This article was originally published by the CBC NEWS on October 15, 2020. You can view the original article here.
Calgary’s EMS system experienced red alerts — meaning no ambulances were available — on 116 days in 2019, something critics say shows a system teetering on the razor’s edge.
Some of those red alerts came and went in the blink of an eye, while others were more prolonged.
On Aug. 12, the worst day for cumulative alerts last year, the system was in red alert almost continuously for just over 65 minutes, between 12:20 and 1:42 p.m.
On Nov. 21 and Sept. 6, the cumulative alerts lasted a mere five seconds.
There were 18 days in 2019 when there were over 15 minutes of alerts throughout the day, and a further 15 days that saw over 10 minutes worth of alerts.
The figures come from data released by Alberta Health Services to CBC News in a freedom of information request.
Stress on crews
Mike Parker, president of the Health Sciences Association of Alberta, which represents EMS crews in the province, says the figures show a system under considerable strain — and it’s been happening for years.
“We have been putting our members on the front lines at risk. We’ve been putting citizens of this province at risk for a very long time,” he said.
“It doesn’t clearly paint the picture of the emergency response capability, when you have one ambulance for an entire city and the stress that it puts on a crew who has just cleared the hospital on an event and does not have time for a vital break, to catch their breath, to reset, restock or do any component of ensuring that they’re ready — and they’re being slammed into another call of unknown origin all the way across the city.”
Parker says the system is run on the “razor’s edge,” even when it’s not in a red alert.
Documents obtained by the HSAA earlier this year showed demand was up almost 20 per cent since 2012-2013, but there’s only 3.4 per cent more paramedics.
Only 10 ambulances have been added to the fleet in that time.
The red alert data also doesn’t show the impact on the communities around Calgary and the crews who service them.
The outlying communities
When the city is in a red alert, the shortfall can be made up by bringing outlying crews into the metro area. Even without a red alert, those crews often find themselves stuck in the city if they venture in to deliver a patient and calls keep piling up.
The system is designed so that the nearest truck has to respond to a call.
“I mean, there’s someone at the end of this line every time because Calgary sucks in the nearest trucks, and then the next closest trucks, and then the next closest trucks, and everything kind of shifts toward the city,” said an EMS employee who works in an area outside of Calgary.
“So that means that Vulcan, or Nanton, or Canmore, or Banff, or Didsbury or Olds — whoever is the end of that line, and their municipalities, are going for hours, upon hours, upon hours without an ambulance because Calgary is a higher priority.”
CBC News has agreed not to identify any EMS employees because they are not authorized to speak and could lose their jobs for doing so.
One employee says AHS will always assure the public that the nearest ambulance will always be dispatched and will always arrive, but they fail to mention that ambulance could be 45 minutes away.
The employee says crews suffer the guilt of not being able to service their own communities, where many live.
Relief for the city
Another EMS employee, who also works outside of Calgary and who is not being identified, says the flip side of the frustration of being pulled into the city is the concern they have for the metro crews who are under considerable strain and working long hours.
“The other issue with all these red alerts in Calgary is, on one hand, I want to help my coworkers, you know, my friends that also are doing this, because I know in Calgary if I’m getting called in, that means they can’t get a break. So they’re getting crushed,” the person said.
“So it’s a double-edged sword. I want to help them, you know, relieve some of that pressure by taking some of their calls. But I also know that I’m now going to probably be working in Calgary until I timeout at 14 hours.”
The cause of the strain could be placed on everything from a lack of resources, shortage of paramedics, a shortage of hospital beds and inability of crews to quickly drop off patients and get back on the street when they do arrive at a hospital.
Neither Parker nor the EMS employees could say whether a shortage of ambulances either in Calgary or the outlying communities has been directly responsible for a bad outcome for a patient, including death.
Darren Sandbeck, the chief paramedic for AHS, says red alerts are simply a management tool that alerts the system that transport capable ambulances are not available, but he says other resources are, including community paramedics and supervisor staff and single practitioner units.
“When we get to those levels of ambulances not being available, we begin to work with our staff in the emergency departments as well as our EMS staff to start making units available,” said Sandbeck.
“So, you know, there could be a unit, as an example, that’s just finishing up a call at a hospital, and they can be made available in seconds to get back onto the street to provide that resource.”
Sandbeck says he’s aware the system is busy and says there are bad days, but also notes there are good ones that don’t involve red alerts or stretched resources.
He also points to response time data — which only shows the time for life-threatening events — that has remained fairly consistent over the years.
“I won’t deny that the system is busy, we know that it’s busy, we do. We’ve made efforts fairly recently, over the last year or so, to reduce what we call end-of-shift overtime, so that we’re ensuring that folks are getting off shift on time, and that they’re not having to experience late calls,” he said.
“So all of that work continues in an effort to, you know, continue to support our staff and ensure that they have the tools that they need.”
Casual employees filling void
Parker says too much of that work includes relying on casual employees to fill the void, workers who aren’t offered benefits, sick days, vacation days or job security.
“So now they’re creating this whole environment of a disposable paramedic workforce, that if you’re sick, you just don’t come to work anymore,” he said.
“We’ll put all of that into the morale of the members that are on the streets that are charged with protecting the lives of the citizens of this province. It’s a failure on behalf of management at AHS and this government. They all know what’s going on.”
Sandbeck says the EMS system uses casuals “extensively” to provide coverage.
One of the EMS employees who works outside of Calgary agrees that more needs to be done to bring relief.
“I think we’re all just really frustrated. Our management is touting all this personal self-care, mental health, and yet they’re not willing to hire the people to let us take our vacation days or time off days. And the days that we are working, you know, we’re on these red alerts all the time,” the employee said.
“And we’re failing our local communities to help these other people, which is still helping, but it’s not our community.”
The system, everyone acknowledges, is complex and constantly shifting. Solutions are not easy. Sick days, vacation days, call volumes and things like weather all play a role in determining how strained the system is.
A provincial budget that is in a record deficit, with a government that is trying to save every penny it can, also plays a role.
Parker would like to see more ambulances on the road, job security for existing employees, and a plan to reduce the amount of time that crews are stuck in hospital with patients waiting for a bed.
Sandbeck says they’re looking at the best use of resources and finding efficiencies, but echoes Parker in saying crews need to be able to get in and out of hospitals more quickly.
“Our real challenge is trying to move patients through emergency departments,” he said.