The York Region Emergency Medical Service (EMS) has a target response rate of eight minutes for 911 high acuity calls, which includes cardiac arrest calls. However, that target is impossible to achieve when there are no ambulances that can reach the patient in time – as is too often the case.
Christina Bonner, a CUPE 905 paramedic in York Region, says she was recently dispatched to a patient experiencing a cardiac arrest located 25 minutes away, because there were no other ambulances available to respond closer to the patient’s location.
“We all know that there is brain damage to a cardiac arrest patient after three minutes, chances of permanent injury increase by the second,” she says. “In that particular case, I can’t say the outcome would have definitely been different has we arrived soon, however response times could certainly play a role in many critical cases.”
“There’s definitely a stark difference in receiving care in eight to 10 minutes versus 25,” she says. “Imagine that’s your loved one – you’re waiting for an ambulance for 25 minutes while you’re doing CPR on your family member. That is the reality of what could happen out there. And I don’t think [enough] people are aware.”
The problem is endemic across Ontario.
Emergency medical services across the province are experiencing frequent Code Blacks – occasions when there is one or no ambulance available to respond to a 911 call (Code Blacks are also referred to as Code Reds or Call Deferrals, depending on the region).
The problem is multi-faceted. Due to an aging population, demand for paramedic services has been rising without a corresponding increase in scheduled ambulance hours. In other words, due to underfunding from the province and municipal governments which equally split operational costs, EMS services are chronically understaffed.
“On a regular basis, we could be delaying care for patients, because we don’t have the staff to respond. So many nights pass where we don’t have the staff at the appropriate stations, overtime calls are going out four to five times a day. Appropriate staffing allows the services to have the response times that we know determine better outcomes for our patients,” Bonner says.
Additionally, due to Ontario’s dramatic reduction in hospital capacity, emergency rooms are overcrowded, preventing paramedics from transferring (or “off-loading”) patients to hospitals in a timely manner. Being routinely in offload delay, at hospitals – often for several hours – this keeps paramedics from responding to other emergency calls. Moreover, it can also has a negative impact on definitive patient care.
“It can be very taxing. Let’s say your grandmother fell and broke her hip,” Bonner says. “And instead of waiting 30 minutes to get to the hospital, now she is waiting three or four hours on the floor. You can imagine how the pain will increase. And there will be negative effects of receiving delayed treatment, complications of increased pain or immobility, it is not ideal.”
The dual pressure of rising demand (combined with limited increase in funding) and off-load delays, paramedics like Bonner routinely face the stressful situation of knowing the demands at work are increasingly rapidly with minimal support.
The lack of resources in the EMS sector also has harmful effects for paramedics, who routinely work overtime in addition to 12-hour shifts without breaks, rushing from one call to the next.
“Let’s say you do an eight-hour job. Now imagine you come into work, and for eight hours, you don’t sit down and you don’t go to the washroom. You don’t eat,” Bonner says.
“There’s so many times during the year where we literally get out of our cars (as we arrive at work), half dressed and you hear the calls coming in. You’re running into the station because there’s another crew that’s been doing it all night and you just want to release them, you just want to let them get home in time so they can sleep and do it again the next day.”
In these very challenging circumstances, paramedics continue to do an amazing job of providing care.
Despite the increase in call volume and the increase in incidents of critical coverage, the average response time to emergency calls only increased by 12 seconds from 2016 to 2018 (based on latest available data).
But this increasing intensity has repercussions for both workers and patients. The number of workplace injury and illness-related claims filed at the Workplace Safety and Insurance Board (WSIB) have skyrocketed. Based on data obtained from 16 services, WSIB claims increased by 31.4 per cent in 2017 and 24.4 per cent in 2018.
The growing number of paramedics unable to report to duty leads to higher workload for their peers, creating a vicious cycle of overtime, injuries and short-staffing.
“A lot of times we go into shifts with low ambulance coverage. Some nights we are down 12 ambulances, or down nine ambulances,” Bonner says, pointing to the fact that often there are no paramedics to staff the ambulances. “You have to address our working conditions – why are so many medics taking time off? Why are we so burnt out?”
With paramedics burning out, services being short-staffed and hospitals overcrowded, the health and safety of Ontarians who desperately need emergency care is at risk.
Bonner says that reality is heart-wrenching for paramedics, who choose the profession to provide high quality patient care.
“I think the hardest part is coming in day after day to the same issues,” she says. “The pandemic has been challenging and as we all head into contract negotiations it quicky becomes apparent that there is little to no support.”