Emergency Medical Services in Saskatchewan

Emergency Medical Services in Saskatchewan A survey of 800 Saskatchewan over 18 years of age. August 3, 2012 Prepared for: Prepared by: Saskatchewan Emergency Medical Services Association David Coletto, CEO

Contents 1.0 Executive Summary... 3 1.1 Key Findings... 4 2.0 Research Objectives... 5 3.0 Evaluations of Saskatchewan s Health Care System... 6 4.0 Respect for Professions... 14 4.1 Paramedics... 15 5.0 Health Care Professionals in Saskatchewan... 17 5.1 Paramedics... 18 6.0 What do Paramedics do?... 20 7.0 Paying for Ambulance Services... 21 8.0 Testing Proposals for Health Reform... 23 8.1 Giving Paramedics a Larger Role in Providing Emergency Care... 27 8.2 Testing a Hypothetical Situation... 28 9.0 Conclusion... 31 10.0 Methodology... 33 11.0 Apprendix A - Tabulations... 35 Insight by Abacus Data Inc. 2

1.0 Executive Summary Abacus Data s survey of 800 of Saskatchewan aged 18 and over found that paramedics are highly respected across the province, that almost all of the province s view them as very important to the health care system, and that most people are aware of the tasks paramedics perform day to day. Generally speaking, Saskatchewan are fairly satisfied with their health care system. While only 2 strongly approve of the job the provincial government is doing managing the system, few disapprove outright with the government s performance. Considering that health care is the top concern for most people not only in Saskatchewan and across the province, these are fairly positive numbers. None the less, there is room for improvement. Perhaps more importantly, a large majority of respondents are confident that the health care system will be there when they or a loved one needs it. Moreover, a similar majority are confident that a paramedic will be there quickly if they require emergency medical attention. When it comes to the role of paramedics in the provinces health care system, the survey results indicate broad support for expanding the role of EMS in delivering health care. A large majority of respondents support expanding the role of paramedics to deliver front-line health care in areas without easy access to a hospital. This is true even among those who live in rural or farming communities who are most affected by limited health care facilities. The public is also open to allowing paramedics to treat patients in their home if their injuries or illnesses do not require transportation to a hospital. Most significant, when given a hypothetical scenario in which the respondent needed to see a medical professional but the time to get to an emergency room would be at least one hour, by a ratio of 4:1, respondents choose speed over being treated by a doctor. Three in four respondents said they would prefer to be treated more quickly by a paramedic at home who could then determine if they needed to go to a hospital versus 17% who preferred to be treated by a doctor even if it would take time to get to the hospital. These results clearly demonstrate that the public is aware of what paramedics do, they trust and respect those in the profession, and view them as being as important as doctors or nurses within the health care system. It is no surprise then that they support expanding their role, especially into areas with more limited access to hospitals and emergency medical care. David Coletto CEO, Abacus Data Insight by Abacus Data Inc. 3

1.1 Key Findings Most are confident they will access the necessary medical care in an emergency; 28% are not confident. Over two thirds of respondents agreed that they are confident that if they or a family member were to become seriously ill, they would be able to access the necessary health care services. 29% disagreed with the statement. Most are confident that a paramedic will respond quickly to a medical emergency; 27% are not confident. Sixty-eight percent of respondents agreed that they are confident that a paramedic would respond quickly to a medical emergency while 27% disagreed with the statement. Provincial approval managing health care 40% somewhat approve, 2 strongly approve, 2 somewhat disapprove, 1 strongly disapprove Provincial approval managing EMS 45% somewhat approve, 25% strongly approve, 8% somewhat disapprove, 6% strongly disapprove, unsure Seven in ten Saskatchewan have a lot of respect for paramedics. Almost all respondents have at least some respect for paramedics with 7 saying they have a lot of respect. Only firefighters are respected a lot by more of Saskatchewan (8). Paramedics are more respected than teachers, police officers, military officers, and scientists. Paramedics are considered very important to the provinces health care system. Nine in ten respondents (89%) believed that paramedics are very important to Saskatchewan s health care system similar to doctors (89%) and nurses (88%). Paramedics are clearly viewed as key actors in the province s health care system. 49% support the province covering the entire cost of ambulance services; 40% oppose it. Seven in ten support increasing the role of paramedics to deliver front line health care in areas without easy access to a hospital. Support was consistent across age groups and among living in different size communities. 76% of survey respondents would strongly or somewhat support giving paramedics a larger role in providing health care in rural Saskatchewan communities. 7 of respondents living in rural communities said they supported this proposal. Seven in ten respondents support allowing paramedics to treat patients in their home if their injuries or illnesses do not require transportation to a hospital. Insight by Abacus Data Inc. 4

2.0 Research Objectives The Saskatchewan Emergency Medical Services Association (SEMSA) represents 82 out of 110 ambulance services within the province of Saskatchewan. Its mission has evolved to play a large role in the "best practices" for this province. SEMSA works with the EMS industry to strengthen and advance EMS in Saskatchewan by ensuring high-quality, accountable patient care and to provide guidance, support, and a common voice on behalf of all EMS members. As part of its advocacy and communications efforts, SEMSA was looking to understand how Saskatchewan viewed paramedics both as a profession and as an actor within the province s health care system. The objectives of this study were: 1. To compare the public s respect for different professions and how paramedics are viewed in comparison to other prominent professions; 2. To assess the Saskatchewan public s evaluation of the overall health care system as well as the EMS system specifically; 3. To gauge how the public views paramedics as actors within the province s health care system; 4. To measure support for increasing the role of paramedics in delivering health care in areas that do not have easy access to hospital; and, 5. To understand whether the public is willing to trade seeing a physician for quicker medical care from a paramedic or other health care professional. To achieve these objectives, Abacus Data conducted a live-interview random telephone survey of 800 Saskatchewan aged 18 and over from July 24 th and August 1 st, 2012. Insight by Abacus Data Inc. 5

