CHIEF TO THE RESCUE
Paramedic boss rebuts report
Ottawa objects to several findings in a report from the Ministry of Health that said the city’s paramedic service violated several policies and service agreements in one August shift, potentially harming patients, says Anthony Di Monte, Ottawa’s acting general manager of emergency services.
But in a long interview on Tuesday, he didn’t reject a ministry finding that paramedics frequently didn’t tell their dispatchers they’d handed patients over to hospitals — which cost Ottawa’s ambulance system hours of work on one night in August and left people with new emergencies waiting.
“There’s a whole bunch of things that, I think, in good faith, they put in there, but they didn’t realize. And we’re providing the documentation; they’ll take a whole bunch of things out. We’ll identify some things that, yeah, maybe there’s some problems there,” Di Monte said. He talks in a rush, idea piling on top of idea as one sentence blurs into the next.
“This is important stuff, because the business we’re in is life and death. And if there’s areas to improve, we always need to look at that. And if a third party like the ministry’s investigations branch has recommendations, that’s fine.”
The investigators reconstructed the Ottawa calls paramedics handled on the night of Aug. 6 this year, after Prescott-Russell paramedics complained that the Eastern Ontario dispatch centre, which Ottawa runs, sent too many Prescott-Russell ambulances to calls in Ottawa to make Ottawa’s response times look better.
Ambulance services in Ontario are supposed to be “seamless,” so dispatchers send the closest free ambulance to an emergency no matter where it’s from. Ottawa and surrounding townships and counties have an ongoing argument about this. Many of them say Ottawa has relied too much on their ambulances as reinforcements, for which we don’t pay.
“I think we need to allow (city management) to do the review and take a look at what’s happened,” said Coun. Diane Deans, who chairs the council committee that oversees the paramedic service. “A lot of the issues are provincially mandated policy. This was one day. I don’t know if one day makes a trend.”
The investigators call the situation “an overall, ongoing and systemic problem.” Because this complaint came from Prescott-Russell and was about one particular shift, the investigators focused on the 13 calls that night that involved Prescott-Russell paramedics, but they spotchecked others to see whether concerns they identified were flukes or something worse.
Aug. 6 was a warm Saturday in a dry spell. A 10-year-old drowned in Constance Bay that day; police found his body that night. In the early evening, before the sun went down, a guy drove himself to hospital after he was shot near Merivale Road. The Redblacks beat the Edmonton Eskimos 23-20 at Lansdowne Park that evening. The night was busy for ambulance calls, with two noticeable surges.
A complication that shift was one Ottawa ambulance had one paramedic in it instead of two — usually that’s because the other medic called in sick. A one-medic ambulance can go to treat a patient but can’t take him or her to hospital. Several times, the Ministry of Health says, that ambulance should have been sent to a nearby emergency but wasn’t.
In one standout case, the investigators found, the one-medic ambulance was six kilometres from a call and a dispatcher had even ordered it into action before waving it off in favour of a Prescott-Russell ambulance 37 kilometres distant.
“The five cases where they say (we sent the wrong ambulances), we’re saying definitively, four is absolutely wrong,” Di Monte said. “(In one case,) I’m admitting, yes, one of our (communications) officers that does 200,000 calls a year may have made a human error. We’re going to coach that individual, and we’re going to talk to all our dispatchers about that individual case. The four others, emphatically, absolutely not.”
Di Monte defended the policy that takes ambulances off the roster if they’re at their home bases and a shift change is coming up. That “concerningly creates a potentially negative effect on response times for emergency calls and hence, patient safety,” the Health Ministry says.
Actually, it’s the opposite, Di Monte said.
“The vehicle’s been on the road for 11 hours and 30 minutes. We’re saying, in the last halfhour, get back to headquarters, because now we have to wash, fuel, process that vehicle because the next two medics are waiting for that vehicle and going out,” Di Monte said. “So it’s very much an operational-side (consideration), because we have a finite fleet size.”
The ministry can’t criticize paramedics and dispatchers for following the rules, he said. “You want to talk about the policy in retrospect? Absolutely.”
And then there’s the 30-minute interval after handing patients over to hospitals. The pause is important, Di Monte said, and the Health Ministry has signed off on it.
When the time is used the way it’s supposed to be.
“Often, you’ll open the back of an ambulance after a major call and there’ll be bodily fluids everywhere,” he said. “The kits are open; drugs have been moved, everywhere. It’s important for the paramedic to completely disinfect, clean the vehicle appropriately, replace all the medical gear in its exact spot, because we work in a very standardized approach. Arrive at an emergency, every second counts: I need my Narcan, it’s exactly in that, so if you rush it — it takes some time.”
Provincial rules say that if an ambulance is a total disaster after transporting a patient, paramedics should let their dispatchers know and take longer to clean it up.
Filling out electronic forms to tell hospitals precisely what paramedics did while a patient was in their care is important, too.
What’s been tried? What drugs do we know are in his or her body? That’s another thing that happens in the 30-minute interval, Di Monte said.
The city is willing to try cutting the interval back to the provincial standard of 20 minutes, Di Monte said. Regardless, getting the posthospital work done quickly is something the paramedic service values.
“It is monitored. It is part of our performance analysis of our staff,” Di Monte said.
The troubling thing is, the investigators found multiple cases of paramedics doing things that kept the clock from starting.
Often, hospitals recorded receiving patients earlier than paramedics recorded handing them off. That happened in four out of five cases the investigators spot-checked. That’s one set of discrepancies.
Then, the provincial investigators counted 24 times in that one shift that paramedics recorded hand-offs to hospitals but still didn’t tell their dispatchers. That’s another set.
Seven times, those delays were five minutes or less. Maybe no big deal. But another seven times, the delays were 20 minutes or more. They added up to 324 minutes, according to the ministry’s figures, or 5 ½ hours ambulances weren’t available when, under the rules, they should have been.
Both Di Monte and Deans said Prescott-Russell’s complaint is really about money.
“The province pays for 50 per cent of the services, and the municipality pays 50 per cent,” Di Monte said. “So in all fairness? The citizens of Ottawa are paying 50 per cent of the municipality of Prescott-Russell’s budget as well, too, and, from a proportional perspective as far as population, our percentage is more.”
“Let’s not piecemeal just paramedics,” Deans said. “Let’s talk about transit services. They all come in. They don’t pay transit tax to the City of Ottawa, but many of those residents come and use our park and rides and use our public transit system. We don’t charge back to the municipalities a percentage of our transit costs. If one would look at one thing, they would need to look at the global picture of how bordering municipalities interact with each other.”
Often, you’ll open the back of an ambulance after a major call and there’ll be bodily fluids everywhere. The kits are open; drugs have been moved … .