Emergency Care in Crisis: Nova Scotia’s Ground Ambulance Service Faces Critical Issues, Reveals Auditor General’s Report

Includes provincial response

Auditor General release:

Nova Scotia’s ground ambulance service is in crisis, facing significant challenges in response times, paramedic staffing, offload delays, and accountability, according to a recent audit by the Auditor General.

Nova Scotia’s ground ambulance service is in a critical state, and the government is not effectively monitoring the performance of Emergency Medical Care Inc. (EMCI) to adequately deliver it, says Auditor General Kim Adair. The government spent more than $147 million in 2022-23 to operate the service, which has encountered increasing response times across the province since 2017. Last year, the average wait time for an ambulance in Nova Scotia spiked from 14 to 25 minutes, an increase of 79%.

“It’s taking ambulances longer, on average, to respond to emergency and urgent calls, putting Nova Scotians at risk. This is true for ambulance responses in large urban areas such as Halifax and in the rural parts of the province as well,” Adair says in a new report. The poor response times are a symptom of the strains on the ground ambulance system, including a 17% escalation of 911 calls requiring an ambulance, staff shortages that force available ambulances to sit idle, and the temporary closures of community emergency departments diverting more patients into regional centres.

In the past three years, the government has implemented some effective initiatives like the introduction of transport operators to alleviate the pressure on paramedic teams and ambulance vehicles. Likewise, EMCI has improved working conditions for Nova Scotia’s 1,000 paramedics, yet these emergency healthcare professionals continue to experience an unsustainable work environment rife with staffing challenges. Paramedic resignations and retirements are outpacing hiring while sick time is on the rise.

In 2021, the Government set a new offload standard of 30 minutes for all ambulance patients arriving at emergency departments. But our audit testing over the course of a year (2022) found that none of the emergency departments in the province’s largest hospitals consistently met that 30-minute standard; it was achieved only 23% of the time. That explains why last year, on average, paramedics spent a quarter of their working hours in emergency department hallways waiting to transfer care of their patients to Nova Scotia Health staff. The offload issue is especially prevalent in the Halifax area, which experiences the longest delays in the province: 155 minutes at the Cobequid Community Health Centre, 170 minutes at the Dartmouth General Hospital, and 195 minutes, or over three hours, at the QEII Health Sciences Centre – Halifax Infirmary.

“Nova Scotians living in the Halifax area, the most populated region of the province, are at the greatest risk of the ground ambulance system not meeting their needs,” says Adair. The audit found that the Department of Health and Wellness is not holding Nova Scotia Health accountable for its role in offload delays in emergency departments nor is it holding EMCI accountable for ambulance response times.

Since 1999, EMCI – a subsidiary of Medavie Health Services – has operated the ground ambulance system in Nova Scotia. The contract was most recently renewed in 2021 and contains response time performance standards and penalties for not meeting the prescribed times. EMCI has repeatedly failed to meet its contractual response times but has never been fined because of the mutual agreement that EMCI will not be held accountable for response times in the current strained system with contributing factors, like offload times, beyond EMCI’s control.

The Auditor General makes 14 recommendations in the new audit, including the reinstatement of accountability for EMCI on response times, and direction to clearly define who is accountable for directives at both the Department and Nova Scotia Health relating to offload delays at emergency departments. The department has agreed to all recommendations and has already started to implement them.

Provincial release (response):

Today, the Auditor General’s Office released its report on Nova Scotia’s ground ambulance service.

The report confirms what we already know: There are system pressures and challenges affecting ambulance response times that must be addressed.

As a government, we couldn’t agree more.

Since 2021, we have made significant improvements in emergency care across the province by investing in people, equipment, technology and changes in policy.

What we have achieved so far is just the beginning. We will do more and that starts by accepting all 14 recommendations in the Auditor General’s report. Some of these recommendations are already complete, others are in progress, but all will be implemented.

As we work with our partners to implement all the recommendations, I want to take the opportunity to share the work that’s been done over the past two years.

We expanded the Emergency Health Services (EHS) fleet with more patient transfer units, medical transport service vehicles, single paramedic response units and a new LifeFlight airplane. They have made a big difference in keeping ambulances focused on responding to emergencies.

For example, as of August, about 86 per cent of patient transfers are handled by patient transfer units, compared with 14 per cent by emergency ambulances. That is an increase and decrease of 10 percentage points, respectively, over the last year.

Our single paramedic response units help to divert people away from emergency rooms by treating and discharging patients on the scene. On average, these units respond to more than 1,000 calls each month, and about half of those calls don’t require a hospital visit, which frees up ambulances for more urgent calls.

We launched our new LifeFlight plane in August, and it’s already making a difference. Transporting non-critical care patients from Yarmouth or Sydney to Halifax, it has saved more than 920 hours of ground ambulance time. Instead of day-long round trips to Halifax transporting patients, these ambulances and paramedics are staying in their communities to provide emergency services. This benefits patients and our paramedics.

To support our paramedics and keep their important skills focused on emergency calls, we hired more than 140 transport operators to staff many of the new units.

We also added a registered nurse to the EHS Medical Communications Centre. The nurse works alongside a clinical support paramedic and physician to give medical advice and treatment options to callers. Our communications centre is one of the few in Canada to have all three of those healthcare professionals embedded.

Last year, we implemented a direct-to-triage policy that supports paramedics to take low-risk patients to the emergency department waiting room to be assessed by healthcare staff. Previously, paramedics had to wait with patients until a doctor took over their care.

We are making it easier and more attractive for people to become paramedics in Nova Scotia by offering more training opportunities, tuition rebates and incentives. It has never been a better time to start training in paramedicine.

Improving the delivery of emergency care for Nova Scotians requires investments and support for other areas of the healthcare system.

Nova Scotia Health, with support of the government, is improving access and flow in hospitals with initiatives like the Care Coordination Centre, the first provincewide command centre in Canada that gives healthcare teams information on bed availability, ambulance offloads and patient transfers. The command centre enables staff and physicians to spend more time providing care instead of co-ordinating it, directly addressing the need for faster access to care.

And there’s SAFER-f, an initiative focused on improvements like completing lab tests sooner, better co-ordinating healthcare teams and improving communication with families and patients, all of which help patients to return home sooner.

Increasing evening and weekend access to services such as physiotherapists, dietitians, pharmacists, occupational therapists and discharge planners also helps patients reduce their length of stay.

And we are building. Many hospital beds are being used by patients who could be better served in long-term care or could be monitored effectively outside of the hospital with the right set-up. That’s why we are building long-term care homes across the province and transition to care beds in key areas. This will ensure people get to the care they need in the right place.

I would like to speak directly to those who work in our Emergency Health Services system – our paramedics, doctors, nurses, administrators and all the professionals who are working hard to provide us care. 

As a nurse, I know working in healthcare isn’t always easy. The days are long, and the work can be demanding physically, mentally and emotionally. Yet, every day, you come to work ready to help people in their moment of need. For that, we all thank you for your dedication and service.

We will continue to focus on improving your working conditions, improving offload times, getting ambulances back on the road faster and working together to get Nova Scotians the care they need. 

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