Hamilton paramedics' code zeroes — 1 or no ambulances for emergencies — tripled over all of 2021

The number of Hamilton-area code zero situations — when there is only one or no ambulances available for emergency calls — has more than tripled compared to all of 2021, according to new data. Code zero incidents are also an issue in other parts of Ontario.

Lack of ambulances for emergencies reported in other Ontario cities as well

The number of code zero situations in Hamilton are now triple what they were last year, and paramedic services are trying to keep up with the demand. A code zero, also sometimes called a level zero or code black, is when one or no ambulances are available for an emergency response. (Hamilton Paramedic Service)

The number of Hamilton-area code zero situations — when there is only one or no ambulances available for emergency calls — has more than tripled compared to all of 2021, according to new data.

Also known as level zeroes or code blacks, there have been 334 of them in Hamilton this year. Last year, there was a total of 97. 

"We're almost gonna be functioning at a Third World level of ambulance service, I hate to say," said Mario Posteraro, president of Local 256 (Brant County) of the Ontario Public Service Employees Union (OPSEU).

As of Wednesday, based on data CBC received from the chief director of Hamilton Paramedic Service (HPS), Michael Sanderson, the number of code zeroes has grown steadily all year, with at least one nearly every week since April.

There were 24 code zero incidents alone from Oct. 10 to 16.

These incidents aren't limited to the Hamilton area. They're being reported across Ontario.

Ottawa paramedics reported 750 Level Zeroes on July 21, in the 500 calls for paramedics on that day, and about 10 per cent of them were tied up at a hospital longer than three hours.

Paramedics in Windsor were facing code black alerts on Oct. 12, with wait times for paramedics of up to 50 minutes. James Jovanovic, president of the paramedics' union, CUPE Local 2974, said emergency services were in and out of code black alerts that Wednesday.

Also on Oct. 12, an ambulance — from Orangeville, Ont., in Dufferin County — had to respond to a call from Dundas, Ont., in Hamilton, about an hour away.

Hospital patient bottlenecks

The data from Sanderson of HPS says its backlog is largely a result of staff shortages at local hospitals and too few hospital beds. These create long wait and offloading times for paramedics. 

In cases where there are no nurses available at a hospital or bed space, paramedics have to stay with the patient until a nurse is available, causing hours of time lost in offloading instead of being on the road again.

Also according to the data, an average of 775 hours have been lost in Hamilton to offloading patients weekly in 2022 due to delays at hospitals. In the week beginning Oct. 10, there were about 1,257 hours lost waiting for hospital staff.

Posteraro said there has been an increase in calls for situations that may feel like an emergency, but don't require an ambulance.

"The core issue is we don't have enough ambulances to respond to the demand for medical assistance and given the increasing demands for service, we don't have enough ambulances on the road," he said. 

The HPS's 2021 annual report lists that the top two reasons for calls for an ambulance involved fall injuries and shortness of breath, each making up 14 per cent of medical responses.

Darryl Wilton, president of the Ontario Paramedic Association, said "hospitals have been facing an unprecedented staffing and bed crisis." He said in a statement to CBC on Wednesday there is a physician, hospital and long-term care bed shortage. 

The Registered Nurses' Association of Ontario told CBC Hamilton there is also a shortage of nurses, and that 26,000 internationally educated nurses are waiting to have their applications processed so they can practise in Ontario.

Posteraro suggested that one solution to the bottleneck at hospitals is for people to educate themselves and become better at understanding when an incident requires a trip to the emergency room and when to go to an urgent care centre.

He also suggested that hospital administration needs to prioritize the beds in the emergency room.

"They'll have to find a way because that's where the logjam occurs."

Asking for more resources

Posteraro said another solution is to press the government for more help. He said, "We [the union] continuously lobby municipal councillors to provide additional resources given the increase in call volumes." 

He added "there's been chronic underfunding of our ambulance service for the last 20 years, and this is the end result."

Mayor Fred Eisenberger sent CBC a statement on Oct. 20, saying he's been aware of the current difficulties that hospital staff have encountered, including meeting the provincial government policy standard in receiving patients. Eisenberger will continue to act as mayor until Andrea Horwath, who was elected to the job in Monday's municipal vote, is sworn in in November.

Eisenberger said he has requested that the Ontario Ministry of Health: 

  • Take steps needed to enforce this provincial standard, and in cases where it's not met to implement a mechanism to get 100 per cent of the cost of providing the service to be transferred to the municipality through a year-end settlement process.

  • Amend the Land Ambulance Service Grant process so that the province uses the current year's council approved operating budget and not the last year's.

CBC reached out to the Ministry of Health on Wednesday, but didn't receive a reply back at time of publication.


  • An earlier version of this story referenced a statement by the president of the Ontario Paramedic Association, who cited figures from the Registered Nurses' Association of Ontario describing a shortage of physicians, hospital beds and 26,000 nurses. In fact, the Registered Nurses' Association of Ontario have described only a shortage of nurses, and said there are 26,000 internationally educated nurses waiting to have their application processed. The story has been updated to make those attributions clear.
    Nov 01, 2022 1:58 PM ET


Michael To


Michael To is a reporter with CBC Hamilton. Passionate about food, entertainment, and local culture, while reporting on all topics and beats. Trained and educated actor, versed in multimedia. Contact he/him at: michael.to@cbc.ca.


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