Toronto blames ‘Code Red’ for hospital delays, not staffing issues

An alarming weekend situation in which no Toronto ambulances were available to respond to a 911 doctor call was largely due to paramedics being stuck in hospitals waiting to dispense patients, city officials said.

While acknowledging that his crews are “exhausted” due to COVID-19 requirements, plus staff absences due to the Omicron variant, paramedic service chief Paul Raftis said Monday that staff levels were not the main reason for a “Code Red.”

Paramedics who waited in the hospital for up to five hours to “relieve” patients for hospital treatment were “really the most important factor leading to this systemic pressure,” Raftis told a pandemic briefing, adding that he is collaborating with hospitals on the issue.

The paramedics’ union tweeted on Saturday “#CodeRed No units available in the city at 18:38 tonight ”and told Star on Sunday that chronic staff shortages were behind the inability to respond immediately to an emergency call.

City officials said 114 ambulances were on duty Monday compared to a “best-case scenario” of 120, and over the weekend as many as 50 at a time were tied up in hospitals.

However, they acknowledged that the explosion of Omicron variant infections was hurting the city’s staff level, with an “unplanned absence rate” of more than 10 percent across all city departments and 12.8 percent for emergency services on Sundays.

Dr. Sam Sabbah, medical director of the University Health Network’s emergency departments, confirmed that the Omicron wave has triggered a “system-wide challenge” of quickly relieving acute patients.

The need to make isolated places available to suspected and confirmed COVID-19 patients in emergency and inpatient wards has reduced available space and triggered delays in the release of paramedics so they can go back on the road.

Hospitals use tactics to address the problem, including a “fit to sit” strategy – where skilled patients wait in emergency room chairs – and ask some two-paramedic teams to “double up” with seeing two patients so other paramedics can return to take calls.

“We have scenarios where patients wait four or five hours for EMS stretchers,” Sabbah said in an interview.

At the briefing, Mayor John Tory tried to assure the Torontonians that paramedical services are immediately available to all critically ill.

“Any life-threatening call remains a top priority, though response times on non-urgent calls may change from time to time,” Tory said.

Mike Merriman of the Toronto Civic Employees Union Local 416 Paramedics’ union said hospital readtimes were a factor in Code Red, but it was also severe staff shortages that had been raised for years, to little avail, by city and city councilors.

The threat of yet another Code Red persists, he added.

The city, which last year hired 200 paramedics and raised the department’s funding by six percent, was not enough to restore capacity in the ambulance system to a worst-case scenario such as exponential growth in infections from Omicron, he said.

“We warned them that there was danger if the big one hit and we are in the big one,” Merriman said in an interview.

“You have to compensate with your system to adjust for it, but it’s just been caught up – we’ve had trouble servicing calls before this (wave of infection) hit, and now s — hit the fan.”

David Rider is the bureau chief of Star’s City Hall and a reporter covering town hall and municipal politics. Follow him on Twitter: @dmrider

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