AHS - EMS Wait Times

[you&me]

Originally Posted by 81MC

Friends 1 year old had a seizure out of the blue while at a restaurant. Child went blue, parent thought kid was legit dead. Ambulance took 45 minutes. That’s a god dammed eternity.

That's terrible. I hope I'm never in a situation like that, but I don't think I'd be sitting around for 45 minutes...

This whole thread is pretty terrifying, especially for anyone with children or elderly parents.

[photon]

Originally Posted by btimbit

There's a few, yeah

I asked the mods if that really good/big post on EMS is archived and can be retrieved, or if it's just deleted. I bookmarked it but it's a dead link now

It should still be archived, what's the link and I'll copy/paste it if it's a post.

[btimbit]

Originally Posted by photon

It should still be archived, what's the link and I'll copy/paste it if it's a post.

https://forum.calgarypuck.com/showpo...postcount=9778

[photon]

Here's the post:

Originally Posted by Yasa

Sure. Still on mobile, so bear with me with the formating and probable spelling mistakes.

I'll try to break this down into a few points of where EMS is being stretched, with a bit of context for each.

I've been doing this job for almost 10 years now in 2 different zones. Please know that these are just my experiences and opinions. It's entirely anecdotal and could very well be wrong in some instances. I'm happy to be corrected or more informed if others have more input.

1) Dispatch
2) Resource availability and staffing
3) Increased call volume
4) Inter-facility Transfers from rural hospitals

Dispatch

Despite popular belief, the consolidation of dispatch has not been a negative change in how we operate. It's been mostly neutral from a front-line perspective. The first few months after the transition were a bit rocky, but that was expected growing pains of new staff and a new system.

Prior to consolidation, dispatch had always worked on a "closest unit available" or "Select and Recommend" system. So regardless of where your base was, if you are the closest unit to a call then you're getting it. One change though, is that IFT and 911 are separate dispatchers, and they don't communicate to each other. I'll go into more detail in point 4.

I had heard a lot of people be concerned with consolidation of dispatch because "Dispatchers don't know the areas." Dispatchers at that time already didn't know many of the areas, and relied on maps and GPS. Red Deer dispatch didn't just dispatch for Red Deer. They also did Eckville, Sylvan, Lacombe, Three Hills, Linden, and Drumheller. SCC did anywhere from Milk River to Sundre or Hanna. You get the idea.

When we had the 7 separate dispatcher centres (SCC, CCC NCC, Calgary, Lethbridge, Red Deer, Wood Buffalo), they followed the same rules. A lot of dispatch centres would also take overflow from other centres. If SCC got too busy, Red Deer would start fielding calls from SCC jurisdiction.

To expand on Select and Recommend; if a rural truck clears from a metro (Calgary or Edmonton) hospital, they're an available unit now regardless of the availability of metro units. If they're 5 seconds closer to a call than an Edmonton truck, they will be dispatched.

We have 6 levels of determination that dispatch assigns to our calls;
Omega (Lowest priority)
Alpha
Bravo
Charlie
Delta
Echo (Highest priority)

Right now there is a rule for Calgary metro that in the last half hour of their shift, they are only to do Delta and Echo level calls. This is to mitigate overtime and alleviate the stress and burden of metro trucks. But what this actually does is every day during shift change (more often now than 2 years ago), rural trucks start getting attached to the Alpha/Bravo/Charlie calls, and pulled away from their towns. Rural trucks don't have the same rule, so a Didsbury truck that is off at 6 pm can get called to Calgary at 530 for an alpha level call an hour away, while a Calgary unit next door off at the same time will sit there. Often times, a rural truck will be attached and the stood-down (cancelled by dispatch) to multiple calls, as new Calgary units sign on, before finally making it to one call. Dispatch has been known to stack calls (not attach units to low priority calls) before, but it's something that should happen more often. I mean, ideally it shouldn't have to happen at all, but these are desperate times.

This leads me to the next point;

Resources and staffing

We simply do not have enough available trucks in our metro areas to accommodate demand. Our rural areas are theoretically well staffed, though could use some reworking. However, with rural units now being pulled in to metro areas, it leaves those towns completely empty.

Our actual staff volume has decreased due to sick book-offs, or attrition, and the flow of incoming staff hasn't been quick enough to accommodate it. This has resulted in trucks being shut down completely in both metro and rural areas, stretching resources thinner and putting an excessive strain on everyone.

