'Code Reds' Becoming More Common in Ontario City

It's five o'clock on a Friday afternoon and not a single ambulance is available in the city.

Thousands of commuters are on their way home or to the cottage. The thermometer is hovering around 30 C. It's a peak time for emergency calls, but nobody can respond.

Five paramedics have called in sick. There are eleven ambulances on the street and they're all busy on calls. Two of them are sitting at St. Joseph's Hospital waiting for their patients to be unloaded.

At the Hamilton Emergency Medical Services headquarters on Victoria Avenue North, supervisors are on the phone with dispatch, jump-starting their emergency plans.

Ambulances are called in from Caledonia, Halton and Cambridge. Patient transfers are delayed.

A senior official calls the hospital to ask for the two patients lying on stretchers to be swiftly admitted.

As each minute ticks by, the tension heightens. They know a new call comes every 10 minutes.

They call it a Code Red, the dangerous moments when the city has zero ambulances available.

Not that long ago, they didn't use the term. The rare occasions when no ambulance was available were anomalies that quickly passed.

Then on May 17, 2006, Hamilton went more than an hour with zero to four vehicles available, a number considered less than safe. For 10 minutes there were none.

The shortage was so unnerving, senior staff invoked the city's emergency plan. Extra paramedics and volunteer firefighters were called in. Hospitals were asked to clear ambulances as soon as possible.

The next day, the issue was front page news.

Other municipalities called Jim Kay, head of fire and emergency medical services, to question all the fuss. Ambulance shortages were no longer emergencies in their communities. They were becoming normal.

It was a grave premonition for Hamilton.

From May to Dec. 12 last year, there were eight Code Reds. Then in the next month, there were 19. Now they're a regular occurrence, about every two weeks.

There aren't any more calls. But more are being upgraded to lights-and-sirens emergencies. Required meal breaks for paramedics are also taking ambulances out of service.

But the main issue for the ambulance team is just a trickle-down of the crisis facing the entire medical system. Supply and demand. There are more patients than beds and medical staff. The backlog travels all the way through the hospital and out the doors to the ambulance bays.

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The Code Red is entering its 13th minute.

"My guess is this is a blip," says supervisor Jeff Dunford, monitoring the status of ambulances on his computer screen.

He's anxious to get the two ambulances at St. Joe's unloaded and back on the road.

"We're fighting with them right now," he says, a phone to his ear.

One ambulance has been waiting since noon, five hours ago, for a diabetic patient to be admitted. The second brought a transfer from the urgent care centre an hour and a half ago.

Fellow supervisor Bev McGauchie jumps in her truck and heads to St. Joe's to talk to the duty nurse about the night ahead. She's made it part of her routine to check in at all the hospitals at the beginning of her shifts.

"The duty nurse is the first line of defence." A couple of years ago, unloading a patient at a hospital took no time, McGauchie says. Then word started to surface about lengthy delays out West, then Toronto.

"Oh my God, it's going to happen to us," McGauchie recalls of her reaction. "If someone had told me then we'd have four-hour delays, I'd have said they were crazy. And now that happens."

A recent report found it took 64 minutes for paramedics to get out of the hospital, 90 per cent of the time. That's up 10 minutes in only one year. The draft provincial guideline is 30 minutes.

For serious cases, beds open immediately. It's the lower-priority patients -- people who would have waited for hours in the waiting room if they'd come themselves to the hospital -- who take the longest to unload.