City decries ‘offload’ time of paramedics

The war of words over ambulance off-load delays heated up Friday, with the city’s head of emergency services warning that Ottawa is at risk of not having ambulances available if there is another terrorist incident or major crash, a concern that hospital officials say is unfounded.

In fact, during last January’s OC Transpo bus crash, in which three passengers died and 23 were injured, 17 ambulances were “stuck” at The Ottawa Hospital, said Anthony Di Monte, Ottawa’s general manager of emergency and protective services.

The city was lucky that day, Di Monte said, because the crash happened at shift change and those coming on shift could go directly to the Westboro site. The city might not be so lucky next time if the situation isn’t rectified, he said. “This is a major problem.” Hospital officials agree the situation is serious, but say Di Monte’s finger-pointing at The Ottawa Hospital in particular is not helping.

And Dr. Andrew Willmore, an emergency physician at The Ottawa Hospital who is among those working on solutions to offload delays and other issues, says Di Monte’s concern about having no ambulances for a disaster is unfounded.

In the case of an external disaster, such as the bus crash, the hospital declares a Code Orange, Willmore said, which allows it to clear the emergency department and release any paramedics waiting for patients to be off-loaded to make room for incoming patients.

But that doesn’t mean there is not a serious ongoing problem, he said.

“I don’t think there is any question that overcrowding is not an acceptable norm and is something we need to address,” Willmore said. “But finger pointing to the emergency department in this case and the hospital is really overly simplifying a very complex problem.”

The issue of ambulance off-load times — the amount of time paramedics spend waiting to off-load patients to hospitals — has become contentious since the city released figures showing that there had been 329 “level zero” incidents in the first eight months of 2019. Level zero means the paramedic service has no ability to transport patients because paramedics are waiting to off-load patients at hospitals.

In the first seven months of 2019, the Ottawa Paramedic Service lost 151 hours a day waiting to off-load and transfer patients to the hospital, the city says. The industry standard for transferring patients is 30 minutes. In those seven months, the 90th percentile time for all Ottawa hospitals was 79 minutes 30 seconds, and it was 95 minutes for the Civic and General campuses of The Ottawa Hospital, the city report said.

Ambulances account for about a quarter of all emergency arrivals. The Ottawa Hospital entered into an agreement last December to off-load patients on arrival at the hospital, but so far has not been able to do so.

A number of programs are underway to fix that situation, but things have yet to improve.

Hospital officials say the situation is complex and relates to the high number of ALC, or alternate level of care, patients filling beds because they have no place suitable to go. That crowding backs up the entire system, which is especially evident at the emergency room. Since June, emergency room waits at The Ottawa Hospital have also become longer because of the introduction of an electronic health record system called EPIC.

Di Monte says those are all issues that belong to the hospital, not the paramedic services, and hospitals should not rely on paramedics to help solve them.

He says he is not criticizing hospital staff, who are doing their jobs, and he acknowledges there are meetings to discuss solutions, but adds it is past time for a solution.

“This is an institutional problem. It is not up to us to resolve. It is up to them to resolve,” he said. epayne@postmedia.com