Toronto ambulance response times up due to staffing issues, health care pressures: report
Toronto residents who called for an ambulance for a medical emergency were waiting longer last year on average than they were before the COVID-19 pandemic, according to a new report by the city’s auditor general.
Toronto Auditor General Tara Anderson says in the report that average ambulance response times by Toronto Paramedic Services are increasing due to staffing challenges and health-care system pressures. Toronto city council’s audit committee will consider the report on Friday, July 5.
“Timely ambulance emergency response is critical, particularly for people with medical issues requiring urgent attention at the hospital,” reads a document, Audit At A Glance, accompanying the report.
“Every second matters for ambulance emergency response, particularly when it is a matter of life or death.”
The report, released this week, contains 10 recommendations by Anderson to help the paramedic service improve its “efficiency and effectiveness.”
Anderson recommends, among other things, that the service review its response time targets, report on performance by geographic areas and explore strategies to manage demand for its services better.
She also recommends that it develop a plan to divert some mental health calls with the help of Toronto police and Toronto Community Crisis Service, improve data analysis of frequent 911 call users and determine the “optimal level” of ambulances it requires to meet its needs.
Offload delays, staffing challenges increasing wait times
The report says response times for life-threatening and “highest acuity” calls, which means calls deemed to be of highest priority based on a triage tool, were both higher in 2023 than in 2019.
For life-threatening and highest acuity patients, the average overall response times were six per cent and 14 per cent higher in 2023 than in 2019, respectively.
In 2023, for example, the average ambulance response time for a call about a sudden cardiac arrest was six minutes, while the average ambulance response time for the highest acuity patients was 6 minutes and 47 seconds.
“There were a number of factors contributing to the increase in average response times, with paramedic wait times in hospitals to offload patients (called offload delays) and staffing challenges being the main factors… Other factors include traffic congestion and having new in-training call takers and dispatchers,” the report says.
The report also found that the number and length of episodes where there was a low availability of ambulances staffed by two paramedics is increasing. The number of episodes increased from 1,300 in 2019 to 6,800 in 2023, according to the report.
According to the report, paramedics spent 60 per cent of their service time in hospitals in 2023, and this trend is increasing. The report says in 42 per cent of cases, it took more than 30 minutes to offload patients at hospitals.
Response times better in downtown Toronto, report says
Interestingly, the report says response times for high priority calls were better for patients in downtown Toronto than for those who lived outside the downtown core.
That’s as call volume has risen by six per cent from 2019 to 2023, the report says.
“Response times have been increasing, and more emergency calls for the highest acuity patients did not meet the legislated targets for response times. In the face of healthcare system pressures, including hospital offload delays, we found more frequent and longer episodes of low availability of staffed ambulances to respond to the increasing number of emergency calls,” the report concludes.
As for staffing challenges, the report says these can be a problem at peak demand times, such as on weekends, after 9 p.m. on weekdays, and during the summer and fall.
The report notes that Toronto’s ambulance communications centre handles roughly 910 emergency calls daily. Of all 22 ambulance communications centres in Ontario, the one in Toronto is the busiest and receives about 16 per cent of Ontario’s medical emergency calls, the report says.
Doctor shortage increasing pressure on paramedics
The report also says an “ongoing shortage of doctors is putting added pressure on paramedic services.”
According to the Ontario College of Family Physicians, more than 516,000 Toronto residents do not have a family doctor. The college estimates that nearly one million people in Toronto may not have a family doctor by 2026.
“With the ongoing shortage of doctors, more people rely on paramedic services (and hospital emergency departments) as a safety net to access basic healthcare services they need when other options are unavailable,” the summary says.
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