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The University of Alberta Hospital in Edmonton on May 7, 2021.JASON FRANSON/The Globe and Mail

Alberta Premier Danielle Smith’s plan to overhaul the province’s health care system has singled out ambulance service as an area that needs urgent attention, in the face of long response times and persistent complaints that paramedics are having to spend too much time waiting to offload patients at hospitals.

Staffing shortages, increased demand and overburdened hospitals have been linked to lengthy wait times for ambulances across the province, with the longest waits more than doubling in urban centres and some patients in remote areas waiting more than an hour. And “red alerts” have been issued with increasing frequency in Calgary and Edmonton when not a single ambulance is available for calls.

EMS call volumes have jumped by 30 per cent compared to prepandemic levels, driven by COVID-19 infections, drug poisonings and a return to regular levels of activity after pandemic public-health measures ended, according to Alberta Health Services, the province’s single health authority. Coupled with a recent surge in respiratory illnesses and cold-weather-related injuries, such as falls on ice, AHS spokesperson Kerry Williamson said the spike in emergency calls is “unprecedented.”

Ms. Smith, whose successful campaign to lead the United Conservative Party focused heavily on changes to the health care system, released her plans earlier this month. She fired the board of AHS and instead appointed an administrator with a mandate to reduce wait times for surgeries and emergency rooms, develop a long-term plan for sustainability in the system, and improve ambulance services.

Improvements to EMS were the most detailed of the four pillars. The government said it would fast-track patient hand-offs at emergency rooms, increase the use of non-emergency vehicles to provide interfacility transfers, and empower dispatch to step-down calls from 911 to Alberta’s health advice phone line. They will also enable paramedics to triage patients on scene to determine the need for an ER.

AHS has been working on those changes since January as part of a 10-point plan designed to improve service and reduce pressure on the EMS system, Mr. Williamson said.

The bulk of non-emergency interfacility transfers is done by trained paramedics in vehicles that do not require advanced medical equipment, but higher-trained staff are still being tasked with these jobs, he said. AHS also has several pilot projects under way, including one that connects patients to taxis, family or care-home shuttles to transport them from hospitals to appointments or home.

Triaging on scene is already a “core function of paramedic practice,” Mr. Williamson added, and AHS is developing guidelines to further equip paramedics to identify and facilitate appropriate health care services. He said a key challenge remains the amount of time EMS crews spend at hospitals to safely transfer care.

Steve Buick, press secretary to Health Minister Jason Copping, said in a statement that progress has been made in some areas, such as a reduction in ambulances being called into Edmonton and Calgary from surrounding communities, “but the system is still under strain from 2½ years of the pandemic and we need to do more.”

Mr. Buick’s statement said additional changes will be announced in the coming weeks with direction from MLA RJ Sigurdson, who was appointed parliamentary secretary for EMS reform in October. This will include work on the 53 recommendations outlined in a report, which had not yet been made public, from an advisory committee on EMS that was assembled in January.

Michael Feldman, an EMS medical director in Toronto, said many jurisdictions are taking similar steps but problems will persist if changes aren’t also made in hospitals, for example, because everything is interconnected. He said Canada’s aging population is also adding strain on the health care system, which he said could be mitigated by more community paramedics to provide mobile medical care in the community to prevent the need for EMS calls or emergency department or hospital admission in the first place.

“Staffing is also a huge challenge and I think that speaks to this demographic time bomb,” he said. “You’re having an increasing burden of elderly and people with chronic diseases at the same time as fewer young people are entering the work force and a lot of our staff are reaching retirement age.”

Data compiled by AHS show the median response times for ambulances were below or close to the agency’s targets for most parts of the province in the second quarter of the 2022-23 fiscal year, the most recent data available, but the longest wait times have been getting worse, particularly in urban areas.

AHS tracks median wait times, as well as the 90th percentile, which measures some of the longest wait times. Those statistics measure the point at which 90 per cent of calls are below; conversely, 10 per cent of calls take longer.

The median wait time for an ambulance to arrive in urban areas during a life-threatening event was about nine minutes in the second quarter of 2022-23 and about 18 minutes at the 90th percentile, according to the data. The median target is about eight minutes and 12 minutes at the 90th percentile.

In rural areas, the median wait was about 17 minutes and 34 minutes at the 90th percentile. The targets for rural areas are also higher: 20 minutes for the median wait time and 40 minutes for the 90th percentile.

Paul McLauchlin, president of Rural Municipalities of Alberta, said the bar is so low in rural areas of the province that “any change is going to be a dramatic improvement.” Mr. McLauchlin said the government’s renewed focus on improving EMS is appreciated but his biggest concern is that change will come slowly and with “a lot of risk in the interim.” The government and AHS said there is no clear timeline for the changes, which are continuing.

Some paramedics are also waiting at emergency departments longer, according to the AHS data. Paramedics must remain with their patients until they are formally transferred to the hospital before they can respond to another call. While the median wait has remained steady in the past two years at under 90 minutes in Calgary and Edmonton, the 90th percentile waits have increased from about 2½ hours to about three hours.

The median ambulance dispatch time – the time between when someone reaches a 911 operator and when an ambulance is en route – was just under a minute in the most recent data, a slight increase from a year earlier. The 90th percentile was 4½ minutes – three times higher than a year earlier and far above the 90th percentile target of 90 seconds.

Early last year, AHS consolidated 911 EMS dispatch, shifting from city-run systems in Calgary, Red Deer, Lethbridge and the Municipality of Wood Buffalo to one of the three dispatch centres under the health authority. AHS said at the time that the change would improve patient care and save about $6-million a year by eliminating duplication. The Alberta government, including former health minister Tyler Shandro, pushed for the change.

Mayors from the affected cities were opposed and some repeated their calls to reverse the change in the wake of the Premier’s health care announcement, while welcoming the promised improvements to EMS.

Last week, Mr. Copping did not rule out the possibility of returning 911 dispatch to municipalities. He said the government is reviewing a report on the EMS dispatch system before deciding how to proceed.

In the northern Municipality of Wood Buffalo, a sprawling area in northern Alberta that includes Fort McMurray and is the size of Nova Scotia, Mayor Sandy Bowman said a major concern is that dispatchers are unfamiliar with the area so paramedics have been sent to the wrong place. He said it is especially frustrating for community members who are in crisis, sometimes shock, and can often only pinpoint their location by landmarks.

Calgary Mayor Jyoti Gondek said firefighters are responding to medical calls at a rate never seen before, often arriving before paramedics. Not only are they expected to perform “double duty” but Ms. Gondek is critical of the province for not providing funding to offset the associated costs.

Lethbridge Mayor Blaine Hyggen said there have been improvements to the centralized system but the “fight is not lost” to turn back time to the original model. Red Deer Mayor Ken Johnston said residents are still getting a dedicated service, but is it as effective as it once was? Not close, he said.