Shortage of ambulances and staff

Across the province, patients calling 911 encounter long wait-times for ambulances, with great consequences for their health and safety.

Municipal paramedic services across the province frequently face Code Blacks whereby there are no ambulances available to respond to 911 calls. Even outside of Code Blacks, services often have critically low ambulance availability.

In CUPE’s 2021 membership survey, 41% of CUPE EMS members said they experience Code Blacks daily. Another 24% said they experience them a few times a week.

Based on Freedom of Information requests, CUPE found that while call volumes are increasing steadily, scheduled hours for ambulances are not keeping pace with demand. Ambulances are often taken off the road due to understaffing, as regional services are unable to recruit and retain enough paramedics.

The primary issue is underfunding by both the provincial and municipal governments, which have compromised care for patients who require emergency medical services.


The provincial and municipal governments must make significant investments to ensure there are enough ambulances and staff to meet high demand for EMS.

Lack of hospital capacity

Across the province, paramedics are facing offload delays at hospitals, undermining patient care and contributing to ambulance shortages. Offload delays refer to occasions when paramedics are stranded at hospitals, unable to transfer patients to the care of staff at the facility.

This is a direct result of the provincial government’s drastic cuts to hospital capacity over the past three decades. Currently, Ontario has the least number of hospital beds per capita across Canada, with no plans by the current Conservative government for significant expansion.

Ontario’s population has increased by about 4.5 million since 1990, and yet we have nearly 15,000 fewer hospital beds today. When compared to 38 countries in the Organisation for Economic Co-operation and Development, Ontario is only ahead of Mexico and Chile.

In the rush to free up beds, hospitals have become accustomed to discharging patients “quicker and sicker” into the community. And yet, we continue to witness overcrowded hospitals as governments take stop-gap measures instead of making investments in capacity.


Ontario must make significant investments in hospital capacity to meet population needs, which will help reduce offload delays for paramedics.

Heavy workloads

The twin pressures of increasing call volumes and offload delays have a major impact on the workload of paramedics. Provincial and municipal governments have not taken necessary steps to address staff burnout.

The response to CUPE’s 2021 membership survey were revealing:

  • 83% EMS members said their workload is harming their physical and/or mental health
  • 91% said that there isn’t enough staff to keep up with demand
  • 73% said their employer is not doing enough to address their mental health

The staffing crisis has been exacerbated due to high rates of injuries and burnout. In CUPE’s 2020 research report, we noted that across just 16 services that provided data through Freedom of Information requests, there were 2,700 WSIB claims annually. The amount of money municipal services paid for WSIB claims shot up by 31.4% in 2017 and another 24.4% in 2018.

Due to high numbers of paramedics taking time off to recover from injuries and/or illness, the staff on duty are burdened with heavier workloads, creating a vicious cycle of overtime, missed work breaks and burnout.

Dispatchers, too, face heavy workloads as call volumes rise without a corresponding increase in staffing. Moreover, they lack mental health supports to cope with the mental and emotional toll of the job.

Workload pressures increased during the pandemic due to a combination of factors including additional responsibilities of disinfecting, cleaning and putting on personal protective equipment, as well as rising call volumes and offload delays.

In addition, 73% of EMS members said staff in their workplace contracted COVID-19, contributing to shortage of workers on duty.

The consequences of these factors have not only affected EMS staff, but the public as well. In the CUPE membership survey, 65% of respondents said that there has been a negative impact on patient care during the COVID-19 pandemic.


Governments need to immediately invest more funding for higher staffing levels, more ambulances and mental health resources to ensure paramedics have safe working conditions.