Ambulance service is a part of pre-hospital emergency services, which are an essential component of the Québec population’s access to health services.
It is important to know about pre-hospital emergency services. Indeed, anybody could one day be in need of assistance from 9-1-1 emergency service, first responders or ambulance technicians.
Pre-hospital Response Chain
When someone calls 9-1-1 in an emergency situation, their call triggers a series of actions and responses that involve several responders. The set of actions and responses taken to assist a person in distress constitutes the pre-hospital response chain.
Ambulance service is an essential link in the pre-hospital response chain, and undoubtedly the best known. However, the other links in the chain play an equally important role in ensuring an effective response to any emergency.
The response chain includes:
- The first responder or first-aid attendant on duty (if present on site)
- 9-1-1 emergency service
- The health communication centre
- First responder service
- Ambulance service
First Responder or First-aid Attendant on Duty
The 'first responder' is a witness, a passerby, a first-aid attendant on duty or any other person present at the scene of an emergency situation. According to section 2 of the Charter of Human Rights and Freedoms , “Every person must come to the aid of anyone whose life is in peril, either personally or by calling for aid, by giving him the necessary and immediate physical assistance, unless it involves danger to himself or a third person, or he has another valid reason.” The obligation to be of assistance thus concerns anyone who witnesses a situation in which urgent action is required. One way to be of assistance is by reporting the situation to 9-1-1 emergency service.
In an emergency situation, call 9-1-1 as quickly as possible because doing so can be important to a person’s survival. You must not hesitate to help a person in distress because Québec laws protect first responders when they provide assistance in good faith.
9-1-1 Emergency Service
In Québec, 9-1-1 emergency service respond to more than a million calls a year. When someone dials 9-1-1, the call is received by an emergency call centre in the municipality or territory from which the call is made. Within just a few seconds, the person on the line can determine if the incident requires the assistance of police, firefighters or ambulance service. When ambulance response is necessary, the call is immediately transferred to the health communication centre.
Health Communication Centre
Emergency medical dispatchers from the health communication centre ask simple questions to determine quickly the nature of the situation and prioritise the response of ambulance service.
In an emergency situation, it is therefore very important to answer the dispatcher’s questions as clearly and calmly as possible.
If the dispatcher considers the case urgent, they will communicate with ambulance technicians within seconds of the call. If necessary, they will stay on the line with the person concerned or the caller to offer pertinent advice while waiting for help to arrive.
First Responder Service
Some municipalities have a first responder service. The role of these people is to make sure that the state of the person in distress does not worsen while waiting for the ambulance technicians. Since first responder service is established by municipal authorities, they have the advantage of being close to the people they serve. As such, in emergency situations, first responders are able to arrive at the scene quickly.
First responders have the required training to do the following:
- Administer first-aid
- Operate an automated external defibrillator when a person is in cardiac arrest
- Administer epinephrine auto-injection in cases of severe allergic reaction
The work of first responders and that of ambulance technicians are complementary. Once the ambulance arrives at the scene, the first responders relinquish responsibility to the ambulance technicians.
In Québec, there are about 4,200 first responders spread over 200 municipal services. About 1,700 first responders serve the Montréal area. First responders are not available in all municipalities in Québec, but new services are added each year. To find out if first responder service is available in your municipality and to know how they operate, contact the the Integrated Health and Social Services Centre (CISSS) or the Integrated University Health and Social Services Centre (CIUSSS) in your region. For the Montréal and Laval areas, contact Urgences-santé (in French only).
The ambulance technician is in charge of evaluating the patient’s health condition, to give them the required care and transport to a hospital. They must also inform the hospital of the patient’s state through a pre-hospital response report. This report is added to the patient’s medical file.
Rigorous and continuous training
Ambulance technicians receive rigorous training in ambulance techniques, which allows them to respond effectively to people in distress in all emergency situations. Several CEGEPs and some private colleges offer this training. All active ambulance technicians must also follow a mandatory annual training program. Through this training program, ambulance technicians maintain their skills up-to-date and learn new clinical protocols essential to their work.
Ambulance service in Québec is provided by different companies:
- Private companies
- Urgences-santé, a public sector company that covers the Montréal and Laval areas
These companies employ over 5,500 ambulance technicians and manage a fleet of nearly 800 response vehicles.
