Several Ontario municipalities say their paramedic services are under immense pressure, with worrying stretches of times during which no ambulances are available to respond to calls—but the province doesn’t track the problem.
The government does have data on the hours paramedics spend waiting in emergency rooms to transfer patients to the care of a hospital, which are often a key factor in ambulance availability, but won’t disclose it.
Some emergency officials and community leaders say more needs to be done to help paramedic services, but the lack of publicly available provincial information makes it hard to assess the scope of the problem.
“We just want to be able to have a baseline to say, ‘Oh, things have improved since 2020, since 2018,’ and being able to quantify the data so that when we do go to the province, or to our employers, we want to be able to go with solutions,” said Niko Georgiadis, chair of the CUPE Ambulance Committee of Ontario.
Ambulance dispatch centres are mostly operated by the province, so they should be keeping track of how often there are no ambulances available—situations known as code zero or code black—said Georgiadis.
A spokesperson for Health Minister Sylvia Jones said the province doesn’t track that because municipalities are responsible for ambulance deployment strategies.
Ontario generates monthly reports based on data from ambulance dispatch centres, including time paramedics spend waiting in ERs to transfer patients—known as offload delays—by hospital. But requests for the figures, including a specific request for the most recent report, went unacknowledged.
Jones has implemented and expanded various programs to address ambulance availability issues, from increasing funding for nurses to monitor ambulance patients so paramedics can get back on the road, to allowing paramedics to take patients somewhere other than an ER.
“Our government’s four-part strategy to tackle ambulance offload time issues is focused on: returning ambulances to communities faster, providing timely and appropriate care in the community, facilitating non-ambulance transportation for stable patients, and increasing health care worker capacity,” spokesperson Hannah Jensen wrote in a statement.
But several communities say offload delays and the lack of ambulance availability skyrocketed from 2021 to 2022. Some say it’s looking a bit better for 2023, but more needs to be done.
Essex-Windsor EMS Chief Bruce Krauter has been combing through his own region’s data, and found that from January to May, code blacks and code reds—when there were either no ambulances or one or two—tended to happen between 3 p.m. and 11 p.m.
He ties that to the lack of availability of urgent care clinics and primary care during those hours, and has asked Jones to fund those services for extended hours.
“If we get some better urgent care, primary care, those code reds and blacks should come down,” he said.
Jones’s spokesperson said the minister is working with health-care leaders in that region on “innovative solutions” to increase ambulance availability.
The County of Essex declared an emergency in the fall due to long offload delays and code reds and blacks. On one day preceding the declaration there were no ambulances available for almost three hours as 26 paramedic teams were delayed at hospitals.
There has been some improvement since then, Krauter said. In October there were a total of 629 minutes during which no ambulance was available. In May that total was 173 minutes. But the local emergency remains in place until there are no more code reds or blacks, Krauter said.
More funding from the province for dedicated offload nurses—who can manage ambulance patients in the ER so paramedics can get back on the road—has helped, Krauter said, as has EMS putting a “navigator” into the dispatch centre to help direct movement of ambulances.
Reprioritizing ambulance calls under a new dispatch algorithm is also expected to help, Krauter said.
“Right now if you call for 911 ... and you say, ‘Hello, I hit my nose on something and it’s bleeding,’ you automatically get an ambulance lights and sirens to your house,” he said.
“We’re over-responding to calls and all that does is drain resources.”
In hospitals, Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, said even with the increased funding for dedicated offload nurses—$51 million extra over three years—the money can’t always be put to use because of general nursing staff shortages.
The health minister’s spokesperson noted the province expanded that program last year to allow paramedics, physician assistants and respiratory therapists to assist.
Ottawa Mayor Mark Sutcliffe has asked the province to pay for 51 new paramedics to act as offload paramedics. Normally, paramedics are funded 50-50 by the province and municipalities, but Sutcliffe argues offload delays are a provincial responsibility.
Last year, Ottawa’s paramedic service spent 93,686 hours in offload delays. In Toronto, that number was about 300,000 hours, according to a paramedic services report.
In Waterloo Region, the amount of time no ambulances were available increased by 571 per cent from 2021 to 2022.
Offload delays are a factor, as are an increase in call volumes and paramedic staff shortages, said John Riches, chief of paramedic services.
The region has increased ambulance resources and 2023 is so far looking a little better, he said, but it’s “not significant enough to celebrate.”
Waterloo Region paramedics and its three area hospitals are hoping to introduce a “fit to sit” program this fall, in which paramedics can leave certain stable patients to wait in the ER, he said.
Hospitals in Durham Region have such a program, and that along with additional offload nurse funding has helped dramatically ease offload delays and code zeros, said paramedic services chief Troy Cheseboro.
Over the past couple of years it wasn’t uncommon to have offload delays of four hours, and now most are under 60 or 90 minutes, Cheseboro said.
“We’re seeing huge, huge changes with the work the hospital has done to try to mitigate some of these added pressures,” he said.
Cheseboro said Durham has also seen great success with the community paramedicine program, which sees them provide in-home care and outreach to frequent callers and those who need help with chronic disease management. He would like to see stabilized funding for it beyond the current 2026 commitment.
