretcher even without the ramp. “The low floor design is well suited for bariatric patient transport and is different from anything else. Several other large EMS services have contracted us asking us how it was built and who built it.

One of those inquiries was from the Winnipeg Fire and Paramedic Service (WFPS).

Emergency Support Buses can transport eight stretchers or seat 13 patients at a time.

When you’re pulling 12-hour shifts on the mean streets of greater L.A., you need a couple of things from your ambulance: 1) toughness and durability, and 2) enough comfort to get you through. Torrance-based Gerber Ambulance Service found both in the new Apex from Crestline Coach.

Gerber has added five of the vehicles since December, and plans to get more.

“What we liked from Crestline was the attention to detail and the durability of the product,” says Gerber Operations Manager Matthew Steeneken. “We were impressed by the powdercoating and the undercoating and a lot of other things that weren’t industry standard.

Built on Crestline’s AeroBody design, the Apex has an integrated roll cage and all-aluminum construction that contributes to better fuel efficiency and more available payload. It isn’t huge (body length: 151”; body width: 90”; interior height: 67”), but it optimizes operational space and offers options and floor plans usually seen on larger ambulances.

The Apex’s overall comfort, Gerber personnel have noted, extends to the cab.

“The configuration allows for the driver’s and attendant’s seats to actually recline,” Steeneken says. “I’ve never seen that. On a 139-inch wheel base, it doesn’t seem possible.”

An operations manager also notices the little things: Insulation, Door latches that can be released without using the handle, Heat and A/C along the roofline, running the length of the patient compartment.

All those little things add up big. Crews have noticed too, and can’t wait to get behind the wheel.

“Everybody wants their opportunity, and we’re trying to limit it right now to some of the better drivers, so they get a good breaking in,” Steeneken says. “The guys pretty much live in these things for 12 hours a day, and they really like to take full advantage of the equipment.”

At first glance, it’s clear the Mobile Primary Health Center is not the typical work area for paramedics. After all, it is a full size bus stationed at various places in Saskatoon, SK, with paramedics and nurse practitioners in it in their jeans. In fact, if it weren’t for the logos and larger-than-life sized photos of paramedics and nursing staff pictured on the bus, a passerby could easily mistake it for a tour bus.

Aside from the huge impact of the identifiable mobile health bus, as it’s referred to around Saskatoon streets these days, the MD Ambulance Care pilot project is causing quite the buzz across the country, representing strategic goals of emergency medical services and the future of EMS Canada. “As many of us know, EMS is no longer merely an ambulance. Paramedics have diversified in so many ways and community paramedicine is a natural progression,” says Jan Heibert, director of corporate services and special operations with MD Ambulance Care in Saskatoon.

Heibert has seen the project grow from infancy to practicality, and she says she’s seen the huge impact the mobile health bus had already had on the community.

“The trust that we have gained in our communities come in part from the time we take to listen to them. It is not a 15 minute appointment with time to only address the most important medical issue, rather time is taken to listen to many issues with discussion of options available to them. This has resulted in identifying healthcare services we can refer them to because as we talk the real health issues come to light,” she says.

In many ways, the project represents community paramedicine at its best. So many patients with limited mobility, who would not normally be able to receive care, can walk a couple of city blocks and step right into a clinic, an ambulance, a referral center and sometimes an informal counseling centre, all rolled into one.

The bus hit the streets of Saskatoon in late August 2008, with the vision to “create mobile community health care as a venue to generate health equity and close the disparity gap of those who are geographically, socially, economically, and/or culturally isolated.

Phase one of the strategic partnership between the Saskatoon Health Region, MD Ambulance Care and the Saskatchewan Ministry of Health – the Mobile Primary Health Center Team – focuses on the inner city population, including aboriginal, children, the elderly, immigrants, and refugees, as well as chronic disease management.

The reason for the focus is to bring health care to those who don’t normally receive it for a number of reasons.

The health bus is a converted RV that contains a fully equipped examination room. A team of paramedics and nurse practitioners provide the following services: health checks; blood pressure and blood sugar checks; chronic disease management; disease prevention; health education (for example, disease awareness, bike and helmet safety, smoking cessation, nutrition); wound care; and follow-up care.

Staff can also link patients who use the health bus with youth, addiction and mental health services; community-based organizations and programs; and other services provided in the community.

Shirley Isbister is the president of the Central Urban Metis Federation and she says her organization has nothing but praise for the mobile health bus. “It’s one of the most positive projects that’s come into the core area (of Saskatoon),” she says. “It’s an opportunity for people who don’t normally go for health care to stop in and get treated.

Isbister says the simple fact that no health care card is needed to receive treatment opens up a huge window for many living on the streets or in high-risk lifestyles.

“You don’t need your hospital card. You can just go in as ‘Jim Brown’ and receive the care you need,” she says. “In the core area there are a lot of homeless, high-risk lifestyle people and for a person to be able to go to that bus for service, it’s really important.”

The team working on the bus consists of a paramedic and a nurse practitioner, widening the range of service available to patients. This combination is proving to be very effective, according to staff working on the bus. “Working with nurse practitioners, I’ve learned a lot. I come from a background of nursing, so for me it’s nice,” said Debbie Oesch, an intermediate care paramedic working on the bus.

Heibert says the combination of the two professions has proven to be not only beneficial, but “necessary”.

“We have very similar visions in striving to bring the best to our communities. Even in this short time the staff have come together with ideas regarding health promotion, linking with other services and engaging in partnerships to better serve the client coming to the mobile health bus,” she says.

