Ambulance unloading times in NS are moving in the right direction, the health committee said

Ambulance unload times have decreased in Nova Scotia over the past six months, a standing legislative committee on health heard Tuesday.

Liberal leader Zach Churchill countered that the “marginal gains” made by the county and county government over the past six months “don’t outweigh the doubling or tripling of wait times we’ve seen at nearly every single hospital in the county.”

The Liberal leader provided statistics for all hospitals in Nova Scotia from April 2019 to March this year, pointing to a decrease in unloading wait times from 2019 to 2020, but an “incredibly drastic increase” since August 2020.

Said increased offload times were from 104 minutes at the QEII in Halifax in August 2020 to over 124 minutes today, 21 minutes to nearly 60 minutes at Yarmouth General Hospital during the same period, and an offload wait time of 35 minutes at the Cape Breton Regional Hospital in August 2020 peaking at 135 minutes today.

Churchill said government policy was responsible for the increases, especially since the election of the Tim Houston-led Progressive Conservative majority government in August 2021.

“The government and government representatives have spoken numerous times about all the initiatives that are intended to (positively) affect waiting times for unloading, but we are actually seeing the opposite happening in very dramatic and consistent ways,” Churchill said.

Kevin MacMullin, business manager of Local 727 of the International Union of Operating Engineers representing Nova Scotia’s 884 active paramedics, spoke of “unbearable working conditions” for the paramedics who have chosen to continue to work in Nova Scotia.

He said more emergency departments are closing throughout Nova Scotia than ever before, resulting in more demand for emergency departments, mostly in regional facilities, to support these closures.

“Illnesses, accidents and medical emergencies are not declining because emergency departments are closed, which is putting more demand on our EHS (Emergency Health) system,” MacMullin said.

“When you look at shrinking emergency departments, it results in increased demand for paramedic services and longer transportation times to open facilities,” he said. “Upon arrival at these ERs, paramedics face reduced staff. … With fewer nurses to care for patients in ER beds, paramedics must wait and keep their patients on stretchers to provide care to those stable enough to receive it.

All the while, he said paramedics are shrinking because of recent retirements.

“About 70 of our 884 active paramedics are currently over the age of 55,” he said. “Our paramedics are recruited from field operations into positions with the Nova Scotia Health Authority because of their scope of practice and ability to work independently. Nova Scotia paramedics are known as a valued resource and are recruited by other provinces for their highly regarded training, extreme competence and expert experience. Those outside offers with better working conditions, higher benefits and a better compensation package have led to a serious loss of workforce.”

He said Nova Scotia trains top Canadian paramedics only to see them leave for greener pastures.

“These issues are reducing staffing levels and, coupled with unloading delays, often make working conditions unbearable for the paramedics who have chosen to stay.”

Nearly 200 paramedics are absent for various medical reasons, including an increase in operational stress injuries, he said.

Less manned units and longer transport times lead to longer delays in unloading.

“Paramedics want to avoid standing in hallways tending to stable patients, knowing they can be used in a more urgent and critical environment at that time,” MacMullin said. “We need to solve this unloading delay issue now, not sometime later. It has been discussed long enough and our Prime Minister and Health Minister have committed this challenge to all stakeholders.”

He said it is time for all stakeholders to sit down at one table to discuss solutions.

“This is a necessity, not a wish, if we are to successfully resolve this crisis and provide the care and emergency assistance that Nova Scotians deserve on a daily basis or in a life-or-death situation.”

The government initiatives promoted to improve unload wait times, to which Churchill referred, were defended at the rally by witnesses Jeannine Lagasse, the Deputy Secretary of the Health Department, Jeff Fraser, the Executive Director of EHS, Charbel Daniel, the Executive Director of provincial operations for Emergency Medical Care Inc. (EMCI) and dr. Tanya Munroe of the Nova Scotia Health Authority.

Daniel said paramedic coverage works like a net all over Nova Scotia.

“At our peak deployment, we have X number of units deployed across the county and when a unit responds to a call, it is pulled out of that net and the net essentially stretches out,” Daniel said.

“Any peak in call volume, longer offload times, have a negative effect on that network. The longer it is stretched, the more tension it gets.”

Daniel said the period Churchill referred to was the height of the COVID pandemic, which had a heavy ripple effect on the health system that probably peaked about six months ago.

System improvements, including the expansion of the patient transfer service to move low-risk patients who do not require medical supervision during transport, reduce annual transfers traditionally made by EHS ambulances and staff by 30,000 and have unload wait times trending in the right direction in the past six months, he said.

“When we talk about that net and the resources being pulled into it, we’ve focused on making sure the resources aren’t being pulled for things they shouldn’t be doing.”

Lagasse said initiatives such as the patient transfer changes and the Single Paramedic Response Unit program, in which paramedics respond to calls at a lower acuity without having to tether an ambulance, are improving the way people move around the hospital and health care system

“We will soon have a second air ambulance to move patients from Sydney and Yarmouth to Halifax for routine testing and treatment,” Lagasse said. “This frees up ground ambulance resources that would otherwise take up to 10 hours to get there and back and allows multiple patients to be transferred at the same time.”

Munroe also highlighted several access and flow programs introduced to relieve pressure on emergency departments, including the C3 Care Co-ordination Center that improves patient monitoring and bed utilization, improves staff scheduling, and enhances collaboration between departments and facilities.

“C3 allows staff and physicians to spend more time delivering care rather than coordinating it,” Munroe said. “By responding directly to the need for faster access to care, we are positively impacting patient flow within the hospital system, which in turn impacts emergency room (ED) bed availability and unload times of ambulances.”