Code zeros down but Hamilton needs to 'make it stick,' says paramedic chief

Code zero events in March and April this year have gone down drastically, but Hamilton Paramedic chief Michael Sanderson can't say the change is permanent.

"We've been successful in getting it down ... the challenge is making it stick," he said.

A code zero is when there is only one, or zero, ambulance available to respond to an emergency across the entire force.

Hamilton saw 119 code zeros last year — that number increased by 59, compared to 2016. 

The reason for code zero events is mainly attributed to hospital offload delays, said Sanderson.

"It's not just waiting for the care in the hospital, it's waiting for transfer of care," he said.

When an ambulance arrives at a hospital, it cannot leave until the patient is triaged by the hospital and successfully transferred. If the patient needs a hospital bed but there is none available, the ambulance cannot leave.

Last year, the average code zero event duration was 1.1 hours. Sometimes ambulances were held up at the hospital for over two hours.

In January, there were 34 code zeros and mayor Fred Eisenberger decided to see the situation at an emergency room.

He was floored to see eight ambulances sitting idle outside, with 16 paramedics standing at the gateway to the hospital with patients.

Effects on the community

While not every patient is waiting for an ambulance with a life-threatening injury, there are many that go through "significant pain and suffering" because of their conditions, said Sanderson.

There were at least 80 patients in January with "significant challenges" such as fractured hips that had to wait for an hour or more for an ambulance to arrive.

Even though the force is well-staffed and there are enough vehicles in their fleet to serve the community, Sanderson said the waiting times at the hospital render the paramedics overworked.

They are frequently missing their meal breaks and also working past their shifts because of those delays.

"The reality is when we're into narrowed resources, paramedics literally have to go from call to call to call," he said. "It's mentally draining, it's physically draining."

Call volumes have also increased by five per cent last year according to a report to council -- which is attributed to an aging population.

Initial solutions

Sanderson said the paramedic service is working with the hospital to find ways to move patients through emergency rooms faster.

The hospitals have modified their patient flow processes slightly and the paramedics are now giving the hospitals more notifications as to how many patients a hospital can expect.

When paramedic service has a lot of vehicles on the roads, they will now notify hospitals "just to make sure they're aware they're going to be getting more patients."

Paramedic service is also looking at putting in more ambulance stretchers at the hospitals, so that if there are two patients that can be looked after by one paramedic, the other can be freed from waiting and attend calls in the community.

Three stretchers, one for each hospital, have been ordered and are on their way.

Sanderson said there's also "excellent support from mayor and council" to find sustainable solutions with the hospitals.

"We're going to continue working with the hospitals and their staff to do everything we can to reduce those challenges," he said.