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Offload delays, no downtime and other problems are stressing out metro St. John’s paramedics

Ambulances park outside the Emergency Entrance at the Health Sciences Complex in St. John's.
Ambulances park outside the Emergency Entrance at the Health Sciences Complex in St. John's. - SaltWire File Photo
ST. JOHN'S, N.L. —

Offload delays in which paramedics are left waiting in hospital corridors to hand over their patients to staff have ballooned from minutes to hours in just a few years at overcrowded St. John’s emergency rooms.

“When I started here, we were into offload delays to 15 minutes,” said Michelle Breen, Eastern Health's regional director of paramedicine and medical transport.

“And two and a half years later we are seeing ourselves anywhere from an hour sometimes to two or three hours.”

“We don’t cause it, but we become victims of it. … But if you go across the country, it’s almost like a pandemic wave.”

No one has hit on a solution for the problem plaguing the Health Sciences Centre and St. Clare’s hospital, said Breen, who insists other jurisdictions in Canada have it worse.

Michelle Breen is the regional director of paramedicine and medical transport for Eastern Health.
Michelle Breen is the regional director of paramedicine and medical transport for Eastern Health.

But to try to combat it, Breen said Eastern Health has had paramedic teams buddy up on low-acuity (least sick/at-risk patients) — one paramedic team can wait with three of those patients while the other ambulances get back on the road.

Casuals can also be called in to free up ambulances, and routine transfers can be delayed.

Data from computer-assisted dispatch should also pinpoint trends of when paramedic resources are maxed out because of offload delays and other demands, Breen said.

Source of delays

But according to paramedics who work in the system — expressed in an anonymous letter — the delays can be related to staffing issues, and patients being transferred to a floor, but also because of non-emergency calls for ambulance services.

“There is a myth that if you call an ambulance, you'll get seen quicker at the emergency department,” said the letter.

Trying to jump the ER queue, however, doesn’t work because ambulance patients are triaged for the severity of their condition when they arrive, with those in life-threatening situations given priority.

Jerry Earle, president of the Newfoundland and Labrador Association of Public and Private Employees (NAPE), said shifting demographics to a more aged population and people’s reliance on ERs for lack of a family doctor may also be contributing to the problem. 

But he said a resolution to offload delays needs to be a priority for Eastern Health.

“If they are seeing it escalating and we know it’s escalating, No. 1, figure it out and you have to work collaboratively. … Talk to the frontline paramedics. Talk to the nurses and doctors in emergency. Talk to the people in their union. … Even if it's a matter of everyone getting in a room for an hour, or days or weeks, we must figure that one out.”

Earle said having paramedics standing around monitoring a low-acuity patient is not what their expertise is for. 

“If that’s the case, someone has a low acuity, could we look at a different classification who could actually be there in the hospital corridor, and release the paramedics altogether? Absolutely,” Earle said.

Ongoing issues

Another solution being considered by Eastern Health — going to the private sector for patient transfers after discharge that require a stretcher — is oversimplified, as there is a risk of even a routine case escalating, the NAPE leader said. 

Many other concerns raised in the letter are longstanding and will continue to be pushed, Earle said. 

NAPE President Jerry Earle. - SaltWire File Photo
NAPE President Jerry Earle. - SaltWire File Photo

“Some of the issues that are captured in that letter are things that NAPE, myself, frontline paramedics have been saying for a very long time. I can go back 20-plus years,” Earle said. 

"These are gravely concerning issues. … Nobody can convince me we can’t do better than this.”

Earle said the union met with the employer — Eastern Health — in late September to address a number of concerns paramedics have, and there were meetings with paramedics beforehand.

In fairness, he said there is an attempt by the employer to address some issues, but others Eastern Health has consistently failed to deal with.

Earle said paramedics should be thought of the same as fire stations — which have firefighters on shift with the hope there’s never a fire — rather than insisting they need to be constantly on calls to justify their numbers.

“Resources — that is something they have to look at. Some people say we can’t have paramedics in an ambulance if they are not busy. Well, you need to have these services in place in the event you need them. … If we had ambulances there and we didn't need them, that would be a good thing."

Timely ambulance access is not just a concern in the metro St. John’s area, he said.

“If somebody in Newfoundland and Labrador picks up the phone because their child is ill, their partner is having a medical event, you are on the scene of a motor vehicle accident, you should not learn at that time there was nobody to respond immediately,” Earle said.

Calling in casuals to pitch in when the metro paramedic system is stretched is not a proper redress, as it might take hours, depending on where the casual is located and how much time they need to get ready, he said.

Little downtime

A major problem is paramedics not getting downtime between calls — many of which can be traumatic for them to decompress from, he said. 

The letter notes paramedics’ mental health, as well as their physical health, is being drained, and the coverage area is too large for the existing resources — from Witless Bay/Bay Bulls to Pouch Cove and all the areas in between. 

“If somebody in Newfoundland and Labrador picks up the phone because their child is ill, their partner is having a medical event, you are on the scene of a motor vehicle accident, you should not learn at that time there was nobody to respond immediately." Jerry Earle
“If somebody in Newfoundland and Labrador picks up the phone because their child is ill, their partner is having a medical event, you are on the scene of a motor vehicle accident, you should not learn at that time there was nobody to respond immediately." Jerry Earle

“Eastern Health paramedics are not being heard by management or the director of paramedicine and medical transport,” the letter said. “Despite numerous concerns being voiced by the medics to their superiors, regarding high stress, lack of downtime between serious calls to debrief, fatigue/exhaustion, workplace morale, quality patient care, mental health, lack of resources, repeated offload delays at both adult hospitals and red alerts, unfortunately there has been very little resolution.”

They blame lack of downtime on a new system of mobile posts which has them sitting in their vehicles rather than returning to ambulance bases at the Health Sciences Centre, Major’s Path and Mount Pearl to clear their heads and get away from the radio chatter.

“The way they work today, the time rarely exists for them to step away from their work for maybe just 10 minutes to gather themselves,” Earle said.

Concerns heard

Breen said managers at Eastern Health have an open-door policy, and paramedics’ representatives and the union have a voice on a committee to raise their concerns.

She also said shifts have been tweaked to match peak volume times, and readjusted since then to allow paramedics to restock their vehicles and file their paperwork at the end of their 12-hour rotation, based on some of the concerns that have been raised.

She said data drives the decisions that are made, but change is not always fast enough for those who bring up concerns.

“Honestly, I think the biggest part of the frustrations sometimes is how long it takes to make a change,” Breen said.

“We don’t just turn on a dime. We’re a big ship, so it takes a little bit.”

Part of the new system supply plan allows units to be deployed as 911 calls come in, while other ambulances are moved into priority areas for better response time.

Ambulances are positioned at those mobile posts to better access communities during rush-hour times, so paramedics are not delayed getting to calls in places like Paradise, which can bottlenecked at certain times of the day. 

“Initially we said out you go, off you go, and then the staff came back and said, you know what, we’re not getting a lot of downtime. Fair enough, I get it,” she said of the readjustments to address the feedback.

Breen said the paramedic call volume hasn’t changed this year from last year, other than the usual two to 2.5 per cent increase a year that is standard. 

Concerns in the letter about ambulances not being restocked or cleaned were not verified by either Breen or the union, as not restocking crucial supplies or cleaning up contamination would be a breach of protocol.

“There’s no medic out there that I am aware of who would be forced or agree to go on a call that's missing a piece of equipment. In 30 years of working, I have never seen or heard tell of that,” Breen said.

Twitter: @BarbSweetTweets


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