As of Ontario As the health-care crisis intensified, the province was asked to double down on a policy enacted more than a decade ago to reduce how long ambulances are stuck in emergency rooms.
In 2008, the then-Liberal government began hiring nurses to help Ontario hospitals unload ambulances and get paramedics back faster.
That person — a dedicated offload nurse — was specifically tasked with receiving low-acuity patients from paramedics and getting the ambulance back on the road.
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It’s a program that Daryl Wilton, president of the Ontario Paramedic Association, said he understood was meant to be temporary.
“We were expecting hospitals in the background to churn through their backlog issues and fix up emergency departments,” he said in an interview with Global News. “And the reality is that it hasn’t happened.”
Documents prepared for Ontario’s health minister in the summer of 2022 show that instead of improving, the situation worsened dramatically in the decade that followed.
According to documents obtained by Global News, the program remains at $16 million per year from 2012 to 2021, with 50 hospitals in 20 municipalities participating.
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But last year, as paramedics grappled with increasing offload times and a shortage of ambulances to respond to 911 calls in some areas, there were calls to increase it.
The three new local governments, which are responsible for operating ambulance services, called for funding for a dedicated offload nurse in the year 2022 to 2023. According to the 2022 budget document, the three new municipalities requesting the money were Sault Ste. Marie, Muskoka and Guelph.
Wilton said Offload Nurses was a “pilot program” when it launched in 2008.
A briefing prepared for Health Minister Sylvia Jones in June 2022 said “demand … for funding continues to increase.”
The document, including huge cuts, was part of a list of decisions Jones “can’t wait to make” when he becomes health minister. Copies were obtained through a Freedom of Information request.
The note asked the minister to sign off on funding for dedicated offload nurses in the year 2022-23. At the Municipalities Federation of Ontario conference, Jones announced that $23 million in funding would flow in for the offload program.
“To help ease the strain on the ambulance system, we are increasing annual funding and increasing eligibility for the Dedicated Offload Nursing Program so more health care professionals can assist in unloading ambulance patients in emergency departments and paramedics respond to their next emergency call as quickly as possible.” Jones said in a prepared speech for the convention.
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The briefing said that – when written around June 2022 – ambulance offload times were “extremely high” in many parts of the province, “expanding rapidly as continued COVID-19 growth increases as ED patient volumes increase.” and health human resources (HHR) shortages.
A series of policies designed to reduce offload times in 2021 and 2022 helped little, but the briefing said “some sites are increasing (offload) for the first time and others continue to struggle due to local factors”. “
In August, for example, the head of Hamilton’s paramedic service said his staff were facing record delays.
“They have probably gone up about 15 or 20 percent. — those are numbers that are very high,” Michael Sanderson said at the time.
At that time, in the middle of the year, he said that about 200 codes were declared void in the city.
The Ministry of Health announced some paramedic changes during the summer.
For example, in an effort to reduce offload times and delays, the province began allowing more paramedics on every call to avoid having to transport patients to the emergency room.
The first phase of the Paramedic Pilot Project was launched in 2020 with programs in more than 40 municipalities that allow paramedics to transport patients somewhere other than the emergency room, such as a mental health facility, or their on-scene Treatment.
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Despite several initiatives, wait times in places continue to grow.
“It’s not ideal — however, we’re really left with no other options,” Wilton said of the paramedic offload nurse program.
“Paramedic services in major municipalities across Ontario are struggling to meet the needs of our patients and communities when they call 911,” he continued.
A spokesperson for the Ontario Hospitals Association said a “‘Team Ontario’ approach was necessary to address the complex, underlying issues facing the health care system and ensure patients receive the right type of care in the right setting.” Are. “
The delay is so severe in Toronto that the issue was raised when Mayor John Tory spoke to Ontario Premier Doug Ford in October 2022 following his victory in the city’s municipal election.
An email from Tory’s chief of staff – obtained by Global News through a separate Freedom of Information request – listed six items expected to be discussed between Tory and Ford.
A brief line in the email says, “I have a note from Chief Raftis, but please check if there’s an update,” referencing paramedic wait times.
A Tory spokesman said that during the meeting they raised the issue of delays in offloads and transfers.
“The mayor reported the experience of waiting hours for multiple ambulances and paramedics to transfer/unload patients, meaning paramedics and ambulances were unavailable for other calls,” the spokesperson said.
“They discussed how the province can help ensure ambulances are on the road and available and that hospitals are not delayed.”
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A prepared note for Jones said some hospitals reportedly recorded delays in unloading patients from ambulances of more than 200 minutes, six times the benchmark time of 30 minutes.
“The rise (offload time) has led to a number of code zero incidents, with no ambulances available for a limited period of time, leading to reduced service levels in some communities with little concern and public criticism,” it reads.
Wilton said that, until hospitals are able to process patients more quickly, innovative policies will only mask the problem — not solve it.
“They are overwhelmed – they have too many patients for the amount of staff and beds available to treat and how do we get our units back into the communities?”
– With files from Global News’ Don Mitchell and The Canadian Press