Paramedics forced to unload ambulances outside Mississauga hospitals during COVID-19 surge

The nightmare scenario governments face in their battle against COVID-19 is the possibility hospital beds could run out. During the first wave of the pandemic, New York and northern Italy provided cautionary examples of the impossible choices faced by healthcare workers when acute and critical care spaces dry up.

This danger was one of the main motivators in March when Ontario Premier Doug Ford ordered the vast majority of businesses to shut down.

Eight months later, despite images of COVID-19’s ghastly toll seared into the minds of those who worked on the frontlines, serious concern about hospital capacity has been largely ignored by many politicians, as debate around economic impacts has dominated the discourse. Record breaking case numbers have led to a rise in deaths, but so far infection has been more common in younger people with lower mortality rates.

Frontline healthcare workers are bracing for more patients with Peel hospitals arleady at capacity

As an increasingly bitter debate over the economy and healthcare priorities plays out, physicians have warned the government COVID-19 cases will rise among all age groups. Hospitalizations, we have been repeatedly told, are a lagging indicator.

After a Wednesday report from Ontario’s Auditor General that slammed the Province’s pandemic response, Health Minister Christine Elliott hit back. “Thanks to the leadership of public health experts and hospitals, Ontario never reached the point seen in New York and Italy,” she said in a statement.

But, in Mississauga, overwhelmed hospital capacity is creating scenes eerily similar. Stretched hospitals in the city have been forced to reassign spaces to care for increasingly ill COVID-19 patients and, as a result, paramedics are unloading people from ambulances outside in the cold, rain and snow.

In the spring, Trillium Health Partners (THP), which operates two hospitals in Mississauga, turned its indoor paramedic bays (used to unload patients from ambulances) into extended emergency areas.

“THP has been vigilantly following all public health guidelines and has required the ambulance bay space for three reasons: we do not have internal adjacent space in which to expand; physical distancing between patients and staff remains an important infection prevention and control measure; and separate space is required to assess potential non-admit COVID-19 patients,” THP spokesperson Keeley Rogers said in a statement to The Pointer. “The bays are currently being used for triage and rapid assessments. The safety of our patients, staff, and community partners is our top priority and such decisions are made with this in mind.”

For paramedics, rushing through Peel’s streets to emergency calls, this decision has caused significant concern. In the summer, unloading patients outside was far from ideal, but in the winter months, it increases the risks patients and paramedics face. Without bays inside Mississauga hospitals where patients are transitioned to hospital beds, those who are seriously ill are being unloaded in public and then shifted into hospitals. Paramedics must guide their stretchers across an open space and into the hospital.

Ambulances need access to hospital space but winter elements can be a challenge

“Short term: fine; warm weather: fine,” Dave Wakely, paramedic union boss in Peel, said to The Pointer. “We’ve been bringing it up since August, concerned about the snow. It’s a risk to patients in terms of exposure to the elements, but also in terms of tipping the stretcher over. We want to get back inside so we can provide as safe care as possible to patients.”

Currently, paramedics find themselves splitting their attention between life saving treatment and navigating blasts of snow or the hazards of icy asphalt.

“We have the need to offload our patients somewhere safe and, ideally, private. These patients are sick, they’re coming in and having the worst day of their life,” Wakely added. “It’s not great to have to walk past the public when you’re doing CPR on someone.”

Despite “raising the issue repeatedly” with THP, paramedics are still unloading their ambulances outside. Spaces have been negotiated inside the hospital to clean stretchers and equipment. THP says it has created a “dedicated area” at Mississauga Hospital to transition patients, while there is a covered entrance at Credit Valley Hospital.

For now, ambulances will continue to remove patients outside.

“THP’s overall capacity continues to be around 100 percent or above on any given day,” Rogers added. She said the number of COVID-19 positive patients at THP hospitals had increased 160 percent in the past three weeks.

“The rise in COVID-19 prevalence coupled with the growing impact of patient admissions requires us to continue the current use of our ambulance bays. We continue to assess our infrastructure and evaluate all our options as we prepare for the winter season and the rising cases of COVID-19 in our community.”

The COVID-19 pressure on hospitals, pushed by a case count in Peel that continues to spiral upward, means some impossible choices are already being made. To guarantee space for patients, and in anticipation of a growing surge, THP has had to freeze paramedics out. The decision increases space inside hospitals, but adds risk to emergency workers and marks the beginning of difficult choices between the needs of first responders in the critical moments of early intervention and the longer term needs of hospitals. 

These are signs that our system has reached its breaking point.

“We all want to work together with the hospitals, we understand this is a time of unprecedented demand. But we talk a lot about partnership and it’s time for it to actually look like a partnership,” Wakely added. “We’ve sort of been paying second fiddle the whole time.”

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