Paramedics continue getting bottlenecked in ERs
Hundreds of life-threatening 911 calls made last year waited more than 20 minutes for an ambulance due to the lack of availability
AROUND 500 PEOPLE with life and death emergencies in Hamilton waited more than 20 minutes for help in 2017 primarily because of a lack of available ambulances.
The cost of hospital overcrowding was made clear during the Hamilton Paramedic Service annual report revealing response times for less urgent patients have gone up by about 12 seconds across the city as paramedics get stuck in the emergency department waiting to off-load their patients — sometimes for two hours or more.
It’s the first time response times have increased since 2014.
“With the challenges we had last year in terms of off-load delay times and call volume growth, that’s not surprising,” chief Michael Sanderson told the city’s Healthy and Safe Communities Committee April 23.
“We lost a little bit of ground last year in terms of the pressures we had, but we’re working hard to regain that.”
Paramedics wasted a total of 26,942 hours waiting in hospital emergency departments in 2017, meaning they were not available to respond to calls. The lost productivity cost an estimated $6 million.
It contributed to 1.3 per cent of life threatening 911 calls waiting 20 minutes or more for an ambulance as vehicle shortages nearly doubled in 2017.
Code zero events, when one or no ambulances were available to respond to calls, soared to 119 in 2017 from 60 the year before and 44 in 2015. The shortages lasted just over an hour on average.
“In 2017 these events continue to be a significant challenge for our community and for our paramedics who live through very challenging shifts,” states the annual report.
The aim is for paramedics to spend 30 minutes or less in the emergency department. But Hamilton’s hospitals reported that 90 per cent of patients were admitted within 108 to 120 minutes in 2017 which is roughly four times the target.
Hamilton Health Sciences and St. Joseph’s Healthcare struggled with record overcrowding in 2017 and the first two months of 2018 with an overflow of more than 200 patients
in January.
As a result the number of long off-load delays of more than two hours were 700 in the month of January alone, Sanderson told the committee.
That has dropped to 140 long off-load delays so far in the month of April as the hospitals and the city have worked together to resolve the issue.
“That is still way too many, but it is a huge improvement in terms of availability and capacity,” said Sanderson.
“We have to continue decreasing our hospital off-load delays, we need to pull those hours back and make them available to the service.”
Code zeros have also dropped to one in March and one so far in April from a high of 55 in January and February.
“It’s not fixed yet,” said Sanderson. “We’ve had significant improvement ... that is improving our availability, the impact on our staff and more importantly its impacting the patients and the community we end up serving.”
Some of the relief has come from better communication between the city and the hospitals as well as the province renewing $1.3 million for nurses dedicated to helping ambulances off-load patients in every adult emergency department in the city.
But the biggest difference has been the hospitals freeing up beds that had been taken up by those who can’t be discharged because they are waiting for other types of care usually in the community. These patients are called alternative level of care and the issue has blocked up to one in five adult acute care beds in Hamilton.
“Alternative level of care patients are down, which tells me patients are going out into the community more quickly,” said Sanderson.
He also described admitted patients in the emergency rooms being sent to hospital wards before the floor is ready for them.
Committee chair Coun. Sam Merulla noted code zeros have been an unresolved problem for at least 12 years, and applauded the hospitals for suddenly making significant progress while expressing shock that they have been quiet about how they did it.
“We never got around to an agreement of the systemic changes that were needed in order to address the code zeroes and ensure ambulances could drop off patients and move on to another call as soon as possible,” Merulla said at the meeting about talks going back to 2006. “Clearly there have been systemic changes within the hospital end that they are not even promoting or applauding ... I’m shocked they are not doing it themselves considering it is an election year.”
Other issues discussed in the paramedic service annual report: Call volumes continue to rise by about 5 per cent a year to 67,712 in 2017 More than one vehicle is often sent to a call for a total of 83,928 responses in 2017
The city recruited 19 new paramedics in 2017 and is aiming to hire 32 more in 2018
The paramedic service maintains 432 automated external defibrillators in the community located in schools, recreation centres, arenas and public buildings.
When a defibrillator is needed, 88 per cent of patients get it within
six minutes between paramedics, fire and public access AEDs.
It cost $530.97 for an ambulance to respond to an emergency
The ambulance service is out of space with paramedics at Hamilton Fire Station 30 at 489 Victoria Avenue North working out of a tent.