Paramedic response times on highest-priority calls rise, city’s auditor general finds

Updated: June 28, 2024
Source: https://www.thestar.com/news/gta/paramedic-response-times-on-highest-priority-calls-rise-citys-auditor-general-finds/

The auditor general’s report compares data on the paramedic service from 2019 and 2023.

An increase in paramedic response times between 2019 and 2023 is largely due to longer off-load times at hospitals, says a new city auditor general’s report.

Response times for Toronto paramedics’ highest-priority calls rose last year, nearly exceeding legislated targets, according to a city’s auditor general report released Thursday.

Sudden cardiac arrests, when a person suddenly stops breathing or their heart stops beating, and “high acuity” patients, such as stabbings and head or spine injuries, are the Toronto Paramedic Service’s most urgent calls. The average response time for cardiac arrests rose to almost eight minutes and over nine minutes for the high acuity patients, the report said.

The report primarily blamed the increase on off-loading delays, the amount of time it takes paramedics to transfer patients at hospitals, which rose between 2019 and 2023, according to the report.

The city’s auditor general also noted chronic understaffing of paramedics at the same time as there are a rising number of calls from Torontonians without a family doctor who rely on paramedic services as “a safety net” for basic health care.

According to the report, which will be debated at council next month, every day last year there were 2.5 hours on average where the service only had five or less staffed ambulances available across the city. The number of instances where there were no paramedics available spiked from 29 in 2019 to more than 1,200 in 2023, with each occurrence lasting an average of two minutes.

“Those numbers are shocking. Those are real world impacts,” said Peter Shirer, vice-chair of the Toronto Paramedic Services Unit at CUPE Local 416. “When you call 911, you’re going to have to wait.”

The report found paramedics weren’t on the road as much as they should be because the majority of their time last year — about 60 per cent — was spent in hospitals waiting to transfer patients.

Best practice in the industry is 30 minutes to off-load a patient. The amount of time Toronto paramedics waited longer than that rose from 33 per cent of the time in 2019 to 42 per cent in 2023. The auditor’s report compared those two years to eliminate the effects of COVID-19 on the data.

Ambulance response times met the eight-minute target for sudden cardiac arrests 79 per cent of the time last year compared to 85 per cent in 2019. For the highest acuity calls, paramedics met the 10-minute target 78 per cent of the time last year and 82 per cent in 2019.

Toronto Paramedic Service chief Bikram Chawla said the findings on response times were not surprising, and that the auditor’s report amplifies the messages the service has been communicating for some time.

Chawla said the service has already take on some of the auditor’s recommended solutions, including the staffing and operations analysis, working with hospitals to decrease offloading delays, looking at an integrated system with the crisis centre and exploring what other options remain with nonhospital facilities.

He pointed to the fact that paramedics are hiring 200 people this year, and working with hospitals to reduce off-load times. He wants to see those times “come down significantly.”

While there are no provincially legislated target times for off-loading, the auditor general is recommending the city ask the Ontario government to establish one, along with investing in a system that would allow patients to be referred to alternative health care facilities that are not hospitals.

“It’s unacceptable,” said Coun. Jennifer McKelvie (Ward 25, Scarborough-Rouge Park) of the increase in wait times. “That’s despite a hiring plan we’ve had over the last five years to add more paramedics.”

McKelvie noted the University Health Network’s Stabilization Centre, where paramedics can take patients to be treated for intoxication, has an average off-loading time of six minutes. “We need more of that,” she said.

The report also makes other recommendations on how to improve the response times, including increasing the number of dispatchers, analyzing 911 data and working with the new Toronto Community Crisis Service to divert some mental health calls — as well as reviewing paramedic service’s performance plans and recruiting strategies.

“We’re definitely short on 200 to 300 (additional) paramedics right now,” Shirer said, adding issues around recruiting and retaining paramedics are partly due to wages. A paramedic in Toronto earning $46.23 an hour makes less than a paramedic working in Durham, Shirer said.

Chawla acknowledged wages are a factor, but noted they are still “competitive” compared to other jurisdictions. The service currently has about 1,400 active paramedics.

Shirer said paramedics working too many extra shifts can also have “detrimental” effects, which the auditor’s report said includes increased burnout, staff turnover and mental health issues.

Clarification — June 28, 2024
This article was updated to clarify that sudden cardiac arrests, when a person suddenly stops breathing or their heart stops beating, and “high acuity” patients, such as stabbings and head or spine injuries, are the Toronto Paramedic Service’s most urgent calls. As well, every day last year there were 2.5 hours on average where the service only had five or less staffed ambulances available, not five.