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

By Liam McConnell

Published January 31, 2023 at 4:08 p.m

Durham area emergency services have reported significant delays and costs due to long waits dropping patients off at hospitals. About CUPE

Paramedics across the Durham area have reported a sharp rise in delays in patient drop-offs at area hospitals, which peaked at more than four hours in October.

At a recent Regional Health and Human Services meeting, Chief Troy Cheseboro told the committee about the increasing amount of time paramedics are spending in hospitals waiting to drop off patients.

In total, the Region of Durham Paramedic Services (RDPS) operates 31 ambulances from 11 service stations, with a 12th station due to open at Seaton in Pickering next fall.

These ambulances have answered almost 95,500 emergency calls (code 1 to 4) and almost 47,000 emergency calls (code 8) in the last year. Codes 1 and 2 represent lower priority calls that may be delayed, while codes 3 and 4 represent urgent or life-threatening calls that require an immediate response.

This call volume is expected to grow in the coming years as the region’s population is expected to grow to 1.3 million people by 2051. About 673,000 people currently live in Durham. As the population grows, it also ages on average and therefore requires more medical care.

This increasing demand has already been demonstrated in recent years. According to Cheseboro’s report, paramedics responded to nearly nine percent more calls in 2022 than the year before, part of a steady increase since 2018.

The jump is also significant, albeit less dramatic, in terms of transporting patients to hospitals. Durham Paramedics transferred 51,718 people to emergency rooms in the area through 2022, a two percent increase from 2021. That rate has also been steadily increasing since 2018, save for a significant drop in 2020 due to the COVID-19 pandemic.

With the increase in transport, the time it takes for patients to be admitted to the hospital has also increased. Paramedics must wait with the patient until the hospital fully takes over their treatment.

The Ontario government believes it should be 30 minutes after the ambulance arrives for the hospital to assume full responsibility for the patient. This 30 minute window is considered a “reasonable” wait time.

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

In 2022, paramedics in Durham spent between 1,718 and 3,629 hours in hospital each month to discharge a patient. The lowest was in February, the highest in October. The average monthly wait time was 2,630 hours.

Cheseboro called those numbers “huge.”

He also found that 90 percent of patients were offload between 121 minutes (1.5 hours) and 249 minutes (4.1 hours). Again, the lowest time was February and the highest was October. The overall monthly average over the last year was 179.1 minutes (2.9 hours) of wait time.

“You see an ambulance sitting in a hospital for almost three hours,” Cheseboro said, “that has a tremendous impact on your ability to react.” Because of this, Cheseboro said, the region no longer has ambulances to respond to emergencies, a situation dubbed “code zero.”

“This is having a tremendous impact on the operational fleet and our ability to respond to emergency calls when we are stuck at hospitals treating patients that we believe are essentially the hospital’s responsibility,” Cheseboro said.

Additionally, Cheseboro found that offload wait times increased sharply in 2022 compared to the previous year. Overall, in 2021, paramedics spent an average of 906.6 hours each month extricating a patient. That wait increased by almost 190 percent to 2,630 hours in 2022.

Last year began with “reasonable” waiting times of around 45 minutes. However, these wait times increased from July until they reached 144 minutes (2.4 hours) in December. “I think, to be perfectly honest, the provincial 30-minute mark is a little outdated now,” Cheseboro said.

Next, Cheseboro turned to the “depressing part,” the cost of offloading patients. The ever increasing wait for patients to be discharged has also created an ever increasing bill for the Durham area.

According to Cheseboro’s accounting of all expenses to operate each vehicle (including wear and tear, fuel, personnel, equipment and more), unloading delays cost the region nearly $8.3 million in 2022. More than $3 million of that cost went towards paramedic salaries. “That’s a significant number and is having a dramatic impact on our operations,” Cheseboro noted.

However, RDPS is working with the region, province and hospital partners to mitigate the unloading delays as much as possible. They’re looking for hospitals in the York area, which Cheseboro says have similar call volumes but much lower wait times for discharge.

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