The strain on the health care system is being felt on a day-to-day basis by paramedics in the London, Ont., area, and while the impacts often stem from influences outside of their control, the head of the Middlesex-London Paramedic Service (MLPS) says reforming its dispatch system could go a long way.
The dispatch system controls the ebbs and flows of ambulance movements throughout London and Middlesex County, as well as how different calls are assigned or triaged, and is currently operated by the Ministry of Health.
That strain was felt first-hand by Josh Allen, who worked as an advanced care paramedic for the MLPS for eight years before leaving in April. He’s since moved on to work with a rural service outside of London.
Leading up to his departure, Allen says he wanted to be more available to attend to a medical family emergency that was hours away from where he was working, but adds that issues he faced while working as a paramedic in London tipped him over the edge in deciding to leave.
Allen says the issues were multi-faceted and made even worse during the pandemic. They include staffing shortages, call volumes and offload delays at emergency rooms.
“You would come in for your 12-hour shift, you would get a call, most days, as soon as you walk through the door, and then you were lucky if you were able to get back to the station for a break,” Allen said, adding that he places most of the blame on the Ministry of Health’s dispatch system
“You need to pee, you need to have a sandwich, you need to put your feet up for 20, 30 minutes a day, and the way the dispatch centres are set up now, it just doesn’t consider those sorts of things. It’s just: Here’s the call, we need the call serviced, put the closest truck on it and then away you go.”
According to Jason Schinbein, the president of OPSEU Local 147, the union representing local paramedics, Allen’s not alone in feeling the strain.
“We’ve found that almost 30 per cent of our staff is looking to leave as soon as possible to find other jobs,” Schinbein said of a recent survey sent to Local 147 members.
Other research conducted by the union found the average age of local paramedics had dropped, with the majority now in their early 20s, according to Schinbein.
“Almost every day, we are running less ambulances than what we want to be running. We aren’t able to fill trucks with paramedics because they just aren’t there. The system has become so overburdened and so neglected for the last decade and more.”
MLPS Chief Neal Roberts says local paramedics are facing an “unrelenting pressure,” driven in part by an increase in calls and offload delays.
“Adding to that, our staff have been dealing with COVID for almost two and a half years, so certainly they’re tired and exhausted,” Roberts added.
“This year alone was unprecedented in our hiring. We hired 83 new staff members and we put on three additional 12-hour vehicles, but the challenge is … the more we hire, the more we need.”
Roberts and Schinbein also agree that a major issue driving the ongoing strain is the MLPS’ dispatch system.
Calls for dispatch reform
According to Roberts, the current dispatch system is outdated, flawed and often leads to unreliable data when tracking “code zero” events, which refers to a given time when there are no ambulances available to respond to calls.
That’s because when the Ministry of Health started tracking code zeros, the proper technology wasn’t available, nor were dispatchers properly trained on how to do so, Roberts said, leading to a disconnect between dispatchers and supervisors on the ground with available vehicles.
Another common problem is that when dispatchers push the button required to declare a code zero, that code zero will remain in effect until it’s given the all-clear by the dispatcher.
“Dispatch is so busy, and I’m not blaming the dispatchers, then they would forget to stop the code zero clock when the system was restored,” Roberts added.
Roberts says under the current dispatch system, too many non-urgent calls are treated as emergencies.
“Eighty to 85 per cent of our calls go out lights and sirens. The reality is we’re coming back lights and sirens about 15 per cent of the time, so there’s upwards of a 70 per cent over-triage or over-prioritization of these calls,” Roberts added.
For years, MLPS and the County of Middlesex, which is responsible for providing ambulance services in the region, have been advocating for dispatch reform.
Middlesex County Warden Alison Warwick tells Global News she intends to reiterate the call when she meets with Health Minister Sylvia Jones during next week’s Association of Municipalities of Ontario in-person conference.
Global News reached out to the Ministry of Health for comment on the MLPS’ concerns with the dispatch system, but did not receive a response prior to deadline.
While the calls for a reformed dispatch system have yet to be answered, Roberts says there are workarounds in the meantime that could lead to long-term solutions.
This includes frequent discussions between MLPS and London Health Sciences Centre officials to find ways to free up vehicles when off-load delays arise.
Another success was found in an ongoing diversion strategy that sees low-acuity mental health patients transported by paramedics to the Canadian Mental Health Association’s Huron Street site rather than an emergency department. Providing paramedics with more alternative destinations for patients could ease the burden of emergency departments even further, Roberts says.
“What I’d like to be able to see is a system where we operate dispatch, and when that call comes in, we’re either sending a transporting ambulance with advanced care paramedics or we’re sending a community paramedic or we’re sending a mental health team or we’re integrating ourselves within the hospital system,” Roberts added.
“A more coordinated, collaborative effort of health care provision … that’s really the goal.”
— with files from The Canadian Press’ Paulo Loriggio.