ER issues
Many wait hours until patient seen, union says
Paramedics union raises concerns with long wait times in transferring patients from ambulances to provincial emergency departments.
Long wait times to transfer patients from ambulances at provincial emergency departments are putting lives at risk, says a Nova Scotia Paramedics Union spokesman.
“Buying new ambulances won’t fix this problem,” said Terry Chapman. “They’ll all be stuck at a hospital. Someone who has the authority to amend policy or look at policy has to admit that there is an issue, and then put their heads together with everyone who is a stakeholder to come to some common solution or at least to alleviate it in part. That’s not happening.”
Chapman said he knows of paramedics who sit in front of hospitals for four, six or eight hours, tending to patients who await admittance to an emergency department.
“The longest I know of is 18 hours.
“Ambulances that should, in my opinion, be back in their communities, are parked at the Queen Elizabeth II in Halifax or at hospitals in Truro or Sydney. They are trapped there for entire shifts, 12 hours or more.”
Emergency Health Services, which runs the provincial ambulance system, and the Nova Scotia Health Authority both acknowledge that the problem is real.
“It’s been at least a 12-year challenge that we’ve had in the system,” said Jeff Fraser, director of provincial operations for EHS.
“Hospitals are as concerned as we are about our communities and they do what they can
and when they can to release our ambulances from the lineup. But we also have patients that we are responsible for and we can’t just leave them there. We have to wait until they (emergency departments) are able to take them in.”
The executive medical director of the central zone for the provincial health authority says paramedics raise valid points.
“It is not in anybody’s best interest to have ambulances not able to offload patients,” said Dr. Mark Taylor. “The majority of cases are unloaded within two hours, some longer. Obviously, the most urgent are treated first.”
He said that could leave less urgent cases waiting longer in ambulances.
“I’d like it to be immediate,” Taylor said. “That should be the goal we all strive for ... But it’s a difficult goal to meet.”
Fraser said the system has peaks and valleys.
“In the last couple of weeks we’ve seen an increase in the de-
mand for our services which just exacerbates the entire situation,” Fraser said. “We work closely with the health authority and the Department of Health to look for viable solutions for a very complex issue.”
He said it’s important to remember that no community owns an ambulance. Paramedics work 12-hour shifts where there is actual and anticipated demand.
“Our medical communications centre does their best to try to get those paramedics back to their community,” he said. “There is no doubt that if we have 50 resources and we end up with 17 of them tied up at a hospital, that’s 17 less that we have on the road.”
Chapman said the system doesn’t work and it is endangering lives. While ambulances are tied up at hospitals, he said, recent history has seen a single ambulance in Milford responsible for a radius that could take it as far away as Wolfville, or an ambulance being dispatched from Antigonish to Baddeck.
“All of those reasonable response times, 90 per cent of them are never being met,” Chapman said. “Everyone needs to step back and take a look at what’s going on.”
And the long shifts that include hours sitting at a hospital are wearing down the province’s 1,200 paramedics, he said.
“Some of these guys on a regular basis are not getting home until five, six, seven hours after their shift ends. They have a family life. They have to be rested for work the next day. They have social commitments, doctor’s appointments. It’s incredibly stressful.”
Fraser said it is important that people not be dissuaded from calling 911.
“These challenges make it so that we are delayed in getting where we have to get to and we know we could be faster,” Fraser aid. “We don’t want people not to call. We will get to you.”
Fraser said better prevention programs to keep people healthy within their communities are important.
Taylor agreed.
He said the problem with emergency departments, accentuated by an unexplained daily spike in patients at the QEII recently, is the bottleneck created when patients aren’t moved quickly enough from hospital beds to care at home or to extended-care homes.
“It’s a serious problem everywhere,” said Taylor, who has worked in medical administration in Manitoba, Ontario and Australia. “Emergency department overcrowding is not something that has been completely resolved by any jurisdiction that I’m aware of. That doesn’t mean it’s not important for us to work on.”