Increased call volume

Call volume has gone up everywhere, and I don't particularly know why. Obviously covid has increased the need for people calling 911, but calls of every type are going up. I have an unsubstantiated theory that the last 2 years has increased people's paranoia and decreased their ability to cope which leads people into calling for absolutely everything. We've always been treated as a mobile urgent care by the public, but it has gotten even worse. Bottom line is, if you're able to walk without pain, shortness of breath, or falling over, and you have a ride to the hospital then it is much faster for you (and beneficial for the system) if you go by private vehicle.

Examples of calls that I've had to drive an hour to the city for include: Nose bleed that has stopped bleeding, can't sleep, infant dropped something on their finger, adult cut finger with kitchen knife, 2 week shoulder pain from previous fall. You get the idea.

Better education would be helpful, but it's also a juggling act between having people think before they call 911 but also not making them too afraid to call when they actually need it.

(Note: calling 911 does not get you seen by a doctor faster. We will all wait until a bed is available as if you went to the ER on your own)

But the biggest misuse of rural ambulances comes from my final point;

Inter-facility Transfers from rural hospitals

These are transfers from one hospital to another, typically for tests such as a CT scan, but also for ER consults at a higher level facility, surgical consults, neuro consults, etc.

These are booked by doctors, nurses, and unit clerks. Calgary and Edmonton metro have a separate set of ambulances for these transfers within their cities. Rural does not. It's the rural emergency trucks that have to do these transfers on top of their 911 case load.

Every rural hospital sends at least one transfer out per day, and sometimes books up to 9 in a single day.

Like I said earlier, IFT and 911 don't speak to each other. It's IFT's goal to get the transfers out as quickly as reasonably possible. But without talking to 911, they aren't always aware of our cutoff limits (fewest available ambulances at any given time). They will just dispatch trucks out for the transfers.

There are plenty of valid reasons to use an ambulance for a transfer. Heart attacks, strokes, massive trauma, septic shock, etc. But these are rare for us.

Many of our patients can and should be going by private vehicle, but due to doctors either being ignorant of the system, being lazy, not caring, or just for liability purposes, they will often be sent by ambulance. I'm talking about patients that have no medical attachments, with no treatments during transport, that can walk. There are many times that family members will straight up request an ambulance because they don't want to transport their loved one, but they'll happily follow behind us in their car to the destination. In these cases we are an expensive hospital-to-hospital taxi.

Just like emerge calls, transfers are also coded as alpha, bravo, charlie, delta. Delta, highest priority, transfers are treated the same as emerge calls. Closest available unit, regardless of resources. These are supposed to be reserved for the highest acuity patients. Ones that have a high probability of loss of life or limb within the time it would take to reach the receiving facility. Hospitals abuse this system in order to get an ambulance faster. It is not uncommon to take a "delta transfer" to a bigger centre ER for consult and wait there for hours while our patient remains stable. There have been instances where I've downgraded delta transfer patients to the waiting room. Doctors also don't realize that this can leave patients stranded at the receiving hospital, which then usually means they have to call another ambulance to bring them home.

Every rural hospital thinks they're the only ones sending transfers of any kind out. They are not. All of them do it, and it completely clogs up the system.

If we take a patient for CT, we have to wait in line with every other patient, and then wait for the radiologist to read the scans and then determine if we return to the sending facility or go to the ER for another consult. This can take hours upon hours.

In addition, if we're sent to Calgary or Edmonton, those are typically drop-offs in the ER. That means we leave the hospital without a patient, and now we're at the mercy of metro. Lately, it means we're now doing metro calls for the majority of our shift leaving our communities without adequate coverage for long intervals.

Doctors need to better communicate with each other, and utilize the telehealth system for consults. For example, an orthopedic consult doesn't always require an in-person exam. An x-ray can be done at a rural facility, and then sent to the orthopedic clinic and consult over telehealth.

These transfers not only tie up resources, but create such an insane amount of wear-and-tear on our trucks that we're nearly out of working frontline units. They're breaking down faster than we can fix them.

