AHS Ambulances not available in Calgary, Police and Fire often step in.

[jutes]

Wife was a RN ER nurse in the early stages of her career. She was spit on, abused both verbally and physically, all without any consequences on the patients. You'll get arrested and charged with assault if you punch a cashier, but "sick" people get a free pass. Oh, she was also called a racist by first nations constantly for not treating them fast enough. She's now in an RN admin job that pays way better with normal hours and doesn't have to deal with the trash of society. Our social healthcare system needs to just die.

[Xtrema]

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It wasn't long ago that activists were protesting outside hospitals and hassling staff coming and going from work.

There isn't enough money to be frontline of anything if people can't behave like decent human beings. Internet manufactured/fanned outrages doesn't help.

[Buster]

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Solve the problem of paramedics spending a third of their shifts idling at hospitals babysitting patients and the “staff to cover shifts” problem balances itself.

The solution cannot always be more shifts.

you would immediately see the hospital staff start a PR campaign against the gov't decision as the shitpile moves from the paramedics to some incompetent triage system within the hospital.

The employees within the large public institutions (education and healthcare) are masters at getting the media to carry their water.

[Buster]

I think we should merge the CBE and AHS. Just to see what happens.

[Cagare]

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I think we should merge the CBE and AHS. Just to see what happens.

Only if Danielle Smith is put back on as a Director.

[jwslam]

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Only if Danielle Smith is put back on as a Director.

Just for fun let's make Druh president

[DonJuan]

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I think we should merge the CBE and AHS. Just to see what happens.

That's how you get residential schools

[rage2]

Anecdotal (although I’ve got a handful of anecdotal experiences) but there’s definitely not a staffing issue at hospitals. There’s a lot of people who don’t need ER jamming up the ER though, and if they’re coming in from an ambulance, makes it way worse.

I went in myself a couple of weeks ago in unbearable pain, suspected appendicitis but ended up being a small kidney stone slicing up my ureter, I was admitted and into a bed in 10 mins. IV and pain killers within the hour, CT scan another 30 mins later after talking to the doctor, and discharged after doctor finished the analysis with prescriptions in hand. Was absolutely surprised how smooth everything was. In and out in around 4 hours total.

By the time I left some of the same people were still sitting in the waiting area. Lots of sketched out folks in there just zombieing around, fighting with the admitting staff. It’s fucked up.

Maybe @TurboMedic might have some insights on my account to see if it’s the exception or the norm.

[Twin_Cam_Turbo]

Fack wish I had been in in 10 mins the two times I went with Kidney Stones. Which hospital?

[rage2]

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Fack wish I had been in in 10 mins the two times I went with Kidney Stones. Which hospital?

Foothills. I was in really bad pain tho so that might’ve expedited the process. Every few mins I’m fetal position on the floor, apparently due to the damage done. Was leaking blood and piss inside me lol.

[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.

Quick edit because I wanted to talk about efficiency. AHS wants peak efficiency. From a business standpoint, that makes sense. From a public safety standpoint, its terrible and people are dying every week as a result. They try to run healthcare (and I'll use EMS and ED's as the example because that is what we are talking about) like a machine. A production machine. If that machine is down, its not doing work, and you're paying for nothing. This concept works fine, for production. For emergency preparedness its backwards. That is what the Fire Dept does well, almost too well. They have oodles of downtime, like a coiled spring waiting to respond, but that is the model of emergency preparedness and public safety. Police a little less so as they are equally busy to us, but with lots of low acuity non time dependant issues, mixed in with their high acuity calls. They go go go just like we do but they have provisions for breaks, not being assigned to calls, etc, that we don't have. The theoretical target was 90% utilization of a unit. IE its being put to work 90% of the time. The standard that is widely accepted is more in the 65-70% range, this promotes better staff health, better mental health, less burnout, and flexibility to deal with varying volumes. Sometimes you'll be busy, sometimes you'll be slow, but you're always meeting your demands. Unfortunately we are at 98%+ utilization right now (I say that 2% because people do end up trying to take time to go to the bathroom, or get a bite while attached to a call, etc. Its actually likely by the numbers pretty well 100% as you sign on, get a call, and then you don't actually have any time not on calls until you go home, typically well after your shift is complete. No flexibility to adapt to varying volumes. Not sure if that was a redundant paragraph or not to what I wrote.......I try not to read over it again as it just makes me angry

Disclaimer, I say this all as myself, not representing AHS, just sharing my experiences because I was asked. I'm just an inside observer. Or maybe I heard it from a friend...I'm not sure.

