P.E.I. making slow progress on ambulance holdups at ERs

While the wait time for an ambulance on P.E.I. is increasing in most areas, the province is making some progress in reducing the amount of time ambulances are held up waiting to release patients to emergency department care.

In September, a report by CBC P.E.I. found ambulances could be tied up at hospitals for six to eight hours, unable to respond to another emergency call, while paramedics waited for their patient to be admitted to the emergency department.

"We're facing a staffing shortage, a crisis actually," Jason Woodbury, president of CUPE Local 3324, the union representing the Island's paramedics, told Island Morning host Laura Chapin.

"We don't have the resources on the Island to have vehicles tied up in the emergency department for long periods of time. The system is fragile and there is many times that we don't have vehicles to respond to emergency calls."

The problem is contributing to an increase in the time Islanders are waiting for an ambulance to arrive, he said.

Provincial records comparing the last quarter of 2020 to the last quarter of 2021 show the following changes.

• Souris and O'Leary: Up 3 ½ minutes to 16 to 17 minutes.
• Alberton: Up almost three minutes to just under 16 minutes.
• Summerside: Up almost two minutes to 9 ½ minutes.
• Charlottetown: Unchanged at about 10 minutes.
• Montague: Down about a minute to 14 minutes.

But while overall waits are mostly up, the province has seen some improvements in getting ambulances in and out of emergency departments.

According to Medavie, the company that operates Island EMS, there were 18 incidents in the last half of 2021 where ambulances had to wait five hours or more. So far in 2022 there have been just three. Health P.E.I. said the average wait time at the Queen Elizabeth Hospital has been cut in half, to about 19 minutes, and the average at Prince County Hospital is down 10 per cent to 13 ½ minutes.

Problem not at the emergency department

While the situation is frustrating, said emergency room physician Dr. Trevor Jain, he doesn't believe the province should follow the example of other provinces, such as Ontario and Nova Scotia, which have assigned an emergency room nurse to care for patients before they are admitted, freeing up the paramedics and the ambulances.

"Those are Band-Aids. That is not a solution," said Jain.

"Emergency departments I worked with in Ontario, they had hired an extra nurse to look after offload patients on the ramp. But what do you do when the ramp becomes full? Do you now go to the garage, do you now go to side of the road."

The problem, said Jain, is not in the emergency department, and the solution should not be looked for there. The problem is with capacity across the system, resource problems that land Islanders in the emergency department because they don't see anywhere else to go.

A recent Canadian study found only 15 to 20 per cent of people in emergency departments needed the specialized care offered there, said Jain. If the province improved long-term care, mental health services, primary care, and allowed other health-care providers practise to the full scope of their abilities, problems in the emergency department would go away, he said.

Changes across the system

Health P.E.I. chief operating officer Corrine Rowswell agrees the problem is not in the emergency department.

"When you've got ambulances in offload delay it's part of a symptom that you've got too many people in the emergency department who are awaiting admission and too many patients in the hospital who need to be discharged," said Rowswell.

Health P.E.I. has been making changes to help improve the situation, she said.

Hospitals are being prioritized for moving people into long-term care and investments have been made in home care. The province's three mobile mental-health units have also helped keep people out of emergency with mental health problems, she said.

Matt Crossman, vice-president of operations for Medavie Health Services, said a new approach to how paramedics work is also having an impact.

"We've seen tremendous success with our mobile integrated health program," said Crossman.

The program has paramedics providing services in the community that don't necessarily involve loading people into an ambulance, such as assisting with palliative care at home. A new aspect of that program will allow patients to be sent home from the emergency department earlier, and be monitored by paramedics while they are at home.

Rowswell is hopeful the situation will continue to improve as COVID cases subside.