Quebec Leaves Another First Nation Without an Ambulance
Mohawk paramedics are the only ambulance service in their region to be denied a secondary vehicle request by the provincial government. Meanwhile, private sector ambulances cash in.
by Hal Newman
Monday, 06H00: The Mohawk community of Kanehsatake’s ambulance service operated was forced to suspend operations indefinitely.
And then The Rover got involved via its The Last Ambulance project. As a consequence, there were a flurry of phone calls, emails, and high-level discussions. By Monday evening, the ambulance — operated by First Nations Paramedics (FNP) — was back in service with help from Groupe CAMBI and Paraxion (two other private ambulance companies).
And then on Tuesday morning, Kanehsatake’s only ambulance was out of service again until Wednesday morning at 09H00.
Are you confused yet? You’re not alone.
It’s difficult for the only Indigenous-owned ambulance company in Quebec because there are two sets of rules — one for First Nations and one for everyone else.
Here’s the backstory.
On April 30th, while returning from Centre-Hospitalier Saint-Eustache, First Nations Paramedics’ ambulance 9291 was involved in a motor vehicle accident with a passenger vehicle. Thankfully, no one was injured in the accident. However, the FPN ambulance sustained significant damage and had to be taken in for repairs.
Were this any other ambulance service in Québec’s second-busiest region for emergency calls, the crew from FPN would have simply transferred their patient care gear to a secondary vehicle and returned to service as quickly as possible.
But First Nations Paramedics isn’t any other ambulance service. It is the only Indigenous-owned ambulance service in all of Canada. And it’s the only ambulance service in its response zone to be refused a secondary vehicle by the Ministère de la Santé et des Services Sociaux (MSSS).
FPN has been asking for a secondary vehicle for 10 years and has consistently been denied — a decision that favours other privately-owned ambulance companies over FPN and the community it serves.
“This uncertainty has FNP and the communities that we serve, facing the possibility of not having access to a solution for the next year and a half,” said Rob Bonspiel, the owner of FPN. “They keep asking us to be part of a solution but they’re not giving us the goddamn tools to be able to do it.”
FPN’s paramedics are forced to work “7/14 shifts” with their inherent response delays while the private company which serves the immediately adjacent community of Oka has its paramedics on hourly shifts. The 7/14 schedule is reviled by paramedics, who must be on call 24 hours a day for seven consecutive days before having a week off. Because the schedule is so taxing, first responders quickly burn through the maximum number of hours they can work resulting in service delays. Hourly shifts don’t have that effect.
You wouldn’t be wrong in thinking there seem to be two sets of rules governing equitable access to quality prehospital emergency care — one which discriminates against Indigenous communities like Kanehsatake and Manawan and one for everyone else.
Manawan is still reeling from a tragedy caused by response delays in its community last month. A seven-month-old baby died in the Indigenous territory in April after 7/14 shifts took its only ambulance out of service. This problem had led to at least two previous deaths in the community but the Quebec government chose to ignore it.
Back to the backup vehicle.
With help from Groupe CAMBI ambulance service in Grenville (about 45 minutes west of Kanehsatake), FNP was able to borrow an ambulance to get back into service as quickly as possible. However, Groupe CAMBI needs their vehicle back for 06H00 the next morning and there are no easy solutions for FNP.
Demers Ambulance, the ambulance manufacturer, has indicated that to purchase a new ambulance, the timeline is in excess of 18 months. With technological requirements, a vehicle loaned from another service must come from region 9000 — that is the Laurentides or Lanaudiere.
“The largest service provider has gone on record as not permitting their organization to lend or rent ambulances to other services. The only other reasonable solution is the cooperation received from Group CAMBI and, in the past, Ambulances HRH,” said Bonspiel. “We believe that it is the right of all First Nations communities to have access to pre-hospital emergency care.”
First Nations Paramedics serves zone 621-A, which includes the federal lots associated with the Mohawk community in the village of Oka, and the geographical area referred to as Kanehsatá:ke. Zone 621-A is a subdivision of zone 621, which encompasses, Saint-Placide, Kanehsatá:ke, Oka, Saint-Joseph-du-Lac and Pointe-Calumet.
The creation of this subdivision took place in 1993 when FNP was officially recognized and awarded a provincial permit. FNP sees the Mohawk Territory as their priority, however Bonspiel is quick to point out his paramedics also also proudly serve the neighbouring community of Saint-Placide.
I asked Bonspiel if it’s true that the paramedics in Oka are assigned to calls on his territory because there's an inherent delay with the 7/14 schedule.
“Yes. The provincial dispatching system attempts to quantify variables regarding the proper resource attribution when a request for assistance comes in. One of the variables is a penalty. This penalty attempts to consider the time it will take for a paramedic on standby to receive a call, get to the ambulance, and finally, get to the user.
“A concrete example of this would be the following: A call for a Priority 1 comes in at 13:00. The computer assesses the proper resource to dispatch. The geographical location of the assessment puts the patient at being 6 minutes from the physical location of the 7/14 ambulance resource. An additional time, i.e., the penalty of 8 minutes, is added to the response time approximation. Adding together the two, the response time of the 7/14 resource registers is 14 minutes. The other ambulance company not in the assigned zone is 13 minutes away and not subject to any penalty. The hourly resource gets the call in a zone.”
According to Bonspiel, FNP has communicated to the people who make the decisions at the ministerial level, attempting to inform the Mohawk community's perception of discrimination by the government.
In 2019, before the pandemic, FNP met with the Mohawk Council of Kanehsatá:ke, CSSS Laurentides and the MSSS to discuss the problem.
“While the MSSS seemed only concerned about the additional expenditures to bring FNP up to par, the Mohawk position included the inherent benefits that the Health Ministry was overlooking.
These benefits took into consideration the FNP view that:
The newly formed hourly resource in Kanehsatá:ke would allow neighbouring ambulance services to more efficiently dynamically deploy their ambulances to high congestion areas during peak times in other zones without compromising coverage of Zone 621.
Building bridges and trust between two cultures who speak different languages, have other belief systems and ultimately, who have not had the ability to work together in the past.
Bonspiel says he’s not backing down. FPN has opened a dialogue with CEGEPs and wants to offer a paramedic program uniquely for indigenous people across Quebec. They’re looking for allies to establish financial assistance to provide scholarships for Indigenous youth to study to become paramedics.
Indigenous paramedics providing emergency prehospital care to indigenous communities operating under the exact same rules and guidelines and laws as their counterparts across Quebec.
I asked Bonspiel why two adjacent communities have different access to emergency medical services.
“That question haunts our existence.”