For Virginia Gamble, the waiting was the hardest part.

Torture, in fact, as the Sault Ste. Marie woman and another relative waited an hour and 45-minutes for emergency medical services personnel to respond after Gamble’s elderly aunt took a spill in Swiss Chalet, leaving the 91-year-old with a double break in her right hip and in “excruciating” pain.

Gamble, the other relative and staff at the Great Northern Road eatery, did their best to comfort the woman, placing coats under her head and providing encouragement.

“We tried to give her some comfort from the floor but, of course, we didn’t want to move her,” Gamble told The Sault Star, relating the March 7 incident.

“We didn’t want to lift her. She was just in dire agony. We didn’t want to damage her or just make her any worse.”

Gamble said she knew instantly her usually stoic aunt, who delivered 10 babies, carried water in winter and washed clothes by hand, was in great pain.

“This lady, never, never complained and she was laying there crying in pain … We were really beside ourselves,” Gamble said.

Once there, EMS were “awesome, apologetic, very professional, very caring,” and Sault Area Hospital staff delivered “top-notch” treatment.

“None of us have any beefs about the paramedics,” Gamble said. “They were sweethearts and did all they could.”

What irks Gamble is the explanation EMS gave, saying they would’ve been there “far sooner” but, due to the current patient offloading policy governing their “release” once a patient is in hospital care, paramedics must wait — “kept hostage,” Gamble says — with that patient until being formally authorized to leave.

“You would think if they’re in the hospital’s care, they have care, nurses and people are going over to them and they’re not alone in a hallway .. why not dispatch these people or, for heaven’s sake, increase staff?” Gamble said.

According to Sault Area Hospital, paramedics arriving at the receiving facility follow the Ministry of Health and Long-Term Care Transfer of Care (TOC) standard, which mandates personnel must attend to the patient while waiting for the facility’s staff to accept him or her.

Ambulance crews are expected to spend no more than 30 minutes each time they drop off a patient at the emergency room, Sault Area Hospital says.

Any extra time is considered an “offload delay,” says Brandy Sharp Young, SAH manager of communications and volunteer resources.

“These delays can occur when hospitals are in an overcapacity situation, not when we are understaffed,” Sharp Young told The Sault Star. “Overcapacity situations are experienced across the health-care system. To improve system efficiency and capacity in the emergency system, Sault Area Hospital continues to work closely with our EMS partners.”

EMS Service operates as a division of Sault Ste. Marie Fire Services.

Fire Chief Peter Johnson says the rules by which paramedics must abide are clear.

“We can’t leave that patient until (the hospital is) able to receive them,” said Johnson in an interview with The Sault Star.

“Any delay is always a concern to us. But, unfortunately, there are always unforeseen circumstances our crews can encounter. It’s hard for us to plan for what calls we receive.

“A crew could be dispatched up north, there could be crews tied up, and, as calls come in, we adjust to that.”

On the day in question, EMS responded to 48 calls and “upstaffed” two crews to assist.

“We were doing everything to mitigate call volume for that day,” Johnson said.

During day shift there are six ambulances on duty, all with two paramedics on each ambulance, one of which is staffed in Garden River First Nation, east of Sault Ste. Marie. On night shift, there are four ambulances on duty, all with two paramedics on each ambulance. One of those is staffed out of Garden River.

A commander is also on duty 24/7.

Sault Ste Marie paramedics responded to more than 15,000 service calls for ambulance service last year, covering more than 44,000 square kilometres of response area.

“Our partners and our staff with EMS … Everybody works diligently and we do our best to mitigate these types of things,” Johnson said. “And, when they do happen, it is unfortunate. I’m certain that everyone doesn’t want to see that happen. But, those are sometimes the real issues that we deal with in these types of professions.”

Meanwhile, any revision to Transfer of Care standards would have to be done by the ministry.

“Is it just a local problem or is it a provincial problem?” Johnson said. “Are they going to look at a small window in any community and say, ‘The whole standard has to be rewritten because it’s not applying well to this community.’”

Ministry of Health and Long-Term Care did not respond Friday to the Sault Star’s request for comment.

Others argue Transfer of Care policy is not the problem — staff shortages are the culprit.

Cathy Humalamaki, Unifor Local 1359 president, whose union represents paramedics, said there is a “crisis” across Ontario with “offload delays” for paramedics, in which there are no vehicles available in the community to respond to calls.

“The reasons are that ambulances are being utilized for other jobs in the community,” Humalamaki said.

Thirty-year paramedic Mary Casola says if a patient brought into emergency “deteriorates, there must be somebody medically trained to pass over patient care.”

“We cannot leave that patient until we actually transfer care to a registered nurse in the emergency department,” said Casola, a work group leader and unit chair.

A host of issues, Casola contends, are at play, such as nursing cuts, hospital bed issues, paramedic staffing and increased service calls, the latter often due to the area’s aging population and drug crisis.

“With that happening and the staffing levels not changing, we can’t keep up with the calls that are coming in,” Casola told The Sault Star.

More ambulances would help, but would hardly ease the pain as SAH staff shortages, “for whatever reason,” pose a “crisis” if the city’s primary health-care facility is unable to accept patients, Casola said.

For example, a patient in emergency could be admitted to an SAH floor not ready to accept the individual.

“We then have to stand there and wait for them to sanitize that room and sterilize that room and clean that room before we can just transfer our patient (to the room),” Casola said. “By this happening, it puts the community at risk.”

A commander’s decision to “upstaff” when volume is high and all ambulances are busy, whether offloading or on call, is no quick fix, Casola said, as paramedics are often reluctant to come in on their four days off to deal with call volume “because of their own mental well-being” and need for rest.

Casola also pointed to the challenges of covering such a large geographic space, which contains many backroads and inroad lakes.

“When you utilize one vehicle, either direction, especially north, (paramedics) are gone for a while,” she said.

Help may come after Dec. 31, when local paramedics begin operating under the District of Sault Ste. Marie Social Services Administration Board. Casola said she understands there is talk of establishing a base in the city’s west end and as well as north in Goulais River with one paramedic — a staffing situation the union questions and plans to address.

Meanwhile, Gamble said her family has made no formal complaints — nor plans to at this point. She mostly brands medical personnel shortages, especially given the fact her aunt’s spill happened a stone’s throw away from the ambulance dispatch centre at 65 Old Garden River Rd.

“It’s just going to fall on deaf ears anyway,” she said about her decision not to make any formal grievance.

“I think there’s an awful lot of greed.”

Gamble’s aunt, who did not wish to be identified, is still recovering. She gets around and remains active, “sidelined a bit now” with a walker.

“She’s a trooper,” Gamble said. “That little lady is amazing. She’s like 80 pounds soaking wet.”

jougler@postmedia.com

On Twitter: @JeffreyOugler