There has been no Eastern Health ambulance on standby and ready to answer emergency calls for an average of 26 minutes per day in the St. John’s metro area so far this year.
The health authority calls those situations "red alerts."
Between Jan. 1 and July 31, there were 286 red alerts, according to documents obtained by CBC News through access to information – an average of more than one a day.
How red alerts work
Normal operations are when "at least one Eastern Health ambulance is available on standby and ready to respond to an incoming request for service," according to information provided by the health authority.
"If there is only one ambulance on standby and that ambulance is dispatched to respond to a call, a red alert status begins."
The red alert period stays in effect until at least one Eastern Health ambulance becomes available for standby.
But that does not mean that calls go unanswered for the entire duration of a red alert, Eastern Health wrote in response to an access to information request.
"While Eastern Health may be in a red alert status, an ambulance may become available within minutes of a red alert status being called. Each ambulance that becomes available will be dispatched to a waiting call and the red alert status will remain in effect until an ambulance is available for standby.
"During a red alert status, calls are continuously being responded to as each ambulance becomes available. The red alert status is terminated when there is an ambulance available for standby."
There was no available ambulance on standby for a total of 5,656 minutes.
The majority of those cases were the more serious type of red alert — Level 1, when there is a call, or calls, waiting for response. (Level 2 means there is no call waiting.)
Eastern Health declined CBC News interview requests. But ambulance availability is not a new issue facing the health authority.
In the fall of 2010, Accreditation Canada gave an overall positive assessment of Eastern Health’s compliance with national standards.
But the group — which provides health-care organizations with an external peer review process to assess and improve the services they provide to their patients — commented on continuing problems in the area of emergency response.
"There is ongoing documentation of daily occurrences of EMS trucks unavailable for response to a 911 call," the Accreditation Canada report noted.
"This has been an issue in 2008, 2009 as well as in 2010. It is recommended that there be a review of the risk associated with this gap in available ambulance service, and that appropriate resolutions be identified and implemented."
In the period before and after that report, Eastern Health announced — and put into place — a number of measures to boost services.
- Hiring paramedics and buying three new ambulances;
- Opening satellite ambulance stations on Topsail Road in Mount Pearl and Major’s Path in the east end of St. John’s, to aid response times.
- Increasing the number of ambulances on the road to a minimum of five ambulances and a maximum of eight at peak times. That’s the double the number of 2006, when there were between two and four ambulances on duty.
There was a significant decrease in red alerts around the same time.
Eastern Health logged more than 14,000 red alert minutes in 2010-11. The next fiscal year, that number dropped to under 6,000.
But the figure has since been climbing again — to more than 8,000 minutes in 2012-13, and on track to jump again to 9,600 minutes this fiscal year, if the pace of the first four months holds steady.
The number of calls for service has not grown as quickly, up less than five per cent in the two years from 2010-11 to 2012-13.
Red alerts vary from day to day
Days can go by without any red alerts being declared.
But sometimes, there are several in one day.
On April 2, for example, there were six separate red alerts — one Level 1, and five Level 2. None of them lasted longer than 20 minutes.
- See the full list of Level 1 red alerts from January to July 2013
- See the full list of Level 2 red alerts from January to July 2013
In fact, many red alerts last only minutes. But others can be lengthy.
On May 24, for example, there was a Level 1 red alert that lasted two hours and 18 minutes.
During that red alert, private ambulances from a company based in Holyrood and Conception Bay South were twice summoned to handle calls in St. John’s.
In its response to the access to information request from CBC News, the health authority said "the decision to call in another ambulance company will depend upon the length of time before an Eastern Health ambulance will be available, and client need."
Over the first seven months of 2013, that happened 19 times.
National comparisons difficult
It’s difficult to compare the number of red alerts here with other jurisdictions.
The Canadian Institute for Health Information says it does not track such information, and is unaware of any overarching national body that does.
And such issues with ambulance availability are called by different names, with different criteria, elsewhere.
In Hamilton, Ont., for example, a "code zero" occurs when one or less transport ambulances are available to respond to an emergency.
There were fewer than 100 code zeroes logged in Hamilton annually between 2007 and 2010. The number jumped to 223 in 2011, and came in at 147 for the first 10 months of 2012.
Hamilton posts tracking information online about the frequency of code zeroes.
Response times can be affected
In a statement e-mailed to CBC News late Monday, Eastern Health acknowledged that ambulance response times to emergency calls can be affected by red alert situations.
"For example, response times can be extended due to the delayed availability and response of an ambulance," Eastern Health spokeswoman Zelda Burt wrote.
"However, emergency calls are triaged to determine which are the most urgent and are responded to based on priority."
According to the health authority, demand for ambulances is driven by factors such as:
- an increase of the overall population in the St. John’s metro area;
- a growing aging population;
- "greater awareness and expectation from the public on the importance and benefit of professional paramedic care."
Last year, the Newfoundland and Labrador government commissioned an external review of the provincial ambulance program.
Government officials received the final report in late August, but have yet to release it.
Newfoundland and Labrador currently does not have benchmarks for ambulance response times, and the provincial Department of Health said earlier this year it does not track them.