3.0 Evaluations of Saskatchewan s Health Care System In an effort to measure overall confidence in Saskatchewan s health care system, respondents were asked whether they agreed or disagreed with the following statement: I am confident that if I or a family member were to become seriously ill, we would be able to access the necessary health care services. Overall, two in three survey respondents (67%) agreed with the statement with 4 strongly agreeing and another 25% somewhat agreeing with the statement. In contrast 29% either strongly or somewhat disagreed with the statement. By and large, confidence in Saskatchewan s health care system was fairly consistent across age groups, between men and women, and among of different types of communities. Agree/Disagree: I am confident that if I or a family member were to become seriously ill, we would be able to access the necessary health care services. (Source: Abacus Data, July 2012, n=800) Saskatchewan 4 25% 1 18% Men 4 25% 1 17% Women 4 2 1 18% 18 to 29 4 3 0% 1 1 30 to 39 4 26% 5% 1 1 40 to 49 3 27% 1 20% 50 to 59 4 2 5% 9% 19% 60 to 69 45% 20% 1 18% 70 + 49% 2 2 City 4 26% 19% Town 5 15% 9% 2 Village 45% 28% 6% 15% 6% Rural/Farm 39% 2 15% 18% Strongly agree Somewhat agree Neither Somewhat disagree Strongly disagree Unsure Insight by Abacus Data Inc. 6

Confidence in the overall system was also consistent across regions of the province except for in the North where respondents were somewhat less likely to strongly agree with the statement. Readers should be cautious of extending this conclusion too far, due to the small sample size in the northern region. Agree/Disagree: I am confident that if I or a family member were to become seriously ill, we would be able to access the necessary health care services. (Source: Abacus Data, July 2012, n=800) Saskatchewan 4 25% 1 18% North 2 29% 1 2 Central 4 2 1 19% Saskatoon 4 26% 7% 17% Regina Qu'Appelle 4 2 1 18% South 4 2 1 Strongly agree Somewhat agree Neither Somewhat disagree Strongly disagree Unsure Insight by Abacus Data Inc. 7

Respondents also had a high level of confidence in the province s EMS to respond quickly to a medical emergency. Over two in three Saskatchewan respondents strongly or somewhat agreed that they were confident that if they or a family member required emergency medical attention, a paramedic or the emergency medical service would respond quickly. Confidence was fairly consistent across all age groups with a majority in all groups agreeing with the statement. Those living in rural or fame communities were somewhat less likely to agree than respondents living in cities. Agree/Disagree: I am confident that if I or a family member required emergency medical attention, a paramedic or the emergency medical service will respond quickly. (Source: Abacus Data, July 2012, n=800) Saskatchewan 46% 2 1 Men 46% 2 1 17% Women 46% 2 1 15% 18 to 29 39% 20% 1 2 30 to 39 58% 19% 5% 9% 9% 40 to 49 45% 2 1 50 to 59 4 25% 7% 18% 5% 60 to 69 5 2 6% 1 70 + 4 2 5% 1 City 5 19% 9% 15% Town 36% 25% 5% 19% 1 Village 4 2 27% Rural/Farm 38% 2 19% 15% Strongly agree Somewhat agree Neither Somewhat disagree Strongly disagree Unsure Insight by Abacus Data Inc. 8

The survey found no significant regional differences when it came to confidence in EMS ability to respond quickly to a medical emergency. Agree/Disagree: I am confident that if I or a family member required emergency medical attention, a paramedic or the emergency medical service will respond quickly. (Source: Abacus Data, July 2012, n=800) Saskatchewan 46% 2 1 North 58% 2 1 Central 4 25% 15% 1 Saskatoon 48% 18% 1 17% Regina Qu'Appelle 46% 2 6% 19% South 47% 26% 1 1 Strongly agree Somewhat agree Neither Somewhat disagree Strongly disagree Unsure Insight by Abacus Data Inc. 9

Separate from confidence in the entire health system, respondents were asked to rate the provincial government s performance in managing the province s health care system. Overall, a majority approved of the provincial government s performance on the health care file with 2 strongly approving and 40% somewhat approving. In contrast about one in three Saskatchewan respondents (35%) disapproved of the government s performance with 1 strongly disapproving. Approval was somewhat higher among men while there was little variation among age groups and different community types. How would you rate the provincial government s performance in managing the province s health care system? (Source: Abacus Data, July 2012, n=800) Saskatchewan 2 40% 2 1 Men 27% 37% 19% 15% Women 17% 4 2 1 18 to 29 25% 4 1 30 to 39 28% 3 2 1 40 to 49 2 38% 2 50 to 59 18% 39% 27% 1 60 to 69 2 4 2 1 70 + 2 4 19% 1 City 2 39% 2 1 Town 2 37% 2 18% Village 29% 39% 1 19% Rural/Farm 19% 4 2 1 5% Strongly approve Somewhat approve Somewhat disapprove Strongly disapprove Unsure Insight by Abacus Data Inc. 10

The survey also found that Saskatoon respondents were marginally more likely to approve of the job the provincial government is doing managing the health care system when compared with Regina Qu Appelle or the southern region of the province. How would you rate the provincial government s performance in managing the province s health care system? (Source: Abacus Data, July 2012, n=800) Saskatchewan 2 40% 2 1 North 2 2 39% 1 Central 20% 4 2 1 Saskatoon 25% 4 17% 1 Regina Qu'Appelle 2 38% 2 South 2 36% 2 15% Strongly approve Somewhat approve Somewhat disapprove Strongly disapprove Unsure Insight by Abacus Data Inc. 11