The emergency medical dispatcher and ambulance technicians take into account the hospital in which the patient’s records are housed as well as the service corridors in place. However, other factors can affect the choice of hospital. These may include:
- The patient’s state
- The distance to cover
- Specialised services offered by the hospital
- The facility’s emergency handling capacity
It is important to know that the health conditions of all patients have been assessed at the hospital’s emergency triage. The goal of these assessments is to establish treatment priority according to the severity of patients’ health. Arriving at emergency by ambulance does not necessarily guarantee priority treatment. As such, someone who arrives by ambulance but is in stable condition could be treated less quickly than someone else who arrived at emergency by other means. Indeed, if the condition of the second person requires immediate attention, their treatment will be considered a priority in triage.
The priority of calls coming into 9-1-1 emergency service is established by the emergency medical dispatchers at the health communication centre. They ask simple questions and use a prioritisation system to determine quickly the nature of the situation and to establish ambulance service response priority.
High Priority Calls
When a call is of high priority, a dispatcher reaches ambulance technicians within the first few seconds and notifies them that a response is required. The same notification is given to first responder service when the service is available in the municipality in question. Ambulances rush to the scene using sirens and emergency lights as needed.
Lower Priority Calls
If the dispatcher determines that there is no immediate danger to the life of the person concerned, they nonetheless notify ambulance technicians. In such cases, they go to the scene using neither siren nor emergency light.
However, if the dispatcher receives a high priority call in the meantime, and no ambulance is available, an ambulance on a lower priority call may be diverted to the more urgent call. It is therefore possible that a person whose condition presents no immediate danger must wait for another ambulance to be free.
Cost of Ambulance Transport
Each year, over 685,000 ambulance transports are dispatched. However, transport to a hospital by ambulance is not a free service. The person transported must pay for the trip, even if it was another person who called 9-1-1 emergency service to request an ambulance. In some cases, exceptional assistance measures set by the government may apply.
The basic cost of transport by ambulance is set at $125 for the pickup, plus $1.75 per kilometre travelled to the hospital. A fee of $35 is charged for any additional patient. The cost for a non-resident of Québec is $400 for pickup, plus $1.75 per kilometre travelled. These rates may be indexed annually. There are no additional fees for someone accompanying the person being transported.
The Government of Québec is responsible for a major part of financing the pre-hospital emergency system. Fees charged to the end-user only cover a portion of the actual cost of their ambulance transport.
Government Exceptional Assistance Measures
The Government of Québec, through its departments and public organisations, covers the entire cost of ambulance transport for:
- People injured in a road accident:
Société de l'assurance automobile du Québec
- People injured in a work accident:
cost covered by the employer
- People transported between two institutions in the health and social services network:
cost covered by the two institutions involved
- Persons 65 years of age and over, and persons receiving Income Security:
cost covered by the hospital where the person has been transported or by the ministère du Travail, de l'Emploi et de la Solidarité sociale, subject to the approval of the attending physician
A person eligible for a government exceptional assistance measure could nonetheless be required to pay for their ambulance transport if the trip is not deemed necessary from a medical perspective.
In some cases, the federal government covers the cost of ambulance transport for:
- Members of the Canadian Armed Forces:
National Defence and the Canadian Armed Forces
Veterans Affairs Canada
- On-reserve First-Nations and Inuit populations:
- Inmates held in a correctional centre:
Correctional Service Canada
Group or individual insurance policies often cover all or part of the cost of an ambulance. Check with your insurer to see if your policy includes this coverage.
Ambulance technicians cannot force anyone to be picked up by an ambulance. When they determine that the state of a person requires them to be taken by ambulance but the person refuses, that person must sign a Refusal of Transport Form. This way, the ambulance technicians are released of all legal responsibilities regarding the person’s health. Someone who refuses the service has no fees to pay.
In certain situations, the police may take someone to a hospital so that they may receive the care required given the state of their health. These conditions are contained in the Act respecting the protection of persons whose mental state presents a danger to themselves or to others . In such cases, the police can ask the ambulance services to transport the person concerned. Under the statute of the law, a person who is taken to a hospital against their will does not have to pay any fees.
Anyone who believes that their rights have not been respected, or is dissatisfied with the ambulance service received, may express their dissatisfaction or file a complaint.
To know your rights and recourse, consult The Health and Social Services Network Complaint Examination System page.
Last update: July 21, 2016