Originally Posted by
TurboMedic
I have many many thoughts on all of this, so yes I can weigh in.
Its a multi faceted problem that will not be resolved by any one thing unfortunately, as each of the things will only have incremental success in resolution of the main problem.
Waiting in hospitals is a thing...100% its a burden on the system of prehospital care, at any given time we can have anywhere from 3-up to 15+ crews at hospitals. We try to mitigate this by having crews take multiple patients, but that only really solves half or less of the issue depending on the severity of the patients issues. This number varies and fluctuates and we do lots of other things to try and avoid this, like transporting minor things to urgent care instead of hospitals, or by not transporting up to 40% of the actual calls that come into EMS.
Staffing is another issue. We have no staff to work on trucks, so every single shift we have units that are just not working because of staffing. We also prioritize rural resources so we often send city staff out to work on rural ambulances to try and reduce the time they are without ambulances. This obviously reduces the amount of actual units in the city, so those that are left are further burdened. The number that is actually shut down varies per shift, it can be only a few, but it has been up to half of the fleet. You can see where that would be an issue, we have high high call volume that would already exceed the FULL staffed compliment, plus we have units tied up in offloads, so we are further in the hole.
We have a physical vehicle problem, we can't get actual ambulances, and those that we have are falling further into disrepair and high milage because we can't get them serviced, so even if we had staff to work full compliments, we wouldn't actually have vehicles to put them in. Now this is not a total AHS issue, this is a manufacturer issue that could not meet obligations, which stems back to Chev not manufacturing enough chassis. Regardless, more in the hole we go!
Then because we can't meet this call volume, we end up stacking calls, so some people wait really disproportionate times for ambulances. This time obviously varies as volume is a flux, but it can be as short as 15 min before someone is dispatched, all the way up to 11+ hours. All that stacking calls does is kick the can down the road, you're really not reducing any kind of load at all as the time you get around to those calls is at 3-4am when we already have the least amount of actual units staffed due to the schedules, and so you're still doing the same amount of calls with the same resources, its just really moving the goalposts.
Theres also a suspension or reduction in patient movement between sites. This is also short sighted as those patients need to move to open and available spaces in order to make room for new patients. If we aren't doing those because we are busy chasing our tails on the emergency side, it results in more hallway waits as those spaces aren't available. Its a really self limiting issue.
Now onto the hospital side, yes they are understaffed as well, for the same reasons we are. You can't pay people enough to come to work in the conditions the way they are anymore. On the EMS side we don't get breaks. We are also told we cannot "take" a break and eat at the hospital. Well how does that work when you clear and you get calls right away as they're waiting in a queue. SO you end up with crews that are going an entire shift barely able to go to the bathroom, eating on the way to calls, using restrooms in patients houses, and then at the end of their shift they are tied up in a hospital, or getting more calls because they keep coming, and they end up with 1-2 hours of OT every single day. Its impossible to plan a family life within EMS. Work life balance is broken beyond broken. You ride people until they're burned out and angry within 5 years. Many leave, many drop to casual employment, and tons are off on various leaves. Sick time is crazy, you break someone the night before, they don't come in the next day. People can't function, people can't care for anyone, compassion fatigue is real, and you end up with complaints. Support is nonexistant, and recognition of the problem is nonexistant. Its just can't we do more calls with the same amount of people? The answer is no, and the answer was no years and years ago already, this is just a culmination of that.
Nurses are in the same boat. High absenteeism for the same reasons. THey even hire contract nurses at like $80/hr and they still can't fill them, so they end up shutting down beds in the department. Some times only a few, but more often than not almost half the beds are not staffed and working. You can see where this becomes a problem with the first issue, hallways. EMS gets used as capacity in the department because they have no other choice, and they feel its a liability to "leave" patients in the department. This has been disputed by legal, and really our responsibility ends when we check the patient in, but of course we are all one so there is no real push back or bite to the initiative.
Lastly, yes there is a TON of people who go into hospital, and call EMS for very very minor complaints. This is an issue with access to physicians being a problem, as well as a misunderstanding that nobody gets in faster with EMS. You can't just tell people to pound sand, an emergency is different in everyone's eyes, and sometimes a bit of education is fine. Frankly rather than saying "why did you come to a hospital" or "why did you call EMS", maybe we just need to meet the volume we have, and call it part of an integrated health care system. To do that we would need more people. More resources. If you want to change that, we need public education, and the ability and condonement of trying to find other solutions for people that may not be a hospital right now. Any cancellations that are done of that 40% mentioned earlier, aside from a small subset of patients, is all done under a practitioners own risk. We try everything possible to keep the system afloat, keep hospitals above water. If we transported every single call (as is the ACTUAL direction from AHS and management), we would crater the system in the first 30 min. I laugh as I say that as the system has already collapsed, and I can't think of a way it could get more grim but I'm sure its out there.
Disclaimer, I say this all as myself, not representing AHS, just sharing my experiences because I was asked. I'm just an inside observer