The London-area ambulance system is under growing pressure as demand returns to pre-pandemic levels.
It starts with the volume of calls to the Middlesex-London Paramedic Service and extends to patient transfer delays at hospitals.
Not only have calls returned to pre-pandemic levels, but they're on track to surpass them, in part due to the easing of COVID-19 restrictions and a gradual return to routine activities, said Adam Bennett, deputy chief of operations.
"We're back to where we were in 2019," he said.
Calls to area paramedics are expected to rise nearly eight per cent in 2021 from last year when there were 90,500 calls, or an average of 248 a day, according to a report prepared for Middlesex County council that oversees the service for Middlesex and London. Calls in 2020 calls were down 3.9 per cent from the previous year.
Adding more pressure on the service is the chronic issue of off-load delays, the hours that paramedics sit idle at hospitals waiting to transfer their patients to emergency room staff.
The London-area ambulance system has lost more than 11,168 hours of service to the delays — the equivalent of two 24-hour ambulance crews being pulled off the road every day — already this year. That represents a cost of more than $1.6 million to the service.
The calls seem to ebb and flow with each wave of the pandemic, as many people avoid London-area hospitals dealing with COVID-19 patients during lockdowns.
"When we had the first wave of COVID, there was a lot of uncertainty that came along with it," Bennett said. "There was a lot of public education about people steering clear of the emergency departments if they could."
He added: "People are (now) having exacerbations of things that they potentially would have sought treatment for earlier on but couldn't or didn't or were afraid to. They're becoming a more urgent matter and are seeking care in the hospital and potentially engaging the 911 system."
Not only is the number of delays in patient transfers at area hospitals rising, but their length of time is growing, too, Bennett said.
The provincial target for paramedics to transfer patients is no more than 30 minutes. Any time beyond this point is considered an off-load delay. Middlesex-London paramedics are spending an average of two hours to off-load patients in city emergency rooms, Bennett said.
The outcome? More strain on the system that has "a finite number of paramedic resources," he said.
The issue can be compounded when crews from neighbouring stations are called in to cover for paramedics stuck waiting at emergency rooms or responding to calls at peak times.
For example, if the volume in London is exceeding paramedics capacity and a Lucan ambulance responds to a call in the city's north end, other Middlesex County ambulances would shift over to cover Lucan, Bennett said. That often results in a longer response time, he said.
In response to the growing strain, Middlesex council last week approved funding the addition of three 12-hour ambulance units at peak times. That will cost the county and city an extra $310,000.
Off-load delay is not a new problem in the ambulance system, nor is it isolated to the Middlesex-London region, Middlesex Warden Cathy Burghardt-Jesson said.
Other regions in Ontario "are experiencing the same thing," she said. "At some point, we have to look at the whole system, and we have to come up with a better solution as to how this is being handled."
A starting point is having all the funders — the county, city and province — at the table to discuss solutions, Burghardt-Jesson said, adding she's "very optimistic" about the progress so far.
"I do believe that having all three voices at the table recently has opened a dialogue that maybe hasn't been as open in the past," she said.
She also cited a recent meeting with Middlesex-London Paramedic Service, the city of London and London Health Sciences Centre.
"I really see that there is a willingness to communicate and work together that that maybe wasn't there before."
Calvi Leon, Local Journalism Initiative Reporter, London Free Press