Like the overall health care system, respondents were more likely to approve of the job the provincial government is doing managing the province s emergency medical services or paramedics system than disapprove. In fact, only 1 of respondents said they disapproved of the job they were doing managing the paramedics system. However, it should be noted that respondents were more likely to say they did know how to rate the government s performance. How would you rate the provincial government s performance in managing the province s emergency medical services or paramedics system? Do you strongly approve, somewhat approve, somewhat disapprove, or strongly disapprove? (Source: Abacus Data, July 2012, n=800) Saskatchewan 25% 45% 8% 6% Men 2 46% 7% 5% 18% Women 26% 45% 9% 6% 1 18 to 29 29% 45% 7% 30 to 39 4 6% 9% 27% 40 to 49 27% 4 9% 6% 1 50 to 59 2 48% 9% 60 to 69 20% 5 8% 5% 1 70 + 3 40% 8% 8% 1 City 27% 4 8% 5% 17% Town 28% 45% 1 6% Village 6 Rural/Farm 2 4 1 9% 1 Strongly approve Somewhat approve Somewhat disapprove Strongly disapprove Unsure Insight by Abacus Data Inc. 12

Evaluations of the provincial government s performance managing the EMS system were consistent across all regions of the province. A majority in each region approved of the job the provincial government was doing managing the EMS system. How would you rate the provincial government s performance in managing the province s emergency medical services or paramedics system? Do you strongly approve, somewhat approve, somewhat disapprove, or strongly disapprove? (Source: Abacus Data, July 2012, n=800) Saskatchewan 25% 45% 8% 6% North 2 4 1 5% 20% Central 26% 4 9% 8% 1 Saskatoon 25% 45% 7% 6% 17% Regina Qu'Appelle 27% 45% 8% South 20% 49% 8% 6% 17% Strongly approve Somewhat approve Somewhat disapprove Strongly disapprove Unsure Insight by Abacus Data Inc. 13

4.0 Respect for Professions Respondents were given a list of professions and asked to rate how much respect they have for each one on a scale from a lot of respect to no respect. In total, twelve professions were tested with firefighters, paramedics, doctors, and nurses being rated as the most respected professions in Saskatchewan. Over eight in ten respondents (8) said they have a lot of respect for firefighters followed by paramedics (7), doctors (7), and nurses (7). It is noteworthy that the professions rated most highly are all emergency or health professionals. There is clearly a strong link between respect and how important a profession is to the well being of the individual respondent. I am going to read you a list of different professions. For each, please tell me if you have a lot of respect, considerable respect, somewhat respect, or no respect for the occupation. [rotate] (Source: Abacus Data, July 2012, n=800) Firefighter 8 9% 6% Paramedic Doctor 7 7 1 9% 1 Tier 1 Nurse 7 1 1 Military officer 6 Police officer 59% 17% 2 Teacher Dentist 58% 57% 2 17% 18% 2 Tier 2 Engineer 5 2 2 Scientist 5 2 2 Lawyer MLA 2 35% 17% 1 4 40% Tier 3 A lot of respect Considerable respect Somewhat respect No respect Refused Military officers, police officers, teachers, dentists, engineers, and scientists were respected a lot by a majority of respondents and comprise the second tier of professions we tested while lawyers and members of the legislative assembly were in the bottom tier with less than a majority saying they had a lot of respect for the professions. Insight by Abacus Data Inc. 14

4.1 Paramedics Looking specifically at paramedics, respect for the profession was fairly consistent across all demographic and regional groups. Women were more likely to say they have a lot of respect for paramedics than men (women 77% a lot of respect, men 70% a lot of respect), while middle aged respondents (40 to 49) were the most likely to say they have a lot of respect for paramedics (80%). There was very little variation across the type of community a respondent lived in. I am going to read you a list of different professions. For each, please tell me if you have a lot of respect, considerable respect, somewhat respect, or no respect for the occupation. [rotate] Paramedics (Source: Abacus Data, July 2012, n=800) Saskatchewan 7 9% Men 70% 18% Women 77% 1 8% 18 to 29 68% 18% 1 30 to 39 78% 1 8% 40 to 49 80% 9% 8% 50 to 59 75% 15% 8% 60 to 69 70% 18% 70 + 68% 20% City 76% 1 9% Town 70% 15% 1 Village 70% 25% Rural/Farm 7 1 1 A lot of respect Considerable respect Somewhat respect No respect Insight by Abacus Data Inc. 15

Regionally, there was almost no variation on respect for paramedics as a profession with over seven in ten respondents in central and south Saskatchewan, in Saskatoon, and in Regina Qu Appelle saying they have a lot of respect for emergency medical service professionals. Only of respondents province-wide said they had no respect for paramedics. I am going to read you a list of different professions. For each, please tell me if you have a lot of respect, considerable respect, somewhat respect, or no respect for the occupation. [rotate] Paramedics (Source: Abacus Data, July 2012, n=800) Saskatchewan 7 9% North 66% 2 1 Central 77% 1 7% Saskatoon 7 Regina Qu'Appelle 7 South 7 1 A lot of respect Considerable respect Somewhat respect No respect Insight by Abacus Data Inc. 16

5.0 Health Care Professionals in Saskatchewan When respondents were asked to rate the importance of six health care professionals to Saskatchewan s overall health care system, almost all respondents believed that paramedics, doctors, and nurses were very important to the province s health care system. Dentists, occupational therapists, and chiropractors were considered very important by comparatively fewer respondents. This finding mimics findings nationally and in Ontario that found paramedics to be considered part of a health care triad consisting of doctors, nurses, and paramedics. This is an important finding that should be repeated to decision makers and health care professionals. The public views paramedics as an integral part of the system and as results later in the survey indicate, the public is open to increasing the role of paramedics in the delivery of health care services, especially in rural and remote communities across Saskatchewan. Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. (Source: Abacus Data, July 2012, n=800) Paramedics 89% Doctors 89% 1 Nurses 88% 1 Dentists 6 3 Occupational therapists 55% 3 6% Chiropractors 45% 37% 1 5% Very important Moderately important Moderately unimportant Very unimportant Insight by Abacus Data Inc. 17

