Ambulance system is improving, say health officials, but union worries it may not be fast enough

Officials with Nova Scotia's health system and ambulance service say recent changes are increasing efficiency, but the union representing paramedics and opposition politicians are still worried about working conditions.

MLAs at the legislature's health committee heard Tuesday that the time it takes paramedics to transfer a patient to the care of emergency department staff after arriving at the hospital are improving.

The provincial average this week is 75 minutes, still well above the goal of 30 minutes. That time is even highest in the central and eastern zones at an average of 94 and 89 minutes, respectively.

Jeannine Lagassé, the deputy minister of health, said she's confident new measures including a command centre that oversees hospital bed availability across the province, along with recruitment and retention efforts for nurses will all help, although she cannot say when the province will meet the 30-minute target.

"I think it will depend on a number of factors and one big one being our health human resource challenges and ensuring that we can get proper staffing and consistent levels of staffing in all locations," Lagassé told CBC.

Charbel Daniel, the executive director of operations for ambulance service provider Emergency Medical Care Inc., said it will take time for the public to see the benefit of moving patients who are stable by aircraft or non-emergency hospital transfer vehicles. But he's confident they're headed in the right direction.

Those changes mean ambulances and paramedics will be reserved for only the most pressing cases. The new resources should mean paramedics will only be responsible for about 10 per cent of patient transfers, he said in an interview.

"Which means that ambulances will only be doing transfers that are critical and time sensitive and all other planned transfers can be done through a separate resource."

About 70 per cent of the calls received are not serious enough to need an ambulance, said Daniel, and call centres try to determine the most appropriate response. That could mean dispatching a care team to treat someone at their home rather than transporting them to an emergency department.

Daniel compared how the ambulance service traditionally operated with a police force.

"They've got their SWAT teams and they've got their police cruisers and what we've done for years is send our SWAT team to every call and it's not the best use of resources because it's not required," he told the committee.

Offload wait times climb over two years

But opposition MLAs were less confident about the changes, at least in part because they are not yet seeing tangible results.

Liberal Leader Zach Churchill noted that waiting times to hand off patients to hospital staff have spiked across the province in the last two years and become a problem at emergency departments from one end of Nova Scotia to the other.

"That was only an issue two years ago in two hospitals here in Halifax," the former health minister told CBC.

Numbers Churchill quoted during the meeting show that the Aberdeen Hospital in New Glasgow is the only regional hospital in the province that regularly meets offloading targets. Hospitals in Sydney, Lower Sackville, Halifax and Dartmouth have waiting times averaging 100 minutes or more this year.

NDP health critic Susan Leblanc said that while officials wait for changes to take hold, the government needs to take steps in the short term to improve working conditions and pay for paramedics, which is among the lowest in the country.

"It's insulting for us to expect so much from paramedics, for them to be there when we need them, and to pay them poorly," she said in an interview.

Kevin MacMullin, business manager for Local 727 of the International Union of Operating Engineers, said contract talks are ongoing, but in the meantime the system is losing people. Fifty-three paramedics have been hired this year, but 49 have left the system, he said. Sixteen of the people who left were advanced-care paramedics.

"You have to manage the resources you have before you don't have the resources to manage," he told the committee.

"We're losing a lot of very valued, experienced paramedics right now."

With more emergency departments closing at community hospitals, MacMullin said paramedics have to travel greater distances to take patients to regional hospitals. That creates longer waits for teams at the hospitals and means those still out on the road are having to log more miles.

MacMullin said he's confident the changes being brought in will improve the system for his members and the public, but what happens in the meantime has him concerned.

"It takes time and we're practically out of time because we're increasingly finding shortages in staffing."

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