Canada: Ambulance Delays Longer in Toronto

(Toronto, Ontario) According to the Ontario Ministry of Health, ambulance response times are becoming progressively longer, with Toronto exhibiting the worst performance, despite province-wide efforts to shorten them.

The widespread increase in urban response times, said Emergency Medical Services officials, hospital doctors and the province, is largely the result of systemic problems outside EMS's control.

Demand for ambulance care has boomed as cities have both grown and aged, far outpacing increases in EMS budgets.

Increasingly overburdened emergency rooms, unable to quickly find hospital beds for admitted patients, have become slower to take responsibility for people brought in by ambulance, forcing paramedics to continue to provide care instead of returning to the streets to respond to new calls.

"Really, the ambulance response time problem is a symptom of the underlying problem: not enough capacity within the whole system. And it's predictable," said Dr. Dante Morra, medical director of the University Health Network's Centre for Innovation in Complex Care.

"The EMS group, and how they respond, is captive to how the hospitals act. The main problem here is that we do not have enough in-patient beds to take care of sick patients. ... These EMS people, who should just walk into the emerg, drop their patient off, and then leave, are frozen in the emerg for a long period of time, because there aren't enough resources there. But the problem isn't even an emerg problem. It's a flow problem."

In summary, increases in demand for emergency services, coupled with the "off-load" delay times when paramedics must sit on their thumbs waiting for emergency rooms to accept patients, are causing ambulance response times to become longer.

From a nuts and bolts perspective, it appears that insufficient resources are being allocated to meet growing demand for emergency care and the situation is most notably exposed through increases in ambulance response times.