5.1 Paramedics The chart below reports how important paramedics are considered in Saskatchewan s health care system across demographic and regional groups. There was very little variation across these groups indicating that regardless of a person s gender, age, or community type, paramedics are considered very important to the health care system. The importance of paramedics to health care in Saskatchewan can be considered a universally held belief that crosses all types of people. Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. Paramedics (Source: Abacus Data, July 2012, n=800) Saskatchewan 89% Men 89% Women 89% 18 to 29 9 6% 30 to 39 87% 1 40 to 49 90% 50 to 59 86% 1 60 to 69 89% 70 + 88% City 89% 1 Town 9 9% 9% Village 98% Rural/Farm 86% 1 Very important Moderately important Moderately unimportant Very unimportant Insight by Abacus Data Inc. 18

The survey also found that paramedics are considered very important by almost all respondents in every corner of Saskatchewan. It should also be noted that not a single respondent believed that paramedics were unimportant to the system. Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. Paramedics (Source: Abacus Data, July 2012, n=800) Saskatchewan 89% North 8 17% Central 89% Saskatoon 90% 8% Regina Qu'Appelle 90% South 89% 1 Very important Moderately important Moderately unimportant Very unimportant Insight by Abacus Data Inc. 19

6.0 What do Paramedics do? Overall, the Saskatchewan public has a good sense of the role that paramedics play and the things they do on a day-to-day basis. Almost all respondents were aware that paramedics administer pre-hospital emergency care and transport patients by air, land, or water to hospitals or other medical facilities. Another nine in ten respondents were aware that paramedics maintain ambulances, assess the extent of injuries or illness of patients, and establish and maintain IV treatment. Although still a majority opinion, fewer respondents knew that paramedics also administer medications. These results indicate that the public is aware of what paramedics do and provides context for a debate about expanding paramedics the role. Consider it this way, the public in Saskatchewan respects paramedics greatly, almost all know what paramedics do on a day to day basis, and almost all believe they are very important to the province s health care system. These three findings provide leverage among the public for expanding the role of paramedics within the system. They trust the profession, think it is important to the health care system, and are aware of paramedics do day to day. I am going to read you a list of things that paramedics could do on a day-to-day basis. For each, tell me whether you think it is something paramedics do or don t do. (Source: Abacus Data, July 2012, n=800) Administer pre-hospital emergency care like CPR, oxygen, bandaging, and splinting 97% Transport patients by air, land, or water to hospitals or other medical facilities 95% Maintain ambulances and emergency care equipment 89% Assess the extent of injuries or illness of patients 87% Establish and maintain intravenous treatment (IV) 86% Administer medications 7 They Do This Insight by Abacus Data Inc. 20

7.0 Paying for Ambulance Services Respondents were asked whether they believed ambulance services were covered or not covered by their Saskatchewan health card. A majority of respondents (57%) believed that the costs were not covered by their Saskatchewan health card while 26% believed the costs were covered. Another 17% said they were unsure. Younger respondents (18 to 29) were most likely to say they did not know while those aged 60 to 69 were most likely to say the costs were not covered by their health card. Those who have used an ambulance in the past were more likely to say that the cost is not covered by their health care than those who have not used an ambulance (used ambulance 2 said covered, have not used ambulance 28% said covered). Based on what you know, are ambulance services costs in Saskatchewan covered or not covered by your Saskatchewan health card? (Source: Abacus Data, July 2012, n=800) Saskatchewan 26% 57% 17% Men 27% 55% 17% Women 25% 59% 18 to 29 27% 50% 2 30 to 39 29% 59% 1 40 to 49 30% 5 18% 50 to 59 2 6 18% 60 to 69 25% 66% 9% 70 + 26% 59% 15% City 2 60% Town 2 60% 17% Village 35% 5 1 Rural/Farm 29% 57% 1 Covered Not covered Don't Know Insight by Abacus Data Inc. 21

When asked whether the cost of ambulance services should be covered by the province, respondents were fairly split. Almost a majority (49%) believed that those costs should be covered while four in ten (40%) believed that they should not be. Twelve percent of respondents were unsure. Respondents aged 50 to 69 were the most likely to believe that ambulance costs should be covered by the province while those aged 30 to 39 were the least likely. Also of note, men were somewhat more likely to believe the costs should be covered than women (men 5 covered, women 46% covered). Overall though, differences between subgroups were small and the split on the question was fairly consistent across subgroups. Ambulance services are not a directly insured benefit, but Saskatchewan Health offsets a portion of the service costs for both road and air ambulance. Do you think that the entire cost of ambulance services should be covered by the province? (Source: Abacus Data, July 2012, n=800) Saskatchewan 49% 40% 1 Men 5 39% Women 46% 40% 1 18 to 29 50% 40% 30 to 39 4 4 15% 40 to 49 45% 4 1 50 to 59 5 3 1 60 to 69 5 40% 9% 70 + 46% 46% 8% City 46% 4 1 Town 55% 36% 9% Village 48% 40% 1 Rural/Farm 50% 4 9% Yes No Unsure Insight by Abacus Data Inc. 22

