Nfld. & Labrador·CBC Investigates

Metro ambulance service 'dangerously understaffed,' Eastern Health tells N.L. government

Senior officials offered a blunt assessment of ambulance capabilities on the northeast Avalon in a briefing to the provincial Department of Health three months ago.

‘Unable to meet call volume demands' for emergency responses, briefing note says

An Eastern Health briefing note obtained through access to information had a grim message for the province about the metro ambulance service last fall. (CBC)

Eastern Health officials offered a blunt assessment of ambulance capabilities on the northeast Avalon in a briefing to the provincial Department of Health three months ago.

"Continuous increases in annual call volumes have left the metro ambulance service dangerously understaffed and unable to meet call volume demands for both emergency and non-emergency responses," the health authority advised in a briefing note.

The document — obtained by CBC News through access to information — revealed some eye-popping impacts of that shortfall of resources in the system.

"Evidence also reveals that off-load delays in the metro hospitals are resulting in the effective loss of one 12-hour ambulance every day of the week … and that if we didn't reserve ambulances back for emergency or 911 coverage each day, we would be in 'red alert' status every day," the briefing note said. 

"As it stands, our data shows that we had 2,022 occurrences over 12 months, whereby we had no ambulance available to respond."

Red alerts happen when there is no Eastern Health ambulance on standby, immediately available to respond to a call.

An appendix to the briefing material revealed that the most serious form of red alert — no ambulance available with at least one emergency 911 call waiting — happened 470 times in that recent 12-month period. That works out to nearly one of every four red alerts logged.

Meanwhile, the number of ambulance transports is well above national operational standards. 

That also causes problems, according to the briefing note.

"Studies show that services running crews at or above [that number] will see an increase in sick use, increased burnout and time loss due to mental health issues and higher than average injury claims."

According to an Eastern Health briefing note, off-load delays at metro emergency rooms resulted in the effective loss of one 12-hour ambulance every day from Monday to Friday for an entire year.

The document was prepared by the director of paramedicine and medical transport at the health authority, Michelle Breen.

It was emailed by Eastern Health vice-president of quality Kenneth Baird to an assistant deputy minister in the Department of Health, and other health officials, on Oct. 27.

"Further to recent discussions pertaining to ambulance resources in [the] metro area, please find the attached briefing note detailing the evidence-based recommendation for resource adjustment, for the department's consideration and approval," Baird wrote.

Details of those recommendations are blacked out in the versions of documents released through access to information.

CBC News asked Eastern Health and the Department of Health for interviews about the contents of the briefing note, and what actions have since been taken to address the issues raised in it.

Eastern Health declined, and steered inquiries to the department.

Officials there also did not make anyone available for an interview, explaining that decision in an email to CBC News. 

"The minister is the primary spokesperson. Given we are in a provincial election, we are not able to arrange for interviews with the minister or send statements on his behalf," a spokesperson wrote.

"However, if following the election you would like to circle back on this request you can certainly send us an email and we can look into it."

Department has taken action, Furey says

Liberal Leader Andrew Furey told reporters the government has moved to make changes.

"My understanding is that the Department of Health and Community Services have taken action on this, on addressing this issue," Furey said during a virtual media availability from Labrador, where he was campaigning Monday morning.

"It's been a perpetual issue, we know, and we're taking action to mitigate some of the acuteness within the last few months, including hiring new employees for front-line paramedicine — some of which are NAPE, and some of which are private."  

The health department declined a followup request to provide more details on what actions have been taken, in the wake of Furey's comments.

But Newfoundland and Labrador Association of Public and Private Employees president Jerry Earle said he is hearing different things from front-line workers.

"If the premier would give us permission, we'll actually bring a paramedic forward, just the same as they've done with the radiologist on the west coast, that would refute that, actually," Earle said. "The issues there have not been addressed."

Meanwhile, the provincial New Democrats said the revelations are alarming, and called it particularly troubling that the public would not have known about the situation except for a CBC News access-to-information request.

"What other bad news is government keeping secret?" the NDP candidate for St. John's Centre, Jim Dinn, asked in a press release.

Jerry Earle is the president of the Newfoundland Association of Public and Private Employees, the union representing Eastern Health paramedics. (Eddy Kennedy/CBC)

Earle, meanwhile, said he was "almost stomach sick" when he went through the document.

The NAPE leader, a former paramedic himself, said the briefing note vindicates what the union — and the front-line workers it represents — has been saying for years. 

"They know it's happening," he said. "They know that people's lives are in jeopardy."

Earle was particularly struck by the number of red alerts referenced in the document.

"Can you imagine, 2,022 periods when no ambulance was available if your child was choking, if your loved one was in cardiac arrest, or if you had a motor vehicle accident or a medical emergency?" Earle said.

"No ambulance was available 2,022 times in a 12-month period."

He also took aim at the impact of off-load delays — over 3,000 hours in total over a one-year time frame.

"What that is is when an ambulance shows up at an emergency room and there is no bed available so they have to stand there with a patient on a stretcher," Earle said.

A 2015 report recommended adding resources — changes that were not fully implemented.

COVID concerns

The day the Eastern Health briefing note outlining all these issues was emailed to the government, there were just four active COVID-19 cases in the province. 

The number is not much different today — still in the single digits.

So what would happen to this already-strained system in the event of a coronavirus outbreak similar to those in other parts of the country?

"They would not be able to handle a significant increase, because they can't handle it now," Earle said.

"Can you imagine if in one of our long-term care facilities, we had a COVID outbreak, and we needed additional emergency resources in the form of paramedics and ambulances? It would not be available."

Read Eastern Health's briefing note: 

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Read more from CBC Newfoundland and Labrador

With files from Katie Breen

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