Overcrowding at the province’s largest emergency department is becoming more and more common. Patients are waiting up to 12 hours in the Halifax Infirmary hallway, dubbed “Ambulance Alley.” Paramedics spend hours, sometimes entire shifts there with patients, unable to respond to calls. Physicians sometimes see patients in those hallways, on benches or in family rooms. This week, StarMetro Halifax talks to people on the ground about what’s happening, and what can be done, in a series we call Code Crisis.

HALIFAX — Thelma Bellefontaine knew something was seriously wrong when she woke up the morning of March 12.

Her leg “felt like a sandbag was tied to it.” She couldn’t move or put weight on it and was suffering severe shooting pains, her daughter Chris Arsenault recalled. Bellefontaine, 80, didn’t want to cause a fuss but gave in and called 911 shortly before 9 a.m. She was brought to the Halifax Infirmary and placed in a hallway.

Bellefontaine would spend the next 12 hours there, alongside 15 other stretchers.

“If you wanted to sit on the little bench that was on the other side, you didn’t have any room to get in,” she said. “If you went in for a test, they’d try to put another stretcher in your spot.”

Bellefontaine’s story is far from unique. Long waits at the province’s largest emergency department are becoming increasingly common and illustrate a growing overcrowding issue that has multiple causes and no quick fixes. An aging demographic with more complex health issues, a provincewide shortage of family doctors and a need for more long-term care beds are just some of the factors.

Last March, a Nova Scotia Government Employee’s Union (NSGEU) report highlighted the ongoing capacity issues and increases in emergency department visits at the Halifax Infirmary.

The 2017 Code Critical report said discussions with hospital administration and staff had led the union to conclude there was a “genuine desire” from everyone involved to address the problem.

“Simply put, the problem stems from continued growing demands on a system that has no capacity to handle the increase,” the report noted.

Until recently, an alarm called a Code Census was called when there was a need to alleviate significant overcrowding by getting in-patient floors to prepare for emergency department patients. Back in 2010, there were 87 Code Census calls at the Halifax Infirmary’s emergency department. By 2015, 110 Code Census calls were made at the facility, the Nova Scotia Health Authority told StarMetro. In 2016, it jumped to 146.

But the Halifax Infirmary no longer calls Code Census. From January to August 2017, when the practice was halted, 67 Code Census calls had been made.

“Code Census is no longer called because the processes that were originally outlined in Code Census represented best practice, and rather than wait for a Code Census to be called to initiate best practice, it was decided to make this part of the hospital’s normal operating procedure,” said Dr. Kirk Magee, site research director of the Halifax Infirmary emergency department, on behalf of the Nova Scotia Health Authority.

In an interview, Magee told StarMetro that when it comes to overcrowding issues, we have started to normalize the abnormal.

“Fifteen years ago it was abnormal to have four or five admitted patients in the (emergency) department, or one or two ambulances that are waiting in hallways (with) paramedic crews,” Magee said. “Now that would be a good day.”

Bellefontaine and her daughter said they contacted StarMetro because they were “very concerned” about the potential trickle-down effects of such long emergency department waits.

As uncomfortable as it was, Bellefontaine said their primary concern wasn’t that 16 patients were crammed into a hallway for hours on end. They were alarmed that each stretcher was watched over by two paramedics, tying up 32 paramedics who weren’t permitted to leave their patients.

“It doesn’t sink in how bad things are in that emergency department until you’ve been in it and see it,” Bellefontaine recalled.

Bellefontaine’s visit happened March 12. According to a statement released the next day by NSGEU, 17 ambulances and their paramedic teams were waiting at the backlogged Halifax Infirmary emergency department, with patients facing wait times of up to 10 hours.

There were 68 patients waiting to be seen as of 7 p.m. that night, and one unnamed emergency department physician said “it was the most (people) he’d ever seen waiting to be seen,” NSGEU president Jason MacLean tweeted.

