The strain on the health care system is felt daily by paramedics in the London, Ontario area, and while the impact often comes from influences beyond their control, the head of the Middlesex-London Paramedic Service (MLPS) says reforming his shipping system could make a difference.
The dispatch system controls the ebb and flow of ambulance movements across London and Middlesex County, as well as the assignment or triage of various calls, and is currently operated by the Department of Health.
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That strain was felt firsthand by Josh Allen, who worked as a paramedic for the MLPS for eight years before departing in April. He has since worked at a rural ministry outside of London.
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Before leaving, Allen said he wanted to be more available to attend to a family medical emergency hours away from his job, but adds that problems he faces while working as a paramedic in London had thrown him over the edge decide to leave.
Allen says the problems have been multifaceted and have only gotten worse during the pandemic. These include staffing shortages, call volumes and delays in outsourcing to emergency rooms.
Josh Allen was an advanced care paramedic with the MLPS for eight years and left the service in April before moving to rural service elsewhere.
Josh Allen / Delivered
“You got into your 12-hour shift, got a call as soon as you walked in the door most days, and then you were lucky if you could come back to the station for a break,” Allen said, adding adds that he places most of the blame on the Department of Health’s mailing system
“You have to pee, you have to eat a sandwich, you have to put your feet up 20, 30 minutes a day, and the way dispatchers are set up now, it just doesn’t account for things like that. It’s just: Here’s the call, we need the call, put the nearest truck on it and go.
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Allen isn’t the only one feeling the strain, according to Jason Schinbein, president of OPSEU Local 147, the union that represents local paramedics.
“We found that almost 30 percent of our employees try to leave as soon as possible to find other jobs,” Schinbein said of a recent poll sent to Local 147 members.
Other research conducted by the union found that the average age of local paramedics had fallen, with the majority now in their early 20s, Schinbein said.
“Almost every day we use fewer ambulances than we want to drive. We can’t fill trucks with paramedics because they just aren’t there. The system has been so overburdened and so neglected for the past decade and more.”
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MLPS chief Neal Roberts says local paramedics are under “relentless pressure” due in part to an increase in calls and delays in discharge.
“Furthermore, our employees have been dealing with COVID for almost two and a half years, so they’re certainly tired and weary,” Roberts added.
“This year alone has been unprecedented for our recruitment. We’ve hired 83 new employees and set up three additional 12-hour vehicles, but the challenge is… the more we hire, the more we need.”
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Roberts and Schinbein also agree that the MLPS’s dispatch system is a major reason for the ongoing strain.
Calls for shipping reform
According to Roberts, the current dispatch system is outdated, flawed, and often results in unreliable data when tracking “code zero” events that relate to a specific point in time when ambulances are not available to respond to calls.
That’s because when the Department of Health began tracking code zeros, the right technology wasn’t available, nor were dispatchers properly trained on it, Roberts said, leading to a disconnect between dispatchers and supervisors on-site with available vehicles .
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Another common problem is that when dispatchers press the button required to declare a code null, that code null remains in effect until the dispatcher gives the all-clear.
“Dispatch is so busy and I don’t blame the dispatchers for forgetting to stop the code zero clock once the system was restored,” Roberts added.
Roberts says that under the current dispatch system, too many non-urgent calls are treated as emergencies.
“Eighty to 85 percent of our calls are through lights and sirens. The reality is we come back with lights and sirens about 15 percent of the time, so there’s over 70 percent over-sorting or over-prioritization of those calls,” Roberts added.
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For years, MLPS and the county of Middlesex, which is responsible for providing ambulance services in the area, have campaigned to reform how shipping is handled.
Middlesex Borough Leader Alison Warwick tells Global News she intends to reiterate the call when she meets with Health Secretary Sylvia Jones during the Association of Municipalities of Ontario face-to-face conference next week.
Global News reached out to the Department of Health to comment on the MLPS’ concerns about the shipping system, but received no response before the deadline.
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While calls for a reformed shipping system have yet to be answered, Roberts says there are workarounds in the meantime that could lead to long-term solutions.
This includes frequent discussions between MLPS and officials at the London Health Sciences Center to find ways to release vehicles when there are delays in unloading.
Another success has been noted in an ongoing diversion strategy whereby mentally ill patients with low visual acuity are transported by paramedics to the Canadian Mental Health Association’s Huron Street location rather than to an emergency room. Giving paramedics more alternative destinations for patients could further ease the burden on emergency rooms, Roberts says.
“What I would like to see is a system where we run the 911 dispatcher and when that call comes in we either send a transporting ambulance with paramedics for advanced care or we send a paramedic from the community or we send in Mental health team or we integrate with the hospital system,” Roberts added.
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“A more coordinated, collaborative effort in healthcare … that’s really the goal.”
— with files by Paulo Loriggio of The Canadian Press.
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