GUELPH – The time it takes for paramedics to reach residents in medical distress continues to lengthen in Guelph and Wellington County.
The Advertiser has reported extensively on paramedic response times, which have lengthened in recent years as lengthy hospital offload delays and rising call volumes have led to what local politicians have called a “dire,” “obscene,” “inefficient” and “unacceptable” situation.
And yet, the problem worsens.
According to data reported on March 8 to Wellington County’s social services committee by Guelph Wellington Paramedic Service (GWPS) Chief Stephen Dewar, response times have increased over the past year with a lack of available crews to respond to incoming 911 calls.
The number of “code reds,” when no ambulances are available because crews are tied up waiting to offload patients, increased in 2022 to 50 by the end of October – from just four in 2021, and none in 2020.
Last year, local paramedics took an average of eight minutes and eight seconds to arrive to potentially life-threatening calls.
That’s an increase of nearly 30 seconds over the 2021 average of seven minutes and 39 seconds.
Help arrived within 14 minutes to 90 per cent of calls last year — in 10% of calls, response times were longer. That’s up from 12 minutes and 36 seconds in 2021.
Response time data are not broken down at the county level.
Response times in the county aren’t included in the service’s monthly analysis, and because of that historical data isn’t available to determine worsening or improving trends at a county level.
However, Dewar told the committee in September 2021 that response times for the county “are longer than the response times for the entire coverage area.”
Longer service-wide response times mean GWPS was unable to meet a single critical time target in 2022.
Most concerning, Dewar wrote in an email to Advertiser, was the service’s compliance with an eight-minute response time to life-threatening emergencies, such as when someone’s heart has stopped working.
The service met that eight-minute target 63% of the time, whereas the target compliance rate set by Guelph council is 65%.
“These are our most critically ill and injured patients, and we consider anything less than our target to be significant,” Dewar wrote.
The service only met its response time target last year when it came to patients with non-urgent conditions, such as a sore throat.
Dewar blames lengthening response times on increasing call volume and the sometimes incredible delays paramedics face when transitioning patients to the care of hospital staff.
“Our paramedics were required to stay in the hospital to care for our patients for almost 11,000 hours in 2022; more than double the number of hours in 2021,” Dewar wrote in a report to the committee.
Those hours, measured from 30 minutes after paramedics arrive until hospital staff take over care, is the equivalent of 913 12-hour shifts.
Of the total 10,960 hours paramedics spent waiting for their patients to be offloaded, 92.6% or 10,147 hours were spent at Guelph General Hospital.
Service responded to 30,204 calls in 2022
The number of calls for paramedics increased to 30,204 last year, according to paramedic service data.
Of the total calls, 61.6% or 18,606 were in Guelph, and 38.4% or 11,598 were in the county.
The data averages out to around 82 calls per day service-wide, and an increase of 8% over the total number of calls recorded in 2021.
Dewar noted a paramedic services master plan, using computer modelling and historic call data, predicts the service will experience a 43% increase in call volume, from 21,426 in 2015 to 30,639 by 2026.
But Dewar said it may not take that long to fully realize such an increase.
“I anticipate that we will at least meet the call volume projected … in the absence of another pandemic or other event not forecasted,” Dewar wrote in his email.
(Call volume decreased in 2020 as fewer people accessed emergency departments during the COVID-19 pandemic.)
Dewar also touched on last year’s call trends, with data suggesting a 43% increase in calls for patients under the age of 18 when compared to 2021 call data.
“The cause [or causes] of this increase is not yet clear,” Dewar told the newspaper.
“We are looking at the calls, as are our peers in other services who have seen similar increases.”
The most common medical complaints across all ages noted by Dewar were for respiratory illness (1,091 patients), cardiac-related chest pain (712 patients), and drug overdoses (510 patients).
Paramedic chief continues advocating for long-term solutions
The service is trying to address offload delays through programs authorized by the province, such as “Fit-to-Sit,” where eligible patients who are transported to hospital by paramedics are quickly offloaded and directed to sit in the hospital waiting room, rather than on a stretcher.
Introduced in November 2022, the paramedic service believes nearly 300 patients were diverted to waiting rooms across hospitals in the county and Guelph, though data wasn’t provided to support the belief.
A busy community paramedic program, funded by the province, is also being credited for preventing visits to emergency rooms.
Using patient survey data, the service credits the community program with diverting 300 visits to the emergency departments last year.
Guelph General Hospital (GGH) has provincial funding to pay for a dedicated offload nurse working a 12-hour shift.
However, according to a statement emailed on behalf of GGH vice president of patient services and chief nursing executive Melissa Skinner, the position hasn’t yet been filled.
“We have not yet hired someone to fill this position as we are still in the process of designing the program,” the statement read.
“We are taking a collaborative approach to this process; working with both our care partners from Guelph-Wellington Paramedic Service and other organizations in the region to ensure we design and implement the best program possible for our patients, families, and caregivers.”
Dewar suggests adding more paramedics, but doubts the long-term benefit.
“It will only mask the problem,” he wrote to the newspaper.
“There will still be paramedics caring for people in [hospital hallways], and more importantly, patients waiting for definitive care in the hospital for prolonged periods of time.”
The service continues to work with GGH and the province on longer-term, real solutions, Dewar said.
