Monday, 7 January 2013

Is the solution to keep our Paramedics on the street?

Dear Readers,

Today, I bring you an article verbatim by Maryam Shah of the Toronto Sun about what happens when an essential service is forced to operate with a restrictive regulation that at first glance, doesn't make much sense! As usual, my response is below with space provided for your comments, unless you want to email your comments directly.

                                                       Toronto EMS
                                                                photo by STAN BEHAL, Toronto Sun
A senior in a nursing home died after waiting more than three hours for an ambulance, according to a union spokesman for Toronto’s paramedics. Mike Merriman, a shop steward with CUPE Local 416, said that EMS received a low-priority call to assist a senior suffering abdominal pain at a nursing home on William Morgan Dr., in the Don Mills Rd.-Overlea Blvd. area, on Dec. 30.

Considered an “alpha call” — meaning it was deemed to be a low priority — an ambulance should have responded within 21 minutes. However, Toronto’s taxed EMS system had its ambulances out on higher priority calls and it took three hours to respond to the senior. “Regardless of what the call came in for, he died waiting for an ambulance,” said Merriman, who has repeatedly complained of staffing shortages in Toronto’s EMS department. “That’s just unacceptable.”

The incident came just days after Toronto hit a point on Dec. 27 when there were no ambulances available to respond to emergencies. When paramedics arrived at the nursing home, the elderly patient exhibited no vital signs, said Merriman. There was a DNR (do not resuscitate) issued for the man. Councillor Janet Davis said Wednesday it’s “very concerning” that this year’s budget cuts 10 EMS positions.

“The recent shortage of emergency response vehicles is very alarming,” said Davis. The call originated at 3:17 p.m. By 4:30 p.m., the nursing home was informed of a delay as ambulances were on other calls deemed to be of a higher priority, said EMS spokesman Arthur Graham. “The units that were assigned kept getting reassigned to higher priority calls,” he said Wednesday.

At 6:29 p.m., the nursing home called to inform EMS the patient was in pain and wanted Tylenol 3s, according to Merriman. A minute later, the home called to say he was not breathing. This propelled the call to the highest level — an “echo” — with a crew responding within minutes. Graham would not release details about the patient, citing confidentiality concerns.

Merriman — who was suspended recently after publicly criticizing the way EMS management handled the department’s funds — said this incident marked the first time he heard of someone dying while waiting for an ambulance. “But I’ve been saying all along, it’s only a matter of time before that happens,” he said. “(I’ve) been trying to warn council or whoever for two years, that something has to give because something is going to happen.”

EMS deputy chief Gord McEachen said Wednesday calls are ranked based on the most current information available. “Once we received (notification about the) change in the patient’s condition, we responded with our highest level of response and we were there within five minutes,” he said.

                                                      Toronto EMS with a shooting victim!!
my response.....

The problem isn’t a lack of ambulances as the EMS union suggests, according to Jeffrey Tighe. The problem is what the crews are doing with their time. The auditor general found the average time EMS crews waited to off-load patients at emergency rooms was 30 minutes, running from few minutes for urgent cases to more than an hour for non-urgent cases. If you walk into an emergency room with a non-urgent matter, you are told to sit down and wait. So why do EMS crews have to wait with non-urgent patients, instead of going back on the road to help others? The province should implement an emergency room requirement of immediate pre-triage of patients by a nurse upon arrival by EMS. Those who are non-urgent should be told to sit down like everyone else or should be transferred to a hospital stretcher, and the EMS crews should be released in minutes, not hours.

                                                 Toronto EMS with another shooting victim!

Off load delay has substantially been cut down in the last 2 years, but the problem that still exists is the time it takes to get triaged and then transfer of care, according to B S Hunter. Offload delay still exists, but not like before, now it is just primarily lack of staffing to keep up with call volume. TEMS has been running over capacity for quite some time, and now if there is the slightest surge in calls, calls get stacked and wait for ambulances to come available. On the good side, upper management are well taken care of with sufficient perks, vehicles, and management staffing levels, so they can pounce on any medic that complains about lack of staffing!

A senior in a nursing home dying after waiting more than three hours for an ambulance is a similar situation to the Danzig shooting in East Toronto when no EMS ambulances were available so an ambulance from Oshawa was sent to the 20 minutes, at best! Can you imagine the uproar for those who are in distress in the east end of Toronto and had to wait for Police or Fire to respond from Oshawa?
                                          Toronto EMS staging times have been reduced of late  

When James Harris died of a heart attack in the lobby of his downtown apartment building while waiting nearly half an hour for care while an ambulance waited around the corner for a police escort; called staging, the demand for change was deafening. Since then, the number of staging incidents have been reduced drastically, judging by the above chart. This regulatory change happened quickly and has been successful in reducing wait times.

So why are our emergency crews still forced to wait in the emergency room for an average of 30 minutes, running from a few minutes for urgent cases to more than an hour for non-urgent cases? Our Paramedics are the folks who intubate to get you breathing and give you the drugs to keep you alive yet we had none available in both of the above emergencies. Will we have to wait until a medical emergency happens to a Toronto councillor's family before something gets done?


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