8.0 Testing Proposals for Health Reform In the next series of questions, respondents were asked to think about health care is currently delivered in Saskatchewan and were read three statements in random order. They were asked whether they supported or opposed the policies being presented. Overall, a majority of respondents either strongly or somewhat supported having provincial health insurance cover patient transportation between health facilities (7 support), increasing the role of paramedics to deliver front-line health care in areas without easy access to a hospital (7 support) and allowing paramedics to treat patients in their home if the injuries or illnesses do not require transportation to a hospital (70% support). There was intense opposition (strongly oppose) to all three proposals by about one in five respondents (2 to 2). These results indicate a level of openness or acceptance from the public for increasing the role of paramedics and in having the costs of transportation between health facilities covered by provincial health insurance. Thinking about how health care is currently delivered in Saskatchewan, please tell me whether you would strongly support, somewhat support, somewhat oppose, or strongly oppose the following ideas for improving the health care system in Saskatchewan. (Source: Abacus Data, July 2012, n=800) Having provincial health insurance cover patient transportation between health facilities. 60% 1 2 Increasing the role of paramedics to deliver front line health care in areas without easy access to a hospital. 57% 1 2 Allowing paramedics to treat patients in their home if their injuries or illnesses do not require transportation to a hospital. 5 19% 5% 2 Strongly support Somewhat support Somewhat oppose Strongly oppose Unsure Insight by Abacus Data Inc. 23

Over seven in ten respondents (7) either strongly or somewhat supported the proposal to increase the role of paramedics to deliver front-line health care in areas without easy access to a hospital. Support was fairly consistent across subgroups with younger respondents being somewhat more supportive than middle aged respondents. Also of note, support was as high among respondents living in villages or rural or farming communities as those living in towns or cities. Increasing the role of paramedics to deliver front line health care in areas without easy access to a hospital. (Source: Abacus Data, July 2012, n=800) Saskatchewan 57% 1 2 Men 5 18% 2 Women 59% 2 18 to 29 6 1 17% 30 to 39 5 2 26% 40 to 49 5 1 5% 2 9% 50 to 59 59% 1 2 60 to 69 55% 28% 70 + 58% 18% 7% 15% City 5 2 Town 6 1 2 Village 58% 2 5% Rural/Farm 59% 1 19% 6% Strongly support Somewhat support Somewhat oppose Strongly oppose Column1 Insight by Abacus Data Inc. 24

Support was also fairly consistent on having provincial health insurance cover patient transportation between health facilities. Over seven in ten respondents (7) either strongly or somewhat supported the proposal with 26% saying they opposed it. There were no significant differences across subgroups except for those aged 30 to 39 who were less likely to support the proposal compared with other age groups. Having provincial health insurance cover patient transportation between health facilities. (Source: Abacus Data, July 2012, n=800) Saskatchewan 60% 1 2 Men 59% 1 25% Women 60% 2 18 to 29 58% 20% 30 to 39 5 3 40 to 49 6 1 20% 50 to 59 6 7% 2 60 to 69 59% 6% 28% 70 + 6 1 5% 19% City 56% 1 2 Town 58% 1 26% Village 69% 2 Rural/Farm 6 18% 5% Strongly support Somewhat support Somewhat oppose Strongly oppose Column1 Insight by Abacus Data Inc. 25

Although a majority of all demographic subgroups supported the idea of allowing paramedics to treat patients in their homes, strongly support scores were measurably lower than the other proposed changes. Interestingly, while those aged 18 to 29 respondents were most likely to support the proposal; those aged 30 to 49 were least likely. Allowing paramedics to treat patients in their home if their injuries or illnesses do not require transportation to a hospital. (Source: Abacus Data, July 2012, n=800) Saskatchewan 5 19% 5% 2 Men 5 2 20% Women 5 6% 2 18 to 29 58% 1 2 30 to 39 4 20% 26% 40 to 49 47% 20% 2 5% 50 to 59 5 20% 19% 60 to 69 5 1 5% 26% 70 + 5 2 5% 19% City 50% 2 2 Town 60% 1 7% Village 5 20% 7% 20% Rural/Farm 50% 1 6% 2 6% Strongly support Somewhat support Somewhat oppose Strongly oppose Column1 Insight by Abacus Data Inc. 26

8.1 Giving Paramedics a Larger Role in Providing Emergency Care Here, respondents were asked to consider a proposal that would allow paramedics to provide services in communities where doctors are in short supply by giving paramedics larger responsibilities in those areas. Overall, a strong majority of respondents either strongly or somewhat supported the idea of giving paramedics more treatment options in rural areas. However, support was lowest amongst those over 70 years of age; perhaps because they are the demographic group most likely to require intensive care by a doctor on an ongoing basis. In rural Saskatchewan communities, health care facilities are having a difficult time recruiting doctors. As a way of providing emergency health care services to those communities, would you support or oppose giving paramedics a larger role in providing emergency care to patients in those areas? (Source: Abacus Data, July 2012, n=800) Saskatchewan 5 2 8% 1 5% Men 55% 2 9% Women 49% 27% 7% 1 5% 18 to 29 5 19% 1 1 30 to 39 56% 29% 5% 8% 40 to 49 49% 2 9% 50 to 59 56% 25% 6% 9% 60 to 69 59% 2 5% 8% 7% 70 + 4 3 8% 1 7% City 5 26% 6% Town 5 28% 1 9% Village 5 28% 15% Rural/Farm 5 2 Strongly support Somewhat support Somewhat oppose Strongly oppose Column1 Insight by Abacus Data Inc. 27

8.2 Testing a Hypothetical Situation This next section presented respondents with a hypothetical scenario and asked them to select which course of action they would prefer paramedics followed if the individual found themselves in the scenario described. Overall, three quarters of respondents would prefer to be treated as quickly as possible at home by a paramedic who would then assess whether further treatment at the hospital were necessary. Imagine there was a medical emergency and you needed to see a medical professional but the time it would take to get to an emergency room would be at least one hour. Alternatively, you could be seen in your home by a health care professional, such as a paramedic, who could treat the emergency. Which of the following statements, if either, comes closest to your view? a. I would prefer to be treated more quickly at home by a paramedic who could then determine whether or not I need to be transported for further medical attention. b. I would prefer to be treated by a doctor only, even if it would take time to get to a hospital. c. Neither comes closest to your view. (Source: Abacus Data, July 2012, n=800) 17% 6% 7 Prefer to be treated more quickly Prefer to be treated by a doctor only Neither comes closest to my view Don't know Insight by Abacus Data Inc. 28

