Ambulance shortage 'should alarm everyone' as Saskatoon and Regina struggle to keep up with emergency calls

Paramedics in Saskatoon and Regina are having a hard time keeping up with the growing number of emergency calls.

Data obtained by CBC shows ambulance services are often taking too long to respond to life-threatening crises. 

Ambulance services in both Saskatoon and Regina say they're falling short because they simply don't have enough ambulances to keep up.

"This should be something that should alarm everybody," said Andrew Williamson, the director of operations for Medavie Health Services West, the private company that runs Saskatoon's ambulance service. 

The national benchmark, observed by many ambulance services across North America, says crews should arrive at emergent calls in an urban setting in less than nine minutes, 90 per cent of the time. 

But according to data provided by Medavie, EMS crews in Saskatoon fell far short of that target when responding to the most serious life-threatening calls known as Delta and Echo calls. For those emergencies, crews arrived on the scene under nine minutes just 70 per cent of the time.

In other words, of the approximately 7,000 "lights and sirens" calls in Saskatoon last year, ambulances took longer than the recommended time on about 2,100 of them. 

My understanding is that there is a financial deficit within EMS in the province. And at this time I've got no indication that any ambulances are on the way.- Andrew Williamson - Medavie Health Services West

In about 450 cases, it took crews more than 20 minutes to arrive on the scene, with about 140 of those instances taking more than 30 minutes, according to the data.

CBC asked Williamson for his evaluation of how his company is doing relative to the benchmark. 

"Poor," he said. "We don't do very good." 

At its peak, Medavie has 11 ambulances available for the approximately 30,000 calls — from serious emergencies to more trivial situations — annually in Saskatoon.

Williamson said they simply don't have enough vehicles on the street.

He said that every day in Saskatoon, 911 operators have to tell people in the midst of a crisis that there's no ambulance available. 

"It's unfortunate that it's routine. It's unfortunate that it's our daily situation — that we're getting good at managing having no resources available," Williamson said.

He said in order to deal with a growing population and an out-of-control meth crisis, Saskatoon needs 15 ambulances, but that number hasn't increased from its current 11 since 2015. 

"I wouldn't be suggesting we need 15 peak cars if I was if I was happy or satisfied with our response criteria right now," said Williamson. "Certainly we want to be getting to those calls in a more timely fashion."

He said Medavie has requested additional funding from the Saskatchewan Health Authority. 

"My understanding is that there is a financial deficit within EMS in the province. And at this time I've got no indication that any ambulances are on the way," Williamson said.

Outskirts of Regina face longer waits

Regina's situation is similar, though not as severe. 

Last year, ambulances arrived on the scene of life-threatening emergencies within the benchmark 80 per cent of the time. That means that in about 1,200 cases, crews arrived after the recommended response time. 

In almost 100 instances, the ambulance arrived 15 minutes or longer after the initial 911 call. 

Data covering the final six months of 2019, provided to CBC by the Saskatchewan Health Authority, shows that most 911 calls from the central part of the city, which makes up about 57 per cent of all calls, were responded to within the benchmark time frame.

However, other parts of the city didn't fare as well.

The north, south, east and west all ranged from 63 to 72 percent of calls in under 9 minutes. August saw the worst week of the year, when only 11 per cent of calls in west Regina were reached within benchmark.

Ken Luciak, the director of EMS for Regina, said he's noticed these numbers and knows they are a problem. 

"We know the paramedics are getting busier. We know that they're working harder and we know that it's because there are more calls," he said. 

Luciak lives in north Regina. He said he sometimes he looks at these reports and thinks, "Well that wasn't a good week."

He said it's not surprising that central Regina receives the most timely service given that the hospitals are centrally located. 

Like Williamson in Saskatoon, Luciak said a lack of ambulances is "our biggest issue." 

Regina EMS argues for more funding

In 2018, Luciak attempted to argue for more ambulance funding. 

To make his case, his team analyzed how often there were no ambulances available to respond to emergencies in the city. 

According to a Saskatchewan Health Authority document, that review found the following. 

"In August alone:

• 87 times – only 2 units available.

• 51 times – only 1 unit available.

• 38 times – no units available.

• 20 times – calls for service with no units available."

That same document noted that delays can put patient health at risk.

It noted that in 2016 there were "42 calls for cardiac arrest where it took more than 9 minutes for paramedics to arrive." The document says that "over 9 minutes [there is a] very low chance of survival."

Since 2012, Regina has had nine ambulances serving the city, though that number goes down during off-peak hours. Luciak said that despite the fact Regina's population has increased significantly, ambulance resources haven't gone up at all.

He said the obvious solution is to put more vehicles on the road. He and his team would like to see funding for two more.

"The problem with that is of course it costs additional resources or additional money to do that in a system that's already stretched to the limits for money," Luciak said. "I mean we're in a huge deficit."

In 2018, Luciak launched a one-year pilot project, funding an additional ambulance using money allocated for overtime. He found this was unaffordable because overtime didn't go down, despite the new vehicle. 

"It ended up being more expensive,' said Luciak. "So we went back to the drawing board." 

