‘Hallway medicine:’ Backlogs making paramedics wait with patients up to 16 hours

Paramedics in Saskatchewan are sometimes spending entire shifts just waiting with patients to be admitted to hospital — a wait that can last up to 16 hours with a single patient.

“In the paramedic profession, it is not uncommon for responding paramedic crew to arrive at a destination facility and have to wait until that bed becomes available,” said Lyle Karaskiuk, director of public affairs for Parkland Ambulance in Prince Albert.

Paramedic Services Chiefs of Saskatchewan (PSCS) president Steven Skoworodko said significant increases in calls for service across the province over the past three to four months, combined with lengthy offload waits for paramedics, are putting considerable strain on emergency medical resources.

“We’ve definitely seen that significant rise in offload delays,” Skoworodko said.

Increases in time spent by paramedics waiting with patients to be admitted are occurring in Regina and Saskatoon especially, with longer wait times ranging from three to 16 hours.

An internal letter signed by 211 Saskatoon emergency physicians and nurses posted to the Saskatchewan Union of Nurses’ Facebook page on Sept. 9 stated that “due to offload delays, paramedics frequently remain with their patients in our hallways.”

Dr. Brent Thoma, an associate professor of emergency medicine at the University of Saskatchewan, called the statement in that letter “completely accurate.”

The letter — which was also shared by the Saskatoon Paramedic Association — also states a patient was kept in the hallway with paramedics for 26 continuous hours.

Skoworodko said that number might be a bit high, but confirmed paramedics in the province will sometimes spend an entire shift waiting with a patient to be admitted to hospital. Sometimes, paramedics will be relieved from waiting with a patient by new crews, who will continue the wait.

“We’re seeing significant pressures across the province right now,” he stated.

In other cases, Skoworodko said some patients are being discharged from the ambulances, while others are receiving “hallway medicine” — care administered by paramedics in the hallways and waiting rooms of hospitals.

“If they’re tied up in a hallway then they can’t get to the next emergency call,” Skoworodko said.

Troy Davies, a Saskatoon paramedic, told 650 CKOM that offload delays have pretty much been happening across Canada since the COVID lockdown. “Some days are worse than others … (It) all depends on how busy the ERs are,” Davies explained.

Karasiuk agreed, adding that offload delay times vary from ER to ER across the province, but it’s likely more common in bigger city centres like Regina or Saskatoon.

In Prince Albert, Karasiuk said paramedics are not seeing the level of delays that Skoworodko said paramedics are experiencing, instead seeing waits ranging from 30 seconds to several minutes.”I don’t see a significant wait for our paramedics,” Karasiuk said, adding that offload waits are not uncommon for paramedics. “We experience them every day.”

The PSCS president, however, said he’s seen rural crews working up to 36 hours straight without taking a break. These emergency responders will report to faraway calls and transport their patients to hospitals for care, then they might also experience multi-hour offload delays before having to travel back to their home communities.

“That’s contributing to some really lengthy times and possibly some unsafe conditions for paramedics and for patients,” he said.

Things like beds being cleaned or waiting for beds to become available are some of the reasons Karasiuk said a wait during offloading could occur. Typically, once a bed has been cleared, paramedics are able to offload their patient to the facility and give their report.

The wait itself isn’t a break for emergency medical personnel, as one paramedic must always remain with the patient, who cannot be left unattended on a stretcher.

Regular vital sign checks and monitoring, depending on the severity of the patient’s condition, and giving medication are some of the other tasks paramedics must perform during these waits.

Skoworodko said there have been some delays in responses from ambulance services because of offload delays, but even when there aren’t any delays, the volume of calls for emergency services has been significant.

Calls for service are up about 20 per cent on average over the past four months, Skoworodko said.

“There is definitely an increase in ambulances responding to calls and then therefore bringing patients to hospital but then there’s also that offload delay when paramedics are getting to the hospital and then waiting with that patient on their stretcher,” he noted.

Karasiuk and Skoworodko agreed COVID is not solely to blame for the wait times paramedics are experiencing.

“That would be an incorrect statement,” Karasiuk said, stating that many factors go into the busy nature of an ER.

Skoworodko said COVID is “absolutely” part of the reason for the long waits, but couldn’t speak to the other issues hospitals might be experiencing that are contributing to long wait times.

“It’s tough … Not very many other professions would have somebody working 36 hours straight without really any break,” Skoworodko said.

“It’s putting a lot of pressure on the paramedics, physically and mentally.”