Ambulance offload delays at hospitals: one step forward (but two steps back)

EMS offload delay and 911 response time, Fire and EMS costs reported

Ambulances are spending a little less of their time offloading patients according to the 2012 Ontario Municipal Benchmark Initiative (OMBI) report.  

That is positive: time spent offloading patients to overcrowded hospitals could otherwise be spent responding more quickly to 911 emergency calls.  Nevertheless, we remain far behind where we were a few years ago.

The OMBI study reports EMS data for 12 large Ontario urban municipalities --and also Muskoka. It indicates:
  • The percentage of time spent in hospital Emergency Rooms (“offload delay”) has declined from 18.7% of total EMS time in 2011to 17.8% in 2012.  
  • However, this is the same percentage as in 2010 and is up significantly from 2009 when paramedics spent 16.7% of their time waiting in ERs. Indeed, in 2007 paramedics spent 15.4% of their time in hospital ERs, and in 2006 they spent 13.3% of their time in hospital ERs.  In other words, since 2006, paramedics are spending 1/3 more of their time in hospital offload delay.
  • The time it took to arrive for 90% of code 4 calls (the most serious calls measured from the time the call was received by EMS until the time an EMS unit arrives) is basically stable.  In 2012 it was 10 minutes and 34 seconds; this is down 7 seconds from 2011 but up 7 seconds from 2010.
  •  There was a 2.76% increase in 2012 in cost per hour of EMS service to $186 from $181 in 2011.  This increase is down from a 5.23% increase in 2011. (The 2010 cost was $172 per hour.)

The OMBI report also provides some information on firefighting.  However, the report covered only 7 Ontario municipalities in 2012 (and 8 Ontario municipalities in 2010 and 2011). It also includes data from Calgary.  As well, the study breaks out the data for rural areas in three of the reporting Ontario municipalities.
  •  Fire staffing hours per capita are stable:  0.53 in 2010, 0.55 in 2011, and .54 in 2012.  So, firefighting hours per capita are not declining over this period.
  • Fire deaths and injuries  per capita declined over the 2010-2012 period. Fire injuries improved from 5.66 per 100,000 per population in 2010 to 4.94 in 2012. Deaths improved from  0.58 per 100,000 population in 2010 to 0.39 in 2012.
  • There was also a decline in residential structural fires with losses per 1000 houses.   In urban areas the decline was from 0 .984 in 2010, to 0.901 in 2011, to 0.891 in 2012.  That is a 9.5% decline in two years.  In the 3 rural areas the reported the decline was from 1.548 per 1000 houses in 2010, to 1.057 in 2011, and 1.047 in 2012 -- an impressive 32.4% decline in two years.
  • Fire costs: front line fire vehicles per hour cost $293 in 2010, $305 in 2011 (a 4.1% increase), and $315 in 2012 (a 3.27% increase).    
  • Firefighting front line vehicle per hour costs are 69.4% higher than EMS vehicle per hour costs.  This is slightly down from 70.3% in 2010.  

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