by Diana Foxall
Randy Slemko hasn’t been around for every single one of BCEHS’ 50 years, but he’s been around the block a few times and has experienced various different eras of the organization since he joined what was then BC Ambulance Service back in 1991.
He began as a contractor, maintaining some of the software applications that were being used by the service in the early 1990s.
“We had a budget expenditure tracking application, and I was maintaining that; for a while, I was maintaining the fleet management application that we had,” Randy said. “I was also maintaining the EMA (emergency medical assistant) licensing and the first responder licensing applications, which technically were MOH (Ministry of Health), not BCEHS per se, but back in those days, we were basically part of the Ministry, and I was technically part of MOH IMIT (Information Management and Information Technology).”
Randy became a full-time employee about two and a half years into his time with BCEHS. At that point, development of a significant application was just getting underway, built from scratch by the small team in the Jack Davis building in Victoria. This application tracked the service’s air ambulances: their calls, the costs, and the carriers. Randy was responsible for maintaining it and when the team’s data analyst retired, Randy’s knowledge made him the go-to person for questions relating to data, and it snowballed from there, leading to a new role as manager of the data analyst team as it expanded.
From the start, he says he perceived a great sense of pride in the organization from all those who worked for it.
“You know, prior to 1974, it was just a free-for-all,” Randy recalls. “There was lots of pride in creating this new standardized care delivery for the province – they created the Infant Transport Team, their Advanced Care Paramedic program, and stuff like that. Everybody was proud of how they progressed over those first 20, 30 years.”
“When I started, within the Jack Davis building, there were about 40 people in there – and that was our headquarters,” he said. “It was quite a small group of people running the service. But the flip of that was that because we were a small service, there was only so much that we could do.”
“And that's kind of where my role started to come in in that sense – there were lots of deficiencies around data and reporting. We’ve been making strides over the years to improve on all of that.”
When Randy began in the 1990s, the dispatch centres in Victoria and Kamloops used a computer-aided dispatch (CAD) system – but the Vancouver centre was still on paper.
“When I started, (Vancouver dispatch) had these little paper dispatch tickets, they called them, and they would write the stuff on the paper. Then the papers would get all submitted and go into a keying into our data processing office and the data processing would upload them to the mainframe (data repository),” he said.
“One of my roles for quite a number of years was maintaining the CAD system in Victoria. At one point in time, I was directed to go to Victoria dispatch once a week to make sure that the CAD was still functioning properly. They had a printer in the back room where the servers were, so I'd go into the back room of the servers and check on everything and make sure everything was running,” Randy said.
“They had a dot matrix printer and it would print out the active calls, the logic being that if the CAD just melted down and died, they'd run into the back room and grab this piece of paper out of the printer and that would have all of their ongoing calls so they could pick up those calls without the CAD running. So, one of my jobs was going out there on a weekly basis to make sure the printer was still working, because it would get stuck in a paperwork jam and it would just drill a hole through the paper.”
When the CAD system in Victoria dispatch was acting up, the dispatchers would swap in the paper dispatch tickets that Vancouver was using.
“At the time, the dispatch centre in Victoria was (shaped) like an X: there were four stations around in the X,” Randy said. “Somebody would take the call and write this stuff down, and then they would take the piece of paper and they'd fling it over to the person on the other side who was going to dispatch it.”
“It was kind of amazing to watch these people,” he recalled. “They had to kind of maintain all of this stuff in their heads. It was managing their cars, all of the units they had dispatched, everything they had. That's why they had a half hour transition when the next person came in – so they would overlap for half an hour to transition their active calls because you can’t just drop everything and walk out the door.”
“It's a lot better now, because it's mostly managed with the CAD system. But back in those days, it was managed in their heads.”
The Kamloops and Victoria dispatch centres replaced the original CAD system with the more modern RightCAD in 2001, as did the air ambulance dispatch.
Meanwhile, Vancouver dispatch was still using its paper-based dispatch system up until 2003, when it implemented an electronic CAD system through E-Comm. Five years later, the Vancouver dispatch centre began the shift to NetCAD, followed by Victoria and Kamloops dispatch centres about a year and a half later, with the air ambulance dispatch getting onboard to close the loop in 2010.
