Study Confirms Paramedic Service Is Falling Behind

Jeff Green | Jun 21, 2023

In 2019, a review of paramedic service performance and projected call volumes, in Eastern Ontario, was commissioned by Apexpro consulting. Although Frontenac County is a small municipality by population, because Frontenac Paramedic Services (FPO) serves Kingston as well, Frontenac Paramedic Services is one of the largest in the region, and took on a leadership role in commissioning the study.

That 2019 study was instrumental in the development of the five year plan for Frontenac Paramedic Services, and the increase in service, with the addition of a new 12 hour ambulance in Kingston this year, was based on projections from that study.

Offload delays at Kingston hospital as well as higher than expected increases in call volumes, have resulted in, have had a negative impact on response times over the last 2 years.

Reports to Frontenac County Council from Chief of Paramedic Services Gale Chevalier at budget time, both in the fall of 2021 and 2022, outlined how response time statistics, unit hour utilization (UHU), overall call volumes, and Hospital Offload Delays (OLD) were headed in the wrong direction. It all points to a system that is increasingly being stretched to meet the needs of the communities in both Kingston and Frontenac County.

OPSEU Local 462, which represents Frontenac Paramedics, has been advocating for increases in funding to meet the increased pressure on their members. The union local has pointed out that when the service is stressed it impacts wait times in more remote parts of Frontenac County more than in more populated centres.

Ambulances are pulled towards the urban core to cover when urban-based ambulances are all unavailable to take on new calls because they are already engaged.

The circumstances facing FPS are not unique and early this year a 'refresh' of the 2019 study was commissioned.

In a report that will be in front of Frontenac County Council this week, the new data confirms that all of the measures show that the system is extended beyond its capacity now. Projections show that trend will only worsen into the future unless the capacity of the system is upgraded through increased investments by provincial and municipal governments, who fund the service.

Among the key findings in the report are that across the region, between 2018 and 2022, call volumes increased by 18%, response times “degraded” by 14%, time on task increased (worsened) by 46% and unit hour utilization increased (worsened) by 32%.

The main factor identified by the report for “declining paramedic performance” was hospital off-load delay.

When an ambulance arrives at hospital, the continuity of care protocol demands that paramedics remain with a patient until the emergency department is able to take over. If nursing staff are available this can happen immediately, or minutes after arrival, but if the emergency department is overloaded, it can take longer, sometimes much longer.

The report found that over the 4 years, offload delay hours increased almost 4 times (383%) and that across the region, the time spent by paramedics waiting for hospitals to admit patients now eats up about $17 million a year, or 9% of the total amount of funding for paramedic services in Eastern Ontario.

The impact of the overstretched system has had a measurable impact on the workload of paramedics working in the region. Unscheduled overtime hours are on the rise, longer shifts are often required, the number, and length, of breaks between calls is down. All of these factors have led to fatigue and stress among the workforce, and absenteeism, the percentage of paramedics on leave for mental health and other reasons, and the number who have left healthcare services are all measurably up.

The report concludes that hospital offload delays need to be fixed, dispatch needs to be modernised to make the best use of resources, and that community college paramedic enrolment needs to be increased.

The report also looked at specific numbers for Frontenac Paramedic Services, which is one of 12 services in the region.

It found that the duration of the average call is up by 30 minutes, from 1 hour in 2018, to 1.5 hours in 2022. The Unit Hour Utilization (UHU) for which the provincially identified optimal number is 35%, has gone from 31% in 2018 to 45% in 2022. The offload delay at hospital is up from an average of 38 minutes to an average of 54 minutes. While that increase may not appear that great, the impact on the service is significant. In 2018, the time spent waiting in hospital used up 0.4 twelve hour shifts per day, across Frontenac County and Kingson, and in 2022 it used up 2.4 twelve hour shifts per day.

Finally the report projects a significant increase in demand across Kingston and Frontenac County over the next 5 years, due in part to population increase but in the main, to the aging demographic in the area.

There were just over 28,000 calls in 2022 and by 2028 the number is projected to rise to 38,000, a 36% increase.

The report concludes that Frontenac Paramedics are not meeting their response time or UHU targets now, and will need “to invest in additional resources in order to meet the demand of a growing and aging population” to address the situation.

Frontenac County Council will receive the report and a staff presentation of its highlights, at their meeting this week.