Hospital drop-off delays of up to four hours hinder paramedics at Ajax, Bowmanville and Oshawa

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Published January 31, 2023 at 4:08 pm

Region of Durham Paramedic Services have reported substantial delays and expenses due to long waits in dropping off patients at hospitals. Via CUPE

Paramedics across Durham Region have reported a steep rise in patient drop-off delays at area hospitals peaking at more than four hours in October.

In a recent Regional Health and Social Services meeting, Chief Troy Cheseboro told the committee of the rising amount of time paramedics spend at hospitals waiting to drop off patients.

Overall, the Region of Durham Paramedic Services (RDPS) operates 31 ambulances out of 11 response stations with a 12th station set to open in Seaton in Pickering next fall.

These ambulances responded to nearly 95,500 priority calls (Code 1 to 4) and nearly 47,000 stand-by or (Code 8) calls over the last year. Codes 1 and 2 represent lower-priority calls that can be delayed, while Codes 3 and 4 represent Urgent and Life-Threatening calls respectively, requiring an immediate response.

This call volume is expected to rise over the coming years as the Region’s population grows to an expected 1.3 million people by 2051. Currently, Durham is home to some 673,000 people. Additionally, as the population grows, it is also aging on average and as a result requires more medical attention.

This increasing demand is already demonstrable over the last few years. Per Cheseboro’s report, paramedics responded to nearly nine per cent more calls in 2022 than the year before, part of a steady rise since 2018.

The jump is also apparent, though less dramatic, in terms of transporting patients to hospitals. Durham Paramedics moved 51,718 people to emergency rooms in the region through 2022, a two per cent increase from 2021. This rate is also consistently on the rise since 2018, besides a significant drop in 2020 due to the COVID-19 pandemic.

As transports have risen, so too has the time it takes for patients to be admitted to the hospital. Paramedics have to wait with the patient until the hospital fully takes over their treatment.

The Ontario Government hold that it should take 30 minutes from the ambulance’s arrival until the hospital takes full responsibility for the patient. This 30 minute window is deemed a “reasonable” wait.

That would be great if possible, according to Cheseboro. “To be quite honest, I would love 30 minutes,” he told the committee, “I’d love an hour to be honest, but the reality is that’s been one of our biggest challenges.”

Throughout 2022, paramedics in Durham spent between 1,718 and 3,629 hours waiting at the hospital to offload a patient every month. The lowest was February, while the highest was in October. The overall monthly average hours spent waiting was 2,630.

Cheseboro called these numbers “huge.”

He also found that 90 per cent of the time patients were offloaded in between 121 minutes (1.5 hours) and 249 minutes (4.1 hours). Again the lowest time was February and the highest was October. Overall monthly average last year was a 179.1 minute (2.9 hour) wait.

“You’re looking at almost three hours that an ambulance is sitting at a hospital,” Cheseboro said, “so that has a huge impact on your response capabilities.” This is why, Cheseboro said, the Region has ended up with no ambulances to respond to emergencies, a situation called a ‘Code Zero.’

“This has a huge impact on the operational fleet and our ability to respond to emergency calls when we’re stuck in hospitals managing patients that are essentially, in our opinion, the responsibility of the hospital,” Cheseboro said.

Furthermore Cheseboro noted that the offload wait times have risen sharply in 2022 compared to the year before. Overall, in 2021 paramedics spent an average of 906.6 hours every month to offload a patient. This wait ballooned nearly 190 per cent to 2,630 hours in 2022.

Last year began with “reasonable” wait times of around 45 minutes. However, these waits grew starting in July until the had reached 144 minutes (2.4 hours) by December. “I think, to be quite honest, the 30 minute mark set by the province is a little outdated now,” Cheseboro said.

Next Cheseboro turned to the “depressing part,” the cost to offload patients. The ever-growing wait to offload patients has also caused an ever-growing bill to Durham Region.

Per Cheseboro’s accounting of all expenses for operating each vehicle (including wear and tear, fuel, staffing, equipment and more) off-load delays cost the Region nearly $8.3 million in 2022. More than $3 million of that cost went to the paramedics’ salary. “It’s a significant number and it’s dramatically impacting our operations,” Cheseboro noted.

However, RDPS is working with the Region, the Province and hospital partners to mitigate the offload delays as best they can. They are looking to York Region hospitals which according to Cheseboro has similar call volume, but much lower offload wait times.

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