Ground Ambulance Service Code Critical

Nova Scotia’s Ground Ambulance Service Code Critical, says AG

For release September 26 – 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, 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.

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