A new study finds that ambulance use in Ontario increased significantly in the years leading up to the pandemic, outpacing both population growth and hospital emergency room visits by other means.
The study was led by researchers at McMaster University in Hamilton and looked at the annual numbers of patients who were transported by paramedics to hospital emergency rooms across Ontario from 2010 to 2019.
It found a 38.3 percent increase in the number of ambulance patient transfers to emergency rooms over the decade, four times greater than the county’s 9.6 percent population growth over the same period.
“What our work indicates is that this current model [emergency department] “It’s likely that the relocations are unsustainable for the county,” said Ryan Strom, the paper’s principal investigator and a doctoral student at McMaster who also serves as a paramedic.
CBC News obtained a copy of the peer-reviewed study in the August issue of Canadian Journal of Emergency Medicine. It comes at a time when Ontario is experiencing unprecedented waiting times in hospital emergency rooms and frequent “level zero” accidents, which means there are no ambulances available to answer calls in the jurisdiction.
The authors say their findings show the need to find ways to address the growing demand for ambulance services, such as giving paramedics the space to move less urgent patients elsewhere than in emergency departments.
Given the change in the population of Ontario, the researchers calculated that emergency department transportations grew 26.2 percent over the decade, much higher than the 3.4 percent growth in patients coming to emergency rooms by other means of transportation in that time period.
The paper suggests that there are a range of reasons for the disproportionate increase in the use of ambulances, including “difficulty access to primary health care, lack of access to timely care, patient-perceived situation, feeling of superior care within the hospital, and lack of awareness of the services provided by the patient.” other health care.
Strom’s analysis suggests that there is a general notion of people who are increasingly dependent on calling an ambulance due to restrictions on access to the rest of the health system.
“They’ve exhausted other options and they’re going to 911 because they know care is available right away,” Strom said in an interview.
Growth in demand has been observed in all regions of Ontario and across all age groups.
People age 65 or older accounted for 42 to 44 percent of annual transfers during the study decade. Among the age groups, the largest growth in ambulance use from 2010 to 2019 was observed in people aged 18 to 39 years.
The study also breaks down the demand for ambulance use by disease severity, using Canadian Sorting and Acute Scale (CTAS), the standard assessment used by paramedics and emergency room medical staff across the country.
Almost half of all patients taken by ambulance to emergency departments were categorized as CTAS level 3, or urgent, which includes symptoms such as chest pain without features of a heart attack, mild to moderate shortness of breath, or vomiting of a small amount of blood. The study found that nearly 485,000 patients were brought to emergency rooms by ambulance in 2019.
The study authors raise questions about whether more can be done to divert non-emergency patients from Ontario’s already overburdened emergency rooms.
When a less urgent patient is brought into an already overcrowded emergency room, paramedics must stay in until the nursing staff can take charge of the patient. This leads to paramedics and ambulance being pushed off the road and unable to respond to calls.
“I think there is a great opportunity for paramedics to look at these factors and to be able to move patients to other healthcare destinations that can provide similar care, to see and treat them faster and potentially at lower cost, such as urgent care clinics or generalized medicine clinics,” Strom said.
The study showed that of the nearly 954,000 patients brought to emergency rooms in Ontario by ambulance in 2019, nearly two-thirds (nearly 608,000) were discharged without being hospitalized.
The study reports 5.98 million patient visits to county emergency rooms in 2019, with about 84 percent of those who did not arrive by ambulance.