The Nova Scotia Health Authority (NSHA) said the March 12 backlog was caused by a combination of factors. The Halifax Infirmary’s emergency department was registering 15 patients per hour and saw 53 ambulances roll through in a 24-hour period, the second-highest volume ever recorded. The average is 45.

“Many patients were frail and elderly, some had dementia and others had suffered slip-and-falls. The department was also short one physician. But the bottom line is the greater issue in the province. At a time of fiscal restraints, we need to do better to achieve the correct number of beds required outside the ED,” said Dr. David Petrie, central zone district chief for the NSHA’s Emergency Services Council.

“Without the proper in-patient beds, nursing home beds and community care beds, the EDs in the province have nowhere to send their patients. This ties up ED beds and paramedics, and it’s a situation nobody wants.”

As one of the patients waiting in the hallway — commonly called “Ambulance Alley” at the Halifax Infirmary — Bellefontaine stressed repeatedly that she received nothing but top-notch care from the paramedics who stayed with her, and even underwent a shift change, while she waited.

She said the nurses and doctor who finally did see her were also “incredible” and she was grateful for the care she did receive.

“We understand that when you walk into emergency you don’t get seen right away. If you have a heart issue or broken hip or something like, you get priority,” her daughter said. “Mom was in pain but wasn’t moaning and groaning and dying in the hallway. But I just think there has to be a better way than what’s happening there.”

Bellefontaine’s appreciation for the care she did eventually receive and her reluctance to complain is something Chris Parsons hears often. Parsons is the provincial co-ordinator for the Nova Scotia Health Coalition, a non-profit working to protect, expand and strengthen public health care.

“People aren’t asking for too much, and in many cases they are just asking for the bare minimum. Maybe it’s a Nova Scotian or Canadian thing, but people are often apologetic when they complain. They say the doctors are doing their best or the nurses we saw are doing their best,” Parsons said.

“I think people are really conflicted. A public health-care system that works, that is universal, is really part of the identity that we’ve constructed for ourselves as Canadians. So this is a real frustration for people because people have seen it work better.”

Bellefontaine and Arsenault stressed repeatedly that although such long wait times are troubling on many levels, their biggest concern was seeing so many paramedics stuck in the emergency department unable to take emergency calls.

They fear for what that could mean down the road.

“They can’t help the sick citizens that need them if they’re sitting there in that hallway so long,” Arsenault said. “What if there was a really bad accident that needed four or five ambulances or if there was a big fire and they have no one? It’s just wrong.”

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The answer to that question will be answered later this week when, as part of this week’s series, we interview a Halifax-based paramedic.

“When a person needs a paramedic, we pray to God that they’re there for you, because that means life or death to some people,” she said.

Arsenault was so concerned about what she had seen at the emergency department that the next day she posted a rant on her Facebook page.

“I had many replies from friends. One works (in the hospital) and said she sees that all the time, that it’s not a one-off,” Arsenault said.

Just six days after Bellefontaine’s experience, NSGEU president Jason MacLean took to Twitter to announce the emergency department was again significantly overcrowded, with 18 ambulances backed up and an understaffed department.

Of all the comments on her Facebook post about her mother’s 15.5-hour emergency department experience, Arsenault said one stood out.

“It said, ‘Let’s not get political. Let’s just fix it.’ And that’s so true,” she said.

“Please, let’s not get political. Take politics out of it. I don’t care who does it, but somebody just needs to fix this situation and they need to fix it soon.”

Following her emergency department visit last month, Bellefontaine has seen several specialists and is now awaiting surgery.

“Mom feels that 911 call saved her,” Arsenault said.

TIMELINE OF THE MARCH 12 ED VISIT:

9:15 a.m. Set up in the hallway

5 p.m. Seen by a physician

5:30 p.m. Pain medication given, blood work taken from stretcher in hallway

6:30 p.m. Doctor back to say a CAT scan was required

7:30 p.m. First CAT scan drink given

8 p.m. Second drink for test

8:30 p.m. Last drink for test

9:15 p.m. Moved to a room in emergency department

12:45 a.m. Released after being seen by the doctor and then a specialist

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