Paramedics stranded in overcrowded ERs demand changes

With paramedics spending thousands of hours stranded with patients waiting to get into overcrowded London hospitals, Middlesex County officials are demanding improvements from the hospitals and the regional overseers of health care spending.

County officials have met twice recently with counterparts at London Health Sciences Centre and once with the South West Local Health Integration Network, each time seeking changes and improvements to the way nurses intervene to bring patients into the city’s emergency rooms, Neal Roberts, chief of Middlesex-London Paramedic Service, wrote in a report to county council.

“The County Delegation requested that London Health Sciences Centre immediately reduce or eliminate EMS gridlock, and that London Health Sciences Centre ensure that the staffing for the EMS Off Load Nurse be consistently staffed as per the agreement,” Roberts wrote.


(Any time greater than 30 minutes spent by a paramedic crew at the hospital ER is considered an offload delay)

2013: 5,921

2014: 6,019

2015: 5,017

2016: 7,437

2017: 10,800+

Even before that call for help, hospital officials had decided to take the unprecedented step of creating procedures to move patients into hallways to free up space in ERs, surgical recovery rooms and intensive care wards — the groundwork was laid in January with the new hallway protocol taking effect earlier this week.

“We have been working with chief Roberts (to) address their offloading concerns,” hospital vice president Julie Trpkovski told The Free Press.

Sometimes, demands on ERs become so high, with no spaces in wards to move patients, the LHSC has had little choice but to move nurses helping paramedics to treat trauma patients in emergency rooms, she said.

Those challenges have been made greater by the growing number of patients taken to hospitals in ambulances — there can be as many as 10 lined up but only room for five stretchers in the hallway leading to the ER, she said.

“Our volumes have definitely grown,” Trpkovski said.

A lack of funded hospital beds has become the norm in many Ontario hospitals, including in London, and that creates a bottleneck that backs up ERs, she said.

“It is a system-wide (problem),” she said.

Paramedics have called for officials to make those in the system more accountable for delays, meeting twice with the local health integration network. Asked this week by The Free Press about those efforts, an official at the network said there would be a response next week.

In 2017 paramedics — who are supposed to spend no more than 30 minutes each time they drop off patients at Victoria and University hospitals — instead spent an extra 10,800 hours, the equivalent of losing a 24/7 ambulance crew for more than 451 days.

Instead of having 24 ambulance crews during the day and 16 at night to respond to 911 calls, too often, there are few ambulances available or none at all, Roberts has said.

That there are lengthy delays at hospital ERs isn’t new — such delays were one of the reasons London Health Sciences Centre (LHSC) embarked four years ago on an ambitious project to streamline care, borrowing methods made popular by giant automaker Toyota.

But instead of improvement, the opposite occurred: Delays for paramedics have more than doubled since 2015, including a 45 per cent jump from 2016 to 2017, data from paramedics shows.

There was some improvement in March compared to earlier months, Roberts wrote in his report to county council.

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