Saskatchewan 7 17% 6% Men 7 18% 5% Women 7 6% 5% 18 to 29 7 18% 8% 30 to 39 7 2 5% 40 to 49 79% 1 50 to 59 7 8% 60 to 69 7 20% 6% 70 + 79% 1 5% City 7 18% 7% Town 76% 5% Village 7 18% 6% Rural/Farm 67% 2 8% Prefer to be treated more quickly at home by a paramedic Prefer to be treated by a doctor only Neither Don't know Insight by Abacus Data Inc. 29

Imagine there was a medical emergency and you needed to see a medical professional but the time it would take to get to an emergency room would be at least one hour. Alternatively, you could be seen in your home by a health care professional, such as a paramedic, who could treat the emergency. Which of the following statements, if either, comes closest to your view? a. I would prefer to be treated more quickly at home by a paramedic who could then determine whether or not I need to be transported for further medical attention. b. I would prefer to be treated by a doctor only, even if it would take time to get to a hospital. c. Neither comes closest to your view. (Source: Abacus Data, July 2012, n=800) Saskatchewan 7 17% 6% North 68% 25% 7% Central 7 20% 5% Saskatoon 76% 17% 5% Regina Qu'Appelle 7 7% 5% South 76% 1 8% Prefer to be treated more quickly at home by a paramedic Prefer to be treated by a doctor only Neither Unsure Insight by Abacus Data Inc. 30

9.0 Conclusion Abacus Data s survey of 800 of Saskatchewan aged 18 and over found that paramedics are highly respected across the province, that almost all of the province s view them as very important to the health care system, and that most people are aware of the tasks paramedics perform day to day. Survey after survey confirms that health care is by far the most important issue for Canadians and Saskatchewan. And therefore it is no surprise that three of the top four professions respected by Saskatchewan are all consider very important actors within the health care system: paramedics, doctors, and nurses. More specific to paramedics, the survey research finds that the public is aware of what paramedics do, that the public respects the profession, and values their contribution in keeping them safe and delivering health care in the province. These three factors (awareness, respect, and value) are important indicators of the strength of a brand or a profession s overall reputation. The strength of EMS public brand in Saskatchewan is deep and broad and should provide SEMSA with support as it seeks to gain recognition and an expanded role in the health care system. As the diagram below illustrates, these three attributes can be leveraged to gain more responsibility and an expanded role in delivery health care. Awareness Respect and Trust Value Support for Expanded Role Generally speaking, Saskatchewan are fairly satisfied with their health care system. While only 2 strongly approve of the job the provincial government is doing managing the system, few disapprove outright with the government s performance. There is however, room for improvement. Perhaps more important though is the fact that a large majority of respondents are confident that the health care system will be there when they or a loved one needs it. Moreover, a similar majority are confident that a paramedic be there quickly if there require emergency medical attention. Keeping in mind the strength of EMS reputation, it is not surprising that the survey also found broad support for expanding the role of EMS in delivering health care. A large majority of respondents support expanding the role of paramedics to deliver front-line health care in areas without easy access to a hospital. This is true even among those who live in rural or farming communities who are most affected by limited health care facilities. Insight by Abacus Data Inc. 31

The public is also open to allowing paramedics to treat patients in their home if their injuries or illnesses do not require transportation to a hospital. Most significant, when given a hypothetical scenario in which the respondent needed to see a medical professional but the time to get to an emergency room would be at least one hour, by a ratio of 4:1, respondents choose speed over being treated by a doctor. Three in four respondents said they would prefer to be treated more quickly by a paramedic at home who could then determine if they needed to go to a hospital versus 17% who preferred to be treated by a doctor even if it would take time to get to the hospital. These results clearly demonstrate that the public is aware of what paramedics do, they trust and respect those in the profession, and view them as being as important as doctors or nurses within the health care system. The results suggest that the public would be very receptive to a discussion about how to improve overall health outcomes by expanding the role of paramedics, especially into areas with more limited access to hospitals and emergency medical care. Insight by Abacus Data Inc. 32

10.0 Methodology The purpose of public opinion research is to measure attitudes and behaviours of a study population within reliable and acceptable statistical margins of accuracy. Abacus Data Inc. was retained by the Saskatchewan Emergency Medical Services Association to conduct a public opinion survey of Saskatchewan 18 years of age and older. Telephone Sample Design and Selection The sample for this survey was designed to complete 800 interviews with Saskatchewan aged 18 and over. The sample was drawn using technology that ensures that all residential listings in Canadian provinces and territories have an opportunity to be selected for inclusion in the survey. Telephone Survey Administration The survey was conducted by telephone with 800 respondents in English using computer-assistedtelephone-interviewing (CATI) technology. The survey was completed from July 24 th to August 1 st, 2012. The average length of time required to complete an interview was 12 minutes. All interviewing was conducted by fully trained and supervised interviewers, and a minimum of 10 percent of all completed interviews were independently monitored and validated in real time. The introduction to the survey informed participants of the purpose of the research, the research supplier, informed participants that their participation in the study was voluntary, and that all information provided would remain confidential. Sample Distribution A sample of 800 drawn from the Canadian population would be expected to provide results accurate to within plus or minus 3.5 percent in 95 out of 100 samples. The margin of sampling error will be greater for regional and demographic subgroups, as presented below. Sample Disposition and Response Rate A total of 9,485 households were dialled for this study, of which 800 qualified as eligible (adults 18 years and older) and completed the survey. The overall response rate achieved for this study was 8.9%. The following report on sample disposition and response rate follows MRIA guidelines, which are set up to establish consistency in reporting across the market research industry. A Total Attempted 9,485 1 Not in service/fax 675 B Total Eligible 8,810 2 Busy, no answer, answering machine 5,825 3 Language barrier 25 Insight by Abacus Data Inc. 33

