In the event an Ottawa Valley resident should be suffering from a major medical crisis such as a heart attack or stroke where a few minutes can make the difference between life and death, the chances of quick medical intervention from a paramedic coming to the aid of that resident may take longer than usual due to the rising amount of stress placed on the Renfrew County Paramedic Service.
During a recent county health committee meeting, Renfrew County chief paramedic Mike Nolan outlined the present and projected strain placed on the overall ambulatory system, and it is a massive strain that in the end could threaten the long term health care of thousands of residents.
Chief Nolan was providing an overview of the county’s paramedic service and that included a multi-year analysis of ambulance response time, the availability of ambulances and pressures on the system serving the largest geographic county.
“From 2015 through 2019 we saw a steady increase of two to four percent in call volumes,” Nolan said. “Since the pandemic we have seen a greater increase in the number of calls, and a significant type of calls are those for a life-threatening emergency. Although a bump for us, we have been able to mitigate those calls compared to our counterparts like Peterborough and Lindsay where their calls ae increasing by up to 16 per cent.”
He explained they have been able to divert many of the minor calls to other resources and that way the ambulances staffed by two paramedics, which he referred to as the most valuable asset in this type of call, are able to respond quickly to the potentially life-threatening event.
But he also cautioned that there are only 10 ambulances per regular shift to handle all calls and they are spread out over thousands of square miles for more than 100,000 residents. With ambulance bases situated in Arnprior, Renfrew, Pembroke, Deep River, Eganville and Barry’s Bay, there are times when some areas are underserviced.
“It’s not common if you see one ambulance in Cobden, it’s the only ambulance available to cover 10,000 square kilometres,” he said. “Even at best, when I have 10 ambulances staffed on base, that means I have one ambulance per thousand square kilometres of coverage,” he said.
Adding to the ambulatory strains is the fact with only five hospitals in the entire county (Arnprior, Renfrew, Pembroke, Deep River and Barry’s Bay), that leaves some areas vulnerable.
“Some areas are especially in a crisis situation because there is no local hospital and Eganville is one example,” he said. “It is time to look at the system and the resources available. We need to talk about putting another ambulance on the road, 24 hours a day, seven days a week, especially in communities like Eganville to be able to backstop that decay of rural response time.”
One message chief Nolan has conveyed repeatedly since he took command of the service in 2004 is the lack of sustainable funding and the provincial system that routinely draws ambulances and their crews out of the county and into the City of Ottawa to provide support for Ottawa’s own overwhelmed system.
In 2018, county council passed a resolution stating Renfrew County ambulances would be required to return to a home base after responding to an emergency outside their jurisdiction. At the time Nolan said it was a good short-term solution.
"Right now, we're using provincial and Renfrew County dollars to do calls in other municipalities, and that's not OK," he said at the time. “Currently, Ontario's Ministry of Health and Long-Term Care requires the closest available ambulance to respond to any life-threatening emergency, regardless of which jurisdiction it belongs to.”
Almost five years later, chief Nolan said little has changed to lessen the strain on the system.
“It is taking us longer to do calls, there are more calls, the calls are more complicated and when we complete a call, we are more often to get stuck in an emergency department or some other part of the health care system and no longer be available for that next call,” he said. “The situation is worse than it has ever been.”
If an ambulance goes to Ottawa to the Queensway Carleton, for example, it is not uncommon for one call to take six hours to complete, he said. This can be due to offload delay or getting a call in the city, among a few reasons.
“We are routinely getting down to one, two, three or zero ambulances available at night in the county, almost on a daily basis,” he said. “We are the largest county in the province and that brings additional pressures. This is compounded by the fact the population is spread about in nodes and also decentralized areas.”
He went on to list several other challenges including a rapidly aging population; ambulances are getting more expensive due to supply chain issues, and ambulances are seeing their kilometres increase rapidly due to the increase in calls and the ambulances need to be replaced earlier than anticipated.
He pointed to some “made-in-Renfrew County” programs that have become provincial models for rural communities not just in Ontario, but across Canada.
“I like to think we are a little more sophisticated in terms of how we look at our community, in terms of quality of life, in terms of patient satisfaction, in terms of what we bring when we respond to patients,” he said. “We know response time matters, but it is not everything.
“We are leading the conversation with the province and our partners to provide paramedics the knowledge skills and ability to safely treat people in their home, keep them in their own home and no longer obligate a trip to the hospital,” he said.
Among the programs is the Renfrew County Virtual Triage Assessment Centre (VTAC): having a staff member at the call centre and working with the dispatchers and having a Commander on site works better dealing with shift overrun and other factors.
“We are the second paramedic service in the province to be allowed to do this,” he said.
He concluded by requesting the new Renfrew County Council continue to lobby on behalf of paramedics throughout the province.
“I’m asking for your advocacy to create sustainable funding models and policy to support these programs which do represent a model of care for the rest of Ontario and much of rural Canada,” he said. There are some programs that are funded 100 per cent by the province, and others that have a 50/50 on the municipal levy. If there is an additional ambulance added to the system that will be another pressure on the levy.
“That is why we need more on the 100 provincially funded programs,” Nolan said.