Paramedic response time slowed by hospital delays

The city's paramedic service has been dangerously close to falling below the city council-mandated response standard for the most life-threatening calls as patient off-load delays keep paramedics parked at hospitals.

The Ottawa Paramedic Service estimates that delays at hospitals in 2019 were equivalent to $7.7 million in lost staff time annually and the city doesn't seem to be any closer to solving the problem with three local hospital organizations.

The paramedic service's 2019 annual report was scheduled for discussion at a community and protective services committee meeting on Thursday but councillors deferred the matter until next

month. Coun. Jenna Sudds, chair of the committee, said executives at three hospital organizations have agreed to participate in the October meeting to discuss the patient off-load crisis.

“These are serious delays that we need to have addressed,” Sudds said.

Sudds and Mayor Jim Watson have addressed the off-load problems with the province. In a discussion with Premier Doug Ford this week, Watson brought up the paramedic delays at hospitals, in addition to issues related to COVID -19.

The paramedic service is jointly

The paramedic service is jointly funded by the province and the city.

The province sets a target of eight minutes for paramedic responses to life-threatening calls. The City of Ottawa has a sub-target that calls for the eight-minute goal to be achieved 75 per cent of the time.

In 2019, paramedics responded to life-threatening emergencies within eight minutes 75.1 per cent of the time, which was a decrease from 78 per cent in 2018 and 77.3 per cent in 2017.

For lower-level emergencies, paramedics comfortably achieved council's standards.

On Thursday, the city didn't provide statistics for 2020, saying the data will be discussed at the October committee meeting.

The average times for paramedic off-loads at some hospitals were getting close to an hour in 2019. At The Ottawa Hospital General campus, it was 52.16 minutes, and at the Civic campus it was 50.1 minutes. The average off-load time at the Queensway Carleton Hospital was 44.14 minutes and at the Montfort Hospital it was 37.58 minutes.

There's an industry standard to have the transfer of care from paramedics to the hospital within 30 minutes at the 90th percentile. Compared to that benchmark, the 2019 statistics at Ottawa adult emergency rooms were shocking: 102.43 minutes at the Civic, 101.83 minutes at the General, 82.98 minutes at the Queensway Carleton and 63.6 minutes at the Montfort.

The paramedic service hasn't met the council response standards for life-threatening calls before, most recently in 2015 and 2016. The city went on a hiring blitz around that time and in the years that followed to increase the number of paramedics to help residents in a growing city.

Paramedics responded to 146,481 calls in 2019, a 1.5-per-cent increase over 2018.

The city has criticized hospitals for not having the ability to quickly take patients and free up paramedics for more calls. The general manager who oversees most of Ottawa's emergency services, Anthony Di Monte, who's a former paramedic chief and is intimately aware of the delay problems, has warned about the danger of ambulances being tied up at hospitals if there's a major emergency.

Not included in the 2019 data is the number of times the paramedic service reached “level zero” — the times when the service didn't have ambulances available to transport patients.

The city in October 2019 revealed that level zero had been reached 329 times in the first eight months of that year.

When Ottawa's paramedic service reaches level zero, it must rely on the next closest paramedic teams in neighbouring municipalities to take calls in the city, and that in itself has been hugely controversial for those border municipalities, seeing their paramedic units dispatched to Ottawa communities.

The Ottawa Hospital, Queensway Carleton Hospital and Montfort Hospital were asked for comment on the off-load problem. The Queensway Carleton and Montfort responded.

“We are acutely aware of the importance of a swift off-load when patients are arriving in ambulance, so that paramedics can get back on the road, where they are most needed,” said Geneviève Picard, the communications director at the Montfort Hospital.

“In the past five years, Montfort has dedicated a lot of focus and energy to improving our performance in this area, and as a result our off-load times have improved greatly. That being said, it is always possible to find new ways to do things and we are collaborating with the other partners in the region to continue to improve the situation.”

Ann Fuller, communications director at the Queensway Carleton, said the biggest challenge at that hospital is that most nights the beds are full and it means keeping patients overnight in the emergency department, which means fewer beds available to receive new patients. Having enough trained health-care workers has also been difficult, especially during the COVID -19 pandemic as staff assist at testing facilities and long-term care homes, while ramping up previously postponed surgeries and other appointments, Fuller said.

The Queensway Carleton has initiatives in the works to speed up patient transfers, adding staff to the emergency department at busy times and finding ways to use “additional unconventional spaces” for more patients, Fuller said.

“Patients should know that, no matter what, they will be safe and cared for,” Fuller said.