A growing population, urban sprawl and a controversial transition to a single provincial health board have left Edmonton’s emergency service stretched to its limit, frequently with few or no ambulances to respond to 911 calls.
The widely held national benchmark is that, in a city, an ambulance will arrive at your door within nine minutes of a 911 call. Delays can be the difference between life and death.
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Edmonton, however, has regularly been in a state of “red” in recent months, with no ambulances to respond to calls as the fleet is tied up waiting at a hospital or transporting non-urgent patients. Often just a few trucks are free to cover the sprawling city of 750,000 that is bigger, in area, than Toronto.
The ambulance delays, ongoing emergency-room overcrowding and a recent series of botched test results are the latest symptoms of the province’s sluggish transition to a single health board known as Alberta Health Services. They all come at a time when Premier Alison Redford is pushing for more health funding from Ottawa.
The extent of the ambulance problem, however, is unclear – AHS is refusing to release Edmonton’s response times, though most jurisdictions publish them routinely. City paramedics say the nine-minute target is rarely hit, while response for critical-care cases sometimes tops 20 minutes.
“It’s been building, and it’s come to a boil,” said Elisabeth Ballermann, president of the Health Sciences Association of Alberta, which represents about 17,000 health workers, including paramedics.
Edmonton’s problem was fuelled by the takeover of ambulance services by AHS that froze expansion as the city’s population exploded. Swaths of Edmonton now aren’t near an ambulance station, sometimes leaving crews racing 30 kilometres or more to calls on the other side of town.
The problems drove paramedics to raise alarms in November through an anonymous survey the HSAA conducted. (They’re not allowed by AHS to speak publicly. The Globe spoke to some on condition of anonymity.)
The written responses paint a picture of a badly overstretched system where morale is at an all-time low. “This system is on the edge of failure on a daily basis,” one wrote. “I honestly hope no one in my family ever needs an ambulance,” wrote another. “I have been in the EMS business since 1984. This has been the worst I have seen EMS,” another said.
“We were, quite frankly, floored by the level of response,” Ms. Ballermann said.
Ambulance services across Canada are stretched by the demands of overflowing hospitals, growing populations and aging baby boomers. Nine-minute responses are now more of a goal than a benchmark.
In British Columbia’s Lower Mainland, ambulances meet that target 48 per cent of the time, the B.C. Ambulance Service says. Toronto EMS says it hits the target 62 per cent of the time. “On a daily basis, we’re told by dispatchers ‘you’re my only ambulance available,’” said Glen Gillies, a 23-year veteran paramedic with Toronto EMS who is also the executive secretary of the Ontario Paramedics Association.
Once a city-run service with its own union local, Edmonton paramedics were swallowed up by AHS more than two years ago and, shortly after, forced from the Canadian Union of Public Employees into the HSAA, which serves more than 200 different professions. They say their complaints have been lost in the shuffle.
For instance, two weeks after their survey was sent to AHS, Alberta Health Minister Fred Horne told the legislature he wasn’t aware of a major problem and wasn’t “asking questions about dire straits.”
That changed as the issue has since garnered attention. Ms. Ballermann assured paramedics in an e-mail last week that “work is underway to address” their concerns. Paramedics, in turn, say the fact their concerns are even being heard is a huge victory.
Sue Conroy, an AHS senior vice-president who oversees ambulance service, said in an interview that “high-quality emergency medical care is being provided to the people of Edmonton.” But paramedics scoff at that assessment and say the delays are pushing them to the brink. One survey response relayed the case of an Edmonton child in cardiac arrest who died – the ambulance took more than 13 minutes to arrive. The paramedic, a 19-year veteran, called it “a call that haunts me to this day.”
“We may not have been responsible for the child’s death but we sure didn’t help in saving it,” the paramedic wrote.
Overcrowded hospitals mean ambulances are idling for hours across Canada waiting to drop off patients, unavailable for emergency calls. “It’s completely wrong, unacceptable, for the hospitals to basically hold paramedics hostage,” said B.J. Chute, director of public education for the Ambulance Paramedics of B.C.
Ambulance response times across Canada are hard to compare – some provinces run ambulance services as one agency, while others leave it to cities. With more stability and more ambulances, Calgary is now a preferred destination in Alberta as some veteran paramedics flee overstretched Edmonton.
“ABE is the term being used out there,” one paramedic said in an interview. “Anywhere but Edmonton.”