Paramedics Colin Waterhouse and Josh Picknell are in their ambulance in Ottawa on Friday afternoon when the call comes in: Code 4, which means they need to get there quickly.
With lights flashing and sirens blaring, they race to the address of the call and assess the patient’s condition; He needs to go to the hospital. Moving quickly, the drive to Queensway Carlton Hospital, in the west end of Ottawa, is quick. But as paramedics arrived at the hospital, the rush of activity stopped.
There are six ambulances already parked outside and the emergency room is packed.
Paramedics will have to wait with their patient and monitor him until his care can be taken to the hospital. “Basically, we’re stuck here,” Waterhouse said.
The experiment is known as ‘delay offload’. This means that their ambulance will remain parked at the hospital for the time being, rather than back on the road, where it can respond to other incoming 911 calls.
“While I’m here with this patient, I could be here for hours. I can’t answer a call. All these paramedics have been taken off duty while we wait to get out of the hospital,” Waterhouse said. . “So you have less ambulances circulating in the city to respond to emergencies.”
This waiting time adds up. Last year, the Ottawa Paramedic Service took 72,000 patients to hospitals and spent 49,000 hours waiting for a delayed discharge. During the first five months of 2022, paramedics in Ottawa spent 25,000 hours waiting in hospitals, with 28,000 patients transferred there.
At that rate, the service estimates they could lose more than 60,000 hours to dump the delay by the end of the year.
Waterhouse said it’s clearly a situation that affects patients and their families as well.
“They are really frustrated,” he said. “Because they have a very reasonable expectation that they will call 911, they will immediately get an ambulance, they will get to the hospital and be seen immediately.”
Watch | Paramedics are under pressure as the city runs out of ambulances:
The extraordinary pressure on hospitals across Canada is having a ripple effect on ambulances and paramedics. The National has gained exclusive access within the Ottawa Paramedic Service as it faces an unprecedented number of “level zero” incidents – when there are no ambulances left to answer 911 calls.
According to the Ottawa Paramedic Service, long wait times in hospitals are caused by several reasons, including an increase in the volume of calls to 911, a lack of access to family physicians, and a lack of staff across the health care system.
“All of this burden is on the hospital system to manage the entire healthcare system — and it is unable to do that,” said Ben Ripley, superintendent of the Ottawa Paramedic Service.
“And because of that, we’re seeing a buildup in the emergency room…and because of that, we’re seeing our trucks sitting there for hours on end.”
level zero
Load delays are not limited to Ottawa; They are a problem in many hospitals across the country, With the healthcare system dwindling Weight shortage of staff which have been described as endemic.
It also leads to another problem being felt in Ottawa and beyond: ‘level zero’, when all service ambulances are already responding to calls or waiting in hospital. This means that there are no ambulances to send to incoming 911 calls.
Ottawa has recorded 1,041 level zero cases this year, from January to July – something medics say can happen multiple times in a single day.
It’s a problem that has worsened over the years, Bicknell said, to the point that it has become common.
“It’s very rare for you to have good levels at work,” he said. “When I came here and there were already ambulances available, that was surprising to me.”
When ambulance availability is low, Bicknell said, it also affects response time, noting that when that happens, the nearest unit may be free to make a call in the entire Ottawa area — and it’s still 30 or 40 minutes away.
“That’s part of where there is so much frustration among doctors, among the patients we deal with, that it’s not appropriate for people who are facing serious and life-threatening conditions to wait this long to get an ambulance. It’s not appropriate.”
The nerve center of the Ottawa Paramedic Service is Ottawa’s central ambulance call center, which takes emergency calls to paramedics any day. CBC the National He had exclusive access to the center one Friday evening in August, when the operation reached level zero.
“This happens almost on a daily basis,” President Pierre Pourier explained. “And especially over the past few months, it’s been terrible.”
To continue responding through level zero, ambulances will be dispatched from a nearby community, or the call will be queued until someone becomes available.
And just like discharge delays, level zero — sometimes called code zero, critical code, black code or code red in other areas — is not unique to Ottawa, Poirier said.
“Our experience is being replicated across the country. It’s not just in Ottawa and it’s not just in Ontario. It’s across the country – from coast to coast.”
While there are no nationally collected statistics on this phenomenon, Mike Sanderson, chief of the Hamilton Paramedic Service, says that in Ontario, both smaller rural services and larger urban services are experiencing an “increasing frequency of level zero events.”
Sanderson is also the co-chair of the Working Group on Hospital Discharge Delays with the Ontario Association of Chiefs of Medical Assistants (OAPC).
In Hamilton, he said, they’ve seen 209 Code Zero events so far this year — a marked increase compared to the past two years.
“It’s just over seven months into the calendar year and we have more than twice as many Code Zero events than in the whole of last year — and seven times more than we experienced in the first year of the pandemic,” he said. Sanderson.
“There is a direct correlation with the frequency of Code Zero events and the amount of time paramedics are required to wait for hospitals to accept transfer of care for incoming ambulance patients.”
According to Chief Medical Officers Canada (PCC), based on anecdotal discussions with their members, level zeros are present to varying degrees across all provinces, and Discharge delay is a problem in most provinces.
Community care as a solution
In Ottawa, the Paramedic Service is taking steps to mitigate the problem, including an initiative in which patients are distributed to local hospitals based on capacity, rather than automatically going to the nearest centre.
The service also introduced Community Paramedic Programs, which use specially trained paramedics who provide patient assessment, diagnosis, and treatment in the community to help prevent emergency calls.
Similar programs are also offered across long-term care institutions, to help improve the quality of life for older adults, allowing them to stay home for as long as possible and reducing visits to the emergency room, as well as for patients in the community with complex care needs.
“We’re trying to help the health care system fill in the gaps…and not take people to hospital, but we’re still providing that excellent care at home,” Pourier said.
Another initiative implemented at three hospitals in the area – Queensway Carlton, the Ottawa Hospital General Campus and Montfort – is to designate an emergency department paramedic who can monitor up to four patients until care is transferred to the hospital, freeing up the staff. who may experience a delay in downloading. (At Montfort Hospital specifically, this paramedic is part of the facility’s emergency department team.)
And despite the current pressures on the system, Bowerer says people shouldn’t be afraid to call if they need medical help. “Please call 911, but use the system appropriately,” he said.
Even during level zero, he said, the service usually has one-on-one response paramedics who are able to provide care; It’s a bridge that has been implemented in recent years “to ensure that we can still provide primary health care and that primary medical service to patients in need.”
When no other resources are available, Ottawa Fire Services will also respond to calls with high priority.
But Pourier said the system was “in crisis”, and help was needed. “We need people to advocate on behalf of the paramedic service,” he said.
As for Waterhouse and Picknell, their hospital discharge was delayed about 1.5 hours this time.
“But we can, sometimes, be with these patients for many hours … watching them wait … and that has been normal for some time,” Bicknell said.
And while Waterhouse believes he has “the greatest job in the world,” he says he’s unsure if he can continue to do so, if the status quo continues indefinitely.
“If you’re going to tell me today that things are going the way they are for the rest of my career, I’ll quit tomorrow.”
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