The Ontario government says an "overall, ongoing and systemic problem" with how Ottawa dispatches paramedics has forced paramedics from neighbouring municipalities to spend more time responding to calls in the capital.
The Ministry of Health and Long-Term Care report, released last week, points to several cases over the night shift where Ottawa paramedic dispatchers fell short of their own standards, including not assigning the closest ambulance for life-threatening emergencies in five cases.
In one case, firefighters tried to resuscitate a patient on Stonehenge Crescent while waiting for an ambulance arrive. The dispatcher assigned paramedics who were 17 minutes away instead of an ambulance five minutes away at Children's Hospital of Eastern Ontario.
The patient didn't survive.
The Ottawa paramedics were nearing the last half hour of their shift, when they are not supposed to be assigned to new calls.
"This practice does not allow for a seamless ambulance service and negates Ottawa Paramedic Service's own mandate of sending the closest ambulance to all high priority calls," the report said.
Prescott-Russell says Ottawa calls doubled
Prescott-Russell paramedics asked the ministry to look at the single overnight shift from August 6 to 7. Michel Chrétien, director of emergency services for the counties, said their calls from the City of Ottawa have more than doubled in the past two years and they have not been able to get an explanation or solution from the city.
"We're supposed to be a resource to help them out in dire situations, but that's not happening," Chrétien said. "We feel like we're almost part of their daily response in their communities because we're doing calls all the time. That's unfair to us."
The report criticizes Ottawa's "return to readiness" policy, which requires dispatchers to wait 30 minutes after paramedics transfer a patient before they can assign paramedics to another call, and another that prevents dispatchers from assigning units in the last 30 minutes of their shift.
The report said those policies create a skewed inventory of what resources are available and contributes to more calls to paramedics in neighbouring municipalities.
And while the end-of-shift policy reduces the amount of overtime claims for Ottawa, it has the inverse effect on surrounding municipalities. Chrétien said, even without overtime, his paramedics responding to Ottawa calls costs Prescott-Russell $500,000 per year.
5 of 13 calls didn't ask for closest unit
The report said in five of the 13 calls on August 6, dispatchers did not assign the closest unit to respond to life-threatening calls, in violation of provincial standards and the Ottawa Paramedic Deployment Plan.
Ottawa paramedics were assigned to non-life threatening calls when resources were low — instead of waiting for more ambulances to be available — twice on the night in question, which violated the deployment plan and requirements for minimum emergency coverage.
The response to non-life threatening calls can be delayed by up to 60 minutes to make sure enough ambulances are available to respond to graver emergencies.
Paramedics were also late in reporting that they had transferred a patient to the care of a hospital on several occasions, with the longest delay being 42 minutes. Those delays would mean dispatch wouldn't know they were available to deploy — and they would get another 30 minutes before their next call because of the "return to readiness" policy.
Calling for the province to 'stop the bleeding'
Five municipalities neighbouring Ottawa have already called for the province to step in and deal with the paramedic resource issue. The municipalities include the County of Renfrew, the County of Lanark, the United Counties of Prescott and Russell, the United Counties of Leeds and Grenville and the United Counties of Stormont, Dundas and Glengarry.
The municipalities say Ottawa refuses to reimburse them for the service from their paramedics. The province made it optional for municipalities to recover costs for emergency services delivered outside their jurisdiction in 2008, where before it had been mandatory.
Chrétien said the report should be followed by a meeting with the ministry and his counterparts in other municipalities.
"I'm looking forward to that meeting and seeing how we can take a step forward on this and at least, as we say in our field, stop the bleeding."
The City of Ottawa said it received the ministry's investigation report on November 29. Ottawa Paramedic Service Acting Chief Peter Kelly said the city has 10 days to review its contents.
"We have contacted the ministry to further clarify some of the information in the report and discuss the validity of the findings," he said in a written statement.
"We continue to have ongoing discussions with the ministry to help them finalize the report with updated information and to discuss next steps."