Delays at hospitals leaving too few ambulances on the road
EMERGENCY SERVICES Paramedics raise alarm over long waits at ERs, frequent code zeros
Hamilton Paramedic Service is raising alarm that hospital overcrowding is increasingly leaving the city with too few ambulances on the road to respond to emergencies.
“We end up having multiple vehicles tied up at the hospital longer than two hours,” Chief Michael Sanderson told the city’s emergency and community services committee Thursday. “It’s not good for patients, it’s not good for our staff and it’s not good for our capacity to respond.”
Paramedics regularly wait more than two hours to hand off patients to Hamilton emergency departments despite recommendations that it take no longer than 30 minutes, reveals the service’s annual report.
In October, it happened 432 times, which translates into 14 times a day.
On one day alone, Oct. 11, paramedics were stuck at the emergency room for more than two hours 44 times.
As a result, there were one or no ambulances left to respond to emergencies in Hamilton — known as a code zero — three times that day.
In that month, there were 18 code zero events.
“There is a significant correlation between the number of patients we have on off-load delay at the hospitals longer than two hours and our frequency of code zero events,” said Sanderson. “If we keep the delays down, we don’t have the code zero events.”
The annual report shows Hamilton’s hospitals take more than three times longer to off-load 90 per cent of patients than the recommended 30 minutes. The worst delays are at Juravinski
Hospital and Cancer Centre with 90 per cent of patients off-loaded within 112 minutes. Next was Hamilton General at 107 minutes and St. Joseph’s hospital clocked in at 91 minutes.
At times in October, it escalated up to 140 minutes.
“It’s creating a lot of pressures for paramedics in the city,” said Ward 7 Coun. Donna Skelly. “Our off-load times are three times what the province is asking.”
Hospital overcrowding was blamed for pushing the number of code zero events to 60 in 2016 from 44 the year before. More than half were in the final quarter of the year when hospitals struggled with occupancy rates as high as 120 per cent.
“I often feel like EMS paramedic services are very much like the canary in the mine shaft,” said Sanderson. “You can’t continue to sustain 100 or 105 per cent occupancy in hospitals. The tipping point has been exceeded.”
NDP leader and Hamilton Centre MPP Andrea Horwath says the annual report should be a “wake-up call” for the province. “You can get rushed to a hospital in an ambulance and than spend hours waiting because there is no room inside,” she said. “We have been on (the government) about overcrowding in the hospitals for years now. It’s reaching a crisis point. The thing that is really worrisome is that in this last budget the government shorted the hospitals by $300 million to just keep services at the inadequate level they are at now.”
Health Minister Dr. Eric Hoskins says he’s put measures in place including incentive funding to emergency departments and cash for dedicated off-load nurses to shorten the amount of time paramedics spend waiting.
“We recognize the challenges associated with off-load delays experienced by emergency medical services providers when transferring patients to hospital emergency departments,” he said in a statement to The Spectator.
Hamilton Health Sciences did not provide comment Thursday about the delays.
St. Joseph’s Healthcare said it has been slammed with 100 to 200 more patients coming in by ambulance some months. It is using several strategies to try to get paramedics back on the road including opening up unfunded beds but the high volumes that started in the fall have continued into the spring.
“The lack of bed capacity is a provincial problem that they’re not addressing,” said Mario Posteraro, president of Ontario Public Service Employees Union Local 256. “It’s being borne by the municipality and our ambulance service, but it’s created by the provincial government.”
The annual report also raises flags about the steady growth in the number of calls to 911 that require an ambulance.
Paramedics responded to more than 79,000 calls in 2016, a jump of seven per cent over the prior year and a cumulative increase of 35 per cent over the past seven years.
If the growth continues, it will mean an additional 22,000 ambulance calls over the next five years.
Ward 2 Coun. Jason Farr said he thinks the growth estimate is far too low considering the aging population.
The biggest demand comes from those aged 80 and over who make about 16 per cent of ambulance calls despite being just over two per cent of the population.
“What we’re looking at is a crisis that’s looming with respect to the increase in call volume,” Posteraro said. “The bottom line is we need more front-line ambulances.”