Fear of waiting for an ambulance in an emergency should be non-existent

“When my brother reached the hospital right after the ambulance, doctors told him that my uncle is no more,” says Sonpreet Kaur Boyal, a local Calgarian who saw and felt firsthand what it is like when there is an ambulance shortage.

On July 30, 2022 at 9 a.m., Boyal called 911 for her uncle Kulwant Singh, a 54-year-old Sikh man who was struggling with severe chest pains at their northeast Calgary home. While they waited for the ambulance, the 911 operator gave the family instructions in order to help Singh feel more comfortable.

Minutes kept passing by, while they waited and waited. Half an hour later, they saw the flashing lights of the ambulance pulling onto the road in front of their house. Singh died soon after reaching the hospital.

With this traumatic event, Boyal and her family are left pondering the what if’s, “if an ambulance could have arrived early, maybe they could have saved him.”

When family members asked paramedics about the delay they were told there is a lack of staff.

Delayed ambulances are a national problem. In the first six months of 2022, there were 2,522 red alerts recorded in Calgary.

Red alerts refer to instances when no ambulances are available to respond to emergency calls. Red alerts are not new, but they have been getting progressively worse and worse. In 2021, 2,358 were recorded in the entire year.

On June 5, 2022, a elderly woman was attacked by her neighbour’s three dogs on 21st Avenue N.W., in the community of Capitol Hill, at about 2 p.m. Paramedics took the woman to hospital in life-threatening condition and she died shortly after.

Alberta Health Services says it has looked into why it took 30 minutes for an ambulance to respond. They stated that the initial 911 call was sent to police based on the information provided from the scene. James Wood says EMS then dispatched an ambulance, which arrived nine minutes later. Wood stated that the incident occurred at a time of very high EMS call volumes. This event showcases the strain on EMS services.

The Health Quality Council of Alberta (HQCA) has agreed to lead the independent review into the EMS response to a dog attack in Calgary on June 5, 2022. They submitted the report to AHS in November, and it has not yet been publicly released.

Cam Heenan, candidate for Alberta NDP nomination in Leduc-Beaumont, and has more than 16 years of experience as a paramedic says EMS staff are leaving the profession. “It’s extremely tough for paramedics to put on the uniforms every day. We’re seeing extremely high burnout rates.”

“I have never seen so many paramedics who are leaving the profession and we’re not talking about leaving the profession 45 years in, we’re talking about leaving the profession three, four or five years in,” says Heenan.

Paramedics’ mental health has continued to be affected, Heenan strongly believes one of the first solutions to combating red alerts is prioritizing EMS staff.

Alberta NDP’s position towards EMS is about recovery, as outlined in their article by David Shepherd Alberta NDP’s Critic for Health. Shepherd repeated the three calls for action from paramedics

Getting EMS crews off shift, on time. The additional hours that paramedics spend stuck at overwhelmed hospitals is one of the main drivers of burnout and turnover in EMS.

Offer every paramedic a full-time permanent contract instead of the 89-day temporary contracts that make up about 40 per of the EMS workforce today.

Expand harm reduction services that save lives and reduce the incredible burden the drug poisoning crisis has put on paramedics and emergency room workers.

Paramedics are facing burnout under the extreme pressures of work, “I’m sitting with staff members while they’re crying,” says an AHS employee who is working alongside paramedics and has had various roles from an assistant supervisor to a manager for paramedics, this individual is not authorized to speak to the media.

The anonymous source hopes to see an improvement with communication and leadership amongst AHS work forces:

“My manager needs to be coming out at least once every three months and going to each station and sitting down saying,’ So how’s it going? And once a year, our director and our CEO should be sitting down with the staff and asking them the same question. Making themselves accessible by answering questions.”

In his experience, he mentioned that while paramedics are with patients in the hospital, there can be things done to get them out quicker once they have checked their patient in:

“Our job as supervisors is to show up, tell our staff to get their trucks clean, tell them to get their paperwork done, and help them get beds or to consolidate to get them out. And very seldomly, do you see a supervisor walk through and do that?”

Burnt out paramedics and frazzled citizens are left wondering what the solution is.

In response to the increasing pressure, on Nov. 17, 2022 Dr. John Cowell was appointed full-time official administrator and is the replacement for Alberta Health Services Board of Directors. Dr. Cowell, working directly with Mauro Chies, the interim AHS CEO, has four goals to achieve highlighted in the AHS Reform Plan.

Goal one is to improve emergency medical services response times. The reform plan highlights four actions to improve EMS response times:

Empower EMS dispatch to step-down calls from 911 to Health Link, based on patient need, thereby decreasing overall emergency calls.

Empower paramedics to triage whether or not a patient needs to be transferred to ER by ambulance.

Fast track ambulance transfers at the ER so paramedics are available for more calls.

Use more appropriate modes of transportation for non-emergency interfacility transfers.

In my video interview with Dave Deines, paramedic and the current president of the Paramedics Association in Canada shares his thoughts on these four actions and their possible successes and obstacles.

One repeated obstacle that paramedics are facing is offload delay. This occurs when patients are transported to the emergency, because hospitals are stretched thin, and paramedics are not able to place a patient in an emergency department.​​ This leads to offload delay and that is when paramedics have to stay with the patient in the emergency department until they are placed.

