Code zero ambulance events in Hamilton hit highest level in 5 years

Code zero ambulance emergencies in Hamilton skyrocketed to their highest monthly level in five years in January, new data from the city shows.

Almost once a day in January, 1 or fewer ambulances were available to respond to calls

Mayor Fred Eisenberger saw eight ambulances sitting idle outside the emergency department door of Hamilton General Hospital last night. (Fred Eisenberger)

Code zero ambulance emergencies in Hamilton skyrocketed to their highest monthly level in five years in January, new data from the city shows.

A code zero is when there is only one — or even zero — ambulances across the service's entire fleet available for a call. So far in January, that has happened 31 times, or more than once a day.

Mayor Fred Eisenberger had what he called an "eye-opening" first-hand look at the stress on the system last night, when he drove a friend in the midst of a medical issue to the emergency department at Hamilton Health Sciences.

Instead of just sitting in the waiting room while his friend was being seen, Eisenberger decided to check in with some of the healthcare workers on shift at the time — and what he found floored him.

We continue to play Russian roulette with the health and well being of our citizens. It is unacceptable.- Mario Posteraro, Ontario Public Service Employees Union Local 256 president

Eight ambulances were sitting idle outside the emergency department door, with 16 paramedics standing the gateway to the hospital with patients, stuck there for hours at a time until there was room for the patients to be processed.

Eisenberger says he made some calls, and found out there were also seven or eight ambulances tied up at St. Joseph's Healthcare, and another four sitting at Juravinski.

"When you look at that, that's almost all the vehicles we had on that shift to be able to deal with any emergent care issues," he said. "It was eye opening in terms of the severity of it. We've known it's been a problem for quite some time.

"It was a stark reality for me to see it again, in real time."

A perfect storm of problems

The city says long hospital offload delays and increasing service demands are major contributors to the frequency of code zero alerts.

The mayor says ambulance workers told him last night that a lack of long term care beds and legislation that dictates they have to bring patients to a hospital instead of places that might be more suiting like a walk in clinic are also contributing factors.

"We need a resolution. We can't continue on this way. This has been getting worse and not better."

In a statement, city spokesperson Allison Jones said Hamilton has seen 911 calls for help spike over 5 per cent, coupled with a more than 20 per cent drop off in hospital offload performance at emergency rooms around the city — and that was an area where Hamilton was already lagging behind the provincial standard.

"Our paramedics, and our patients, have experienced more than 600 ambulance offload delays that stretched longer than two hours — yesterday alone there were 40," Jones wrote.

"Our hospital partners report the hospital offload delays are result of surges in demand at the Hamilton hospital sites, particularly with frail elderly and with patients experiencing multiple medical problems."

Mayor Fred Eisenberger says he plans to meet with the heads of the city's ambulance, fire, and police services as well as members of provincial parliament to address the city's healthcare issues. (Chris Young/The Canadian Press)

The city says it is "not aware of any clinically adverse outcomes or fatalities" as a result of ambulance shortages, but there was at least one in July. The coroner's office is now investigating the circumstances around the death of 71-year-old Catherine Terry, who died of a heart attack during a code zero.

While there were no reported deaths this month, the city says there have been 74 patients with lower priority problems like fractures and general illness who have had to wait more than an hour for an ambulance to arrive. 

Mario Posteraro, president of Ontario Public Service Employees Union Local 256, which represents Hamilton paramedics, says that some of these "lower priority" problems were seniors who had slipped, fallen, and broken bones. They were then left to wait over an hour in searing pain for help.

The union representing local paramedics says that Hamilton's EMS workers are being pushed to the limit. (Samantha Craggs/CBC)

The provincial benchmark for arrival times that paramedics strive to hit on non-emergency calls is 25 minutes. That means 74 times this month, Hamilton paramedics were more than double that marker.

"We're prolonging emergency response times, causing pain and suffering for a very vulnerable segment of our population," Posteraro said. "We continue to apply band aids and promises to problems that require dollars and common sense."

"We continue to play Russian roulette with the health and well being of our citizens. It is unnacceptable."

'This happens every day'

Posteraro also said that this problem isn't news for the mayor, who routinely gets requests for more funding for paramedics. 

"He's known about it. City council knows about it," he said. 

"It's certainly no surprise to us. This happens every day."

Provincial NDP leader Andrea Horwath released a statement about the issue Tuesday morning, taking aim at hospital closures from the Conservative government in the Harris years, and Liberal spending freezes in recent years.

Officials say there is a complex web of issues that lead to code zero events in Hamilton, like a lack of long term care beds and space in hospitals, increasing call volumes and a lack of resources for frontline paramedics. (CBC)

"We have to stop settling for bad or worse when it comes to health care. It simply doesn't have to be this way," Horwath said. "Annual funding should, at a minimum, keep up with the rate of inflation and population growth, and take a look at the unique needs of each community — things like aging populations."

Hamilton hospitals have been reporting that they have been well over capacity, in the midst of flu season. Hamilton Health Sciences has been "consistently over 105 per cent since October 2016," spokesperson Lillian Badsioch told CBC News earlier this month. The hospital was at 114 per cent capacity on Jan. 15.

St. Joe's, meanwhile, was 28 beds over capacity in the same timeframe.

While certainly a problem today, code zero incidents were even more common in Hamilton a few years ago. In 2013, there were 242 of them in Hamilton. That number dropped to 44 in 2015, but has been creeping back up.

Eisenberger says the city hired more paramedics over the years, which was "supposed to help" — but says he knows the numbers in recent months keep getting worse.

"It needs resolution here. It's not sustainable," he said.

"It's an untenable situation for patients, for paramedics, for healthcare staff."


About the Author

Adam Carter


Adam Carter is a Newfoundlander who now calls Toronto home. He enjoys a good story and playing loud music. You can follow him on Twitter @AdamCarterCBC or drop him an email at adam.carter@cbc.ca.


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