Out-of-town paramedics had to respond to calls in Hamilton this past weekend when the city was left with no ambulances to go to emergencies — because they were lined up at local hospitals.

For three and a half hours on Oct. 20, the city had one or zero ambulances to respond to emergency calls, says the Hamilton Paramedic Service. Such instances are known as a code zero event.

At the same time, there were long delays in transferring patients to Hamilton's emergency departments that kept paramedics stuck at hospitals for more than two hours.

"It paints a grim picture of what's to come," said Mario Posteraro, president of Ontario Public Service Employees Union, Local 256. "With the flu season that is fast approaching and the lack of capacity within the hospitals, there's likely going to be an increase in off-load delays which will also contribute to code zero events."

Ontario's overcrowded hospitals are worried about how they are going to cope with even a mild flu season, which was evident from their overflowing emergency rooms over the last weekend.

Within 30 minutes of an ambulance arriving, care of the patient is supposed to be transferred to hospital staff at least 90 per cent of the time, so the paramedics can quickly get back on the road, according to the benchmark set by the province.

But on Oct. 20, there were 53 times that it took more than one hour for paramedics to do the transfer. Roughly half of those, 27, were off-load delays longer than two hours.

It was the culmination of a weekend of increasing off-load delays. Paramedics were stuck at the hospital for longer than one hour 21 times on Oct. 18 with eight of those being longer than two hours.

On Oct. 19, there were 28 off-load delays of one hour or more and 11 were longer than two hours.

"These are no longer unique events," said Posteraro. "We've all become accustomed to code zeros."

For three-and-a-half hours on Oct. 20, the city had one or zero ambulances available to respond to emergency calls. | Barry Gray/The Hamilton Spectator

Even outside of the code zero event, the service spent much of Oct. 20 with four or less ambulances available due to prolonged off-load delays.

"Given Hamilton's vast geography, even having four ambulances available to respond puts us in a predicament," said Posteraro.

He gives the hypothetical example of a senior falling and dislocating a hip. When four or fewer ambulances are available to a city, a lower-priority call like that could wait up to an hour, says Posteraro.

"Those patients are waiting, lingering in pain for 30, 40, 50, 60 minutes," he said. "That's unacceptable."

Overall, the number of code zero events and their duration have been dropping — 71 so far this year compared to 106 at this time two years ago — due to strategies put in place by the city, hospitals and $1.3 million in funding from the province.

But the Ministry of Health has not yet confirmed the funding will continue for the fiscal year that started April 1. It pays for nurses dedicated to speeding up ambulance off-loads.

"We anticipate it will again be funded," said paramedic service chief Michael Sanderson. "We have proceeded with maintaining them based on verbal assurances from the ministry."

So far, the measures put in place haven't been enough to get anywhere near the provincial benchmark. In 2018, only 43 per cent of cases were transferred in 30 minutes or less. The 90th percentile at Hamilton General was 102 minutes, it was 114 minutes at St. Joseph's and a whopping 132 minutes at Juravinski.

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Off-load delays "continue to be a significant pressure on ambulance availability, response time performance, and workplace wellness for our paramedics," said Sanderson. He urges the public to get their flu shot and only call an ambulance in a true emergency.

Although the real problem isn't the hospitals, says Posteraro. It's the lack of community resources like long-term care and home care that are "critical to alleviating hospital overcrowding."

"When a patient goes to the emergency department they're waiting because there is no room or no capacity in the hospital," he said. "Why? Because there is no capacity in the community. It's a cascading series of events that translates into unsatisfactory care for our patients and our citizens."

At the end of the day, the backlogs in the entire system fall on the paramedic service, says Posteraro.

"We're running full tilt," he said. "Our paramedics are going non-stop. There has to be some reprieve."

But the problem is not going to go away particularly with an aging population that is leading to a higher number of emergencies. In 2018, paramedics responded to an average of 187 calls a day compared to 150 in 2012.

Hamilton paramedics transported 51,763 patients to hospital in 2018 up from 42,144 in 2012.

"It's difficult for us to keep pace," said Posteraro. "The call volume exceeds our ability to respond in a manner that is satisfactory."

jfrketich@thespec.com

905-526-3349 | @Jfrketich