Airdrie's ambulance response targets unmet

Airdrie's 2023 ambulance response times have yet to hit their target goal: a 12-minute response time for the most serious 9-1-1 events 90 per cent of the time and an eight-minute median time.

Response Times

During their presentation to Airdrie's city council on Monday, November 20, Alberta Health Services Emergency Medical Services (AHS EMS) executives conceded that they hope to meet the target time, but agreed that it has not happened thus far in 2023.

Statistics provided by AHS EMS show the 90th percentile response times for only Delta & Echo events, as well as the 50th percentile response time. (Graphic credit to AHS EMS / City of Airdrie)

Councillors continued to question why AHS EMS does not include all events within their statistics - including Alpha, Bravo, and Charlie calls. Deputy Mayor, Councillor Tina Petrow, who had also brought this topic up last November during a similar meeting underlined this point on Monday.

Councillor Petrow noted that in a separate AHS presentation which she participated in, in Edmonton; the AHS presentation presented all call types ranging from Alpha to Bravo and Charlie, as well as Delta and Echo.

"Why are there such inconsistencies in the way that the reporting is done from one region to another or one presentation to another?"

Anne MacDonald, Executive Director of EMS Provincial Operations noted that this is changing.

"We are trying to get it, so, it's the same across the board. We're also trying to show not just our Delta and Echo [calls], but looking at why we encompass Delt and Echo and then Bravo and Charlies; It's to show what our high acuity [calls are] plus those next group of calls," she said. "Because if we're doing well for Delta and Echoes, but we're not doing great for Bravo through Charlie's then it's not showing our system."

When comparing data provided by AHS EMS from a November 2022 presentation to council, improvement in response times has yet to be achieved. 

A November 2022 presentation to Airdrie City Council by AHS EMS officials shows that in 2022, the 12-minute 90th percentile was also not met. (Graphic Credit to City of Airdrie)

How many ambulances does Airdrie have?

According to a graphic presented by AHS EMS executives, Airdrie was listed as having four Advanced Life Saving (ALS) ambulances, with two Inter-facility transfer (IFT) ambulance units.

Confusion ensued over a graphic presented by AHS EMS executives to the council which prompted plenty of back and forth on how many ambulances Airdrie currently has. (Graphic credit to AHS EMS/ City of Airdrie)

Both Councillor Jones and Councillor Chapman asked for clarification on whether there were two IFT units or one. After some back and forth, Tony Pasich, Associate executive director for EMS Operations in Calgary Zone, clarified that it is one physical truck. 

"It's one IFT unit - 16 hours a day. So, it's not two units," Chapman replied. "It might be two different shifts, but it's one unit for 16 hours a day. It's not a 24-hour unit."

Councillor Chapman also underlined that several years ago when Airdrie's population was around 39,000, the Airdrie Fire Department (before the province's takeover of Alberta Health Services) staffed four ALS ambulances 24 hours a day.

"We are now over 80,000. We have not seen an increase. It doesn't make sense to me. We had a system that worked very well. I didn't agree with it going away but it is what it is," he remarked. "But I can't understand why we haven't seen an increase with a more advanced life support system out here."

MacDonald, however, said that there is an ongoing resource study to determine resource allocation.

"When you look at the province, [in] some areas if we add a truck, it won't change the response times, because it depends on where they're driving to; other areas, maybe like Airdrie - I don't know for sure, because I don't have that info yet - that might be an area where if we put another resource, we could have our response times dropped even further."

45-minute offload at hospitals 

One of the key initiatives that AHS EMS executives honed in on was the effort to have paramedics and ambulances return to service faster once a patient comes into an emergency department. Pasich said the reduction of off-load times also filters down to response times.

The initiative was first launched in Calgary on March 15 and then rolled out across the province to 16 regional hospitals by mid-April. Pasich summarized key statistics thus far:

• April 2023: offload times were clocked in at approximately 1.3 hours
• Summer months of 2023: 1.4 hours of offload times, though Pasich underlined that in November 2022 offload times were approximately 3.7 hours.
• September/October 2023: 1.6 hours of offload time was recorded in October. Pasich underlined that the increase in offload delay time could be attributed to call volume, as well as respiratory virus outbreaks in facilities coupled with cold and flu season.

Although the statistics focused on the larger hospitals in Calgary, Pasich added that the current offload time at the Airdrie Urgent Care Center was approximately 1 hour and 15 minutes. 

Councillor Chapman remarked that the 45-minute offload delay target did not appear to be successful, though he added that the offload delay isn't the paramedics' responsibility - but encompasses a vast network of other hospital personnel and factors.

MacDonald clarified that while there are days in which ambulances are hitting a 50 percentile target of 45-minute offload delay, the vast majority of the offload delay time is much longer.

"At [the 90th percentile], they're at an hour and 15, to an hour and 20 minutes; 90 per cent of our events are done there. There is an area for improvement," she said. "We're trying to figure out strategies to get our crews back out."

According to data from the Freedom of Information and Protection of Privacy Act (the FOIP Act) request provided by an Airdrie local (2023-G-20), there were six specific dates in 2023, in which 50 per cent or more of ambulances in the Calgary Zone achieved the 45-minute offload target:

• March 18, 2023 (55 per cent)
• April 2, 2023 (50 per cent)
• April 12, 2023 (50 per cent)
• May 13, 2023 (52 per cent)
• May 21, 2023 (50 per cent)
• August 23, 2023 (50 per cent)

Red Alerts and ambulance shutdowns

Councillors also scrutinized the fact that there was no data available for red alerts for Airdrie specifically. AHS EMS representatives said that red alerts are only tracked within Edmonton and Calgary. However, several councillors noted that red alerts within Calgary may very well impact Airdrie's ambulances and hence should be tracked. 

While data on red alerts was not presented, data from another FOIP request showed that ambulance shutdowns in Airdrie have exponentially increased from year to year.

According to a summarization of the data, in 2019 an ambulance in Airdrie was out of service every two weeks. By 2020 that increased to a frequency of 6.5 days, while in 2021 that became even more frequent with ambulances being shut down every 2.9 days. Last year an ambulance in Airdrie was shut down every 1.4 days, and thus far this year, an Airdrie ambulance is shut down for every 1.48 days. 

In 2023, not including October to December 2023, 184 Airdrie ambulances have been shut down for a total of 2,094.58 cumulative unstaffed hours. 

Retaining Staff

While AHS EMS executives did not discuss ambulance shutdowns in Airdrie during Monday's presentation, they did agree that there has been an issue with human resources and that this is part of one of the many initiatives that AHS EMS is attempting to address. The initiatives include improving the workplace for existing staff, as well increasing and enhancing recruitment of new staff, as well as ensuring an efficient and supportive work environment.

However, FOIP statistics that were provided by Councillor Ron Chapman showed that there are fewer paramedics working today than several years ago.

"...But with nearly a 31 per cent increase in workload," Councillor Chapman underlined.

In response, MacDonald said that she wasn't sure what part of the data he was referring to. 

"I don't know what that FOIP request is being pulled or the exact information they've asked for."

When Councillor Chapman asked if MacDonald would agree that frontline paramedics have decreased, MacDonald disagreed. Pasich said that when looking at Calgary's numbers, it does appear there are more staff.

"I know we have 420, some casuals today. Last year, we had 350; we've increased the number of full-time positions, some of them are still vacant. When you look at us from an EMS operations perspective, we have 41 supervisors and those folks are in SUV all day responding," Pasich said. "Our goal is to make sure that we have the frontline resources and keep increasing those capacities to provide the care."

Council agreed to accept the presentation for information and underlined that they would like a quarterly update from AHS EMS representatives. 

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