4 Ill/Incapable 0 5 Eligible not available / Callback 0 C Total Asked 2,960 6 Household/Company Refusal 250 7 Respondent Refusal 1907 8 Qualified Termination 3 D Co-operative Contact 800 9 Not Qualified 0 10 Completed Interview 800 REFUSAL RATE 72.9% (6+7+8) / C RESPONSE RATE 8.9% D / B Data Weighting The data reported for province-wide results was statistically weighted by health region, age, and gender. Insight by Abacus Data Inc. 34

11.0 Apprendix A - Tabulations Insight by Abacus Data Inc. 35

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Health Regions (recoded) Gender Age group Type of Community Union household I am confident that if I or a family member were to become seriously ill, we would be able to access the necessary health care services. Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Unsure Percentage Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 18 11 3 25 42 1 766 800 North 23 14 10 29 21 2 26 35 Central 19 12 1 24 42 2 186 264 Saskatoon 17 7 4 26 44 2 237 190 Regina-Qu'Appelle 18 13 1 23 43 1 199 141 South 13 16 4 23 42 1 111 160 Don't know 36 24 0 7 33 0 7 10 Male 17 12 3 25 42 1 389 306 Female 18 11 2 24 43 1 377 494 18 to 29 13 14 0 31 41 1 154 81 30 to 39 12 13 5 26 43 1 113 70 40 to 49 20 14 3 27 34 3 126 155 50 to 59 19 9 5 22 44 1 144 179 60 to 69 18 13 2 20 45 2 97 167 70 and over 24 4 2 21 49 1 115 126 Refused 28 19 3 13 38 0 18 22 Rural or farm 18 15 4 24 39 1 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 6 15 6 28 45 0 80 66 23 9 2 15 52 1 83 111 19 10 2 26 42 2 354 332 Refused 17 13 4 26 40 1 133 143 Yes 15 13 2 27 43 0 279 262 No 19 10 3 23 43 2 468 513 Unsure/Refused 23 27 0 24 24 2 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Health Regions (recoded) Gender Age group Type of Community Union household I am confident that if I or a family member required emergency medical attention, a paramedic or the emergency medical service will respond quickly. Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Unsure Percentage Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 16 11 3 22 46 2 766 800 North 10 11 0 21 58 0 26 35 Central 13 15 4 25 41 2 186 264 Saskatoon 17 11 4 18 48 1 237 190 Regina-Qu'Appelle 19 6 3 23 46 3 199 141 South 12 12 1 26 47 1 111 160 Don't know 26 0 12 24 38 0 7 10 Male 17 11 3 22 46 2 389 306 Female 15 11 3 23 46 2 377 494 18 to 29 22 14 4 20 39 1 154 81 30 to 39 9 9 5 19 58 0 113 70 40 to 49 14 16 1 21 45 3 126 155 50 to 59 18 7 2 25 43 5 144 179 60 to 69 14 6 2 23 52 2 97 167 70 and over 16 11 5 22 44 1 115 126 Refused 16 6 8 37 34 0 18 22 Rural or farm 15 19 3 24 38 1 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 27 4 1 23 44 1 80 66 12 19 5 25 36 3 83 111 15 9 4 19 51 2 354 332 Refused 15 7 2 26 48 2 133 143 Yes 16 10 1 21 51 1 279 262 No 16 11 4 23 43 2 468 513 Unsure/Refused 11 0 9 26 53 0 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Health Regions (recoded) Gender Age group Type of Community Union household How would you rate the provincial government s performance in managing the province s health care system? Strongly disapprove Somewhat disapprove Somewhat approve Strongly approve Unsure Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 14 21 40 22 3 766 800 North 22 23 39 14 2 26 35 Central 13 24 41 20 2 186 264 Saskatoon 12 17 42 25 3 237 190 Regina-Qu'Appelle 16 21 38 21 4 199 141 South 15 23 36 24 2 111 160 Don't know 7 12 57 0 24 7 10 Male 15 19 37 27 2 389 306 Female 13 23 43 17 4 377 494 18 to 29 14 16 43 25 2 154 81 30 to 39 14 21 34 28 3 113 70 40 to 49 16 22 38 21 3 126 155 50 to 59 14 27 39 18 3 144 179 60 to 69 13 22 41 21 3 97 167 70 and over 13 19 43 21 3 115 126 Refused 21 8 45 17 9 18 22 Rural or farm 12 21 43 19 5 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 19 13 39 29 0 80 66 18 22 37 22 0 83 111 13 22 39 23 3 354 332 Refused 14 21 42 19 5 133 143 Yes 16 22 37 22 3 279 262 No 13 20 42 22 2 468 513 Unsure/Refused 14 19 40 13 13 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 I am going to read you a list of different professions. For each, please tell me if you have a lot of respect, considerable respect, somewhat respect, or no respect for the occupation. [rotate] Paramedic a lot of respect considerable respect somewhat respect no respect Don't know /No response Health Regions (recoded) Gender Age group Type of Community Union household Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 73 16 9 1 0 766 800 North 66 23 11 0 0 26 35 Central 77 14 7 2 1 186 264 Saskatoon 72 16 10 2 0 237 190 Regina-Qu'Appelle 74 16 10 0 0 199 141 South 71 16 11 2 0 111 160 Don't know 88 12 0 0 0 7 10 Male 70 18 10 2 0 389 306 Female 77 14 8 1 1 377 494 18 to 29 68 18 12 2 0 154 81 30 to 39 78 14 8 0 0 113 70 40 to 49 80 9 8 2 0 126 155 50 to 59 75 15 8 1 0 144 179 60 to 69 70 18 10 0 1 97 167 70 and over 68 20 10 1 0 115 126 Refused 75 19 3 0 3 18 22 Rural or farm 71 14 14 1 0 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 70 25 4 0 0 80 66 70 15 12 2 1 83 111 76 14 9 1 0 354 332 Refused 74 18 6 3 0 133 143 Yes 76 16 7 0 0 279 262 No 72 15 11 2 0 468 513 Unsure/Refused 77 23 0 0 0 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. Doctor very important moderately important moderately unimportant very unimportant Don't know /No response Health Regions (recoded) Gender Age group Type of Community Union household Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 89 11 0 0 0 766 800 North 91 9 0 0 0 26 35 Central 89 11 0 0 0 186 264 Saskatoon 90 10 0 0 0 237 190 Regina-Qu'Appelle 86 14 1 0 0 199 141 South 92 6 0 2 0 111 160 Don't know 76 12 12 0 0 7 10 Male 91 9 0 0 0 389 306 Female 87 12 1 0 0 377 494 18 to 29 88 12 0 0 0 154 81 30 to 39 90 9 0 1 0 113 70 40 to 49 86 13 1 0 0 126 155 50 to 59 90 9 0 1 0 144 179 60 to 69 90 10 0 0 0 97 167 70 and over 91 9 0 0 0 115 126 Refused 81 14 5 0 0 18 22 Rural or farm 89 11 0 0 0 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 87 13 0 0 0 80 66 86 14 0 0 0 83 111 90 10 0 1 0 354 332 Refused 91 8 1 0 0 133 143 Yes 87 12 0 0 0 279 262 No 90 9 0 0 0 468 513 Unsure/Refused 85 11 4 0 0 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. Nurse very important moderately important moderately unimportant very unimportant Don't know /No response Health Regions (recoded) Gender Age group Type of Community Union household Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 88 11 1 0 0 766 800 North 94 3 0 0 2 26 35 Central 87 12 1 0 0 186 264 Saskatoon 90 9 0 0 0 237 190 Regina-Qu'Appelle 89 11 0 0 0 199 141 South 85 12 2 0 1 111 160 Don't know 88 12 0 0 0 7 10 Male 89 9 1 0 0 389 306 Female 88 12 0 0 1 377 494 18 to 29 85 14 1 0 1 154 81 30 to 39 90 9 1 0 0 113 70 40 to 49 88 12 0 0 0 126 155 50 to 59 90 9 1 0 1 144 179 60 to 69 86 13 0 0 1 97 167 70 and over 93 7 0 0 0 115 126 Refused 88 12 0 0 0 18 22 Rural or farm 84 15 0 0 1 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 95 5 0 0 0 80 66 89 9 2 0 0 83 111 90 9 0 0 1 354 332 Refused 83 15 2 0 0 133 143 Yes 86 12 2 0 0 279 262 No 91 9 0 0 0 468 513 Unsure/Refused 73 27 0 0 0 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. Paramedic very important moderately important moderately unimportant very unimportant Don't know /No response Health Regions (recoded) Gender Age group Type of Community Union household Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 89 10 0 0 1 766 800 North 83 17 0 0 0 26 35 Central 89 10 0 0 2 186 264 Saskatoon 90 8 0 0 2 237 190 Regina-Qu'Appelle 90 10 0 0 0 199 141 South 89 11 0 0 0 111 160 Don't know 74 26 0 0 0 7 10 Male 89 10 0 0 1 389 306 Female 89 10 0 0 1 377 494 18 to 29 92 6 0 0 2 154 81 30 to 39 87 11 0 0 2 113 70 40 to 49 90 10 0 0 0 126 155 50 to 59 86 13 0 0 0 144 179 60 to 69 89 10 0 0 0 97 167 70 and over 88 10 1 0 1 115 126 Refused 90 8 0 0 3 18 22 Rural or farm 86 12 1 0 0 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 98 2 0 0 0 80 66 91 9 0 0 0 83 111 89 10 0 0 1 354 332 Refused 86 12 0 0 2 133 143 Yes 90 10 0 0 0 279 262 No 88 10 0 0 1 468 513 Unsure/Refused 96 4 0 0 0 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca

