2022 was a 'horror show' for Hamilton paramedics, chief says 2023 won't be a repeat

After being in paramedicine for half a century, Michael Sanderson said he never saw a year for paramedics like 2022.

The time it took to get patients from ambulances to hospital rooms reached an all-time high, he said.

In one case, a paramedic waited almost an entire 12 hour shift to get a patient from the ambulance to a hospital bed.

Those kinds of delays led to a record number of code zeros — when someone calls for help but there's one or no ambulance freed up to go.

"It was a horror story, the worst I'd ever seen," Sanderson, who is also president of the Ontario Association of Paramedic Chiefs, told CBC Hamilton.

The issue was seen across Ontario, but halfway through 2023, Sanderson said there's already been a remarkable turnaround in Hamilton.

Why was 2022 so tough on paramedics?

The paramedic service's annual report shows there were 98,114 calls made for an ambulance, up from 90,892 the year prior.

Despite the rise in calls, paramedics' response time exceeded the provincial standard in all categories.

But the issue last year came down to the number of ambulances available to respond — and that is, in large part, because paramedics were stuck waiting to transfer their patients from the ambulances to the hospital.

The annual report shows the number of code zero events nearly quadrupled from 2021 to 2022.

In 2022, there were 381 code zero events, compared to 97 in 2021.

Paramedics waited at least 30 minutes to transfer patients from an ambulance to the hospital 1,643 times last year, compared to 994 times the year prior.

There were 313 times last year where paramedics waited over six hours, according to the report.

"Patients did deteriorate while they were waiting," Sanderson said.

He said staffing issues in hospitals and COVID-19 patients taking up beds in the intensive care units caused offload delays.

"The hospitals were really challenged in their abilities to discharge patients into the community [and] the community care settings were not really set up," he said.

"The emergency departments were quite literally jammed."

Sanderson noted he's most proud of the fact paramedics did as well as they could given the circumstances.

"Crews were missing tons of lunches," he said.

Here's why 2023 will be better

Sanderson said there's already been "significant" improvement this year.

By July 21, 2022, there had already been 161 code zeros, but this year there have only been 22 code zeros in the same timeframe.

"We're still experiencing three or four hour offload delays, but it's not at every site," Sanderson said.

"We've not had a code zero in five weeks."

He said the changes started at the Juravinski Hospital and Cancer Centre in December and have been "tremendous."

Hamilton Health Sciences (HHS) declined an interview request but provided a written statement from Neil Johnson, the hospital network's vice president of oncology and the site executive lead at the Juravinski Hospital and Cancer Centre.

He said the hospital network added "much-needed inpatient bed capacity" with help from the provincial government.

Those beds, he said, allowed HHS to change how the emergency department operates, and cut ambulance offload times "significantly."

Johnson said in July the time it takes to offload 90 per cent of ambulances has averaged 25 minutes and has been as low as 11 minutes.

"This improvement allows ambulances to get back on the road and respond to needs in the community quicker, and it can mean less code zeros," he said.

Sanderson said Juravinski modified the offload patient areas which was "very significant."

He added St. Joe's is still dealing with challenges but has also seen improvements.

St. Joseph's Healthcare Hamilton also declined an interview but provided a written statement from Dr. Erich Hanel, its interim chief of emergency medicine.

He said support from the province allowed for more staffing to expedite offloading patients when no beds are open.

"These patients are cared for by a physician assistant and registered practical nurse until a bed is available," he said.

When a code zero occurs, Hanel said the hospital engages a protocol that allows inpatient units to accept emergency department patients within 30 minutes.

If offload delays increase past 30 minutes, the hospital engages the superintendent of the paramedic service to review the situation. 

Hanel said St. Joe's is reviewing its current state, strategies and opportunities to further improve our process and wait times.