Ambulances on stand-by at the St. Catharines hospital site on Tuesday.
Niagara hospital plans will aggravate ambulance offload delays, warns paramedics union
No strategy will "all of the sudden" clear up ambulance offload problem, says hospital chief of staff
By Allan BennerStandard Reporter
Wed., Jan. 25, 2023timer4 min. read
Already waiting thousands of hours to deliver patients into the care of Niagara hospital emergency departments each year, Niagara Emergency Medical Services paramedics fear the situation will become far worse in years to come if Niagara Health continues with its plan for hospitals.
"I was very concerned when I read this announcement, this new plan that they have," said Jon Brunarski, who is an active paramedic and president of CUPE 911.
"With the number of ambulances that we have on the road, with the number of ambulances that are stuck on offloads, with added travel time for serious patients, it's very concerning."
The hospital system released its 2023-28 strategic plan last week. It plans to close facilities in Port Colborne and Fort Erie and downgrade Welland hospital to an ambulatory care centre with limited emergency services.
Brunarski said the plan, to be implemented after the new south Niagara hospital opens, will leave paramedics primarily with only two options when transporting patients.
"If you're going to take Welland hospital out of the picture, we have two options — either St. Catharines or the new south Niagara hospital (in Niagara Falls)," Brunarski said.
Paramedics, he added, are only permitted to transport "very low acuity calls" to urgent care centres.
"I don't know how that's going to get fixed and I don't know if Niagara Health is taking into consideration the ambulance provider having to move all of these people all of that distance."
Niagara Health chief of staff Dr. Johan Viljoen, however, said there is no single "strategy that we can adopt that is all of the sudden going to clear this up."
"That certainly is ongoing work, and it's multifactorial," he said.
In 2012, a report by then Niagara Health hospital supervisor Kevin Smith recommended closing the Welland site entirely. The 2012 recommendation also called for the Port Colborne and Fort Erie sites to close.
The new plan is significantly different.
Viljoen said the existing plan for the Welland site, which the newest strategic plan incorporates, was developed in 2018. It called for more emergency services in Welland than a typical urgent care centre usually has, such as additional diagnostic imaging. But the hospital would no longer have a full emergency department.
That plan was a significant change from the 2012 recommendations.
In April, 2022, the Ontario legislature unanimously approved a motion by Niagara Centre MPP Jeff Burch calling for the Welland site to remain a fully functional acute care hospital. However, that motion was symbolic, with no force in law.
In the years since the 2018 plan was developed, Brunarski said the offload delays have become steadily worse.
It's normal for five to 10 ambulances to be on offload delay at any given time in Niagara, and it has become "an anomaly" for there to be no ambulances waiting to deliver patients, he said.
"It does happen, but it's not a normal thing anymore," Brunarski said. "It's very frustrating for us."
As Brunarski spoke to The Standard on Monday, he said five ambulances were waiting at Niagara Falls hospital, four at St. Catharines and three at Welland.
Unless something can be done to address the issue before the strategic plan is implemented, he said downgrading Welland's emergency department will have a devastating impact on paramedics and the patients they transport to the two remaining emergency departments.
"I'm very worried about how this is going to work," he said.
Niagara Region's former EMS chief Kevin Smith has updated regional council several times on the offload situation during the past few years, and interim chief Rick Ferron has continued to keep councillors informed.
In a Jan. 10 report to the Region's public health and community services committee, Ferron said paramedics spent roughly 33,400 hours waiting to deliver patients to hospital emergency departments in 2022, and he expects that number to increase to at least 52,000 hours this year.
It's also costing Niagara Region millions of dollars, including $2.4 million allocated in April to cover the cost of putting two more ambulances on the road 24 hours a day along with a third ambulance that will operate for 12 hours.
In an email, Ferron said he remains hopeful the situation can be resolved.
"Niagara EMS continues to work closely with Niagara Health, and we are dedicated to ensuring the residents and visitors of Niagara receive the highest level of care available," he said.
Viljoen said Niagara Health is constantly working to improve the flow of patients through its emergency departments, and hospital patient beds.
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He said "a lot of work is being done at all three acute care sites" to address issues, and the hospital system is starting to see some improvements as a result.
Viljoen listed a few of those initiatives.
The SCOPE program — Seamless Care Optimizing the Patient Experience — has helped reduce emergency department pressures that have contributed to offload delays, he said.
It's an initiative that gives primary health-care providers virtual real-time access to medical specialists, hospitals and other health services, in some cases eliminating the need for a hospital visit.
Viljoen said Niagara Health will also begin a review of its ambulatory care programs in the months to come, with plans to establish a series of rapid access clinics, treating patients for a variety of issues from cardiac care to geriatrics.
"There's an entire spectrum of rapid access clinics that we will be developing as we go on," Viljoen said.
Emergency department physicians will then be able to refer patients to those clinics for appointments within 24 hours.
Viljoen said each of those elements "provides a tiny little domino, so when we put it all together it will translate into making life easier in congested" emergency departments.
Allan Benner is a St. Catharines-based reporter with the Standard. Reach him via email: allan.benner@niagaradailies.com