Deines says offload delay “can range from 10 to 15 minutes all the way up to.. the record now in Canada was over 40 hours in New Brunswick last month where literally the patient was on a paramedic stretcher for 40 hours before they’re able to be placed.”

Heenan recognizes that this has been an issue, even when he started in EMS in 2004.

[Mystery source] offers a solution and provides an example to combat offload delay and potentially free up paramedics. “I show up first [with a patient], the next [paramedic] who comes in takes my patient, I leave.. And so on, and they do a rotation. So everybody’s getting in and out and getting back on the road in a timely manner.” To sum, if a paramedic is already waiting for their patient to get placed on a bed and another paramedic comes in with a patient, then the first paramedic hands their patient over to the second one and leaves, and so on. This rotation allows paramedics to get out faster.

This massive issue is one of the four actions – fast track ambulance transfers at the ER so paramedics are available for more calls – being addressed.

Deines agrees with taking action towards combating this issue. However, he says that unless the widespread health care issue is addressed, “that ambulance is just going to go to another call and bring another patient back.”

Another action in hopes of improving EMS response times is to empower paramedics to triage whether or not a patient needs to be transferred to ER by ambulance.

Because of the advanced technology paramedics have, for example cardiac monitoring and diagnostic equipment, they now have the ability to bring these to the patient’s side.

“They have the ability to measure blood glucose, blood saturation and other kinds of key physiological metrics that allow paramedics to say, all of your vital signs appear normal, you know, perhaps this is something that your family doctor or an urgent care center can deal with more appropriately,” says Deines.

Allowing paramedics to conduct a field triage and make diagnoses that provide advice on scenes will help alleviate the emergency departments.

The third action is to use more appropriate modes of transportation for non-emergency interfacility transfers.

Deines highlights the issue this potential solution arose from, which among paramedic staff is commonly known as repatriation. This refers to when a large volume of patients move between health care facilities, and healthcare facilities back to their residents. In some jurisdictions, it is completed by a dedicated transfer service. However, in others it is completed by the 911 fleet. The jurisdictions that utilize the 911 fleet to complete those interfacility transfers can put a drain on the paramedic system.

An example of this is if a patient from a long term care facility falls and they need to go for X rays. If a 911 crew is providing that service, that takes the crew away and out of the queue for other 911 calls.

However, offloading a patient to a private service that uses non paramedics can bring rise to new questions and problems. What if that patient being transferred has another acute medical condition happening in conjunction with why they need to be transferred.

“They may have an acute hip fracture that needs to be stabilized..they may need fluid resuscitation because they’re bleeding internally that hasn’t been recognized by the staff at a long term care facility,” says Deines. “The risk to using a non paramedic service to provide those transfers is it delays care if that patient actually requires paramedic care.”

Deines sheds light to greater Vancouver and its robust inter facility transfer service, that is an example for a potential solution to this issue. Part of the British Columbia emergency health services is the use of non 911 units that utilizes paramedics to complete those calls, but aren’t utilized within the 911 system. The other advantage to that is they can be utilized in surge emergencies.

For example, “if we have a large aircraft that crashes at YVR, that again, puts that surge under the 911 system, we can draw from that inter facility transfer fleet that allows that extra ability to respond in a disaster,” says Deines.

The last action is to empower EMS dispatch to step-down calls from 911 to Health Link, based on patient need, thereby decreasing overall emergency calls.

This can refer to 811 or another common term is nurse link. In jurisdictions such as British Columbia, it is a dispatch function that’s utilized through an online triage. They can be referred to as secondary triage. These services are primarily provided by paramedics where initially the call is coded as not requiring an urgent or immediate paramedic response, and it goes into a queue. Then specially trained paramedics go into that queue, call the patient back and utilize a secondary triage algorithm, not only to retrieve the call, but they’re empowered to help the patient navigate the appropriate service for their condition.

An example of this that we have seen in primary health care is when TELUS utilized this during COVID. Deines says it has been employed in some areas among paramedics. Typically, a clinician can log through video chat and they can see the patient and can see their level of distress. This allows the clinician to visualize some of the key indicators that paramedics would look for in terms of whether you’re stable enough to go to another type of treatment area as opposed to needing a 911 response and going into the emergency department.

Additionally, community paramedics that are not part of the 911 service can do remote patient monitoring, which in parts of Canada has already been utilized. An example provided by Deines is if a chronic disease patient takes their blood pressure with an at home blood pressure machine, with bluetooth that is connected to their cell phone, which then sends the results to the community paramedic. This allows the paramedic to make a decision on whether or not they should schedule a video conference in order to visualize the patient, ask them a bunch of questions, and ask them to take their blood pressure again. “Then make a determination clinically, whether they need to be transported by ambulance to the hospital, whether another service can provide that, or whether we can get her in to see her primary health care provider,” says Deines.

The presented reform plan is a step in the right direction. But, what needs to be addressed is why there are so many people going to the hospital, why healthcare staff can’t move acute care patients out of acute care beds to free up that space, and why there are not enough ambulances to respond to 911 calls.

Deines says his association is always ready to help:

“Paramedics are very resilient and very resourceful when it comes to solutions at the moment and have a lot of good solutions to offer around call mitigation and appropriate health care navigation for these patients.”

In the near future, Boyal hopes to see an improvement with ambulance response times and the fear of waiting for an ambulance in an emergency should be non-existent.