In recent years, Ontario has improved emergency medical services (EMS). Years ago, even for-profit funeral parlours ran local ambulance services. Now we have a highly regulated, public EMS service staffed by highly skilled, professional paramedics and dispatchers. Ontarians now expect professional paramedics and dispatchers to provide excellent pre-hospital care and save lives on a routine basis.
Nothing less should be expected by the public.
But the prospect of funding cuts threatens the level of care that Ontarians expect. This upcoming election could be a watershed: we may see continued excellent care, or we may see constant erosion of emergency medical services.
Professional care from highly trained and regulated professionals
The role of paramedics and pre-hospital emergency care has increased dramatically in recent years and, with this, the provincial government has increased the education, qualifications, and skills required by primary care and advanced care paramedics.
Graduates of approved two-year emergency care programs must successfully complete Ministry of Health and Long Term Care certification before being issued an Advanced Emergency Medical Care Assistant. Only after this can you become a primary care paramedic. Further training is required to become an advanced care paramedic.
Unlike most other employment relationships, paramedics are not just overseen by their employers. The Ministry of Health and Long Term Care frequently discipline paramedics, up to and including removing their right to practice as paramedics. The province also appoints base hospital physicians who have the right to limit or remove the right of paramedics to practice. The government is now looking to create a regulatory college for paramedics. This would be a fourth level of oversight of the paramedic profession.
The Province also certifies and reviews EMS operators under legislated regulations and standards. The certification and review programs utilize peer review every three years. Paramedic call reports are audited by base hospitals for compliance with legislated patient care standards and delegated medical acts. The Province operates an Investigation, Complaint and Regulatory Compliance program.
Emergency medical services are being squeezed by provincial funding
Already, work overloads are pulling ambulances off the street. Back-ups in emergency rooms are part of the problem. Thousands of hospital beds have been cut and hospital bed occupancy is now at exceptionally high levels in Ontario (97.9 per cent) causing Emergency Rooms to overflow. As a result paramedics are unable to transfer their patients to hospital staff and are caught up in Emergency Room “offload delays”.
So, for example, in Hamilton the number of times there were NO ambulances available to respond to 911 emergency calls has increased dramatically. In 2007, the City had to increase funding to improve EMS response time. But the “code zeroes” (when no ambulances are available to respond to 911 emergency calls) began to creep up again. In 2009, there were 43 “code zeroes”. That increased to 94 in 2010. Earlier this year, the City of Hamilton had to increase funding another 833,000 dollars for more ambulances and paramedics to deal with a chronic ambulance shortage on the streets after the code zeroes increased again.
The provincial government has benefited financially by pushing the problem back to the EMS operators. While the province funds almost all hospital expenses, they only have to pay 50 per cent of approved EMS costs. As in Hamilton, the municipalities, which are required to provide emergency medical services, are stuck with the extra costs.
In London, ambulances and their patients waited outside London ERs for more than 685 hours in March — that’s an average of one working paramedic crew unavailable for emergencies for every hour of every day that month. The cost to sit and wait in that month alone exceeded 100,000 dollars.
In Niagara, ER closures are driving up ambulance response time. A 2010 report from Niagara EMS suggests that the closure of two hospital Emergency Rooms in Fort Erie and Port Colbourne has resulted in longer “offload delays” for paramedics. In fact, the offload delays were projected to hit 10,000 hours, an increase from 2,504 hours in 2006.
The Niagara EMS described its situation as follows: “The offload delay issue remains the primary public safety challenge within Niagara EMS… the ability to maintain this level of service is becoming increasingly challenging as EMS resources become critically compromised during peak offload periods.”
The provincial government has slowed down the implementation of the new response time standards for emergency medical services. A revised provincial regulation now allows municipalities two more years before they must report on response times and their response time plans. This put off response time reporting until after the provincial election.
These problems are reminiscent in some ways of the ER problems a decade ago after the cuts to hospital services by the Mike Harris Progressive Conservative government. At that time ambulances were turned away from backlogged hospitals, infamously resulting in the death of a young asthma sufferer, Joshua Fluelling.
Fluelling, 18, was having a severe asthma attack in January 2000 when his ambulance was redirected from the closest hospital and sent to one more than twice the distance away. On route to Markham, the teenager suffered respiratory failure and brain damage. He died later in hospital. A coroner’s jury into the death called for more paramedics to be hired and for hospital bed closures to be stopped. But by 2010, 682 hospital beds had been cut instead. These recommendations are even more urgent today.
Bottom line: Highly skilled paramedics are being pulled off the road. Our concern is that we will not be there for the public when it counts.
Government health care funding plans suggest that this problem will get much worse after the election– unless we change the funding plans.
Funding Plans will lead to a serious decline in health care and EMS services
The Liberal government’s health care funding increases will be cut in half compared to the first two terms of the government, according to the Auditor General. As a result, the Auditor notes: “The expense estimates assume that the hospital sector will achieve savings totalling 1 billion dollars between 2011/12 and 2013/14.” This will leave little alternative but to cut services. This is all the more troubling as the Progressive Conservatives funding plan is even weaker than the Liberal plan.
Will Paramedics be replaced by less skilled staff?
In the past, one way to implement cuts has been to replace highly skilled paramedics with less skilled staff. Instead of bringing on more fully qualified paramedics to deal with the overload, we are concerned that government may try to rely on less qualified responders. Here is what happened the last time this was tried.
The Ontario Progressive Conservative government introduced legislation in 2000 allowing hospitals to use for-profit “patient transfer” companies rather than ambulances to move patients between hospitals or long-term care facilities in some circumstances. This led to a drastic increase in the number of patients transferred by for-profit companies.
Despite assurances prior to the legislative changes from then Minister of Health, Elizabeth Witmer, and her parliamentary secretary, Tim Hudak, now the leader of the Ontario Progressive Conservative Party, minimum standards for staff or equipment were never developed.
While some patient transfer attendants are qualified paramedics, many have no medical training beyond a basic CPR certificate. They are often paid in the range of 11 dollars to 13 dollars an hours. Patient transfer attendants have recounted trucks catching on fire and lug nuts shearing off wheels. One attendant told CBC documentary maker that she was ordered by her dispatcher to drop off a homeless patient in a back alley of Toronto. Workers within the industry who express concern to their dispatch operators about their patients’ safety are routinely suspended or fired.
The Ombudsman followed up the CBC documentary with his own report on this industry earlier this year. He was equally scathing.
Ontario residents would be better off taking a taxi to a hospital than one of the privately owned vehicles used to transfer hundreds of thousands of non-critical patients each year, provincial watchdog Andre Marin told the Canadian Press.
“Of all the cases that I’ve done since I’ve been ombudsman, this is a case where I’ve rarely seen such incontrovertible and conclusive and convincing evidence early on, that was really not in dispute,” Marin said. It’s allowed private companies to charge hundreds of dollars per patient for transports in old, beat-up ambulances operated by “kids” with no medical training, he said.
“They place people’s lives in serious jeopardy,” Marin said.
Replacing highly trained paramedics is a threat to the quality of our health care. Instead of fewer highly trained paramedics, Ontario needs to adequately fund health care, resolve the hospital back-ups, and hire more paramedics.
Support Emergency Medical Services: Ask your local candidates to support more hospital beds and services and more paramedics. Nothing less will do.