Once again Nova Scotia’s ambulance service is in the headlines. This time a widow is questioning whether the response time – which appears non-existent – contributed to her husband’s death.
Problems with our ambulance system are an on-going issue which health executives have consistently failed to resolve.
In the fourth quarter of 2011-12 the former Capital District Health Authority reported taking 144 minutes to off-load patients from ambulances instead of meeting the 20-minute provincial requirement. Capital Health promised then Health Minister Maureen MacDonald to improve performance by 10 percent per quarter. Capital Health’s self-imposed deadline gave them until September 2015 to meet the provincial requirement.
On March 21, 2019, when ambulance line-ups outside Halifax hospitals dominated the headlines I asked Minister Delorey who in his department monitored Capital Health’s progress and if the Halifax hospitals ever met their self-imposed targets. Neither the Minister or anyone in his department responded.
The Minister has called for a review of the circumstances which caused this recent death. But what is the point if no one is held accountable and nothing changes?
The availability of the emergency services is impaired by our misallocation of assets. A great percentage of the calls EHS ambulances and paramedic teams make are non-emergencies. EHS are operating an expensive taxi service, transporting patients between medical facilities as well as residents of nursing homes and long-term care facilities to and from hospital.
Patients moving between hospitals need the safety and security of medical expertise provided by paramedics. However, most long-term care residents don’t. They may need to go to hospital for a treatment, appointment, procedure or medical test, like an x-ray. These are necessary trips, but no more of a medical emergency than that of the person who drives themselves to hospital for similar reasons. The reason an ambulance is used is either due to physical impediment (like being bed-ridden or confined to a wheelchair which can’t fit in a regular vehicle), lack of alternative transportation or a fear of litigation.
The Department of Health and the NSHA seem populated with people fixated on ‘what if’ scenarios. What if the resident needs help while being transported? Well, what if there is a real medical emergency and there are no ambulances and paramedics available? That seems to have been the situation this week.
At a March meeting about changes to the Valley Regional Hospital’s ER in Kentville, I asked the ER manager how many patients arriving by ambulance are emergencies. He said, “Anecdotally – and I don’t want to be held to this number – 50 percent of ambulance deliveries are an emergency.”
That means 50 percent aren’t an emergency.
Nova Scotia has 180 ambulances based across the province. Terry Chapman, business manager for local 727 with the International Union of Operating Engineers, which represent paramedics, says the employer’s data shows 162 ambulances are available each day. According to data compiled by Andy Muise, Project Coordinator, EHS Ambulance Operations Management, the service received 182,452 calls in 2018. Of these, 72,933 calls, or 40 percent of volume, fell under their urgent-need/emergency call breakdown.
So the bulk of ambulance and paramedic time is devoted to medical transportation.
NSHA and the Department of Health will tell us that scheduling ambulances are a complicated operation. It may be, but where is the proof anyone has moved on the problem?
According to someone familiar with the ambulance industry, most of the world has one ambulance per 8,000 people. Nova Scotia, because of our geography, has one ambulance per 7,000 people. HOWEVER, my source says, “Unfortunately as our population ages more long term beds are required and the lack of these resources in the rural areas force more transfers toward Halifax and make the pile up worse.”
“The wait time to unload is not an ambulance problem. It is the result of not having any place for the patients in the hospital so they pile up in emergency causing a backlog.”
Those transfer pile ups are also growing at regional health centres, like Kentville, where the bulk of hospital patients seem to be waiting for alternative accommodation.
After the Kentville update on ER improvements an ER nurse, stopped in the parking lot to scream, “We’re working in chaos in EVERY shift! Why aren’t we using former hospitals in Berwick and Wolfville for bed space!?!”
Hers is a valid question. Those former hospitals are mostly occupied by government offices, like school boards, which could easily relocate to other buildings. We should do a quick inventory to identify all empty or underused provincial property to see what could wiftly be rehabbed into long-care facilities.
For example, the former Colchester Regional Hospital inTruro has been vacant for five years. A former minister told me the building has asbestos. Well, it had asbestos when it was a hospital. Government House had asbestos and we found $8 million to remove it and make necessary structural changes. Whether the former Truro hospital is to be sold or demolished, the asbestos will require an expensive removal and disposal process. Using the example set by buildings of similar square footage, like St. Pat’s High School in Halifax, the cost of demolition would be in excess of $3.5 million. How much could that go to making the building useful again? Why not bring it up to code and offer a sweetheart deal to a proven nursing home operator as an incentive to add 150 new long-term beds to inventory?
As for freeing up ambulances so they are ready for real emergencies, why not invest in local services like Kings Point-to-Point Transit, which services those with mobility issues. To mitigate liability and provide patient support, make an CNA or LPN available to travel on non-emergency transfers and supervise the hospital handover. That’s a cheaper alternative to using a paramedic team and ambulance.
My industry advisor says, “The problem we have is not the ambulances. In my view our problem is the management and structure. We should consider “farming out” the management to someone like the CEO of a corporation and apply basic business principles to the problem(s). Now we have a health system run by government using the only tool they know: throw more people and more money at the problem.”
All more money and people have done is buy time for those in charge. It’s time for new service-oriented thinkers, with clear performance targets to meet, to take charge.