So what can we do? Well that's a big question that requires a lot of thought and nuance. An increased budget first and foremost. More metro trucks. Better public education and PR. Accountability for rural doctors abusing the IFT system. Better dispatching to get rural crews home. A dedicated rural IFT system, like in metro.

If your family member is to be sent on a transfer to another facility, please advocate to take them yourselves if it's feasible (ie, no treatments needed, and they can walk without major assistance) this not only helps us, but it helps the patient. It gives them a small bit of autonomy in their care.

If you feel like you have to call 911, by all means do so. Never be afraid to. I hate discouraging people from asking for help. Just keep in mind, is it for a chronic problem that can be seen by a family doctor or urgent care? Can you make it to a hospital on your own power without great discomfort? It's not a binary thing by any means, but they're just thoughts to keep in mind.

If anyone needs more clarification/information, feel free to PM me or start a thread and I'll do my best to answer.

Thanks for reading!

[btimbit]

You're a beauty, thank you

[Johnny Makarov]

Originally Posted by 81MC

Friends 1 year old had a seizure out of the blue while at a restaurant. Child went blue, parent thought kid was legit dead. Ambulance took 45 minutes. That’s a god dammed eternity.

45mins?? I'd be jumping in my F1 car racing to the children's after 10 mins.

[Sliver]

Yeah, after hearing about these wait times I think I'd be more inclined to throw an injured person in my car and race them to the hospital myself.

WhiteTiger - are you guys able to give an ETA when somebody calls or is that just not possible?

[PsYcNeT]

FIL had a cardiac event on Sunday night; Fire got there about 20m after my MIL called 911, EMS arrived about 15m later.

He's okay, but yeah I was surprised that I had time to stop cooking dinner, put everything away, pack a bunch of "gonna sit at the hospital for a few hours/overnight" items, get my toddler sorted and into the car, drive to their house (~10m away) and still beat EMS by 10m or so.

[WhiteTiger]

Originally Posted by Sliver

WhiteTiger - are you guys able to give an ETA when somebody calls or is that just not possible?

Could I personally, given my experience, probably give a pretty accurate ETA? Yes.

Would I? Never. That creates an expectation which can put me into a legal bind if something happens and the person gets sue-happy.

Let's say you called about some noise you heard outside your house that scared you. I tell you that the police car dispatched to your call is right around the corner, so open your door and meet them. A priority call comes in and that police car speeds off to that emergency. You get injured by the burglar you surprised and sue the city (me) because I created a false expectation for you. City loses lawsuit, I lose my job.

At best, all you are likely to be told is "A unit will be dispatched as soon as possible."

I am not familiar with AHS/EMS policy, but I'd be shocked if it wasn't similar to C911's.

[Sliver]

Originally Posted by WhiteTiger

Could I personally, given my experience, probably give a pretty accurate ETA? Yes.

Would I? Never. That creates an expectation which can put me into a legal bind if something happens and the person gets sue-happy.

Let's say you called about some noise you heard outside your house that scared you. I tell you that the police car dispatched to your call is right around the corner, so go out and meet them. A priority call comes in and that police car speeds off to that emergency. You get injured by the burglar you surprised and sue the city (me) because I created a false expectation for you. City loses lawsuit, I lose my job.

At best, all you are likely to be told is "A unit will be dispatched as soon as possible."

I am not familiar with AHS/EMS policy, but I'd be shocked if it wasn't similar to C911's.

Gotcha. That's not unreasonable, but I guess if you're in a position to get a lift to the hospital that's probably your safer bet to see a medical professional as quick as possible given the unpredictability of wait times for an ambulance.

[WhiteTiger]

Originally Posted by Sliver

Gotcha. That's not unreasonable, but I guess if you're in a position to get a lift to the hospital that's probably your safer bet to see a medical professional as quick as possible given the unpredictability of wait times for an ambulance.

NOTE I AM NOT A DR OR HEALTHCARE PROVIDER AND DON"T GIVE THAT KIND OF ADVICE. This is how I've been looking at it, for my family. If I need to go to the hospital (and both myself and my wife have needed to in the last 10 years) I ask myself if I need specialized emergency care EN ROUTE or not? If yes, call an ambulance. If not, can I drive (if my wife isn't around to drive me)? If not, call a taxi/uber, etc.

