Alarm sounded on paramedics
Dispatch system for ambulances failing patients, investigators say
Ottawa’s paramedic service has “an overall, ongoing and systemic problem” that leaves patients waiting for ambulances coming from far away even though closer ones are available, a Ministry of Health investigation has found.
The city has even violated numerous rules and standards for how it’s supposed to dispatch ambulances, the ministry says.
In one case, on a night the investigators studied, firefighters tried for 17 minutes to resuscitate a patient on Stonehenge Crescent in Pineview before the first ambulance arrived. The nearest one was five minutes away at the Children’s Hospital of Eastern Ontario, but its paramedics were nearing the end of their shift so they weren’t sent. The patient died. One dispatch centre, run by the City of Ottawa, orders ambulances around across Eastern Ontario. Emergency services in nearby towns and counties have complained for months that Ottawa relies on them to rush to patients in places such as Cumberland and West Carleton because Ottawa ambulances that are supposed to be in suburban and rural Ottawa are constantly being called to help downtown.
The explanation from Anthony Di Monte, Ottawa’s general manager of emergency services (and formerly the city’s paramedic chief) has been that the city’s dense downtown has more need for paramedics than city council has been willing to pay for.
“It’s basic math,” Di Monte said last February. “You have a certain number of resources and you add growth and aging demographics, and something has got to give.”
Maybe so, says the new investigation report, prompted by a complaint from Prescott-Russell’s paramedic service, but Ottawa is not handling the situation properly. “We have contacted the ministry to further clarify some of the information in the report and discuss the validity of the findings,” said Peter Kelly, the acting Ottawa paramedic chief, in a written statement relayed through the city’s communications department. They want to help “finalize the report with updated information and to discuss next steps.”
The investigators, who do not describe their report as a draft, closely studied the paramedic service’s night shift last Aug. 6. They looked into Prescott-Russell’s allegation that Ottawa dispatchers spent that night grabbing out-of-town ambulances and calling them to Ottawa to keep their official response times low.
The investigators examined more than 60 files from that August shift and reconstructed the night second by second, call by call. The picture is ugly.
In five of 13 calls involving Prescott-Russell ambulances, dispatchers didn’t send the closest available ambulances to emergencies, the way they’re supposed to, the investigators said, though they did not reach any conclusions about why.
But in studying those 13 calls, and where they fit into that August night’s paramedic assignments, the investigators found worse problems. The Ottawa dispatch centre violated its own practice manual and its performance agreement with the provincial government, and paramedics on the road contravened their operating rules, the report says.
Dispatching ambulances — let alone caring for patients in emergencies — is a chaotic, high-stress job that probably can’t be done perfectly. Often, the investigators found, dispatchers did the right thing, sending the closest ambulances to the neediest patients.
They dealt with understandable screw-ups, such as assigning and reassigning ambulances when they thought the police were asking for paramedics on Highpark Crescent in Blackburn Hamlet — but it turned out the call was on Hyde Park Way in distant Centrepointe.
But even within that one episode, the investigators found, the Ottawa dispatchers brought in a Prescott-Russell ambulance when there were two Ottawa ambulances closer to the Blackburn Hamlet address.
Then, when a third Ottawa ambulance booked in after leaving a patient at CHEO, the dispatchers sent that one to Blackburn Hamlet but neglected to call off the one speeding in from Prescott-Russell with lights and sirens going. They only turned that one away after getting the correct address several minutes later.
The systemic problems go beyond humans making an occasional error in an extremely difficult job.
Paramedics are supposed to check patients’ vitals regularly. Those check-ins amount to a log of the time a patient was in their care, from the time they’re picked up until they’re formally transferred to a hospital.
In the records from that one August night, “multiple discrepancies in the documentation of the (transfer) time versus the last documented vital signs were identified.”
Specifically, they found gaps between the last logged vital signs and the times the paramedics claimed they handed their patients over.
The investigators say there are two possible explanations. It could be the patients were handed over to hospitals sooner than the paramedics recorded. Or “the paramedics failed to obtain vital signs every 10 minutes as required by the Basic Life Support Patient Care Standards and the Ministry Documentation standards.”
In dry language, that suggests either the paramedics were fudging the records or weren’t following the standards for patient care. Which would you prefer?
Next problem: Ottawa allows its paramedics 30 minutes to gather themselves after a hospital handoff. It’s an unusual policy and it applies even if the patient was under his or her own power and didn’t need a stretcher or make a mess in the ambulance. Other paramedic services don’t have such a policy, the ministry says — they let paramedics say when they need time to clean or resupply.
The investigators found that in 29 of the cases they looked at on that one shift, the patients weren’t in very bad shape and didn’t require major care. In those cases, it still took more than 25 minutes, on average, for the paramedic teams to book back in after delivering their patients.
“The investigation found that this practice caused significant delays in the return to readiness status for Ottawa (paramedics),” the report says.
In one case, Ottawa had seven ambulances that could have responded to calls but six were officially unavailable because they’d only recently dropped off patients. Dispatchers summoned an ambulance from Embrun to an emergency call at Elgin and Cooper streets at 4:30 a.m., right in
downtown Ottawa, only to send it back four minutes later when they found an Ottawa ambulance that was much closer.
Some Ottawa paramedics took longer than 30 minutes to return to service but didn’t explain why. In one case, a patient refused to go to hospital but the paramedics took 28 minutes to tell their dispatchers.
Third: Dispatchers sent ambulances to lower-priority calls even when the system was strained and the rules say the patients are supposed to wait a little longer, which “contributed to the diminishing resources during a call surge.”
Finally, Ottawa has a policy that’s meant to return paramedics to their home bases as the ends of their shifts approach. If they’re “home” and the end of a shift is coming up within half an hour, the dispatch computer removes them from the list of available ambulances, even if they’re still on duty and even if there are no other ambulances available.
“This practice does not allow for a seamless ambulance service and negates Ottawa Paramedic Service’s own mandate of sending the closest ambulance to all highpriority calls,” the report says.
That’s what happened with the person who died on Stonehenge Crescent that morning.
Almost. An ambulance was free at CHEO, six kilometres away. Its crew was 31 minutes from the end of their shift when the call came in, not even quite in their don’t-sendus-out window. But dispatchers called in an ambulance from Rockland instead — 37 kilometres away.
The dispatch centre ended up switching the assignment to a slightly closer ambulance in Embrun, then to a second leaving from the Queensway-Carleton Hospital, and finally to a third at the Montfort Hospital, which got rolling nine minutes after the call came in — four minutes after the ambulance at CHEO could have arrived, in the investigators’ estimate.
The original call was for a patient who had no vital signs. Maybe getting an ambulance there faster would have made no difference. But this system did not give that person his or her best chance.
The townships and counties around Ottawa are understandably peeved that their paramedic services are subsidizing ours. According to this investigation, we’ve got a much bigger problem on our hands than that.