Ottawa paramedics spending 'exceptional amount of time' waiting in ERs, miss response time targets

The Ottawa Paramedic Service missed response time targets for life-threatening and heart attack calls last year, in part due to paramedics spending "an exceptional amount of time" waiting to offload patients in hospital emergency rooms, according to a new report.

The Ottawa Paramedic Service 2023 annual report shows paramedics spent over 100,000 hours waiting to offload patients in Ottawa hospital emergency rooms last year and there were 1,672 times when there were no paramedics available to respond to calls within the city of Ottawa.

"In 2023, the Ottawa Paramedic Service continued to experience challenges affecting overall service delivery to the community including increased response volume, increased hospital offload delayed, and occurrences of level zero events, all of which pose a risk to public health and safety," says the report for the emergency and protective services committee.

"As such, in 2023, the Ottawa Paramedic Service experienced difficulty achieving legislated response time performance standards and Council-approved targets."

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Paramedics responded to 193,127 calls for service in 2023, up 4.9 per cent from 2023. There were 184,113 calls for service in 2022, 149,344 calls in 2021 and 132,631 calls in 2020.

The statistics show paramedics responded to life-threatening calls within the target time of eight minutes only 68 per cent of the time in 2023, and responded to urgent calls within the target time of 10 minutes 68.8 per cent of the time.

"This can be attributed to annual increases in overall service demand and the excessive amount of time paramedics continue to spend in offload delay at Ottawa hospitals which depletes the availability of paramedic resources in the community," the report says.

Paramedics responded to sudden cardiac arrest calls within the target time of six minutes 64.8 per cent of the time.

The report says while paramedics missed the target response times for heart attack and life-threatening calls, response times did improve compared to 2022.

"This can be attributed to several strategies the service has implemented and matured over the past three years to mitigate impacts associated with increased response volume and offload delay, and to reduce occurrences of level zero," staff say.

One Ottawa resident tells CTV News Ottawa, he and his wife had a first-hand experience with ambulance delays during a frightening moment.

"In the wee hours of the evening, my wife accidentally took the wrong medication - she took two doses instead of one," said resident Charles Soifer. "It was a poisoning."

He rushed to call 911, who told him there were lengthy delays for ambulances.

"They were like, 'Yeah, we'll get you when we can - expect a wait time of 45 minutes to an hour,' and then we call Telehealth and they're like, 'No, you need to get to the hospital right now,'" he said. "The system has been broken here for so long, but now we're seeing the real side effects of it."

They ended up taking an Uber to the hospital.

"No answer now could be good enough to tell me why my wife, who was potentially facing a fatal incident, was bumped so far down the list that we had to wait an hour, which could have been way longer than she had."

Offload delays in ERs

The Ottawa Paramedic Service spent 102,105 hours in offload delay at Ottawa hospitals last year, up 8.6 per cent compared to 2022.

"This represents an average of over 559 hours of paramedic time that were lost per day in 2023 or the equivalent of 47 staff per day," says the report.

The target for transfer of care is within 30 minutes, 90 per cent of the time at hospital emergency rooms.

The report shows the average length of time paramedics waited to transfer care in ERs in 2023, 90 per cent of the time:

• Ottawa Hospital General Campus: 158.08 minutes (162.72 minutes in 2022)
• Ottawa Hospital Civic Campus: 142.2 minutes (136 minutes in 2022)
• Montfort Hospital: 234 minutes (224.18 minutes in 2022)
• Queensway-Carleton Hospital: 171.81 minutes (167.84 minutes in 2022)
• CHEO: 39.46 minutes (39.10 minutes in 2022)

Staff say the offload delay is a "complex, chronic, and systemic issue that has created challenges" for years, with root causes linked to patient volume, bed availability, surgical backlogs and staffing pressures.

There were 1,672 times where Ottawa Paramedics declared a 'level zero' event in 2023, when no ambulances are available to transfer a patient to hospital. The report shows paramedics spent 52,995 minutes in 'level zero' in 2023, compared to 73,060 in 2022 and 24,310 in 2021.

"Even one occurrence of level zero can put patients at risk of poorer health outcomes," the report says. "Level zero combined with excessive offload delays is a risk to public health and public safety, and the impact on community and staff of the Ottawa Paramedic Service is substantial."

The report does note there were fewer 'level zero' events in 2023 compared to 2022, when there were 1,806 'level zero' events.  Paramedics reported 719 'level zero' events in 2021 and 435 in 2020.

Ottawa paramedics continue to oversee a 'Dedicated Offload Nurse Program' that allows paramedics to transfer patient care to a dedicated offload nurse in the ER, allowing crews to return to service. In 2022, paramedics launched a pilot program that places a primary care paramedic in the Montfort Hospital's ER to reduce offload delays.

Council approved a plan to hire 17 new paramedics in 2024, 2025 and 2026, subject to confirmation of provincial and/or hospital funding, to help mitigate offload pressures in hospital emergency rooms. The report says the Ministry of Health has not responded to a request from the Ottawa Hospital for $4.5 million to cover costs to staff beds at Ottawa hospitals.

"Resolving the offload delay issue in hospital emergency departments is critical to eliminating level zero events and improving service delivery, response times and patient outcomes," the report says. "While the province and local hospitals are responsible for developing mitigation strategies to reduce offload delay, the Ottawa Paramedic Service continues to seek additional ways to improve the Dedicated Offload Nurse Program and maximize the availability of paramedics in the community."

A spokesperson for Health Minister Sylvia Jones tells CTV News Ottawa the ministry has invested $51 million over three years to the Dedicated Offload Nursing Program across the province..

"Last year (22/23), Ottawa’s DONP funding was topped up to $2.6 million and their funding increased, receiving $2.84 million for 23/24. This, combined with the $53 million our government has provided Ottawa in funding for their Land Ambulance Services Grant, has increased ambulance availability by over 30,000 hours in 2022-23," the spokesperson said.

"As municipalities across the province know, the Land Ambulance Services Grant is based on 50/50 cost sharing with the province. Should the City of Ottawa want to increase their budget, the province will be there to match that request, as is the case with every other municipality.”

Council approved hiring 23 new paramedics in 2023 and 2024 to address the growing demand for service. The plan calls on the city to hire 69 new paramedics by 2026.

The emergency preparedness and protective services committee will discuss the Ottawa Paramedic Service annual report on June 17.

--With files from CTV News Ottawa Sam Houpt