JUST SAYIN’ – Code Black! Somebody Call An Ambulance
If you live in Essex County and have been contemplating a heart attack, you might want to reconsider your timing and location, or you might die without ever reaching the hospital.
That’s because Essex County has been suffering through a perilous shortage of available ambulances and paramedics for almost a year.
In late 2022, for a five-day period in mid-October, the Warden declared an emergency when the County of Essex was left without ambulance coverage for hours, spread across the first two weeks of October.
Even though the emergency was rescinded, in a news release, the County of Essex conceded that “there have been no systemic changes that would warrant rescinding this local emergency.”
While the formal declaration has passed, the real emergency persists.
A “Code Black” (also called a “Code Zero” in some jurisdictions) occurs when there are no ambulances available in a jurisdiction to respond to a call. A “Code Red” occurs when there are only two ambulances or less — potentially, one car accident away from a code black. Windsor Essex experienced a cumulative 3,253 minutes in code red in 2021 and 791 minutes in code black.
According to Town of Essex Mayor Sherry Bondy, in 2022, those numbers jumped to 8,806 minutes in code red and 2,257 minutes in code black.
At the end of the first quarter of this year, those numbers were 864 minutes in code red and 2,257 minutes (already last year’s total) in code black.
Although the problem is critical here, according to Niko Georgiadis, a paramedic and chair of CUPE Ambulance Committee of Ontario, (writing in the Toronto Star in May 2023), Windsor Essex is not alone: “Data collection is inconsistent, but we know that Toronto witnessed 1,139 code zero incidents in 2021; Ottawa 750 times in 2022 by July alone (matching the number of such incidents in 2021); and Waterloo Region 87 times in 2022 (a fourfold increase relative to 2021.”
Data collection is fractured, as CBC reported on the deficiencies in maintaining, sharing, and tracking these statistics in a story last month, noting: “A spokesperson for Health Minister Sylvia Jones said the province doesn’t track that [Code Blacks] because municipalities are responsible for ambulance deployment strategies.”
It also pointed out: “Ontario generates monthly reports based on data from ambulance dispatch centres, including time paramedics spend waiting in ERs to transfer patients — known as offload delays — by hospital. But requests for the figures, including a specific request for the most recent report went unacknowledged.”
The causes of these ambulance shortages are numerous, complicated, and interrelated.
As reported by Global News, in February 2023, the biggest single source is off-load delays — when paramedics are stranded at a hospital and unable to transfer a patient due to lack of capacity. But the causes of the off-load delays themselves vary from hospital to hospital, and include long-standing issues of hospital capacity, (according to the Toronto Star; Ontario, alongside Mexico, ranks among the bottom of the 38 member nations of the Organization for Economic Cooperation and Development, in hospital beds per capita), patient flow, a shortage or lack of primary care providers such as after-hour clinics, and increased usage of the 911 system. (One theory is that a belief may exist that travelling to the ER by ambulance allows you to jump the line).
Locally, our problems are compounded by the competitive disadvantages this market already faces.
The President of CUPE Local 2974, James Jovanovic, representing Essex Windsor EMS workers, has said that our region “has trouble attracting paramedics because the Greater Toronto Area absorbs almost all newly-graduated paramedics, and paramedics in those areas might make between $5 and $10 an hour more.” (CBC.ca, May 12, 2023).
Consequently, working conditions in Windsor Essex, where the current complement of 300 paramedics is already short by an estimated 50, are particularly alarming: “Constantly rushing from call to call, missing meal breaks regularly, being forced to work overtime beyond our 12-hour shifts, knowing that patients are being short-changed by the system, facing violence on the job (often from exasperated people reacting to trauma) takes a tremendous amount of mental and physical toll.” (Niko Georgiadis in the Toronto Star, May 2023).
What are the solutions?
The provincial government recently began augmenting a 2008 then-Liberal government’s Dedicated Offload Nursing Program — which, as the name suggests, funds the cost of additional nurses in the ER dedicated to unloading ambulances, triaging patients, and returning paramedics to the field. That program was created as a pilot program and was intended to be temporary, but it “remained consistent at $16 million per year from 2012 to 2021, with 50 hospitals across 20 municipalities taking part.” (Isaac Callan, Global News, February 11, 2023).
This year, the Province announced a further $7 million increase to the program “as well as expanding the 9-1-1 models of care to empower paramedics to provide timely care in the community.”
These other models envision paramedics providing on-scene care, (in lieu of attending the hospital), delivering low-acuity patients to other care destinations, or assessing them for “fit to sit” programs (in which they merely wait in line like everyone else).
Recently Essex-Windsor EMS launched the Community Assessment Triage Team, designed to provide low-acuity patients the treatment and services they need while reducing the volume of unnecessary transports to the hospital emergency department following 911 calls.
The program is currently staffed by two Primary Care Paramedics, operates 12 hours per day, seven days a week, from 7 a.m. to 7 p.m. out of the Mercer Ambulance base in Windsor, and provides response across Essex County. The program has so far been successful in diverting transports to the emergency room and there are plans to expand it to six Primary Care Paramedics in September.
CUPE believes the Province needs to address the problem on a province-wide basis, pointing out that “The municipalities are competing for the same pool of paramedics and dispatchers. We need a staffing plan that accounts for population growth and ageing, deficiencies in other parts of the health sector, and the insufficient number of paramedics graduating from college programs to fill vacancies.”
Either way, it appears the Province will have to budget more money to this area of the healthcare system sooner than later.
Until then, hold off on that heart attack . . . just sayin’.
PUBLISHER’S NOTE: The views and opinions expressed in this editorial are those of the author and may or may not represent the views or opinions of those associated with Biz X magazine.
