The union representing Emergency Medical Services workers says very little has improved almost a year after an 87-year-old woman died after waiting three hours for an ambulance.

"From what I'm hearing there's really been no improvement, if anything things may be worse," Mike Merriman, the EMS unit representative for CUPE Local 416, told CBC News.

'When you're calling it could be hit or miss. If it's a bad day you may be waiting a while.'- Mike Merriman, EMS unit representative for CUPE Local 416

"When you're calling it could be hit or miss. If it's a bad day you may be waiting a while. If you get lucky and it's a good day you'll get your ambulance," he said.

His remarks come as new details emerge around the death of the woman at a Leaside nursing home last year. CBC News obtained an internal investigation looking at the delay. The 52-page report found dispatchers felt overworked that night and that there were too few paramedics on the road. At one point that night, according to the report, there was just one ambulance available for the entire city of Toronto.  

The incident happened at the Leaside Retirement Home on Dec. 30, 2012. Staff called for an ambulance, reporting the 87-year old had abdominal pain from the night before. The report says the call was prioritized as an "alpha" — the lowest priority. Dispatchers advised the caller that EMS was very busy and there would be delay.

hi-toronto-ambulance-852-4col

There was just one ambulance available for all of Toronto at one point on the night of Dec. 30, 2012, according to a report obtained by CBC News, when an 87-year-old woman died after waiting three hours for paramedics to arrive. (CBC)

An hour later, the nursing home called back and was told there was still no unit available to respond. 

A unit was sent 45 minutes later, but was re-directed to a higher priority call. The report found an ambulance was dispatched seven times and each time was re-routed to a more serious call.

Staff unable to cope

The report found that staff followed proper procedure and made the right decision in diverting the ambulances.

But it also found staff both at the communications centre and on the road were unable to cope with the volume of calls that night — and the retirement home call was lost in the shuffle. 

The dispatcher who took the call told investigators: "I couldn't tell you how many cars we had that day, no staff and that shouldn't happen. Honestly it was so busy, I barely recall this call, otherwise, I was just taking emergency calls."

One of the superintendents on duty that night said all dispatchers were "frustrated to the point of trying to keep their heads above water." adding, "I never stopped for 12 hours."

Eventually the retirement home called back saying the patient's condition had worsened. She was unresponsive and no longer breathing. The call was upgraded to "echo" — the highest priority — and a crew arrived within five minutes. But it was too late and the woman died. 

City needs more paramedics

The report lists eight recommendations, though two were redacted in the copy obtained by CBC. Better handling and monitoring of lower-priority calls are among the recommendations. 

EMS Deputy Chief Gord McEachen says the service is taking steps to address these issues. He says the city has hired 65 new paramedics this year and is working to hire the same number for the next three years. 

A recent consultant's report says Toronto needs more than 200 new paramedics to meet the demands of a growing and aging city.

McEachen said EMS is taking a measured approach, noting it has to work within a tight city budget.

"It's a significant investment in to the community. So there has to be a measured balanced approach," McEachen said.

He pointed out that schedules for paramedics were changed at the beginning of the year to match higher demand on evenings and weekends. He said situations when only one ambulance is available for the entire city aren't as frequent anymore.

"We've maximized our resources and we've improved our efficiencies so we don't get it to those situations as often," he said. "EMS calls — they're unpredictable when they come in — so we've tried to match our call demand with the resources we have available."

While paramedics are paid for by the city, dispatchers are paid for by the province. McEachen said he's also working on hiring more dispatchers. A schedule change for their shifts, to match demand, is coming in 2014 as well.

But Merriman said even with all the changes, the public shouldn't take for granted that an ambulance will be able to immediately respond to an emergency.

The public "should be very concerned, very concerned, especially if it's an immediately life-threatening situation," he said.