By Teri Pecoskie
The Hamilton Spectator
ONTARIO, Canada — Hamilton is on track to record its worst ambulance shortage ever, despite devoting time, money and manpower to solving the problem.
In the first two months of the year, the city’s paramedic service reported 39 “Code Zero” incidents, times when there is only one ambulance - or no ambulances - available to respond to an emergency. That’s more than double 2010’s figures for the same two months and triple the year before.
“We are stretched to the max,” said EMS director Brent Browett, noting the city is on pace for 241 Code Zero incidents this year.
Browett attributed the spike to several factors, including rising patient off-load times, limited resources and an increase in the number of calls. Hospital officials say the spike could also be driven by an unusually heavy flu season, as well as protocol put in place to manage the C. difficile outbreak at St. Joseph’s hospital.
In January and February, it took paramedics 67 minutes on average to transfer a patient into the care of hospital staff — a 15 minute jump over the time reported by EMS in the first two months of last year.
As a first step, Browett said, it’s essential the city approve the service’s request for $1.1 million to deal with McMaster University Medical Centre’s transformation to a children-only emergency room for the rest of this year.
Browett noted the ambulance shortage would be even worse were it not for a provincial nursing initiative designed to speed up the time it takes ambulances to transfer patients and get back on the road. The city has asked for close to $1 million to fund the program in 2011, which would allow it to staff Hamilton General, Juravinski and St. Joseph’s with an off-load nurse 12 hours a day, year round. A nurse would also be placed in the McMaster ER until it switches to a pediatric unit April 4.
Mario Posteraro, president of the paramedics union, said he sees the nurse off-load initiative more as a Band-Aid than a long-term fix.
“It hasn’t made enough of a difference to warrant not looking at other solutions,” he said, adding that the best way to minimize Code Zero events is to increase funding and front line resources.
Posteraro also said there would be “very severe consequences for the community” if the shortage and wait times aren’t rectified soon.
Isabel Hayward, director of emergency medicine at Hamilton General, said the off-load times recorded by EMS, which are calculated from the moment the ambulance wheels stop at the hospital to the moment they start moving again, aren’t an accurate gauge of off-load times. Instead, the hospital records the time from a patient’s first interaction with a triage nurse until treatment is taken over by hospital staff.
In January, the average off-load time recorded by Hamilton hospitals was 47 minutes - about 20 minutes fewer than the times reported by EMS.
Hayward said a reason for this could be that EMS off-load times don’t account for things like paramedics grabbing a cup of coffee or finishing paperwork before heading back to the ambulance.
Posteraro disagreed that paramedics were biding, saying many have been skipping mandated breaks and working overtime.
Ida Porteous, clinical director for St. Joseph’s Healthcare, said the ambulance shortage is also fuelled by capacity issues. More patients, with more serious ailments, are utilizing the system.
Porteous added that hospitals and paramedic services are more prone to spikes like this during the winter months. She also said it’s harder to move patients into community beds because of outbreaks in long-term care facilities.
“It’s not unusual in the first three months of the year to experience these challenges,” she said.
Auditor General Jim McCarter highlighted the patient flow problem in his annual report, saying Ontario’s emergency rooms face lengthy wait times for severely ill patients because there aren’t enough beds. He blamed the shortage on two factors: the vast number of beds being occupied by patients waiting to be moved out, and the mismanagement of open beds.
Hamilton hospitals recently reported that patients with severe injuries or ailments wait an average of 18 hours before they can be moved out of the emergency room and into a bed - seven hours longer than the provincial average.
Professor Michael Carter, director of University of Toronto’s Centre for Research in Healthcare Engineering, said Code Zeros can’t be attributed to a single factor. He argues that the problem is one with the system itself rather than insufficient front line resources.
“I really don’t think that it’s a lack of ambulances and I really don’t think it’s a lack of capacity in emergency departments. It’s a flow issue and we get stuck,” he said.
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