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Nova Scotia ambulance service plagued by continuing poor response times: auditor

Nova Scotia's ambulance service is in a "critical state" and is failing to meet mandated response times for emergency calls and for patient transfers at hospitals, auditor general Kim Adair reported Tuesday.

Adair said the average wait time for an ambulance in 2022 rose to 25 minutes from 14 minutes. Between 2017 and 2022, Adair's report found, average response times grew between two and five per cent annually.

"What we found is that ground ambulance services are in a critical state," Adair told reporters. "For the past five years, wait times for an ambulance have been on the rise. It's taking ambulances longer on average to respond to calls, and that's putting Nova Scotians at risk whether you live in an urban centre or a rural community."

Adair said the poor response times are symptomatic of a system that over the last five years has seen a 17 per cent escalation in 911 calls requiring an ambulance. Other contributing factors are staff shortages that see available ambulances sit idle and temporary closures of emergency departments that divert patients to larger hospitals.

"There's a myriad of issues and pressures impacting response times, and there are so many interconnected parts," she said, pointing to delays in transferring patients at hospitals as an example.

The report says that in 2022, paramedics, on average, spent a quarter of their working hours in emergency department hallways waiting to transfer their patients at a cost of over $12 million to the health system.

The longest delays were in Halifax-area hospitals, where delays of more than three hours were reported at the Halifax Infirmary. Adair said none of the province's largest hospitals consistently met the province's transfer standard of 30 minutes last year, with her audit finding the standard was met only 23 per cent of the time.

"We heard from all parties involved that significant off-load delays have become so prevalent in the health-care system that they are the norm rather than the exception," the report states.

Complicating matters are significant paramedic staffing challenges, with resignations and retirements outpacing hiring, while sick time is also increasing. Those factors contributed to an average of 23 per cent of ambulances being unstaffed in 2022, up from three per cent in 2017.

Adair's audit found that the Health Department isn't holding the provincial health authority accountable for its role on the patient transfer delays, nor is it holding the ambulance service accountable for ambulance response times. She said responsibility is shared throughout the system and not just at the highest levels.

Among her 14 recommendations is a call for the government to implement penalties for not meeting prescribed response times that are currently in the contract with the ambulance service provider, Emergency Medical Care Inc.

Following two written warnings, the Health Department can impose a fine of $10,000 per month when a response time standard is not achieved. The fine can also increase by $1,000 for every subsequent month the standard goes unmet, although the department has confirmed that no fines have been imposed since the contract was renewed in 2021.

Health Minister Michelle Thompson told reporters that her department accepts all of the findings in the auditor general's report.

"It is a system, and it is a bit of a spider's web," Thompson said. "It is really essential that we look specifically at whether it's an area where the company can improve, but we also have to look at how we can impact the system in order to make things better for patients in Nova Scotia."

She added that some steps have already been taken to address concerns flagged by the report, such as an increase in the use of other vehicles to transfer non-emergency patients in order to free up ambulances for emergencies.

The use of a new province-wide command centre has also helped unclog hospitals by providing information on bed availability and patient transfers, Thompson said.

This report by The Canadian Press was first published Sept. 26, 2023.

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