One of the health bus priorities is to have regular consultation with emergency rooms in the area. This helps manage ER return visits. For example, health bus staff can give IV antibiotics, write prescriptions, remove sutures and care for wounds.

Since the bus hit the streets, it’s had a positive response from the community, officials and representatives of special groups.

And the people living in inner city Saskatoon, where the bus is stationed, are not mistaking it for a tour bus, but more and more are quickly recognizing the bus for what it is: a treatment centre, a referral hub, and a place where they can come to just rest if it’s -40ºC outside.

“The trust we’ve built up is phenomenal. We have one client, who’s a drug abuser, and he first came in for sores, and just wanted a prescription and to get out. The next time he came in he sat with us and talked about his addiction,” Oesch recalls.

Aside from the general positive feedback from the Metis, aboriginal and high-risk population, Heibert says there’s also been a tremendous impact on the immigrant and refugee population.

“Many of these individuals are adjusting to a new life in a foreign country and are unfamiliar with access to health care. There was joy in their faces when they saw the health bus drive to their community,” she says. Because many newcomers don’t know how to access a family physician, the health bus staff has been there for them, and patients constantly give good feedback. As one way of measuring success of the Bus, a diary is kept by staff for patients treated:

October 24, 2008: “Tonight’s story involves a couple that came by for the flu shot, both are HIV positive. The young lady was an IV drug user and the guy I’m not sure about. The woman convinced her partner to come by for his first shot. Both have turned their lives around and are attending school to become addiction counselors.”

November 6, 2008: “A young woman brought to us from Infinity House. Initially we were called by a representative from Infinity House asking if we do pregnancy tests. Both client and representative arrived a short time later. Test results were positive. We also found out she is taking antibiotics that are contraindicated during pregnancy. Her response to the results went from crying to feeling confident about her options. She is going to keep the child and was setup to start prenatal care immediately.”

There are pages upon pages of these accounts of people being helped, and each one is written in a tone that conveys the hopefulness of the staff working on the bus. One thing that staff all emphasized when speaking about their new job is that they now have the time to understand patients a little more than in the traditional primary/emergency care setting.

“It’s a lot less adrenaline because most of the care is non-emergent,” says Paramedic Tanya Hibbert, who also works on the bus. “It’s more of a medical clinic… there’s less pressure.”

Also, instead of wearing uniforms, staff on the bus are outfitted in jeans and a health bus t-shirt, and while some members of the public were quick to question the casual dress code at first, Hibbert says the effectiveness of wearing casual clothing is evident.

“Wearing jeans and the health bus t-shirt, I get more respect from people in the bus than I ever did in my uniform,” she says.

Reliable, accessible and multi-faceted, it’s easy to see why the pilot project has gotten such positive response from across the nation.

Before deciding on the project, a lot of research went into community and primary health care. Community health care in several other places in the world was looked at, including United Kingdom, Australia and the provinces of Ontario and Alberta.

The health bus is also in tune with the EMS Chiefs of Canada’s recently released White Paper, which endorses “the future of EMS in Canada is providing mobile primary health care as defined by the needs of each community. The health bus goals include to: Strategically link traditional institutional health services with mobile community health care; re-define the provision of out-of-hospital care via a Mobile Primary Health Center Team; prepare for the demographic changes and health care complexities of tomorrow; and implement Treat & Refer protocols.

By partnering with the Saskatchewan Health Region and MD Ambulance Care, the project addresses needs of vulnerable populations, relieves some pressure on the health care system, and addresses demographic and health care trends as well as resources.

The bus is establishing new and creative health care delivery in core neighborhoods as well as decreasing fear and isolation within neighborhoods. This is done by creating a sense of trust among patients, something the health bus staff is seeing more and more.

Staff see many patients are warming to the notion of the bus and using it as a comfort, something Hibbert says is “restoring her compassion for people.”

The beginning

While the health bus is proving to be a successful pilot project, with other jurisdictions looking on closely, and showing interest in doing the same in their communities (in fact, Calgary has just launched a similar project), it wasn’t an incredibly smooth start. Like any brand new idea, it took a lot for people to focus in and get the right project on the go.

“From a project development perspective, it was difficult at times to keep structured with our process and to not get carried away with trying to do too much, too fast,” Heibert says. “We had to be cautious and understand that although the potential for this project was enormous, it was crucial to take bite size pieces in order to have success. We needed to find the partners that could help us make this work and look at a project that would demonstrate the potential of this kind of service.”

When it was initially thought of by Dave Dutchak, CEO and President of MD Ambulance Care, a concept of “providing health care and immunization by means of mobile community health bus” was presented, Heibert recalls.

“Although the concept was good, the timing was premature. The Saskatoon Regional Health Authority was not situated to approve funding for the project at that time,” she says.

Shortly after, MD Ambulance sent two of their senior management paramedics to the UK to attend a health care conference, and that’s when the idea was firmly planted in their minds.

“In the fall of 2007 we began researching the possibility of bringing a health bus to our communities,” Heibert says.

The biggest challenge, as with many new projects of this scope, says Heibert, was funding. Funding of the amount needed was unavailable from the SRHA, but finally the Ministry of Health division of Saskatchewan government started to show interest, and that’s what boosted the project and made it a reality.

“A true collaboration with the Ministry of Health, Primary Health in the SRHA and MD Ambulance Care Ltd. made this project possible,” Heibert says.

Pilot project getting local praise from the community and other health regions are watching closely.