Every day in Ottawa — sometimes multiple times a day — there are no ambulances to respond to an emergency, a situation that's occurring more frequently and suggests the city's paramedic service is under too much pressure.

"It is happening daily," confirmed ​Anthony Di Monte, the city's manager of emergency and protective services.

"Having it multiple times a day is absolutely an indicator of a system under pressure. And demand is outweighing our capacity."

The Ottawa Paramedic Service routinely experiences what's called "level zero," a state in which there are no available ambulances to dispatch. And according to Di Monte, the last time the situation was this critical was 12 years ago.

'Level zero' occurred 22 times over 2-week period

Even if the paramedic service is fully staffed during a shift, it can run out of ambulances when there's a sudden surge of emergency calls — for example, during bad weather.

But the frequency with which paramedics run out of ambulances has been increasing. The dispatch centre recently had to send out level zero alerts to all Ottawa hospitals 22 times over a two-week period.

Darryl Wilton is the president of the Professional Paramedic Association of Ottawa (Submitted)

"An alarm goes off when it happens. And it should be alarming," said Darryl Wilton, president of the Professional Paramedic Association of Ottawa.

A level zero alert "puts every paramedic on edge," Wilton added.

"There are people out there who have dialled 911 with life-threatening emergencies who have no access to medical care," he said.

For life-threatening emergency calls, paramedics are sent in emergency sedans called rapid response units, in addition to the next available ambulance. And in the case of "cardiac arrests, other emergency partners (such as the Ottawa Police Service and Ottawa Fire Services) may also be tiered to respond to the call," the city said in a statement.

'It needs to stop'

But neighbouring municipalities say they've also been forced to pick up the slack when Ottawa has no free ambulances.

"It needs to stop," said Mike Nolan, chief of the County of Renfrew Paramedic Service. "Frankly, it's disheartening to paramedics, but it's dangerous to the public."

The alerts can last more than an hour, meaning paramedics from outside the city have to travel long distances into Ottawa to help.

Nolan said his staff sometimes spends up to six hours — more than half a typical shift — responding to calls in the capital.

Mike Nolan is the chief of the County of Renfrew Paramedic Service. (Ashley Burke/CBC)

'Broken' system

The fact that Ottawa routinely runs out of ambulances is the latest revelation in a growing dispute between the city's paramedic service and paramedic services in neighbouring municipalities.

Counties outside of Ottawa have becoming increasingly frustrated by the growing numbers of calls they answer in the city. For instance, Prescott-Russell recently filed a complaint with the province about a specific night last August when Ottawa called their paramedics for help 13 times.

That led to a damning report suggesting the Ottawa Paramedic Service has systemic problems.

Due to changes in provincial policy, adjacent municipalities are no longer reimbursed for attending to Ottawa's emergency calls. The counties are unhappy that the city is now refusing to pay for those services, an issue that Di Monte says is at the heart of the discord between the two sides.

Matt Rouselle is a paramedic in Arnprior with the County of Renfrew Paramedic Service. (Ashley Burke/CBC News)

Renfrew paramedic Matt Rouselle said he believes Ottawa's system is "broken."

Rouselle told CBC News he became a paramedic to keep his two children, aging parents and community safe. Now, he said, he finds he's spending more and more time away from his home.

"I grew up in Arnprior, my family still lives here," said Rouselle. "I'm frustrated with the amount [of time] we are spending in Ottawa right now. It just seems it's so one-sided."

Calls to help out in Ottawa emergencies growing

Paramedics from all jurisdictions are quick to say that they're happy to help in an emergency. And Ontario regulations require whichever paramedic is closest and available to respond to emergency calls. Because rural paramedics are sometimes dropping off patients at Ottawa hospitals, they may find themselves the closest first responders when a 911 call comes in.

But they also feel that the types of calls they must respond to are too broad. Nolan says his paramedics are often responding to potentially minor troubles like dizziness and broken bones.

We overuse this 'good neighbours' relationship. That shouldn't be. I have to admit it. I feel really bad about this, because it is true. - Coun. Eli El-Chantiry

This fall, five municipalities adjacent to Ottawa sent a letter to the premier asking for help with the volume of emergency calls into the city.

According to that letter, calls from Ottawa to neighbouring rural paramedic services increased by 60 percent in June 2016 compared to June 2015.

Prescott-Russell saw service calls from Ottawa shoot up 105 per cent, while neighbouring Lanark County has seen an 88-per-cent spike.

"Honestly, I'm not going to sit here and defend it," said Coun. Eli EI-Chantiry, who represents Ottawa on the Rural Ontario Municipal Association.

"We overuse this 'good neighbours' relationship," said El-Chantiry. "That shouldn't be. I have to admit it. I feel really bad about this, because it is true."

City resources not keeping pace with demand

Response volumes for calls in Ottawa have increased almost 24 per cent over the past five years, according to the most recent annual report. And resources haven't been added to keep pace, said El-Chantiry.

"God forbid, I don't want somebody anywhere — whether in the city or a neighbouring municipality — to lose their life or their loved one just because we couldn't provide an ambulance," El-Chantiry said.

Ottawa paramedic chief Anthony Di Monte says the plan to hire new paramedics and buy new vehicles is a sign the city is playing "catch up" — but it will help. (CBC)

The city's budget, approved last week, includes money to hire 24 new paramedics and buy five emergency response vehicles. Another 12 staff members were also hired earlier this year,

However, according to the paramedic association, while the new resources might have been enough to address demand levels two years ago, they may fall short if the number of calls continue to increase in 2017.

"We're playing catch up, without a doubt," said Di Monte, adding that the additional resources will still help.

The paramedic service is also hoping to get 14 more paramedics and two ambulances in 2018, Di Monte said, although that plan still has to be approved by Ottawa city council and the number could go up or down.

"I think we're taking the issue head on," said Di Monte. "We're attacking the problem."