Hamilton's population is older than the rest of the province — and it's starting to take a toll on paramedics in the city.

According to the paramedic service's annual report for 2016, there was a seven per cent demand increase in 911 calls in Hamilton last year, coupled with a cumulative increase of 35 per cent over the past seven years.

All signs point to demands on local EMS workers growing at much higher levels than simple population growth, Paramedic Chief Michael Sanderson said in the report.

"This rate of service demand increase is higher than community population growth can explain and must be attributed to an increasingly aging population, socio-economic factors, and an increasing reliance on care in the community or home for patients with complex health care histories or issues," Sanderson said.

Census data shows that the fastest-growing population segment that EMS workers serve is people over the age of 65. Provincial projections estimate that 25 per cent of the province's population will be in this category by the year 2021.

Hamilton has a higher than average percentage of population aged 65 and older, according to the latest census data. The region also has a higher number of people over the age of 50 than the rest of the province — 38 per cent of Ontario's population is over 50-years-old, while 41 per cent of the Hamilton LHIN (which includes Niagara, Haldimand and Brant) is over 50.

Offloading times a problem at Hamilton hospitals

Sanderson says in the report that while seniors represent about 16 per cent of the city's population, they accounted for 45 per cent of the demand on ambulance workers last year.

"One in every four ambulance responses last year was to a senior citizen aged 80 or older, a four per cent segment of our total population," he said.

The latest census data shows that seniors now outnumber children in Canada, as the population experiences its greatest increase in the proportion of older people since Confederation. There are now 5.9 million Canadian seniors, compared to 5.8 million Canadians 14 and under.

"In combination, what this means is that as the percentage growth of senior population continues to accelerate, and ever increasing levels of care are being provided in community settings, the demands being placed on our service will continue to grow at much higher rates than either inflation of community growth," Sanderson said.

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After a significant decrease "code zero" ambulance events rose again in Hamilton last year. (CBC)

In the face of those issues, Sanderson says in the report that EMS workers managed to improve response times across the city, which he attributes to a commitment from paramedics who "routinely went from one call to the other," missed meals, and worked unwanted overtime at the end of shifts.

But as calls increase, problems persist within a strained medical system. One issue paramedics are identifying is "offloading times" for patients at area hospitals.

'Code zeros' back on the rise

The report says the provincial recommendation is that 90 per cent of patients are offloaded from an ambulance within 30 minutes at a hospital. The provincial average last December was 46 minutes.

In Hamilton, it took a lot longer. In December of 2016, it took 107 minutes for patients to be offloaded at Hamilton General, 112 minutes at Juravinski, at 91 minutes at St. Joe's.

"While our leadership team continues to meet and collaborate with our hospital partners, and we understand that there are a variety of issues primarily related to hospital capacity, internal hospital patient flow and flow out of the hospital, the fact remains that [offloading delays] significantly impact the availability of ambulance resources required for emergency community coverage and response," the report reads.

And after a marked decrease in the last couple of years, the number of "code zero" incidents — which is when "one or less" ambulances are available to help on emergency calls — rose again slightly last year.

There were 60 code zeros last year, compared to 44 the year before. That's a marked improvement from a much higher trend, peaking at 242 in 2013.

"Code zero events continue to be a significant challenge for our community and for our paramedics who live through very challenging shifts," the report reads.

adam.carter@cbc.ca