Airdrie paramedic on EMS crisis: 'It's a moral injury when you watch it happen'

The view of EMS problems facing the city was presented from a local paramedic's perspective during Tuesday evening's EMS town hall.

Airdrie Primary Care Paramedic, Ryan Middleton, underlined that he was presenting data from various FOIP (The Freedom of Information and Protection of Privacy Act) requests he gathered as a patient advocate and as a resident of Airdrie, and not as an employee of Alberta Health Services (AHS). However, it was his anecdotal retelling of what occurred to his daughter that underscores the problems facing both the public and paramedics and the moral injuries paramedics face on a day-to-day basis. 

Middleton recalled an emergency call in Airdrie, in which he was attending a construction site where a worker had fallen and was injured. By the time he had gotten to the hospital with the patient, his wife had called him to let him know that his daughter had had a near-miss with a massive tree that had fallen.

Middleton reflected that because he had previously called for back-up (which was later stood down) on the medical call he was attending, the information he received was that the next available ambulance was coming from Linden, Alberta. This fact made him reflect on his own family. 

"If my daughter had been crushed by that 60-foot poplar, it would have been 52 minutes until the first person could have knelt beside her," he said. 

Key Metrics 

During his presentation, Middleton elaborated on four key metrics surrounding EMS. Eight minutes is what is accepted as a worldwide benchmark for first responders - including police, ambulances, or fire crews to get to a scene of an emergency. However, he underlined that Airdrie has not met that benchmark.

"It went from being eight minutes to it being eight minutes half the time (50 percentile) and 12 minutes 90 per cent (90 percentile) of the time," he said. "Then it went from being - this is a rural municipality, this isn't an urban center, so, let's say it's 10 minutes and 15 minutes."

Currently, the Airdrie Monthly EMS Activity Summary provided by AHS factors in only Delta and Echo (the most dangerous and critical) events into its response times for life-threatening events. The statistics have not been updated since October 2022.  He said that staffing as another key metric is crucial.

"The number of paramedics that work for AHS right now is lower than it was in 2015. Let that sink in. We have fewer paramedics today than we did seven years ago. The call volume has not gone down since then."

According to the statistics provided by Middleton via FOIP, last year, on average, an ambulance was shut down every 1.1 days, while one in four ambulances was short-staffed.

"In 2019, just in the Calgary zone, we shut down 1300 ambulances throughout the year - 27 of those were for Airdrie ambulances," he said. 

In March 2023,  Alberta Health Service confirmed that during the evening on March 13, there was one Advanced Life Support and one Basic Life Support unit available in Airdrie. However, since Airdrie should have three ALS ambulances in its fleet in the evening as well as one BLS ambulance - this meant that two ambulances were not in service on March 13.

While he did add that Health Minister Jason Copping had announced that 10 paramedics would be hired in Calgary as part of the province's initiative to try and deal with staffing issues, Middleton said that over the last year, 244 paramedics have left the profession in the province. 

Middleton said that while there has been progress on off-load delays in recent months when looking at the grand scheme of things it is a very brief snapshot in time.

"If we condense that entire 12-year history of AHS [EMS] down to the face of a clock, we have had higher offload delays every single year for every hour in that clock until the last 30 seconds. We were waiting, just in Calgary hospitals for something like 200,000 hours per year." 

Middleton also elaborated on another metric, which is utilization. He explained that unit hour time utilization is the per cent of the time during a paramedic shift that a first responder is on their way to an emergency, handling it, or still with the patient at the hospital. Middleton said that the province's former Chief Paramedic, Darren Sandbeck, had expressed that he would have liked to see 100 per cent hour utilization.

Middleton explained that this kind of rate is almost impossible and comes with disastrous consequences - and it did happen last year in the Calgary zone. 

"In November of last year, the Calgary zoned up to 99 per cent availability for utilization, meaning that for a 12-hour shift. That means in a 12-hour shift, you had 12* minutes to pee, and four minutes to eat three meals that you're supposed to have in 12 hours."

Airdrie's Fire Chief on Co-response

Airdrie Fire Chief, Mike Pirie, who also attended the town hall, presented a brief history of what EMS looked like prior to the province's takeover and what the relationship between EMS and firefighters looks like now.

A slide from Airdrie Fire Chief Pirie's presentation to the EMS town hall illustrated the interconnected systems between the entities. (Photo/ Graphic provided by Airdrie Fire Department/ Chief Mike Pirie) 

Chief Pirie, a paramedic of 27 years, who only recently stepped back from patient care in 2020, said that once the province took over EMS in 2009, the fire department began to participate in an advisory role to the Medical First Response [MFR] program in 2010.

"We can't provide EMS, [but] what can we do is provide good service. We maintain all of our staff as a minimum of primary care paramedics, about a third of them are Advanced Care Paramedics," Chief Pirie said. "We can do the best we can with what we have."

He underlined that accountability is difficult to pinpoint in such a monolithic organization as AHS EMS and it's made all the more labyrinthine since the jurisdiction is provincial, but its effects are felt municipally. Because the fire department is a co-responder on medical calls, the role should be one of partnership. Chief Pirie, however, underlined that the system as it is now is a partnership.

