Code zero incidents drop as stress on Hamilton ambulances improves

Hamilton has endured a longstanding problem where there just aren't enough ambulances to go around in emergencies — but the latest numbers from the city finally show signs of improvement.

For the last six months or so, the number of code zero incidents in Hamilton has shrunk dramatically. A code zero is when there is only one — or even zero — ambulances across the service's entire fleet available for a call. With no ambulances available, people in crisis wait longer and longer to get medical attention.

Back in January, code zero emergencies in Hamilton skyrocketed to their highest monthly level in five years at 34, or more than one a day. February wasn't much better at 21.

But then in March, that number dropped to just one, and stayed low in April at two. There was a blip in September with nine code zeros (compared to six the year before), but the numbers have been even more reassuring heading into flu season.

There have only been seven code zero incidents in October so far, compared to 20 last year, and 18 the year before.

"The first two months [of 2018] were pretty horrendous … but March through September were much improved," said Michael Sanderson, chief of the paramedic service.

"This is still very concerning, and we've had some significant challenges, but we are improving."

Sanderson credited improvements with offload delays at local hospitals as influencing the change. When an ambulance arrives at a hospital, it cannot leave until the patient it is carrying is triaged and successfully transferred. If the patient needs a hospital bed but there are none available, the paramedics who brought them in can't leave to respond to other calls.

Local hospitals are starting to change how they handle patient flow, Sanderson says. At St. Joe's, the hospital has agreed that paramedics can now leave low-risk patients in the waiting room while they can respond to other calls. Similar discussions are underway with Juravinski and Hamilton General Hospitals.

Sanderson pointed to Oct. 11 as a specific day in the last month where the impact of offload delays on ambulances was drastic.

There were 43 offload delays at local hospitals that day, which led to code zeros, he said.

So is it possible to get the number of code zeros in Hamilton down to zero?

"I think the hospitals have an awful lot to do yet in terms of patient flow," Sanderson said.

"But if they're able to get emergency departments flowing properly, I think it's possible."

adam.carter@cbc.ca