>> Jeyan: Blaring sirens help ambulances carry patients at top speed to the hospital.
It's not helpful, then, if once they arrive patients and the paramedics treating them are
stuck in lineups waiting for care.
Justin Chandler covers the Hamilton-Niagara region for Ontario hubs.
He has been looking into why that's reaching troubling levels in St. Catherines and other
Ontario health regions.
Hey, Justin.
>> Justin: Hey there.
>> Jeyan: Okay.
So for your latest article on tvo.org, you talk a lot about off load delays.
What exactly is that?
>> Justin: So an off load is the process that paramedics and hospital staff go through when
care for the patient is transferred between those two groups.
So once a patient has been registered and is under hospital care and off an EMS stretcher
they've been off loaded.
The provincial standard for that since 1987 has been 30 minutes.
If the process takes longer as is frequently the case especially now that considered
an off-loading delay.
>> Jeyan: Why is this such a problem Ontario, specifically description but we're seeing it
in other parts of the province, as well, correct?
>> Justin: They're saying it's throughout the region.
But in the Niagara region some of the things that have be been cited are hospitals getting back
into regular operations.
This means that all the people who delayed things or who maybe had health problems and those
problems are not worse because they weren't getting hospital care during pandemic closures
when more hospitals were focused on COVID and paused certain operations.
It just means there is a significantly higher level of demand.
And that coupled with staff burnout in hospitals and the paramedics, that's just meant
that there are fewer people available and then there's just the continuation of hospital bed
shortages which has been a problem in the province for years.
>> Jeyan: Let's talk about that.
Of course we've talked about hallway medicine for quite a while.
What exactly are you hearing from experts in the hospital talking about the ripple effect
of bed shortages to these off load delays?
>> Justin: One of the things they're say something hospitals are really running out of places
to put people.
Because potentially there's not enough long-term care spaces or because there are too few
community paramedic programs that can treat people outside of hospitals.
Hospital beds end up getting taken up by people who maybe don't usually need hospital
level care but need to be cared for somewhere so they end up in hospitals and that just means
that there are fewer places that incoming patients can actually be moved to in an expeditious
amount of time.
>> Jeyan: I think there's one thing a lot of people don't talk about.
Is once you call the paramedics, the ambulance comes, gets you on the stretcher and takes you to
the hospital and then you're waiting there this ties up resources for other calls as
well.
What sort of shortage in terms of ambulances for other calls have we been seeing some stories
0 that as well?
>> Justin: This is a big concern.
It's something that, for example, Niagara EMS, the chief there, Kevin Smith, he said that
this is actually a crisis.
Because not only are people waiting so long, but when these ambulances are tied up, it means
that there are not other ambulances available for calls.
So this even mean that in some cases there might not be any ambulances available for calls
and Hamilton has logged that in the last several months that that's been happening.
So really it's sort of this problem where it hits us from multiple ends.
Not only are patients waiting in hospitals sometimes for hours for care, but then those
paramedics are also there and they're not on duty being able to respond -- well, they're on
duty -- but they're not in their same capacity where they can just go out to a call and so it
means that then people who are trying to get help are waiting longer, too.
>> Jeyan: On that point, I'm curious -- are patients getting care when they're still waiting
for beds in the ambulance or just sort of ready to be off loaded into the hospital?
>> Justin: Yes, the paramedic leaders I have talked to have said yes, paramedics are trained
to do a high level of care and they're going to do the best that they can.
But they don't do hospital care.
So there are some things here that can be a little tricky.
So paramedics won't have permission necessarily to give patients food.
So like in the past seven months in Niagara, before my article came out, about 350 people
waited 4 to 6 hours for care.
This that 4 to 6 hours could you get hungry maybe you have to go PEE.
So the paramedics will be talking to hospital staff saying this patient that we have here
is it okay to feed them?
They have to negotiate whether they can give them that sort of care.
Because there are only so many things they're legally allowed to do in that time-frame.
>> Jeyan: 4 to 6 hours that's quite a long time.
I am curious: Are we seeing an increase in, say, more serious health issues or, say,
fatalities because of these sort of offset delays?
>> this is a little bit trickier.
The paramedic services have said that if people are in life threatening conditions in
Hamilton, for example, that's about 10% of EMS transfers to hospital that you are much less
likely to wait.
But I also had it said that it could happen that someone is in serious need and dozened up
waiting longer.
It's more likely that someone who's in a less life threatening condition but still needs
hospital care would be the sort of person who's waiting.
>> Jeyan: Earlier this year I spoke to a couple of paramedics and they explained the
day-to-day struggles they had where they would go through a 12-hour shift and not have a
lunch break or they wouldn't have a chance to go to the washroom because they have to be
beside their patient as they wait.
I'm curious.
What have you heard from paramedics in terms of the impact it's had on their health?
>> Justin: Ashley Smith in Niagara says this is something that's contributing to staff
burnout and sick pay usage.
For example, the average off load delay recently has been 90 minutes and what I'm hearing
that means for paramedics that they're going to be going right back out shortly after being in
the hospital.
They're lacking that time that they can decompress.
They said that from April to August this year sick time has been up 33% which equates to
about $121,000.
This is a problem that ends up costing a lot of money, too.
You can look at this time that everyone is spending in hospital.
In Niagara that forecasts to be about $20,000.
The certify industries is saying that that's over $2 million in lost time.
>> Jeyan: Speaking of money, we know earlier this week the province announced it would be
expanding one of the hospitals in the Peel region.
I'm curious, are health regions or the Ontario government doing anything to address this
specific issue knowing that there are some ripple affects as well with bed shortages and
stuff but to this specific issue?
>> Justin: There are different things.
The Ontario government, for example, has said that they've done work how paramedics treat
people in the community without taking them to hospital.
They've also provided funding for nurses to help with off-loading this is something
that paramedics in hospitals are working together on.
Just trying to find any sort of way that they can make things go faster.
Some examples that I have heard, things that are in discussion would could be, for example,
maybe nursing students helping off load patients instead of that just being a regular nurse
or maybe changing it so that it's not paramedics who are transferring people in between
hospitals.
But people are looking for all sorts of ways that we can save a little bit of time.
Because although, yes, this is a big systemic issue those things take time to fix and there are
problems now.
And it sounds like people want to come up with some creative solutions.
>> Jeyan: We'll look forward to that.
I really appreciate it, Justin, thank you so much for this.
>> Justin: Thank you.
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