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Patients in Ontario are spending longer waiting to be transferred from the care of paramedics to hospitals, tying up ambulances that could otherwise be on the roads.
Ambulance offload delays have increased since 2020, according to data obtained by The Trillium through a freedom-of-information request.
Across all hospitals, patients waited an average of 20 minutes in January 2020, rising to 24 minutes in July 2023, according to data reported by hospitals to Ontario Health each month. Waits dipped early in the COVID-19 pandemic as people stayed home, then climbed in 2021 and peaked in 2022 as pre-pandemic habits resumed.
Delays have varied across the province. At London Health Sciences Centre's University Hospital, the average delay rose from 27 minutes to almost an hour and a half, while at Hamilton's Juravinski Hospital, times are down from 52 minutes to 16, after ambulance shortages hit a crisis point in the city.
Ontario's auditor general said in a report released this week that the government has no target for offload times, but that 30 minutes is considered best practice — one that's not consistently met. He cited offload delays of as long as three hours in Ottawa, where ambulances' time off the road totalled 98,000 in 2022-23.
"Tying up ambulances poses a significant risk for communities, and it is an ongoing challenge. For example, on multiple occasions in 2023, Essex-Windsor Emergency Medical Services had to declare 'code black,' a designation that signifies no ambulances are available in the community," wrote auditor Nick Stavropoulos.
The following chart is searchable by hospital — or search "Provincial Average" to see the broad trend over time. Some data is missing due to reporting issues or low volumes. Other hospitals have incomplete data due to closures.
Minutes can make all the difference, said Scott Bernaerts, a paramedic of six years in Oxford County. He recalled an overdose response in London — a code four, the most serious.
"That is lights and sirens," he said.
Code fours are handled by the nearest ambulance, including those in nearby municipalities. If another, closer ambulance suddenly becomes available, it'll take over. Though Bernaerts was 25 minutes away, he was the closest.
"We never used to make those response times," said Brandon Wise, the vice president of OPSEU Local 114 and an Oxford County paramedic of 32 years. "Because somebody would clear up in London and do the call."
"But for this call," Bernaerts said, "it's going through my mind, 'Surely another crew will become available.'"
None did. Bernaerts said he took the patient to a London hospital, where she waited on a stretcher "probably for an hour and a half." By the time she was seen, she had to be intubated, he said.
"That's a bold decision. They don't just throw that around lightly," Bernaerts said. "I can't say for sure that if somebody got to her sooner, she would have had a different treatment. And ultimately, I'm not sure what her outcome was. But it's all just questions in my mind."
Wise said his crew has been called into London "quite a bit more" recently, especially in the last year. He estimated he spends an hour or two offloading the average patient, but said four hours isn't uncommon.
London is far from the only place dealing with ambulance shortages. The province refused to release ambulance offload data this summer, with The Trillium only obtaining it through the freedom-of-information process.
The number of 9-1-1 calls keeps growing as Ontario grows and ages, but the number of paramedics hasn't kept pace, said Peter Shirer, the vice chair of Toronto Paramedic Services Local 416, under CUPE.
“So you have no surge capacity left in the system," he said.
His union has launched a campaign calling attention to the 1,139 times there were no ambulances available in Toronto to respond to 9-1-1 calls.
Because there's no fat on the system's bones, Toronto's demands of nearby municipalities can cause ripple effects — Toronto draws on Peel, Peel draws on Halton, and so on — said Charles Labelle, also with Local 416.
"So it's something that the entire system feels when there aren't enough units available," he said.
Oxford County has just seven ambulances on the road at night, Bernaerts said.
"When you take one of those away, that's really impactful for our emergency coverage," he said.
And when cities have to focus on high-priority calls, those for patients with non-life-threatening injuries — like a senior who has fallen and broken their hip — are "delayed, delayed, delayed and delayed," Shirer said.
"They will ... wait eight to 12 hours sometimes for paramedics to show up to take them to the hospital. And that's something we see every day. Every day, people are waiting well over four hours for paramedics," he said.
The delays are a symptom of the health-care system's overall strain, Wise said. Primary care is lacking, so people are forced into emergency departments for non-emergency reasons, and nurses tasked with offloading the patients are burnt out, he said.
"People have nowhere to go for their sore throats, their stomach, GI issues — the lower-acuity things that emergency departments shouldn't really be dealing with," Wise said.
The Ford government has added $51 million to the Dedicated Offload Nursing Program first launched in 2008, boosted provincial ambulance funding by six per cent, and now allows paramedics, physician assistants and respiratory therapists to help with offloading, Health Minister Sylvia Jones' spokesperson, Hannah Jensen, said in a statement.
"This program has helped partners like Guelph General Hospital reduce their off-load times by 85 per cent," she said.
The auditor general recommended that the province continue to review and enhance the program to ensure it supports improvement in offload times, and that it ensure hospitals and paramedic services share the best practices that can bring times down. The ministry accepted both recommendations.
Jones also noted the government's continuing rollout of advanced ambulance dispatching, and its move to allow paramedics to decide where to take patients instead of mandating emergency department visits.
Labelle said the new freedom hasn't made much of a difference to him, as it only applies to "a very small percentage of the calls we do."
NDP health critic France Gélinas said she believed the Ford government was making progress on offload delays. But if that were true, the data would show a "sharp decrease" in wait times, she said.
"And to the opposite, in many places, it got worse," she said.
"The government can't blame COVID-19 on this," Liberal health critic Adil Shamji said.
Solving the delays means attracting and retaining more emergency department nurses and primary care providers, he said.
"Every time an ambulance is not available, you put each and every one of us at risk," Gélinas said.
