Discussions continue around delays faced by paramedics at hospitals provincewide. The Region of Durham Paramedic Services (RDPS) are among several organizations contending with these issues.
Tracking offload delays
On Thursday, RDPS Chief Troy Cheseboro spoke to the region’s Health and Social Services Committee. He noted offload delays have tied up paramedics for thousands of hours, monthly, in 2022.
“Any time where there are greater than 30 minutes [in the hospital], we track it as an ambulance offload delay,” he said. “We consider that lost ambulance availability to the residents of the region.”
When there are not enough staff available at a hospital to treat everyone immediately, a paramedic crew is required to stay with their patient in the waiting room. This can prevent the crew from getting back on the road to respond to other calls.
In January, paramedics experienced a combined 2,660 hours in offload delays. That number fell to around 1,700 in February before climbing up to 3,054 in May. July’s figure was similar, at 2,932.
Cheseboro noted regional officials are in touch with the provincial Ministry of Health, as well as other hospital partners. He noted new initiatives are being considered to work around patient flow issues.
That includes offering care for certain palliative patients at home. It also includes an ‘alternate destination’ model which would see some patients taken to places like hospices or crisis centres, depending on their needs.
“All of those initiatives are going to take time to implement,” he said.
“Provincial funding for the Community Paramedicine program – that provided a very small relief,” he noted. “But each one of these things is just a small little bite out of a giant wheel.”
Code Zeros in August
Meantime, paramedics continue to track the availability of ambulances.
Whenever there are no crews free in the region, a ‘Code Zero’ is declared. In these situations, ambulances are often brought in from neighbouring regions to attend calls.
“Code Zeros aren’t unique to Durham Region,” said Niko Georgiadis, chair of the CUPE Ambulance Committee of Ontario, in a September 1 interview with Durham Radio News. “Our paramedics are seeing them across the province. We need to find solutions that aren’t necessarily one-size-fits-all, but that work for each community as well.”
CUPE 1764, a union representing Durham paramedics, alleges that at least three Code Zeros were declared in August.
“Code Zeros are difficult to plan for,” said Georgiadis. “We don’t know when they’re going to happen, how often they’re going to happen and they can be caused by lots of things. They can be caused by long offloads that we’re seeing at the hospital. It could be increasing paramedic call volumes we’re seeing across the province or even a multi-casualty incident that can occur.”
“The theme, however, between all of these issues, is the external pressure on the system,” he added. “We don’t have a built-in surge capacity to help have an ambulance available when these pressures increase. Unfortunately, the only mechanism we have right now is [relying] on neighbouring services to be called in to help.”
“That’s not fair to the residents of those communities because it takes an ambulance out of their community,” he continued. “What if they’re in a Code Zero at the time as well? Or what if someone needs an ambulance there?”
“It’s important to have a surge capacity built in and that will allow for safe staffing levels for patients and staff,” he concluded.
There are other components as well.
“When we talk about health, we talk about a community system,” said Georgiadis. “It’s holistic. What we’re finding is the public doesn’t have the community support out there. There is a decrease of family physicians and community supports for people. And the hospital sometimes becomes the area where people go to […] when they have no other options.”
“We always want people to call us when they’re having an emergency,” he added. “That’s never a question. People need to call us. Call 911 always, but those community supports need to be out there so people don’t necessarily always have to go to the emergency department.”
Georgiadis noted the toll current pressures are having on paramedics’ mental health.
“With how busy it’s been lately, you’re just going from call to call,” he added. “We just don’t have have that […] time to decompress between calls.”