By Jonathan Sher, The London Free Press
Ontario bureaucrats who oversee paramedics are using a broken tool to track when there aren’t enough ambulances on the road because they’re bogged down at swamped hospital emergency rooms, area officials say.
Regulators have told London officials to ignore the very system set up to warn when cities have very few or no ambulances to respond to emergencies, Middlesex-London Paramedic Service says.
They say the system in London is failing because it relies on 911 dispatchers — who are often consumed with responding to emergencies — to note exactly when the number of available ambulances falls below a critical threshold.
That process has led to so many errors that Ontario’s Health Ministry told the area paramedic service to disregard the data, the service says.
“Sometimes, dispatchers are too busy,” Deputy Chief Al Hunt said. “That’s a concern.”
That worry is heightened in London, where in 2017, paramedics supposed to spend no more than 30 minutes each time they drop off patients at Victoria and University hospitals instead spent an extra 10,800 hours — the equivalent of losing a 24/7 ambulance crew for 450 days.
Such “off-load hours” have more than doubled since 2015.
In London, those shortfalls are supposed to be tracked using two codes: critical, when there are three or fewer available ambulances; and zero, when there are none.
“Incidents of code-critical coverage (and) code-zero coverage (are) becoming more frequent, which have a direct impact on patient care,” Neal Roberts, chief of the Middlesex-London Paramedic Service, warned in a recent report.
London’s troubles are shared by other Ontario cities, as well.
At underfunded hospitals with too few staffed beds, emergency departments become bottlenecks where paramedics wait for hours for nurses to take over care.
The Ontario Hospital Association blew the whistle on overcrowded hospital wards last year.
Paramedics are required to monitor their patients until their care is formally handed off to emergency room staff. If an ER is backlogged, that leaves paramedics stranded with their patients, unable to respond to other emergencies.
But while ER woes are shared across Ontario, paramedics use varied ways to track the lack of ambulances, something that’s left the Health Ministry looking for a better approach to dispatching ambulances.
“Across the province, municipalities establish and implement their own ambulance deployment plans, including the specific level at which a code minimum is called,” ministry spokesperson Laura Gallant wrote Thursday in response to questions from The Free Press.
“As we move forward with implementing a new medical priority dispatch system in the province, we will continue working with local partners to ensure our emergency services are providing patients with high-quality care.”
But critics say Ontario’s Liberal government needs to take responsibility for a mess that’s only getting worse.
Problems in the ERs and for paramedics are symptoms of a failing system that needs reform, Jeff Yurek, the Progressive Conservative health critic at Queen’s Park, said. But change is made harder when regulators can’t even track the lack of ambulances.
“Part of the system is broken,” said Yurek, the Elgin-Middlesex-London MPP, who’s a pharmacist by profession. “The health-care system has become unmanageable under this government.”
That view is shared by MPP Teresa Armstrong (NDP – London-Fanshawe), though with a twist: Her party argues the Liberals have greatly worsened problems brought on by previous PC governments.
“Hospitals continue to burst at the seams,” she said.
It’s wrong to expect emergency dispatchers to also carefully record when alert codes should be started and stopped, she said. “It’s unrealistic.”
Delays for paramedics in London have more than doubled since 2015, including a 45 per cent jump from 2016 to 2017, data from paramedics show.
Since 2008, the Health Ministry has provided funding to hospitals to assign nurses to focus only on taking over the care of patients brought there by ambulance, but London Health Sciences Centre appears to be alone in sometimes directing off-load nurses to return to the ER, Roberts said earlier this week
The crisis not only affects patients, but also the bottom line — more than $1. 5 million in lost coverage and extra costs for items such as overtime and extra staffing.