In 2013, BCEHS’ Patient Transfer Network (PTN) took on the role of coordinating interfacility transfers within the province. Previously, BC Bedline, which fell under the Ministry of Health, had been responsible for facilitating communication between doctors at hospitals and healthcare facilities when patients needed to be moved and coordinating their transportation. As part of this transition, the BC Bedline Case Manager application was migrated from E-Comm’s hosting environment to BCEHS servers.
PTN connects the sending and receiving physicians to determine the patient’s needs and coordinate the transfer, before passing it on to the Patient Transport Coordination Centre (PTCC), which manages the logistics, dispatches ambulance resources, and coordinates air and ground transports for critical care. Most of the transfers are done within BC, but some involve moving patients to or from hospitals in other provinces – and occasionally out of the country.
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Originally – and unsurprisingly – the reports from the information that was fed into the data processing centres came out on paper. Randy recalls thick books that were thousands of pages long being shipped to his office in the 1990s, and the service realized that this kind of data delivery wasn’t going to cut it much longer.
At that time, the Ministry of Health was launching a project to upgrade its data capabilities, and the service was going to see similar upgrades as part of those plans – but not until much later in the anticipated timeframe.
“Our IT manager at the time proposed to the ministry that we couldn’t wait for that, but could we use the same software, the Oracle database and MicroStrategy reporting, so that when we did get to that point, we would be well positioned to migrate into the new data environment,’” Randy said.
The ministry agreed, and the service was able to move forward with bringing its data reporting online.
“We built a process to ETL – extract, transform, and load,” Randy said. “We call it Data Mart. It's a warehouse kind of a thing where we took all the data from the CAD systems and fed it in and built our reporting environments. We had a web reporting environment so district managers could go run their own reports … they could go and subscribe to reports, get reports automatically emailed to them, stuff like that.”
Data Mart was built in 2002, and it’s still in place in 2024, sending out 1,400 reports per day – more than half a million reports each year, representing the vast majority of BCEHS’ reporting.
In 2009, BCEHS built its Patient Care Information System (PCIS) to house patient care data. At that time, paper patient care records (PCRs) were still being used by paramedics when collecting data during a call, but instead of having to mail in the paper PCRs to the data reporting centres afterwards, paramedics could now scan in the sheet at the station, and it would automatically be sent off to the PCIS system. The creation of PCIS also involved improving the PCR form itself to provide better data.
“PCIS had a keying service, and they would take the scanned image and they would key that in,” Randy said. “The paper was no longer mailed in. It was all done electronically – but it was still a paper-based system.”
It wasn’t until closer to 2020 that a fully electronic patient care system was in place.
“We fully implemented Siren, the electronic PCR, in May 2019,” Randy said. “Now, there is a tablet in the ambulance and they do it all on the tablet and it flows automatically. The data is available right now, whereas in the PCIS system, because of that scanning, keying process, we were always three months behind.”
As well, dispatch centres have continued to see innovations in technology in recent decades.
“When I started, we didn't actually have the Medical Priority Dispatch System, the MPDS,” Randy said. “The dispatchers, they were all paramedics, and they were the ones answering the 911 calls, and they would decide what to do.”
MPDS is a structured decision-making tool that instructs call-takers to ask very specific questions to determine the prioritization of resources to 911 calls. It was implemented by BCEHS in 1997, and the system is regularly tweaked as research identifies better ways to ask the questions that provide more accurate results, ultimately providing the call-taker with one of roughly 2,000 unique MPDS codes.
“(MPDS) is implemented into the CAD, so CAD has a module that launches and goes through that, and then the results feed back into the CAD system,” Randy continued. “It was broken down into 33 cards, and then each one into a determinant, so Alpha, Bravo, Charlie, Delta, Echo, with Echo being the urgent and Delta being the next level (down).”
“In 2018, we implemented a Clinical Response Model (CRM), which kind of replaced (the determinant categories) and it took it into the colours: the purple, red, orange, yellow, green, blue, which is roughly equivalent to the Alpha, Bravo, Charlie, Delta, Echo – so the Echoes are roughly the purples, and the Deltas are roughly the reds.
One of the exciting new developments within BCEHS’ data world is FirstWatch: a real-time reporting environment that many other ambulances services across North America are using. The program began rolling out within the organization in 2022 and more teams and people are being onboarded to use the platform.
