Ambulance use in Ontario has grown far faster than population, study finds

A new study finds ambulance use in Ontario increased significantly in the years leading up to the pandemic, outpacing the growth in both population and hospital emergency room visits by other means. 

The study was led by researchers at Hamilton's McMaster University and it looked at the yearly numbers of patients transported by ambulance paramedics to hospital emergency rooms across Ontario from 2010 to 2019. 

It found a 38.3 per cent increase in the number of ambulance patient transports to ERs over the decade, an increase four times larger than the province's 9.6 per cent population growth over the same period. 

"What our work points to is that this current model of [emergency department] transports is likely unsustainable for the province," said Ryan Strum, the lead researcher for the paper and a PhD student at McMaster who also works as a paramedic. 

CBC News has obtained a copy of the peer-reviewed study in the August edition of the Canadian Journal of Emergency Medicine. It comes at a time when Ontario is seeing unprecedented waits in hospital emergency rooms and frequent "level zero" incidents, which means there are no ambulances available to respond to calls in a jurisdiction. 

The authors say their findings demonstrate the need to find ways of addressing the growing demand for ambulance services, such as giving paramedics the scope to transport less urgently ill patients somewhere other than emergency departments.   

Accounting for the change in Ontario's population, the researchers calculated that transports to emergency departments grew by 26.2 per cent over the decade, far higher than the 3.4 per cent growth in patients coming to ERs by other means of transport in that time period. 

The paper suggests there is a range of reasons for the disproportionate increase in ambulance use, including "difficulty in accessing primary health care, a lack of timely access to care, perceived situation by the patient, a sense of superior in-hospital care, and a lack of awareness of other health-care services." 

Strum's analysis suggests there's an overall theme of people increasingly relying on calling an ambulance because of constraints on gaining access to the rest of the health system.

"They've exhausted other options and they are moving to 911 because they know that care is available immediately," Strum said in an interview.  

Growth in demand was seen across all regions of Ontario and across all age groups.

People age 65 and older accounted for 42 to 44 per cent of yearly transports during the decade of the study. Among the age groups, the greatest rate of growth in ambulance use from 2010 to 2019 was seen in people aged 18 to 39. 

The study also breaks down the demand for ambulance use by severity of illness, using the Canadian Triage and Acuity Scale (CTAS), the standard assessment used by paramedics and emergency room medical staff across the country.

Roughly half of all patients transported by ambulance to emergency departments were classed at CTAS Level 3, or urgent, which includes such symptoms as chest pain without the features of a heart attack, mild to moderate shortness of breath, or vomiting a small amount of blood. There were nearly 485,000 such patients brought to ERs by ambulance in 2019, the study found.  

The study's authors raise questions about whether more could be done to divert non-emergency patients from Ontario's already overburdened ERs. 

When a less-urgent patient is brought to an already overcrowded emergency room, the paramedics must stay until the nursing staff can take charge of the patient. That takes the paramedics and their ambulance off the road and unable to respond to calls. 

"I think there's a huge opportunity for paramedics to look at these factors and be able to transport patients to other health-care destinations that could provide equivalent care, to see and treat them faster and potentially at a lower cost, such as urgent care clinics or generalized medicine clinics," said Strum. 

Of the nearly 954,000 patients brought to Ontario emergency rooms by ambulance in 2019, roughly two thirds (nearly 608,000) were discharged without being admitted to hospital, the study shows.

The study reports 5.98 million patient visits to emergency rooms in the province in 2019, with about 84 per cent of those not arriving by ambulance.