The timer counting down until our next 911 call has been shortened again by dispatch, the third time this shift. We just finished transporting a teenager with serious self-harm injuries to SickKids hospital. Now we’re under the gun again.
We are supposed to have 40 minutes to offload a patient into a bed, sometimes change their clothes, attach them to equipment, or help them to the washroom; provide a report to the triage nurse; clean and disinfect our stretcher and ambulance; restock our supplies; complete our paperwork; and debrief with our partner. Now, dispatch updates us to say we only have 33 minutes.
I’ve been a paramedic in Toronto for three years, and for two years before this in Guelph. My name is Parker Palmer, though that’s not my real name — to write this article, I have to use a pseudonym. Our contract prevents us from speaking openly about our employer, and writing the article under my own name could jeopardize my career. The patient stories that I tell in this article are a patchwork of real events from multiple different patients, with identifying details removed to protect their privacy.
Staff and infrastructure shortages in Toronto Paramedic Services (TPS) are chronic issues, decades in the making. A 2015 report by our union local CUPE 416 identified the causes behind critically low morale among paramedics: call volumes that grow by three to five per cent each year; not hiring enough staff; a lack of trust in management. When it was presented to city council, it was ignored.
Since then, these issues have skyrocketed, made worse by the pandemic. They culminate in “code reds,” times where there are zero available ambulances in the city. According to freedom of information (FOI) documents, Toronto Paramedic Services reported an average of 5 hours and 31 minutes in code red per day in 2022, or 23 per cent of each day. The city says 2023 was better, reporting 2 hours and 24 minutes per day with less than 10 per cent ambulance availability. (They haven’t yet released data for the amount of time spent in code red).
While the causes of this crisis are systemic and multifaceted, their burden is shouldered mostly by rank-and-file paramedics, emergency room (ER) staff, and our patients, who are increasingly people suffering from poverty, disabilities, mental health issues, lack of access to basic medical services, and social isolation.
Susan, a five-year veteran paramedic in Toronto, tells me about her days at work: “I’m not really an anxious person at all, and I have found that working in Toronto, I’ve actually developed night shift anxiety. […] I feel anxious about entering a night shift because I know we’re probably going to get wrecked for 12 hours straight without a break […] and then have to work longer than 12 hours.” (I’m using a pseudonym for Susan, to protect her job.)
Back at SickKids, not one of the roughly 150 ambulances staffed in Toronto today is available, and there is a call in Scarborough, a 45-minute drive away, that has been waiting for hours. With our paperwork unfinished, dispatch reduces the 33 minutes we thought we had down to 29.
This is nothing compared to the grueling four-hour wait our injured elderly patient endured, trapped on the floor, covered in his own urine, unable to stand. He called 911 in desperation three times, but there weren’t enough staff working in dispatch, so he was put on hold.
After an hour commute, we arrive at a Toronto Community Housing Corporation (TCHC) apartment in shambles: dishes, clothes, and garbage litter the tiny space, various known and unknown insects skitter away as we enter. Our 85-year-old patient is face-down in a small washroom, naked, yelling for help. We determine the immediate cause of the fall is likely sepsis from a UTI, causing weakness and delirium.
I call our patient’s family. They tell me that this is the third such fall in as many weeks, recounting a heartbreakingly familiar story: despite their best efforts, the waitlist for a long-term care home is too long, in-home care services are overstretched, and the long hours they work to make ends meet prevent them from being present. Their loved one isn’t safe at home anymore, but he has nowhere else to go but the ER.
After 16 years on the job, Diane recounts the extent of her heartbreak. “Watching patients die on offload delay, that’s happened to me multiple times. How is that even possible? That’s disgusting. But that’s not in the news.” (I’m also using a pseudonym for Diane, to protect her job.)
Diane’s patient could easily be mine. After driving quickly to the closest hospital, the triage nurse tells us there are no beds. We will care for our patient for an unknown length of time, in a hallway usually reserved for garbage bins and laundry. This is offload delay.
While offload delay has been touted by senior TPS management and Mayor Olivia Chow as the single largest issue contributing to code reds, the reality is that it’s only one of many problems — problems that exist within TPS, the city of Toronto, Ontario, and Canada at large. But offload delay is a convenient issue to point to, because hospital administration is not under municipal oversight, it relieves both TPS management and city politicians of any responsibility for the crisis.
Speaking about what the city’s response has been, Susan is livid. “Instead of helping us, they are looking for ways to further reprimand us, to scare us, to belittle us to comply with a dictatorship.”
The crisis in our ERs is decades in the making. In Ontario, a series of governments — first the Liberals and now Doug Ford’s Conservatives — have cut funding to our healthcare system. Canada is an outlier among OECD countries, with one of the lowest numbers of hospital beds per capita. And Ontario ranks worse than all other provinces.
Many of the paramedics I interviewed for this article tell me the same thing: funding preventative health care to help patients avoid serious medical issues is the number-one way governments should begin to address this crisis. That money is being spent anyway, on repeat ER visits by chronically ill patients and, increasingly, on paying private companies to fill in the gaps.
As the ambulance crisis rages on, businesses are circling like vultures. Medavie Health Services, a private health-care company, recently took over management of paramedic services in Lennox-Addington County near Kingston, despite multiple issues with the company’s management of ambulance services in New Brunswick. There, the auditor general found that the company was paid millions in bonuses to meet ambulance response time targets that were biased against rural areas, and collected $8 million in surplus payments that came from cost savings due to a shortage of paramedics, creating a disincentive to hire more paramedics.
Back in the hospital, after hours of waiting, our patient becomes so sick that he requires a resuscitation room. I provide a report to the doctor while my partner cleans our stretcher in the company of six other medics who are still on delay. It’s now 90 minutes past the end of our shift, and with the half hourlong drive back to the station, we will have worked 14 hours today.
My partner drives while I finish my paperwork. A message pops up on our computer screen: “Hello lovely medics, we are experiencing a high number of calls today. Anyone who would like to work overtime, please call the Duty Officer!” Exhausted, we shake our heads in disgust, wondering what more we could possibly give. We’re 10 hours from doing this all again, and it won’t be nearly enough.
This article appeared in the 2024 Feb/Mar issue.
