Off-Load Delays Highlight Paramedic Powerlessness
Time was, when paramedics brought patients to the emergency department, they'd "off-load" the patient on to a bed in emerg and get right back on to the street. Nowadays, cutbacks in hospital beds and high volumes in emerg put medics and their patients in "off-load" delay.
This week on White Coat Black Art, we show you the impact of off-load delay on emergency responsiveness in Halifax. Three years ago, Emergency Health Services Nova Scotia had a contractural guarantee to off-load their patients within 20 minutes of arrival in emerg. Now, it's not uncommon for medics there to complete an entire 12 hour shift alongside a patient in a hallway in the emergency department. Click on Podcasts to listen to the story, which first aired May 12 and is rebroadcast May 16 at 8 pm (830 pm NT) on CBC Radio One.
Off-load delay is a problem that's happening in cities across Canada and the United States. Check out this letter from Bob Fisher, a paramedic from Calgary. Note that his opinions are his own, not those of Calgary's Emergency Medical System or the City of Calgary
"I just listened to this and if I closed my eyes it could be Calgary. This is happening here every day. We have Paramedics in the hallways from the health region (CHR) (only during certain times of the day) they serve to take certain patients and free up the ambulance crews to get back on the street.
We tried the "Patent Flow Coordinator trick" which was essentially an acting superintendent in the halls to supposedly speed up getting ambulances back in service, and to be a liaison with the triage nurse. This didn't work as well as expected (the triage nurse still has the POWER!). During code Yellow... 11 ambulances left) and code orange (7... ambulance left) there has been developed a policy that the hospitals have to free up a certain number of units immediately. Superintendents then go to the hospitals and push to see that this happens. The whole thing is an exercise in frustration.."hurry up and wait" is the rule of thumb. Somehow the true life threatened patients still get attention though. It's magic.but we are waiting for the "Perfect Storm" when all hell breaks loose and our seat of the pants system fails. It is just a matter of time when lives will be lost.
The interview mentions a Pizza place (as a private industry) not being able to run like that. Well, I can't understand for the life of me how the Health Region can expect the citizens of Calgary to pay for and fund an Emergency Service.and allow their units to be virtually useless in their time of need. Is it a matter of PR? What will move the giant Government Wheel? What prominent citizen will have to die before something is done? Our Province has been building various extensions to hospitals, with a new hospital scheduled in the works. But the Premier himself has stated that "Staffing" issues will be the problem that continues to plague the system, and that Emergency wait times will continue.and hence "hallway medicine" will still be the norm.
As an Emergency Paramedic for 34 years.I have seen a lot of things change over the years, some for the good, but a lot for the bad. I did not join this profession to be a "babysitter" in the hallways of the hospitals. I think after a month of this I deserve a nursing degree!!! The wrong people are being forced to perform this duty. This is a nursing duty. clearly NOT a Paramedic duty. If I wanted to be a nurse I would have went to nursing school.
The patients being treated in the hallway by the Paramedics are usually very appreciative of the quality of care they get. Then when they get into a bed.sometimes for what ever reason, they are neglected. After all they are going from one on one or two on one patient care to a nurse that has 5 or 6 patients.
My Dentist told me of his experience with his son that had a dislocated collarbone. The Medics gave him pain medication in the hallway on a regular basis, when they got him a bed.was neglected to the point where
he was in severe pain. The Dentist asked if he could get more pain medication for his son and was told if he didn't be quiet that security would escort him out. I found this story more than a little disturbing. Talk about a POWER TRIP!
Calgary EMS is striving to be the best service they can be, but the conditions that Medics have to work in are forcing some very long time employees to leave the service. Nurses also are being burned out at a fast rate, because they cannot cope with the extra workload. Like the interview said. we are caught in the middle.
Come to Calgary.check it out.listen to the corporate and Government rhetoric and perhaps do another story."
We want to hear from paramedics, nurses, physicians, hospital administrators and patients. How has "off-load" delay affected you and the place where you work? Why do you think the problem seems to defy a solution? How would you fix the problem?
Categories: Past Episodes
Previous Comments (5)
Excellent paramedic story. Keep up the good work on educating Canadians on the complexity and intricacies of the modern health care system and the myriad of personalities and difficult issues in the system.Spyro Trifos, May 16, 2008 7:26 PM
Hi Brian, I challenge you to read this comment on air.
Good on you for this morning's interview on poaching foreign doctors.
The poachnig of the doctors is compounded by the terrible way that those doctors are treated when they get here. This reflects the deceitfullness of Canadian authorities who will not challenge the gatekeepers to these professions, to let qualified professionals practise their profesions. Canada openly lie to these people who often settle for menial jobs. Then when these people complain about the deceitfullness we tell them that they should be happy that they are here, or to go back home if they are unhappy here...this is what I hear on the streets. I know because I too am an immigrant who had to jump through hurdles to practice my teaching profesion...
Thanks Andy and keep this subject alive,
What revolts me is that we all know stories such as these, yet we continue to be told we have the world's best healthcare. I don't think so. Everyone I know who has needed medical care in western Europe (Switzerland, Belgium, France) has nothing but good stories of quick access to skilled medical care. I remember my relatives in Europe asking "Why did you wait at emergency. If it's an emergency, shouldn't a doctor see you right away?".
Everyone I talk to of Canadian hospitals has tales to share of waiting room limbo, overworked staff, med students doing specialists' work and just plain neglect. We don't have the world's best healthcare system, far from it. And we shouldn't look to the US for inspiration: we should turn our eyes across the Atlantic where it's done right.Denis Vermeirre, May 26, 2008 8:09 AM
Great article and comments. There are many issues that lead to the off-load problems that EMS professionals are facing as we all know. One if these issues is misuse of the EMS system. Perhaps public education about what truly constitutes an emergency (i.e. a sprained ankle is not an emergency, but an MI is) would ease some of the wait times due to decreased call volume. Perhaps paramedics could have authority to cancel transport for patients that are obviously not emergencies without repercussions if due diligence is followed. This is a challenging issue and I would enjoy learning about options to solve it. Then there's the multitude of issues that hospital professionals face in the ED, and further into the hospital system.... Where to start?Connie, July 26, 2008 12:59 PM
I listened to your story today, Aug 25th. It must be a summer repeat. I was very interested because I work as a Paramedic in BC and an Emergency Room Attendant in a lower mainland trauma hospital. The hospital was having record number of pts in the hallway and needed a new method of dealing with them. The solution they came up with was to hire paramedics and have them work in the hall. It is our job to take care of the hallway pts and get the crews back on the street where they belong. Paramedics work in conjunction with LPNs and RNs (who have a greater scope of practice) to watch and treat the pts who are stuck in the hall.
This unfortunatlly doesn't mean that we never have paramedics stuck with pts in the hall, it does mean that they are there less often and for less time. Also the paramedics will off-load their pts to the first crew who has to stay. A crew of 2 paramedics can watch up to 5 pts depending on how sick the pts are.
We have been working this system for about 18 months and so far it is helping. I wouldn't say that it has been greeted with open arms by all. There has been and will continue to be bumps in the road while the job is defined and people get used to it. It is defenitlly not a final solution to the problem, but but we need to start to think of different solutions to long running problems. Just recently Surrey Memorial hospital has started to look for EMAs for their hall. Who knows where it will go from here.David Melrose, August 26, 2008 3:02 AM