Middlesex-London paramedics pitch solution to ease pressure on overwhelmed emergency rooms

Seconds count when an ambulance responds.

However, once patients reach local emergency rooms, offload delays can keep paramedics tied up for hours until the hospital has a bed available.

This year ambulance offload delays in the region have soared to unprecedented levels.

Chief Neal Roberts of Middlesex-London Paramedic Service (MLPS) warns, “[There are] longer offload delays than ever before. It’s impacting our crews, it’s impacting patient care.”

A new report to Middlesex County Council, which oversees local land ambulance service, details the rapidly expanding problem.

In Middlesex-London, the number of offload delays has climbed 37.8 per cent this year, and the average length of each delay has grown by 46.4 per cent.

Since July 1, there have been 57 instances when the availability of local ambulances dropped to "code zero."

The report reads, “Code Zero reflects that at that moment in time there are no available MLPS paramedic resources available to respond to 911 calls. Fluid deployment across the province of Ontario would result in the dispatching of the closest ambulance from another county or catchment area.”

According to Roberts, Ontario’s Ambulance Act requires — with few exceptions — paramedics to transport patients to a hospital with an emergency room even if the visit is not medically necessary.

Those patients add to the workload of clogged ER’s and subsequent offload delays keep two paramedics and their ambulance from responding to the next 9-1-1 call.

Therefore, MLPS leadership want permission from the Ministry of Health to try a new approach.

Dubbed the “Treat & Refer Pilot Project,” less serious “code 3” calls would be handled by a single paramedic that self-dispatches from a medically equipped SUV.

After receiving treatment on scene, patients would then transfer to community paramedics who offer less urgent care for ongoing medical conditions.

“We could treat on scene and refer to a community paramedic, to give a better level of care, a faster level of care, and to reduce some of the burden on the [ambulance] crews and hospitals,” explains Roberts.

There would be no change to emergency “code 4” calls.

Middlesex County has been working with the City of London and local hospitals seeking the provincial government’s permission for the pilot project.

“We all recognize there is a crisis right now,” says Middlesex Warden Alison Warwick. “There are a lot of provincial rules that are no longer applicable or working, so now is the time to see what will work or not.”

Middlesex-London is also pushing for permission to dispatch more appropriate forms of care, rather than always sending a traditional ambulance.

“It actually may require a community paramedic, a single paramedic to treat them on scene and to discharge them, maybe it requires sending a mental health support team rather than an ambulance,” adds Roberts.

If it gets the green light, the Treat and Refer Pilot Project would be the first of its kind in Ontario.