As Ontario’s health-care crisis intensified, the province was asked to double down on a policy created more than a decade ago to reduce how long ambulances are stuck in emergency rooms.
In 2008, the then-Liberal government began employing nurses at Ontario hospitals to help unload ambulances and get paramedics back on the road faster.
That person — a dedicated offload nurse — was tasked with working exclusively on receiving low-acuity patients from paramedics and putting ambulances back on the road.
It’s a program that Darryl Wilton, president of the Ontario Paramedic Association, said he understood was supposed to be temporary.
“We were expecting the hospitals in the background to kind of churn through what their backlog issues were and fix the emergency departments,” he said in an interview with Global News. “And the reality is that hasn’t happened.”
Documents prepared for Ontario’s minister of health in the summer of 2022 show that, instead of improving, the situation worsened dramatically in the decade that followed.
According to documents obtained by Global News, the program remained consistent at $16 million per year from 2012 to 2021, with 50 hospitals across 20 municipalities taking part.
But last year, as paramedics struggled with growing offload times and a shortage of ambulances to respond to 911 calls in some areas, there were calls to increase it.
Three new local governments, which are responsible for operating ambulance services, asked for funding for a dedicated offload nurse in the 2022 to 2023 year. According to the 2022 budget document, the three new municipalities to request funding were Sault Ste. Marie, Muskoka and Guelph.
Wilton said the offload nurse was a “pilot program” when it was launched in 2008.
“Demand for … funding continues to increase,” a briefing prepared for minister of health Sylvia Jones in June 2022 read.
The document, including heavy redactions, was part of a list of “can’t wait” decisions presented to Jones when she became health minister. Copies were obtained through a freedom of information request.
The note asked minister to sign off on funding for dedicated offload nurses in the 2022-23 year. At the Association of Municipalities of Ontario conference, Jones announced that funding of $23 for the offload program would flow.
“To help relieve pressure on the ambulance system, we are increasing annual funding for the Dedicated Offload Nursing Program and increased eligibility so that more health care professionals can assist with offloading ambulance patients in emergency departments and paramedics can respond to their next emergency call sooner,” Jones said in a speech prepared for the conference.
The briefing said that — when it was written around June 2022 — ambulance offload times were “very high” in many parts of the province, “having risen sharply due to successive COVID-19 surges, ED patient volume increases, and health human resource (HHR) shortages.”
A series of policies in 2021 and 2022 designed to reduce the offload time helped a little, but the briefing said, “some sites are experiencing (offload) increases for the first time and others continue to struggle due to local factors.”
In August, for example, the head of Hamilton’s paramedic service said his crews were experiencing record delays.
“They have gone up probably about 15 or 20 per cent. — those are numbers that are way, way too high,” Michael Sanderson said at the time.
At the time, midway through the year, he said there had been almost 200 code zeroes declared in the city.
The Ministry of Health announced some paramedic changes during the summer.
For example, the province began to allow more paramedics to avoid taking patients to the emergency room on every call in an attempt to cut down on offload times and delays.
The first phase of the paramedic pilot project was launched in 2020 with programs in more than 40 municipalities that allow paramedics to take patients somewhere other than an emergency room, such as a mental health facility, or to treat them on scene.
Despite a range of initiatives, wait times continue to grow in places.
“It’s not ideal — however, we’re really left with no other option,” Wilton said of the paramedic offload nurse program.
“Paramedic services in major municipalities across Ontario are struggling to meet the needs of our patients and communities when they call 911,” he continued.
A spokesperson for the Ontario Hospitals Association said it was essential to take a “‘Team Ontario’ approach in seeking to overcome the complex, underlying issues facing the healthcare system and ensure that patients receive access to the right kind of care in the right setting.”
Delays are so severe in Toronto that the issue was pencilled in for Mayor John Tory to raise when he spoke to Ontario Premier Doug Ford in October 2022, after winning in the city’s municipal election.
An email from Tory’s chief of staff — obtained by Global News through a separate freedom of information request — listed six items to be discussed between Tory and Ford.
“I have a note from Chief Raftis, but please check if there are any updates,” a brief line in the email says, referencing paramedic wait times.
A spokesperson for Tory said that, during the meeting, he raised the issue of offload and transfer delays.
“The mayor reported on the experience of many ambulances and paramedics waiting hours at a time to transfer/offload patients, meaning those paramedics and ambulances were unavailable for other calls,” the spokesperson said.
“They discussed how the province could help ensure ambulances are on the road and available and not delayed at hospitals.”
Some hospitals reportedly recorded delays in offloading patients from ambulances of 200-plus minutes, six times the benchmark time of 30 minutes, the note prepared for Jones said.
“Rising (offload time) has led to several code zero events with no ambulances available for limited periods, leading to lower service levels in some communities along with heightened anxiety and public criticism,” it read.
Wilton said that, until hospitals are able to process patients more quickly, innovative policies will only mask — and not solve — the problem.
“They’re overwhelmed — they have too many patients for the amount of staff and beds available to treat them and how do we get our units back in the communities?”
— with files from Global News’ Don Mitchell and The Canadian Press