[Sliver]

Originally Posted by WhiteTiger

NOTE I AM NOT A DR OR HEALTHCARE PROVIDER AND DON"T GIVE THAT KIND OF ADVICE. This is how I've been looking at it, for my family. If I need to go to the hospital (and both myself and my wife have needed to in the last 10 years) I ask myself if I need specialized emergency care EN ROUTE or not? If yes, call an ambulance. If not, can I drive (if my wife isn't around to drive me)? If not, call a taxi/uber, etc.

Yep, I'm going to look at it like that, too. Most of us in Calgary are pretty fataing close to a hospital at all times. Things would need to be pretty dire for me to roll the dice on an ambulance showing up quickly right now.

[vegasbound]

A friend of mine just quit her 12 year paramedic career last week. She was primarily in Okotoks/Black Diamond. She said she couldn't do it any longer. When I spoke to her last summer as I had to call an ambulance for the first time, she said that 11 mins was shockingly fast. Of course, this was an emergent situation. It didn't seem that fast at the time!

[Old Yeller]

Originally Posted by Johnny Makarov

45mins?? I'd be jumping in my F1 car racing to the children's after 10 mins.

Yeah hearing about the wait times has obviously created some public outcry, but it's probably going to have another effect in that people won't even bother calling 911 anymore and just become their own ambulance.

[DoubleF]

Originally Posted by Sliver

Yep, I'm going to look at it like that, too. Most of us in Calgary are pretty fataing close to a hospital at all times. Things would need to be pretty dire for me to roll the dice on an ambulance showing up quickly right now.

Agreed. An individual needing to be revived prior to transport and/or the inability to move the individual without concern would be when I'd call. Any other situation I'd say drive them over to the emergency, it's faster. By the time the call is over, you'd almost be half way there.

I should probably go do a Red Cross/CPR type course sometime. I assume stabilizing someone and/or the ability to increase the odds of driving someone to the hospital would be highly beneficial in general.

Originally Posted by Old Yeller

Yeah hearing about the wait times has obviously created some public outcry, but it's probably going to have another effect in that people won't even bother calling 911 anymore and just become their own ambulance.

This honestly should be the way it is. I think movies have given a very false understanding of when you actually should be calling an ambulance.

[81MC]

Originally Posted by Johnny Makarov

45mins?? I'd be jumping in my F1 car racing to the children's after 10 mins.

Me too. Except imagine the mental anguish thinking ‘well, it has to arrive any minute now. Just one more minute. Yep, k, one more minute.’ Then you get in your car, realize the hospital is 20 minutes away and you have no way to monitor the child, and navigate an unfamiliar city, and move traffic out of your way, and not crash because you’re so jacked on adrenaline.

30 minutes later you’ve told yourself it’s just another minute and that waiting is all you can do. Ihgggggg

[Old Yeller]

Originally Posted by DoubleF

This honestly should be the way it is. I think movies have given a very false understanding of when you actually should be calling an ambulance.

I don't disagree, but ambulances are designed to be quite visible/audible where as my black SUV is probably slightly less so. Also compounded by the fact I'm driving dangerously because my kid is in the back turning blue and it could potentially be setting a dangerous precedent.

[bagofpucks]

We live not too far from Marv’s in WhiteTiger’s example and we have had two separate health care providers tell us that if the 911 operator can not confirm an ambulance is in the area that we need to drive to the hospital ourselves, regardless of the situation, because we could be more at risk waiting due to the massive issues of ambulance service in rural areas. I can only assume the situation is going to get worse as we see massive burnout rates of EMS and medical staff and the lead time it takes to get people trained.

[Mayo]

Originally Posted by photon

Is this a problem common across Canada? Or is Alberta particularly bad?

As I get older I don't really like the idea of dying because there were no ambulances available.

If you Google basically "__________ Province ambulance wait times" it appears this problem is not unique to the AHS.

BC:
https://bc.ctvnews.ca/b-c-paramedic-...nion-1.5330153

Ontario:
https://www.kenoraonline.com/article...taff-shortages

Newfoundland and Labrador:
https://www.cbc.ca/news/canada/newfo...ador-1.6468419


I agree with whomever posted that ambulances should only be used for those who need, or could need care in transit.

[IliketoPuck]

It's almost like providing systemically insufficient resources, supports, and wages while demanding unrealistic outcomes from front line workers during a pandemic could have completely foreseeable negative affects.