Ontario paramedics say ambulance response times are slower due to growing offload delays

People who call for an ambulance in Ontario may have to wait longer for one to arrive as health-care staffing shortages and recent temporary emergency room closures slow down emergency services' response, a paramedics' group said Friday.

Ambulance offload delays — when paramedics wait in an emergency department for a patient to be transferred to the care of a hospital — are tying up paramedics for longer and longer, preventing them from responding to calls during that time, said Michael Sanderson of the Ontario Association of Paramedic Chiefs.

"Not only does it slow the response to emergency calls, in other words, the life-threatening calls, the heart attacks, strokes, major trauma," it also means there are fewer ambulances available to respond to calls for broken bones and other less critical conditions, said Sanderson, who co-chairs the association's working group on offload delays.

Stretches of time when there are no ambulances available to respond to calls — known as "code zero" events — are also growing more frequent, he said.

Sanderson, who is chief of the Hamilton Paramedic Service, said the city has seen 196 so-called "code zero" events so far this year, more than double the tally for all of last year. "And it's probably headed towards the worst year that we've had," he added.

Darryl Wilton, president of the Ontario Paramedic Association, said in a recent interview that offload delays have gotten 12 times longer in the last year alone.

Wilton said the delays have reached a level he has never seen before in his 25 years on the job.

Offload delays of one to two hours were previously considered extreme, but now some patients and paramedics are waiting 10 to 15 hours, he said.

'Beds and staff' needed to resolve issue

"A patient could be picked up this afternoon and not be offloaded until sometime tomorrow morning, and that's not unusual anymore," he said. That means multiple paramedic crews may be caring for the same patient over several shifts, he added.

The worsening delays are "having a massive impact on paramedic availability," and the effects ripple out through neighbouring communities, Wilton said.

"This is something that, plain and simple, requires beds and staff to fix the problem," he said.

Ontario Health Minister Sylvia Jones said in a statement Friday that the province has added more than 10,500 health-care workers to the system since the start of the COVID-19 pandemic.

"Like many other jurisdictions around the world, Ontario's health system faces pressures due to the challenge of maintaining the required staffing levels," she said.

"We have been working proactively with all partners, including Ontario Health and the 140 hospital corporations, the regulatory colleges, and health sector unions, to address these staffing pressures. This includes identifying solutions for both the short and long term."

The Ministry of Health said the government's most recent budget included $7 million in additional funding for a program that brings in health-care workers to help transfer ambulance patients to hospital care. The budget was presented in April but did not pass before the June election.

Neal Roberts, chief of the Middlesex-London Paramedic Service and past president of the OAPC, said staffing shortages across the health-care sector, combined with the recent temporary hospital closures and a slight uptick in calls for paramedic care have created "almost like a perfect storm and a bit of a domino (effect)."

Paramedics forced to take patients farther away

The closures force paramedics to take patients to hospitals farther away, which takes more time and reduces service in their community, he said in a recent interview. It also places more strain on the hospitals where those patients are taken, contributing to delays and bottlenecks there, he said.

Just as hospitals are seeing shortages in nurses and doctors, paramedic services have also been stretched thin due to increased demand and the expansion of their duties during the pandemic, he said.

"We've hired upwards of, I think, 50-odd staff this year and we still could hire more," he said. "It's just the more we hire, the more we need — and we're just seeing this across all health care."

Some hospitals — including Lakeridge Health's Bowmanville hospital and the Seaforth Community Hospital in Huron County — have announced closures or reduced hours ahead of the long weekend.

Several Ontario hospitals have previously warned that emergency department closures could be a recurring issue this summer as a result of staffing shortages. Rural areas have been particularly affected, with communities such as Perth, Clinton and Wingham seeing their ERs close for stretches as long as several days.

Offloading delays predate the COVID-19 pandemic but paramedics' groups say the issue has gotten worse during the health crisis.

Earlier this year, the Ontario government issued a memo to emergency services, telling them to consider having paramedic crews tend to more than one patient at a time in ERs — something known as "batching" patients — so that paramedics could return to service more quickly.