“In nearly every region of Ontario, paramedics are in crisis and unable to meet growing demand for EMS…There are tragic consequences every day – patients in cardiac arrest not getting care in time. Elderly people lying for hours on the floor, suffering as they wait for an ambulance to arrive.”
(Niko Georgiadis, CUPE Ambulance Committee of Ontario)[1]
If you live in Essex County and have been contemplating a heart attack, you might want to reconsider your timing and location, or you might die without ever reaching the hospital. That’s because Essex County has been suffering through a perilous shortage of available ambulances and paramedics for almost a year.
In late 2022, for a five-day period in mid-October, the Warden declared an emergency when the County of Essex was left without ambulance coverage for hours spread across the first two weeks of October. Although the emergency was rescinded, the County of Essex conceded then that “there have been no systemic changes that would warrant rescinding this local emergency.”[2]
Although the formal declaration has passed, the real emergency persists.
A “Code Black” (also called a “Code Zero” in some jurisdictions) occurs when there are no ambulances available in a jurisdiction to respond to a call. A “Code Red” occurs when there are two or less – potentially, one car accident away from a code black. Windsor-Essex experienced a cumulative 3,253 minutes in code red in 2021 and 791 in code black. In 2022 those numbers jumped to 8,806 minutes in code red and 2,257 in code black. At the end of the first quarter of this year, those numbers were 864 minutes in code red and 2,257 (already last year’s total) in code black.[3]
Although the problem is critical here, according to CUPE, Windsor-Essex is not alone: “Data collection is inconsistent, but we know that Toronto witnessed 1,139 code zero incidents in 2021; Ottawa 750 times in 2022 by July alone (matching the number of such incidents in 2021); and Waterloo Region 87 times in 2022 (a fourfold increase relative to 2021.”[4]
Data collection is fractured, as CBC reported on the deficiencies in maintaining, sharing, and tracking these statistics in a story last month, noting that “A spokesperson for Health Minister Sylvia Jones said the province doesn’t track that [Code Blacks] because municipalities are responsible for ambulance deployment strategies.” It also noted that: “Ontario generates monthly reports based on data from ambulance dispatch centres, including time paramedics spend waiting in ERs to transfer patients – known as offload delays – by hospital. But requests for the figures, including a specific request for the most recent report went unacknowledged.”
The causes of these ambulance shortages are numerous, complicated, and interrelated. The biggest single source is off-load delays – when paramedics are stranded at a hospital and unable to transfer a patient due to lack of capacity. But the causes of the off-load delays themselves vary from hospital to hospital, and include long-standing issues of hospital capacity (it is alleged that Ontario ranks among the bottom of OECD countries, alongside Mexico, in hospital beds per capita[5]), patient flow, a shortage or lack of primary care providers such as after-hour clinics, and increase usage of the 911 system (one theory is that a belief may exist that traveling to the ER by ambulance allows you to jump the line[6]).
Locally, our problems are compounded by the competitive disadvantages this market already faces. President of CUPE Local 2974 representing Essex Windsor EMS workers has said our region “has trouble attracting paramedics because the Greater Toronto Area absorbs almost all newly-graduated paramedics, and paramedics in those areas might make between $5 and $10 an hour more.”[7]
Consequently, working conditions in Windsor-Essex, where the current complement of 300 paramedics is already short by an estimated 50, are particularly alarming: “Constantly rushing from call to call, missing meal breaks regularly, being forced to work overtime beyond our 12-hour shifts, knowing that patients are being shortchanged by the system, facing violence on the job (often from exasperated people reacting to trauma) takes a tremendous amount of mental and physical toll.”[8]
What are the solutions?
The provincial government recently began augmenting a 2008 then-Liberal government’s Dedicated Offload Nursing Program – which, as the name suggests, funds the cost of additional nurses in the ER dedicated to unloading ambulances, triaging patients, and returning paramedics to the field. That program was created as a pilot program and was intended to be temporary, but it “remained consistent at $16 million per year from 2012 to 2021, with 50 hospitals across 20 municipalities taking part.”[9] This year the Province announced a further $7 million increase to the program “as well as expanding the 9-1-1 models of care to empower paramedics to provide timely care in the community.”[10]These other models envision paramedics providing on-scene care in lieu, delivering low-acuity patients to other care destinations or assessing them for “fit to sit” programs (in which they merely wait in line like everyone else).
CUPE believes the Province needs to address the problem on a province-wide basis, pointing out that “The municipalities are competing for the same pool of paramedics and dispatchers. We need a staffing plan that accounts for population growth and ageing, deficiencies in other parts of the health sector, and the insufficient number of paramedics graduating from college programs to fill vacancies.”[11]
Either way, it appears that the Province will have to budget more money to this area of the healthcare system sooner than later. Until then, hold off on that heart attack…just sayin.
[1] https://cupe.on.ca/a-province-wide-staffing-strategy-needed-for-paramedics-cupe-calls-on-ford-government-to-fix-a-sector-in-crisis/
[2] https://www.cbc.ca/news/canada/windsor/essex-county-emergency-ambulances-ems-1.6632888#:~:text=Officials%20have%20rescinded%20the%20emergency,the%20crisis%20isn’t%20over.
[3] https://windsor.ctvnews.ca/it-s-getting-worse-town-of-essex-urgently-calls-on-province-to-help-fix-growing-code-black-crisis-1.6399476
[4] https://www.thestar.com/opinion/contributors/paramedics-are-increasingly-not-available-when-we-need-them-in-ontario/article_0e00d5da-248d-5501-bd38-21af2688ba71.html#:~:text=Paramedics%20are%20increasingly%20not%20available,it%20challenging%20to%20recruit%20workers.
[5] Ibid.
[6] https://globalnews.ca/news/9400807/ontario-paramedic-ambulance-offload-delay-nurse/#:~:text=The%20briefing%20said%20that%20%E2%80%94%20when,resource%20(HHR)%20shortages.%E2%80%9D
[7] https://www.cbc.ca/news/canada/windsor/healthcare-ambulance-bondy-motion-1.6842210#:~:text=Windsor-,Essex%20mayor%20wants%20to%20see%20province%20take%20action%20on%20ambulance,in%20Windsor%20and%20Essex%20County.
[8] Ibid, note 4.
[9] Ibid, note 6.
[10] Ibid, note 3.
[11] Ibid, note 1.
