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In Royal Inland Hospital in Kamloops, B.C., emergency-room doctor Eric Haywood-Farmer is often worried about who’s in the waiting room, potentially dying, and where he is going to place them.

The department, he says, frequently experiences the situation where one nurse cares for 10 patients while the normal nurse-to-patient ratio is 1:4.

“We just cannot provide a safe environment for our patients. It’s just impossible,” Dr. Haywood-Farmer said in an interview with The Globe and Mail.

The emergence of such crises at Royal Inland is related to a series of factors, including the severe shortage of health care workers largely caused by sick leave, early retirements and employees quitting to work elsewhere. In addition, there is a lack of access to primary care and an influx of patients from neighbouring and rural communities, such as Clearwater and Merritt, as emergency departments in those areas have been frequently shuttered.

“With regard to the closures of the peripheral hospitals, that does have a big impact on us,” said Dr. Haywood-Farmer.

Interior Health, the regional health authority, isn’t facing this crisis alone. A provincewide staffing shortage has also shut down emergency rooms in other small and rural communities, including Port McNeil on Vancouver Island, in recent months. Across the country, in provinces such as Alberta, Quebec and Ontario, emergency rooms are also stretched beyond capacity because of staffing shortages.

Royal Inland, a 246-bed acute-care hospital, serves an area of more than 225,000 British Columbians.

The hospital’s emergency department typically admits more patients than the number of beds it has, said Dr. Haywood-Farmer. As a consequence, some patients can be in the department for days before they get to a bed, he added.

For any patients who can possibly be upright, they are seated in the chair for their whole stay, he said.

“And if they’re there for eight to 12 hours, even if they have severe abdominal pain or vomiting, they’re essentially seated in a chair, in a very small area with all kinds of other people who have similar problems,” the doctor said.

Patients from peripheral hospitals “essentially take up not only all of our nursing resources, but they take up all of our physical space.”

About an-hour-and-a-half drive away, Clearwater opened its emergency department Tuesday morning after it remained closed or on diversion since Sunday early morning.

Since May, the ER in the district municipality – home to roughly 2,400 residents and serves around 5,000 people in the area, has experienced temporarily closings 11 times because of staffing shortages.

Meanwhile, more than 1,000 people are in the area working on the Trans Mountain pipeline, according to Merlin Blackwell, mayor of the District of Clearwater.

The district, which is also a heavily travelled highway corridor, had several serious accidents over the past couple of months, which led to multiple fatalities and injuries, the mayor noted. “So it’s very concerning to citizens,” he said.

“But with the extra industrial load and tourism travel season here, we’re playing a real game of chicken here as to whether or not we’re going have an incident that’s serious and we can’t take care of.”

Mr. Blackwell said he knows of multiple incidents where people have either waited for the ER to open the next day or have had to travel to Kamloops.

Since last October, the closings of the ER in Clearwater started to become more frequent, Mr. Blackwell said.

“They really started to stack up last fall through to Christmas. And then now into this new year, where we’ve had 20 basically in the last six months.”

Dr. Helmcken Memorial Hospital in Clearwater is supposed to run on eight registered nurses with emergency service, and four licensed practical nurses and five doctors, said the mayor.

But “we’re basically half staffed doctors, RNs and LPNs.”

He said several factors contributed to the crunch, including a housing crisis in his municipality, retirements, sick days and departures from the system because of burnouts.

Interior Health declined to provide an interview. In a statement, it said recent emergency closings relate to both physician and staffing challenges, which are a combination of vacant positions and short- or longer-term leaves.

It stated that the health authority is working closely with physicians and nurses to cover all shifts, and active recruitment continues for additional physicians and staff to support services at all facilities.

In a statement provided by Island Health, it acknowledged that it’s extremely challenged by the health work-force shortage. It said the health authority is actively working to ensure the availability of emergency services in the Alberni Valley region and beyond.

Ramneek Dosanjh, president of Doctors of B.C., described the workload for many physicians as “unsurmountable,”

“It’s incredibly concerning for both health care providers and patients, and illustrates the lack of equity in health care settings in rural and urban communities, as well as inadequate resources and inadequate funding and allocation of health care staff,” she said.

On Tuesday, Emergency Department waiting times show that the expected length of stay at B.C. Children’s Hospital was more than nine hours and at Richmond Hospital and at Lions Gate Hospital in North Vancouver, it was about four and half hours.

Interior Health didn’t provide the average waiting times at Royal Inland in recent months.

“This is a cry for help. And we need to ensure that we have primary care stabilization, we have access and attachment for our patients to go to somewhere to be seen in a timely fashion,” said Dr. Dosanjh.

She added that the province needs to look at what’s causing the attrition.

Such shortages do not come as a surprise to the B.C. Nurses Union.

“We knew this back in the late ‘80s, early ‘90s, that this would happen if the government did not keep up with the rate of retirements, attrition,” said Aman Grewal, president of BCNU.

However, the province still does not have enough seats for students who want to become nurses, and there are waiting lists in nursing schools, she said. “There should never be a waitlist in a nursing school for somebody to go to school to become a nurse when we’re in a shortage.”

Earlier this year, the B.C. government announced that it will add 602 new nursing seats to public postsecondary institutions throughout the province.

Ms. Grewal said she appreciates that the province started to look at the issue but “we need more”.

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