'Level zero' crisis turning deadly, city warns

For a period totalling more than five days over the first eight months of this year, there were no ambulances available to respond to medical emergencies, according to a new report released by the City of Ottawa.

Mortality, morbidity on the rise as paramedics held 'hostage' at hospitals, GM says

Long delays to off-load patients at Ottawa hospitals left the city with no paramedics available to respond to urgent calls on 329 occasions between January and August 2019. (Ashley Burke/CBC)

For a period totalling more than five days over the first eight months of this year, there were no ambulances available to respond to medical emergencies, according to a new report released by the City of Ottawa.

It's referred to as "level zero," when all ambulances are tied up on other calls or waiting to off-load patients at the hospital, leaving none available to respond to new patients who need help.

Stop keeping our staff as hostages.- Anthony Di Monte, GM, emergency and protective services

There were 329 level zero occurrences between January and August 2019, totalling 138.4 hours, according to the city. The longest single period without any available ambulances lasted seven hours and 40 minutes.

It's a problem the city's paramedic service has grappled with for years, but it's getting worse, according to emergency and protective services manager Anthony Di Monte.

Di Monte said the root of the problem lies in the city's understaffed emergency rooms, and he said the results can be deadly.

"Mortality and morbidity is increasing as a result of off-load delays," Di Monte said.

Hospital drop-offs taking longer

When a paramedic team drops a patient off at the hospital, they aim to transfer care to hospital staff within 30 minutes. But in Ottawa, it's taking closer to one hour and 20 minutes.

At The Ottawa Hospital, which includes the Civic and General campuses, it takes even longer: more than 90 minutes, or three times the target time.

What's more, the off-load delays are increasing. In the first seven months of 2019, Ottawa hospitals saw a 12.5 per cent bump in the length of time ambulances are spending waiting at the ER over last year. 

That means fewer ambulances available to respond when someone calls 911, and Di Monte said there's only so much the city and its paramedic service can do.

"It's very frustrating because we don't have the levers of control," he said.  

Anthony Di Monte is Ottawa's general manager of emergency and protective services. (CBC)

The delays are growing despite special funding from the Ministry of Health to dedicate nurses to receive patients more quickly. Those nurses can only treat certain types of patients, according to the city's report. 

Mayor Jim Watson has met with Health Minister Christine Elliott to press her to recruit more nurses to fill critical vacancies in local hospitals. 

In September, the government announced an additional $424,000 toward additional nurses to help with off-loading patients. 

New plan in the works 

Di Monte said the short-term solution is clear, but it's up to hospitals to implement it. 

"Stop keeping our staff as hostages," he said. "You can do that tomorrow morning by hiring who you have to hire, whether it's a nurse or some other staff, so that when we arrive the patients are off-loaded from our stretcher."

City officials are negotiating with The Ottawa Hospital to try some new ideas to get ambulances back on the streets so they can respond to calls.

One idea is to station a paramedic at the hospital emergency room where they can care for up to five patients at a time until they're admitted. The hospital is looking for money from the Champlain Local Health Integration Network to give that a try. 


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