Paramedics burning out 

The increasingly frantic pace is taking a toll on paramedics. 

Regina has about 100 paramedics on staff. Last year eleven of them quit, a turnover Luciak said is "one of the highest years we've ever had." 

"When we interview these people they tell us it's because of workload," Luciak acknowledged.

When you're asking people to cut corners you have a huge risk of patient care.- Anonymous paramedic

While waiting for new money, Luciak has implemented policies designed to save time. 

For example, paramedics used to have scheduled lunch break in the core of the city every day. 

That became too time-consuming, so staff were told to fit in lunch when they could and where they could. 

Luciak said that means that sometimes paramedics don't get a lunch break until eight hours into their 12 hour shift. 

According to a Regina paramedic, speaking on condition of anonymity, the job of caring for people in crisis is difficult enough without the added pressure. 

"You'd be at a hospital and you'd be alerted, 'You need to drop your patient right away because there's another call holding and you're the only unit that could possibly respond in the whole city,'" the paramedic said. 

They said this type of pressure went from being unusual to becoming the norm and it puts a strain on mental health,. 

"If something was to happen to that person you know that it almost puts the onus on you. What if the outcomes are bad?" the paramedic asked. "What if by the time you get there it's too late?" 

The paramedic said it inevitably affects patient care. 

"Imagine if you were to go into the emergency room and have somebody follow a doctor along with a stopwatch and say 'OK your five minutes are up. You took too long. You've got to move on to the next one," they said. 

"When you're asking people to cut corners you have a huge risk of patient care."

A 45-minute wait

Dallas Kalaman knows the effect that ambulance delays can have on a family.

On Jan. 5, his 81-year old grandmother June Diamond became seriously ill. 

"She started to display stroke-like symptoms. Slurred speech, just things of that nature that were obviously very serious to me," he said.

"She was like 'Dallas, help me.'"

Kalaman, who lives in Regina, called 911. 

"They told me that there wasn't any ambulances available at the moment but there was one on the way as soon as one becomes available," said Kalaman. He said they told him to call back if her condition got worse. 

He did call back. He said the operator asked him to perform a series of tests to determine his grandmother's condition. 

Based on those tests, "They thought, 'No, this doesn't sound like it's an urgent matter in terms of she's having like a stroke right now,'" Kalaman said.

Once again, the operator said an ambulance would be sent when one was available. 

Kalaman's grandma was panicking. 

"It was traumatizing. I wouldn't wish anybody to go through that." 

Kalaman said an ambulance finally arrived 45 minutes after his original call. It turned out his grandma hadn't suffered a stroke but he said given her symptoms EMS should have come sooner. 

"If we're going to play Russian Roulette here with a medical diagnosis over the phone because they think it's not serious then why the hell do we have emergency services?" he asked. 

No ambulances available 

On Feb. 2, Crystal Beach noticed that the condition of her adult daughter, who has special needs, was deteriorating. 

Beach called 911 and told them her daughter was experiencing severe pain on her right side, running a fever and feeling nauseous. 

She said she was told an ambulance was being dispatched.

Time ticked slowly by, but no one showed up.

She said the phone rang 15 minutes after her original call. It was the dispatcher saying, "they wouldn't have an ambulance available for a little while but that we should be getting one shortly." 

The expectation of the community and the public is 911 means now. Not 911 later.- Andrew Williamson - Medavie Health Services West

Beach said an ambulance arrived 30 minutes after that, a total wait of 45 minutes. 

She said that once they arrived at the hospital, it became clear to her how severe the ambulance shortage was. She said the hospital was in code burgundy, which means a backlog in the emergency department. 

Beach said there were "probably about three stretchers in front of us lined up in the hallway. And as we sat there probably about another three stretchers came in and lined up behind us in the hallway." 

She said each of those stretchers had a patient attended by an EMS crew.

EMS crews aren't allowed to leave a patient until they are transferred to a hospital. Both Luciak and Williamson said these transfers can result in serious delays, but agreed that the main problem in Regina and Saskatoon is a lack of funding for new ambulances. 

Provincial government responds

CBC asked the provincial government about the data provided by Regina and Saskatoon EMS services. 

The province offered numbers of its own, saying "approximately 81% of urban emergency non-cancelled calls in Saskatchewan's 10 largest urban centres received a response in less than 9 minutes." 

CBC asked the government to show how it arrived at that number by breaking it down city by city but the province replied "the Ministry does not report EMS response time by specific communities." 

CBC asked the province about the funding issue. It didn't address the question directly. 

Instead, it pointed to a "modernization and standardization of emergency medical services" that is underway in the province. 

"Government has provided direction to the Saskatchewan Health Authority on key priorities for emergency medical services, including the completion of performance based contracts, dispatching the closest available ambulance to emergency calls, advancement of community paramedicine, and expansion of Advanced Life Support services," said an email from the premier's office. 

Williamson said he's happy to work with the SHA on any initiatives to improve patient care, but that ultimately the solution is more funding for more ambulances and he believes that the government is aware of that. 

"The expectation of the community and the public is 911 means now. Not 911 later."