Staffing challenges add to struggles for beleaguered Thunder Bay ambulance service

The chief of Superior North EMS says ambulance service in the Thunder Bay, Ont., district is facing increasing pressure as the service struggles with the effects of an aging population, the opioid epidemic, the COVID-19 pandemic, an overtaxed emergency room, and now a staffing crisis.

Prior to the COVID-19 pandemic, code blacks – periods when there is no free ambulance to respond to a call – occurred once or twice a week, Wayne Gates told CBC in March.

By late winter, they were a daily occurrence. And since then? 

"Unfortunately things have not gotten better," Gates said on Tuesday, speaking to CBC News about the current situation. "They've probably gotten a little bit worse."

Ambulance services under pressure across Canada

Ambulance services across the country have been facing similar challenges as they struggle to keep up with demand.

The Ottawa Paramedic Service said this summer it could lose 60,000 hours to offload delays at the city's hospitals this year.  A woman in the B.C. interior was told in July that she'd have to wait half an hour for an ambulance while trying to revive a friend who'd suffered a cardiac arrest. B.C. Emergency Health Services has also launched an investigation into a reported death of an infant in late August while waiting for an ambulance. 

A recent study led by researchers at Hamilton's McMaster University found that the number of patients transported by ambulance to Ontario emergency rooms grew by 38.3 per cent between 2010 and 2019.

That's four times the province's 9.6 per cent population growth over the same period. 

Some of that growth in demand was expected, based on an aging population, Gates said. 

"But what we really didn't see was the pandemic, COVID, and the after effects of COVID that are still going on … but we also have the drug situation, the addiction situation that hit us as well."

Not only has the pandemic brought with it more calls related to mental health challenges, it has also contributed to a staffing crisis, Gates said.

He now sometimes finds himself without enough paramedics to staff all the ambulances that could be operating at a given time, he said.

"Part of it is we still have some staff that end up being off sick for COVID, but a big challenge for us is the number of graduates that came out this year," Gates said.

The primary care paramedic program at Confederation College graduated just 11 students this year, according to Rob Plummer, its program coordinator. 

That's down from between 16 and 25 in a typical year.

Plummer blamed the shift toward online learning at the start of the COVID-19 pandemic for a higher-than-usual drop-out rate.

"We cannot deny that these were not ideal circumstances for our paramedic students to learn in," he said in an email.  

The head of the union local representing Thunder Bay paramedics said the profession has also lost some of its appeal.

"Who really wants to get into a job that is putting increasing demands on the [paramedics] with very little help from the province?" said Rob Moquin, the chair of Thunder Bay City Paramedics' union.

While the career is no less rewarding than it was 20 years ago, Moquin said paramedics face more pressure than before. 

"Twenty years ago, speaking quite candidly, paramedics were often able to sit back and reflect on maybe some difficult calls they've attended throughout the day; they were able to, as sad as this is … have lunch," he said.

"Now … paramedics are showing up to work, they're doing ambulance work for 12 hours, 13, sometimes 14 hours, and then going home without … having that break to eat or sit down or process what they've seen."

Pay for Thunder Bay city paramedics ranks in the top third of paramedic services in the province, Moquin said, though it's still less than other first responders, namely police officers and firefighters.

Gates said he is working with the unions and the City of Thunder Bay to create more incentives to attract workers to  northern Ontario and then keep them working there. 

Confederation College is also taking new steps to help retain its paramedic students, Plummer said, including creating a new Paramedic Student Resiliency Training course scheduled for release in January. 

It will also be holding regular team debriefings and student check-ins and issuing a weekly mental health check-in form, to monitor student mental health on a weekly basis – so it can intervene early if students show signs of mounting stress.

Need to take patients somewhere other than the hospital

Meanwhile, Gates, the EMS chief,  hopes to launch a public education campaign aimed at discouraging people from calling 911 unnecessarily – though Moquin cautioned that people should not be made to feel reluctant to call the number in a time of need.

Both Gates and Moquin said the city needs alternative destinations for patients so that EMS can bring them somewhere other than the hospital.

St. Joseph's Care Group put forth a proposal to the province last year for a 40-bed crisis centre for the city, which would include 20 crisis beds and 20 mental health beds.

"It wouldn't solve the problem. But it certainly would help us out on this," Moquin said. 

An improved detox facility could also help, he said, as the service deals with a high number of alcohol-related calls for patients who are currently taken to hospital simply because there is nowhere else for them to go. 

Once at the hospital, paramedics can be held up transferring patients to the facility's care, despite the presence of an offload nurse tasked with helping expedite the process, Moquin said.

"We had a crew just last night, as a matter of fact, that had done just about half of their shift on an offload delay, just a little more than five hours from just after one until about 6 a.m. this morning," Moquin said.

"It's not uncommon for us to be sitting with patients for two, three, four, sometimes five hours."