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Funding needs, other factors don’t improve outlook, director warns
By JEFF OUTHIT
The Record (Kitchener-Waterloo, Ontario)
Paramedics are taking longer than ever to reach emergencies, unable to keep up with soaring calls for help.
“I think we have a problem,” Coun. Jake Smola said. “I’m now, more and more, hearing ‘What took the ambulance so long to get there?’”
Regional council has doubled ambulance spending since 2001, hiring paramedics, building stations and adding vehicles. Yet:
Paramedics took 61 seconds longer to reach emergencies in 2004 than in 2003, reversing earlier gains.
Ambulances now take 14 minutes to reach 90 per cent of calls. That’s five minutes past council’s never-achieved target of nine minutes.
Paramedics are even slower this year. Response times are expected to soar past 15 minutes in 2005.
Ambulances take longer to reach emergencies than in seven comparable communities, all of which outspend this region on paramedics.
Councillors have been warned that ambulances are expected to slow even more, as the population ages.
Are lives being put at risk?
Emergency services director John Prno said firefighters often arrive ahead of paramedics to perform first aid and revive stopped hearts.
“There is help getting to the scene,” he said. “We’re able to stop the clock, start first aid, start life-saving defibrillation, and those sort of things.
“What we’re delaying is that next step of care, the advanced level of care, the transportation to hospital.
“Yes, we’d like that time shorter. But you know, it’s not that there’s nobody showing up to help you.”
This includes police cruisers, which are being equipped with heart-shocking defibrillators in rural areas.
Several factors help explain slower ambulances:
Calls for help are soaring by four to six per cent a year, as the population ages. People older than 70 are seven times more likely to call for paramedics than people under 65. This ties up more ambulances.
Ambulances no longer take patients to the nearest hospital, but to the hospital designated for the kind of care they need. This is better for patients but ties up ambulances longer.
Paramedics are waiting longer in hallways to unload patients, while crowded hospitals try to free up beds. This ties up ambulances longer.
Across eight comparable communities, average spending on ambulances is $32 per resident. Regional council spends $22.
That’s 31 per cent below the average.
“I think it shows, in a nutshell, to some extent, you get what you pay for,” regional chief administrator Mike Murray said.
“If you’re not putting as much money into the system, you’re not able to have the fully optimized system that we’d like to have,” Prno said.
He added: “This is not a panic time. It’s a wakeup call.”
In part, ambulance spending is lower here because the province sends $10 per person to help. That’s more than some places but less than some other communities that get between $13 and $18 per resident.
The discrepancy relates partly to different hospital roles, but local officials are pressing for more aid.
Councillors, who are expected to hike ambulance spending to $13 million next year, are reluctant to accept greater spending as the only way to speed up ambulances.
“We have to find a way to reverse that trend, without breaking the bank,” Coun. Tom Galloway said.
He suggested more closely integrating firefighters and paramedics.
“Maybe a paramedic should be in the fire department, on every truck,” Galloway said.
One hurdle is that the region looks after paramedics but cities and townships look after firefighters.
This can complicate co-operation, as seen recently when councils battled over a plan to house paramedics in a Kitchener fire station.
Galloway figures co-operation in emergency services would be smoother with one level of local government instead of two.
Wilmot Mayor Wayne Roth agrees that “from a logical point of view, it would.”
But he figures there are other good reasons why councillors continue to favour a two-level system dismissed as outdated by critics.
Prno has advised council to abandon its goal, set in 2003, of achieving nine-minute ambulance responses for 90 per cent of calls. “I don’t think we can get there,” he said.
(Ambulances are not measured by how quickly they arrive on average, but by how quickly they arrive 90 per cent of the time.)
Councillors appear unwilling to give up on their target, even though it is increasingly distant.
“If it’s proving to be totally and financially completely irresponsible, then we have to revise that and maybe come up with a more realistic figure,” Roth said. “But I think it’s always best to shoot for the moon.”
“I don’t want to give up on the nine-minute response,” Woolwich Mayor Bill Strauss said.
Prno also suggested council consider setting different response standards for urban, suburban and rural areas.
“I don’t like the idea of having different response times, because that sort of gives you first-, second- and third-class citizens, and I don’t think that’s fair,” Roth said.
He added: “I hear no complaints about ambulance service in Wilmot Township. I’m assuming from that that people are reasonably satisfied.”
Local ambulances, while underfunded compared to other communities, are considered efficient. Costs per patient carried are 21 per cent below the average, for eight comparable communities.