Code red: As hospital admissions stall, ambulance gridlock rises

Paramedic services in Ontario's Waterloo region have seen a spike in the number of code red incidents since the arrival of the COVID-19 Omicron variant. Deputy chief Robert Crossman says longer offload times, shortages in staff and overwhelmed hospitals contribute to delays for ambulance turnaround and readiness for dispatch.

2 recent cases with offload times of 8 to 11 hours, says Waterloo region's paramedic services deputy chief

Ambulance services are under strain in various areas of Ontario, including Waterloo region, Hamilton and Toronto, according to a member of the Ontario Association of Paramedic Chiefs. (Kate Bueckert/CBC)

Longer offload times, shortages in staff and overwhelmed hospitals due to Omicron are all contributing factors to a spike in code red instances in Ontario's Waterloo region — meaning there are no ambulances available to respond to emergency calls.

Robert Crossan, the region's paramedic services deputy chief, said there were 11 code red instances in December, more than double the number recorded the previous month. Some may last a few minutes, others can delay an ambulance up to half an hour. 

"To have six to seven crews at each hospital on offload at the same time is not unusual [now]. And that's two-thirds of our vehicles that are on the roads at that time," he said.

The ambulance crew doesn't leave until the hospital has assumed responsibility for the patient. 

"The hospital system, when we run out of qualified staff to make sure that there's enough beds open and everything starts to back up in the emergency department, we're at the end of that," he explained.

A call would normally take ambulance crews approximately an hour when there are no offload delays, as they move through the process from initial dispatch to case clearance after delivering a patient. But Crossan said that is now taking several hours, noting two cases in early January when one took eight and another took 11.5 hours.

"When there is no place to put those patients, we're the ones standing in the hallway for four hours."

Hospitals face 'unprecedented level of pressure'

Grand River Hospital put out a call for community support Thursday as hospitals face "an unprecedented level of pressure."

As of Thursday morning, the hospital's occupancy dashboard showed 11 patients were waiting on a stretcher in the emergency department to be admitted to an inpatient unit. Friday afternoon that had fallen slightly to nine people.

"Looking at the 660 beds across GRH's K-W and Freeport Campuses, there is only one available bed, which means there no place for these patients to go," a release from the hospital read.

Hospital president and chief executive officer Ron Gagnon said, "We are now at the point where we may need to start transferring patients out of our hospital for care, and it's a point we never wanted to reach.

"We also know that this is not an easy or ready fix, as many hospitals in the region and across the province are in the same situation."

Paramedic services are also dealing with a record call volume, Crossan said.

Normally, about 900 to 1,000 calls come in per week, he said. Lately, paramedics have been dealing with 1,100 to 1,200 calls. Crossan points to the Omicron variant for the influx in calls.

"We're in the middle of a pandemic and people are calling with COVID symptoms on top of everything else we would normally deal with," he said.

"When you add all that up, it equals more calls and those calls we hope would take an hour or an hour and fifteen minutes are taking us four, five, six hours."

More ambulances not the solution

The issue of staff shortages, overwhelmed hospitals and longer offload times are not unique to Waterloo region, with neighbouring jurisdictions of Hamilton and Toronto also dealing with similar situations, said Crossan, also a member of the Ontario Association of Paramedic Chiefs.

He said solving the issue of code red is complex, as it involves the entire emergency response sector, and simply adding more ambulances and paramedics won't solve the problem.

"The big picture of what is going to change code red for every service, for every municipality, is a major investment from the province in ensuring that we have enough hospital infrastructure to handle it," he said.

That would allow for more hospital staff to be hired, more equipment to be on site that would then allow for shorter patient offload times. 

Crossan said the association works with the province in advocating for paramedic services and also regularly meets with hospital staff to find solutions.

"When you're at 110 per cent of your beds occupied, and people are in hallways and there is nowhere else to put people, we can't expect [hospitals] to continue to take more and more patients without the whole system being overhauled."


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