When people in Hamilton frantically dial 911, increasingly, no ambulance crews are free to respond.

Dozens of times already this year, the Hamilton Paramedic Service has registered "code zero" incidents, where there is only one — or zero — ambulances across the service's entire fleet available for a call.

Just eight months into the year, there have already been more code zero incidents in Hamilton than all of last year — and that number is getting worse instead of better, says Mario Posteraro, president of Ontario Public Service Employees Union Local 256, which represents Hamilton paramedics.

"We're almost at the implosion point," Posteraro said. "I don't mean to sound melodramatic, but patients will literally die."

City statistics show that up to July 27, Hamilton had 71 code zero incidents, 11 more than all of last year.

That number doesn't include two possible code zeroes from Monday, which haven't yet been fully validated by Hamilton paramedics.

If we don't properly fund the Hamilton Paramedic Service, we're going to be a third-rate, banana republic ambulance service. - Mario Posteraro, president of Ontario Public Service Employees Union Local 256

The situation is really taking a toll on EMS workers, Posteraro says, who are extending shifts and missing meal breaks just to make sure ambulances are on the roads.

"The pace is almost unacceptable. It's a blistering pace," he said.

When there are no local ambulances available, crews are brought in from other cities. In recent weeks, paramedics from Niagara, Halton and Brantford have all been working in Hamilton at the city's expense, Posteraro said.

"We can't rely on neighbouring services to bail us out," he said.

A resurgent problem

Code zero incidents were even more common a few years ago. In 2013, there were 242 code zeroes in Hamilton. That number dropped down to 44 in 2015, but it has been creeping back up ever since.

"Any time we have a code zero event, it's a concern," said paramedic service deputy chief Russell Crocker. "However, it is still lower than those four years [from 2011 through 2014]."

So what's causing the problem? According to paramedics, it's a surge in call volumes for help, and problems with increasingly long wait times offloading patients in local hospitals.

The president of Ontario Public Service Employees Union Local 256 says that the city needs more paramedics. (Samantha Craggs/CBC)

According to the paramedic service's annual report for 2016, there was a seven per cent demand increase in 911 calls in Hamilton last year, coupled with a cumulative increase of 35 per cent over the past seven years.

"This rate of service demand increase is higher than community population growth can explain and must be attributed to an increasingly aging population, socio-economic factors, and an increasing reliance on care in the community or home for patients with complex health care histories or issues," wrote paramedic service chief Michael Sanderson said in the report.

It also says that while seniors represent about 16 per cent of the city's population, they accounted for 45 per cent of the demand on ambulance workers last year.

Census data shows that the fastest-growing population segment that EMS workers serve is people over the age of 65. Provincial projections estimate that 25 per cent of the province's population will be in this category by the year 2021.

Hamilton Health Sciences and St. Joseph's Healthcare Hamilton both need to cut millions from their budgets by the end of the fiscal year in March. (Cory Ruf/CBC)

Hamilton has a higher than average percentage of population aged 65 and older, according to the latest census data. The region also has a higher number of people over the age of 50 than the rest of the province — 38 per cent of Ontario's population is over 50-years-old, while 41 per cent of the Hamilton LHIN (which includes Niagara, Haldimand and Brant) is over 50.

"Those demographics point to an increase in call volume," Posteraro said.

Offloading times a problem as cuts loom

Then there are offloading times at hospitals, which the city says directly influence code zeroes.

"In particular, having numerous hospital offload delays longer than two hours has been shown to be correlated with Code Zero events," city spokesperson Aisling Higgins wrote in an email.

The paramedic service report says the provincial recommendation is that 90 per cent of patients are offloaded from an ambulance within 30 minutes at a hospital. The provincial average last December was 46 minutes.

Offloading times for ambulances at Hamilton hospitals are above the provincial average. (Samantha Craggs/CBC)

In Hamilton, it took a lot longer. In December of 2016, it took 107 minutes for patients to be offloaded at Hamilton General, 112 minutes at Juravinski, at 91 minutes at St. Joe's.

Hospitals largely attribute these delays to overcrowding. As an example, on July 25 of this year, Hamilton Health Sciences was operating at 109.9 per cent occupancy, and occupancy has been, on average, over 105 per cent since October 2016.

While hospitals are slammed, funds are scarce. Hamilton Health Sciences says it needs to cut $20 million from its budget by the end of March, while St. Joseph's Healthcare needs to cut $7 million.

"We just can't do any more unless we get more frontline ambulances, and hospitals get their acts together and open more beds," Posteraro said.

"If we don't properly fund the Hamilton Paramedic Service, we're going to be a third-rate, banana republic ambulance service."

adam.carter@cbc.ca