[Buster]

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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

Two questions for you:

1. What percentage of your calls are FN?
2. What percentage of your calls are overdoses?

[ThePenIsMightier]

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Two questions for you:

1. What percentage of your calls are FN?
2. What percentage of your calls are overdoses?

All.
Ambulance is a cab for FN. From Eden Valley all the way to Black Diamond.

[Misterman]

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Solve the problem of paramedics spending a third of their shifts idling at hospitals babysitting patients and the “staff to cover shifts” problem balances itself.

The solution cannot always be more shifts.

Is this honestly a real problem? Is there some data on this? It takes 5 minutes to admit someone at Emergency, so unless your assessment of it all being due to lazy admitting nurses that don't want to deal with homeless druggies, and those homeless druggies make up the lions share of patients that ambulances are bringing in, it just doesn't add up.

[dirtsniffer]

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Two questions for you:

1. What percentage of your calls are FN?
2. What percentage of your calls are overdoses?

I can feel kert getting triggered from here.

[colsankey]

.

[Twin_Cam_Turbo]

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Foothills. I was in really bad pain tho so that might’ve expedited the process. Every few mins I’m fetal position on the floor, apparently due to the damage done. Was leaking blood and piss inside me lol.

Weird, took me almost an hour when I went to Foothills to get in, almost passed out parking my car and had to have a bystander park it for me while I crawled into emergency. The second time I went straight to Rockyview and I had to have surgery, 8mm stone stuck in there.

[Buster]

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Weird, took me almost an hour when I went to Foothills to get in, almost passed out parking my car and had to have a bystander park it for me while I crawled into emergency. The second time I went straight to Rockyview and I had to have surgery, 8mm stone stuck in there.

8mm?

Dafuq dude.

I still maintain that kidney stone was the worst experience of my life. The entire ER line-up at the checkin desk at Rockyview allowed me to cut in front of them because I was making such a scene.

[TurboMedic]

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Two questions for you:

1. What percentage of your calls are FN?
2. What percentage of your calls are overdoses?

Honestly, in the grand scheme, a pretty insignificant number to #1 vs. the rest of the population, so alter your perception. And #2, depends on the current supply out there, keep in mind that EMS in the city can do 3-400 calls in a day, so overall not a huge number are OD's (the chart says 5%, but that includes just drunk people, as well as regular medication "overdoses", not just opioid). The other thing is that OD's don't tie up ambulances that long, honestly they mostly get up, give you the finger and walk off..Some thank you....So overall its much less impactful than most other calls in terms of resource intensity.

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Is this honestly a real problem? Is there some data on this? It takes 5 minutes to admit someone at Emergency, so unless your assessment of it all being due to lazy admitting nurses that don't want to deal with homeless druggies, and those homeless druggies make up the lions share of patients that ambulances are bringing in, it just doesn't add up.

This is such a bad take I'm not sure where to start or if I even should. Yes, this is a problem. Yes there is data on this, plenty of it, I've quoted what I could find quickly that was compiled as up to date as I could, which was 2020 I believe (not my data, someone else compiled it via FOIP). The number would be higher, this only goes one direction. No, it does not take 5 minutes to admit someone at emergency, and no its not laziness. Homeless druggies make up a very very small amount of the people that end up in hospitals to begin with, and also a small amount that end up in hallways. The VAST lions share of the hallway waits is elderly falls (hips/heads/etc) because there are so many of them and they are low priority in terms of severity, and then general sickness complaints, nausea/vomiting/abdo pain, and then seizures. They're all low priority as well, and they can't be "left alone" in a waiting room due to various reasons so they get parked.
So you're right, your assessment doesn't add up.

In 2019/20 FY, time lost to Transfer Of Care delays at hospital totalled 289,573 hours. 106,726 of those were in the Calgary Zone. AHS EMS estimates the cost of these TOC delays that year were $43,311,414.
Calgary specific stats:
-106,726 hours
-292 man hours per day
-24 paramedics removed from service for entire 24 hour period
-equivalent to 12 ambulances parked for 24 hours every day

[Twin_Cam_Turbo]

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8mm?

Dafuq dude.

I still maintain that kidney stone was the worst experience of my life. The entire ER line-up at the checkin desk at Rockyview allowed me to cut in front of them because I was making such a scene.

Yeah. 0/10 do not recommend. We called an ambulance for my dad when he had a similar sized one, we thought he was having a heart attack the way he was acting.