Ottawa To Deploy Taxis to Back Up Ambulances

To cope with seriously excessive offload times at overtaxed ERs that are keeping ambulances off the streets, the city-run Ottawa Paramedic Service (OPS) is planning to transport non-critical patients to the hospital by taxi. Under the OPS’ Safe Alternate Transportation Program, patients with ‘low-acuity’ health conditions, like twisted ankles or cuts that require stitches, will be sent to the ER in taxis ordered by paramedics. This will free up their ambulances to respond to other more urgent calls, rather than wasting hours waiting for overworked ER staff to accept their low acuity patients.

The Ottawa Paramedic Service serves a million Ottawa city residents. It responds to about 180,000 calls annually using 600 paramedics, transporting around 90,000 patients in this period.

Chronic Challenges in the ER

The reason the OPS has developed the Safe Alternate Transportation Program and many other options is due to chronically overused ERs in the Canadian province of Ontario. A serious shortage of family doctors across the country, along with an inadequate number of walk-in clinics, means that many Ontarians go to the ER whenever they have medical issues. The matter is being exacerbated by a shortage of long-term beds for chronically ill patients, with them being parked in acute care hospitals instead. Ontario is also short of nurses due to inadequate pay and poor working conditions, which have become worse since COVID-19.

The result is that Ontario’s ER staff are chronically working at full capacity or beyond, which delays the offload/transfer of patients from ambulances to hospitals. Until that transfer happens, the ambulance crew that delivered the patient is required to sit in the parking lot and wait — even if there is an urgent call for help in the community.

The result: “The Ottawa Paramedic Service has been under tremendous pressure to deliver reliable service to our community and meet performance response time targets that have been established by our city council,” said OPS Paramedic Chief Pierre Poirier. “The pressure that I speak about is the fact that the 90th percentile offload time in the City of Ottawa is 160 minutes, and that is devastating. Essentially I'm losing a paramedic crew every time they go to the hospital for two and a half hours.”

Level Zero Events

The consequence of these offload delays is known as Level Zero events, which is what happens when the OPS has no ambulance available to respond to that next call for service. “In 2022, we had over 1800 events where we did not have an ambulance able to respond,” said Chief Poirier. These Level Zero events continue to occur in Ottawa to this very day.

Unfortunately, the number of Level Zero events occurring in Ottawa doesn’t tell the whole story. There’s also the actual period in which no ambulances were available in Canada’s capital city. “There were over 73,000 minutes of Level Zero in 2022,” Chief Poirier said. “If you do the math, that's about seven weeks of time in a year where there was nobody able to respond to that next call for service in an ambulance.”

With any luck, the OPS will receive permission to launch its Safe Alternate Transportation Program and start to reduce the number and time length of Level Zero incidents. “I expect to have approval from the Ontario Ministry of Health to offer the taxi-based alternate transportation in the coming weeks,” said Chief Poirier.

In the meantime, the OPS is also recommending other options to free up its ambulances for real emergencies, such as taking patients with substance abuse issues directly to non-hospital treatment centers, having one OPS crew at a time be responsible for multiple patients waiting to be offloaded at ER to free up the other crews and to even cancel calls for non-emergency patients who do not need to go the hospital at the current time. Granted, these are all ‘workarounds’ for a Canadian public health care system that is underfunded and overstressed. But given the appallingly high number and length of Level Zero events in Ottawa, anything that makes a difference is worth a try.