Saskatchewan Emergency Medical Services Association Provincial Survey, n=800, + 3.5% July 24-August 1, 2012 Now think about the importance of the following health care professionals to Saskatchewan s overall health care system. Please tell me whether they are very important, moderately important, moderately unimportant, or very unimportant. Dentist very important moderately important moderately unimportant very unimportant Don't know /No response Health Regions (recoded) Gender Age group Type of Community Union household Percentage Percentage Percentage Percentage Percentage Unweighted Saskatchewan 64 32 3 0 0 766 800 North 54 40 6 0 0 26 35 Central 65 32 2 1 0 186 264 Saskatoon 71 26 2 1 0 237 190 Regina-Qu'Appelle 58 38 4 0 0 199 141 South 62 33 5 0 0 111 160 Don't know 62 38 0 0 0 7 10 Male 65 32 4 0 0 389 306 Female 64 32 2 1 0 377 494 18 to 29 65 32 2 1 0 154 81 30 to 39 48 45 6 1 0 113 70 40 to 49 63 33 3 0 0 126 155 50 to 59 66 31 3 1 0 144 179 60 to 69 72 25 2 0 0 97 167 70 and over 72 26 2 0 0 115 126 Refused 69 31 0 0 0 18 22 Rural or farm 66 31 3 0 0 116 148 Village - under 1,000 Town - Between 1,000 and 5,000... City - Over 5,000 55 40 4 0 0 80 66 63 31 5 1 0 83 111 67 29 3 1 0 354 332 Refused 62 37 1 0 0 133 143 Yes 62 35 2 1 0 279 262 No 65 31 4 0 0 468 513 Unsure/Refused 76 24 0 0 0 19 25 Abacus Data Inc. www.abacusdata.ca @abacusdataca