Health-care officials are grappling with the problem of ambulances being tied up at larger hospitals across Nova Scotia.

Offloading patients has become a slow process when hospital beds are at or near capacity. Those working in the system say it's a complex problem that won't be easily solved.

The International Union of Operating Engineers local 727, which represents paramedics, has been ringing alarm bells over ambulance offload delays for months.

Emergency Health Services, which runs the ambulance service, says it is working with the province on solutions.

Kirk Magee, interim head of emergency medicine in the health authority's central zone, said the problem involves the entire hospital, not just the emergency department.

"Whatever happens upstairs on the floor, which is really outside of my jurisdiction, the effects are felt all the way down in the [emergency room], right up to the paramedics and ultimately back into the community," he said.

Dr. Kirk Magee is the interim head of emergency medicine at the Nova Scotia Health Authority's central zone. (Craig Paisley/CBC)

The number of available beds in any hospital changes regularly depending on patient flow and staffing levels, he said.

Hospitals have to do a better job of managing patients and beds to make space available in emergency rooms, Magee said.

That would free up space in the emergency room and help ambulances offload patients quicker.

Having paramedics divert patients from emergency departments plays a part, he said.

Working on efficiencies

EHS already does that by treating some patients at Halifax nursing homes. It is planning a new community-based program for Cape Breton that will see some patients, when appropriate, treated in their own homes.

Magee said that will definitely help, but it won't solve the problem.

"There's probably no single solution that's going to be a magic pill to the system," he said. "Everything that decreases patients coming into the department and ultimately helps patients move out of the department does lessen the issue of hospital overcrowding, emergency department bed-block and ambulance offload delay."

Emergency department managers and administrators from other parts of the hospital are constantly working on efficiencies, Magee said.

Replacing 'code census'

The hospital system is replacing the old "code census" system with a new surge capacity protocol that will trigger other floors to start freeing up beds before the emergency department reaches capacity.

"Paramedics and the emergency department are almost like the canary in the coalmine," Magee said. "When you see ambulances that are not able to offload, what that really tells you is in most scenarios, the issue is lack of capacity within the hospital."

Mike Nickerson, business agent for the paramedics' union, said having paramedics treat people in the community will help, but it's not the solution.

Michael Nickerson is the business agent for the International Union of Operating Engineers in Sydney. (Tom Ayers/CBC)

"It may help mitigate and defer a few patients from going to the ER, but I don't think it's the answer," he said.

The union isn't just complaining though, said Nickerson. It wants to help solve the problem.

"I'm glad that the ambulance service and the health authority are communicating and looking at solutions. However, in regards to the community paramedicine program that's rolling out in Cape Breton, we don't even know what that's going to look like. We haven't been told anything."

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