“Currently, active events are not available in our Data Mart data – only completed events,” Randy said. “So that’s one of the advantages with FirstWatch, it’s real-time active: you can see the current active events, outstanding events, and things like that, they can show up on a map, they can do KPIs, they can have triggered feedback mechanisms.”
FirstWatch is also able to blend BCEHS’ PCR data and CAD data with other data sources to maximize the information available and can be used on smartphones, making it more accessible to support in-the-moment decision-making.
Randy and the BCEHS data team will also be involved as the Provincial Health Services Authority (PHSA) creates its new Platform for Analytics and Data (PANDA), which will act as a warehouse for data from PHSA and all of its agencies, including BCEHS. This new initiative will provide a fulsome breakdown of a patient’s journey through the healthcare system from all angles – connecting pre-hospital care data with in-hospital care data and patient outcomes.
“The big benefit is we'll be able to look and say, ‘Well, when we pick up the patient, take them there, and they go and get this treatment in the hospital, and they were released at such and such time,’ so you get a good picture of the entire journey of the patient.”
The development of PANDA is expected to take several years, with the beginning phase of the work currently underway. PHSA and its agencies are collaborating to determine what the system will look like and how to merge all of the data sources to create a comprehensive resource. Randy anticipates it will be a valuable tool once it’s realized, as it will offer the ability to evaluate whether the implementation of new medications or processes at the pre-hospital level had an impact on patient care and survival rates.
“We have the ability to do all sorts of things with the data now, whereas when I started, we had very limited access to data, we could hardly figure anything out or know what was going on,” Randy said. “We’ve made huge strides with that, having a province-wide CAD system, an electronic patient care system, and the FirstWatch system is starting this journey towards integrating with PANDA, and being able to do that fulsome review.”
BCEHS has a largely paper-based data environment across all provincial operations.
Kamloops and Victoria Dispatch Operations Centres are using computer-aided dispatch (CAD) systems, but Vancouver Dispatch Operations Centre uses paper dispatch tickets to record 911 calls and dispatching of resources.
The Medical Priority Dispatch System (MPDS) was introduced. Prior to the implementation of MPDS, dispatching was done by paramedics using their experience and training. MPDS is a structured decision-making tool that instructs call-takers to ask very specific questions to determine the prioritization of resources to 911 calls. The system is regularly tweaked as research identifies better ways to ask the questions that provide more accurate results, ultimately providing the call-taker with one of roughly 2,000 unique MPDS codes. It was broken down into 33 cards, and then each one into a determinant, so Alpha, Bravo, Charlie, Delta, Echo, with Echo being the most urgent type of call, and Delta being the next level down.
Dispatch Operations Centres begin the transition to NetCAD, with Vancouver finally bringing dispatching online and ending its paper-based processes, followed by Victoria and Kamloops shifting over from their previous CAD model.
BCEHS built its Patient Care Information System (PCIS) to house patient care data. At that time, paper patient care records (PCRs) were still being used by paramedics when collecting data during a call, but instead of having to mail in the paper PCRs to the data reporting centres afterwards, paramedics could now scan in the sheet at the station to automatically be sent off to PCIS.
BCEHS’ Patient Transfer Network (PTN) took on the role of coordinating interfacility transfers within the province from BC Bedline, which fell under the Ministry of Health. PTN connects the sending and receiving physicians to determine the patient’s needs and coordinate the transfer, before passing it on to the Patient Transport Coordination Centre (PTCC), which manages the logistics, dispatches ambulance resources, and coordinates air and ground transports for critical care. Most of the transfers are done within BC, but some involve moving patients to or from hospitals in other provinces – and occasionally out of the country.
BCEHS implemented a Clinical Response Model (CRM), which replaced the alphabetical determinant categories and categorized events by colours: purple, red, orange, yellow, green, blue, which is roughly equivalent to the Alpha, Bravo, Charlie, Delta, Echo – so the Echoes are roughly the purples, and the Deltas are roughly the reds.
Siren, the electronic PCR, was fully implemented around the province. Each ambulance now has a tablet that paramedics use to input all patient care information. The data from ePCRs is available roughly an hour after the respective call is completed.
Implementation of FirstWatch, a real-time reporting environment, began. FirstWatch blends BCEHS’ PCR data and CAD data with other data sources and can be used on smartphones, making it more accessible to support in-the-moment decision-making.