"What we signed up for was to be first responders and co-responders [and] not really to take over when it falls apart. That's not what these systems were designed for."

One of the contentious issues is not that the fire department is called for a co-medical response - which is part of their mandate, it's the issue of why they're being called so frequently to provide the co-response.

"The number of times you're getting called because there are no resources available is high. The deal we made was - we were not providing second attendance to drivers for ambulances," Chief Pirie noted. "We were not doing that [because] we were actually specifically prohibited from doing that at one point, but that occurs."

The Airdrie Fire Department just recently began to gather data on how long fire crews wait on the scene for an ambulance to arrive.

"You have to be careful when you talk about averages because remember, averages also have extremes on both ends. But, what we started to notice, is that in the first three months [of 2023], and we've heard this from other cities as well, we're seeing a drop in how long are we waiting."

A graph provided by the Airdrie Fire Department illustrates the wait times the city's Fire Department has observed when waiting for EMS to arrive. (Photo/ Graphic provided by Airdrie Fire Department/ Chief Mike Pirie) 

However, the city's fire chief noted that the issue of paramedics waiting in hospitals and the pleas for the practice to stop has been a topic of discussion since the late 90s. He cautioned that the improvement Airdrie's Fire Department is seeing is only a sliver portion of the system as a whole, and while it does give way to optimism, it's cautious optimism.

"My instincts are we're still not seeing depth to the system that should be there. We're only seeing that initial first unit back. Is that a good start? I think that is a good start," Chief Pirie said. 

What is the role of the municipality leaders and the MLAs? 

Many of Airdrie's residents asked Middleton what can be done in the way of advocacy in order to put pressure on the province, and although healthcare is a provincial jurisdiction, the fact that it impacts a municipality was not lost on those in attendance.

While all members of Airdrie's city council and the Mayor had attended the town hall, there was pushback from city council members on how much they are doing to advocate for Airdrie residents. Middleton remarked that it would be beneficial for the council to request a monthly meeting with AHS EMS executives on status updates on the ambulance situation in Airdrie.

"Council has now met with AHS EMS twice and both times it was brought up that we'd like to see them more frequently and they [AHS EMS] nodded and smiled and said absolutely. But they're waiting for you guys to ask them. So, you're at different sides of the gymnasium during the dance, waiting for the other to ask," he added.

Mayor Brown disagreed with the analogy.

"I'm not here to contradict you Ryan, but that's not true. We meet with them as administration to administration. We advocate constantly when it comes to healthcare. You don't think we do, but we do. We can provide letters and phone calls and information. But I text the [health] minister directly. So, every time Ryan sends me a note, I send him a note and say, 'Is this happening in our community?'"

Middleton said that councillors could bring up how other municipalities are dealing with the ambulatory problems in their communities - pointing to Strathcona County, Vulcan, and Red Deer. 

"Red Deer leaned so hard on them saying, our firefighters are sitting in your hospital hallways, doing your calls and we're kind of fed up with it. So AHS conceded and said yes - we have been utilizing them heavily. Now at the end of every month, the city of Red Deer sends an invoice for all the hours worked by their paramedics to AHS and they pay the city of Red Deer. Red Deer bought and maintains the trucks."

Numerous city councillors said they were unaware of this, although, in January 2022, Discover Airdrie published an article on the issue regarding the project in Strathcona County and Spruce Grove. 

While MLA for Airdrie- East, Angela Pitt was in attendance she did not speak at the town hall. Discover Airdrie reached out to her for her thoughts on the meeting on April 19. 

"I have heard the information already before Ryan presented last night. I was told I wasn't allowed to speak at the town hall last night, which I respect. However, there is an updated set of information that I would like to share with the public. I'll be holding a town hall next Tuesday with our parliamentary secretary, and we'll present an updated set of facts," she said.

Pitt said that she has routinely voiced her displeasure at the shortcomings of the EMS system, but noted she was also disappointed at the town hall.

"I was disappointed with some of the outdated information. I think there's a better story here to tell and I think that the public needs to be made aware that the system is getting better, things are improving," Pitt added. "All of the noise that's been made over the last number of years is, is finally making a difference."

Though Pitt did not speak at the town hall, UCP MLA for Fort McMurray-Wood Buffalo, Tany Yao, who said he was a paramedic for 20-some years, was in attendance and requested to speak. Organizers of the event asked him if he was seeking re-election, to which he replied he wasn't and had come at the behest of MLA Pitt.

While Yao acknowledged Middleton's notion that AHS EMS has been struggling since the province took over ambulances, he disputed the statistics provided by Middleton.

"Wait times have dropped by four minutes for ambulances, which is substantial," Yao said.

Middleton disagreed, pointing to FOIP documents he obtained three days ago.

"The data that I got literally 48 hours ago shows that the response times provincially are at the highest historically, it's ever been since we started recording in 2011."

Although Middleton's outspoken advocacy has meant several ongoing and past professional repercussions, he continues to advocate for patient care. A social media group that he started, has nearly 2,000 members in it. 

"As much as I'm an employee; I'm a father, I'm a neighbour. I'm a friend," he said. "I don't want anyone in my life to have to sit there and decide whether they should or shouldn't call 9-1-1."

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(Editor's note: One per cent of a 12-hour shift equates to 7.2 minutes.)