Ambulance off-load delays costing taxpayers millions
Problem cost $2.4 million in wasted time in 2021 — and it’s getting worse
It’s a crisis for paramedics and a $2.4-million problem for taxpayers.
That’s how much money it cost for more than 21,000 hours of ambulance time wasted on off-load delays in 2021 — and the situation is getting worse.
Just about any day of the week, Niagara EMS paramedics can be found waiting with stretchered patients at the hospital until emergency department staff can find an available bed, which allows Niagara Health System to assume the duty of care.
The situation is termed an offload delay, and — combined with increased call volumes, overtime and pandemic-related job stress — the conditions are taking a physical and mental toll on Niagara EMS personnel, said Rick Ferron, Niagara EMS director of operations.
The problem isn’t unique to Niagara, but the situation here is acute and predates the pandemic. A recent report by Ontario Health comparing each hospital’s off-load performance ranked the St. Catharines hospital last (out of 74) for average off-load times over the past year.
Ferron told regional council Thursday the service is projecting a loss of more than 30,000 hours this year — which equates to 26 per cent of its allocated ambulance resources, worth an estimated $3.4 million.
“Without an injection of resources, these combined pressures have a real potential to overwhelm our EMS system,” Ferron said.
An emergency motion passed by regional council Thursday directs staff to add two 24-hour ambulances and one 12-hour ambulance for 90 days. The motion directs staff to tap the Region’s main reserve fund for $750,000 to try to buy the system more time — and relieve some of the pressure on the paramedic service.
“I’m actually really pleased with us as a council because we are
stepping forward and trying to do something — at least in the short term — to make sure the people of our region are being properly taken care of,” Lincoln Coun. Rob Foster said. “This is truly inexcusable.”
The off-load delays have also contributed to an increase in Code Zero calls, which mean no ambulances are available for calls across the entire fleet. The situation is worse in Niagara because the region is a peninsula surrounded by two lakes and an international border, limiting the options to call on neighbouring services for help.
In 2019, there was just one Code Zero situation. The number increased to 14 in 2021. In 2022, there have been nine already. On one day in early January, there was a 70-minute period where no ambulances were available across the entire region, though the service holds back some ambulances at that point in case of a major emergency).
“We can’t just keep throwing money at this problem,” Fort Erie Coun. Tom Insinna said. “This has to be accounted for somehow — perhaps we need to send a bill to the Minister of Health or the Niagara Health System. Perhaps they need a little fire lit under their posteriors.”
Ferron told council that while Niagara EMS has seen recordsetting 911 call volumes for the past 10 months, the number of patients transported to local emergency departments has remained relatively stable.
Health and the hospital system are provincial responsibilities, but Niagara EMS and regional council have been trying since well before the pandemic began to find local workarounds. COVID-19 turned the problem into a crisis.
“So what we have here is a downloading of the expense that should be borne by the Ministry of Health being loaded onto the local taxpayers and our paramedic service?” St. Catharines Coun. Brian Heit asked Niagara EMS Chief Kevin Smith. “Can I say that?”
“That’s an accurate statement,” was Smith’s reply.
Since 2019, Niagara EMS has been using innovative approaches to reduce the number of patients transported to hospitals. It starts with providing patients, where appropriate, with non-hospital care and options for treatment and followup through Mobile Integrated Health teams. As a result, those teams have been able to divert 10,083 ambulance responses, a staff report to council said.
On top of that, Niagara EMS is the only system in Ontario using nurses to complete a secondary triage of patients calling 911 with “non-emergency, low acuity health concerns.” Emergency communications nurses diverted an additional 1,877 ambulance responses.
Niagara EMS is also conducting a pilot project of offering taxis to get some patients the care they need without going to an emergency department. The staff report said feedback has been positive so far.
The financial impact of offload delays includes the cost of lost productivity and increased employee sick time and overtime, Ferron said.
Ferron told council while offload delays can’t be specifically identified as a reason for staff sick time, working conditions are a significant contributor.
As off-load delays continue through the duration of a paramedic’s shift, it is often difficult to find a paramedic to relieve them at the end of their shift. Communicators are fatigued with increased 911 calls and the stress of constantly juggling resources to respond to every call.
Comparing 2021 to 2020, combined sick time for both communicators and paramedics increased 38.9 per cent, an increase of 16,303 hours with a cost of $859,125.