More demand for paramedic transports contributes to ED wait times

The increase in paramedic transport rates over the last decade far exceeds population growth and walk-in emergency department (ED) visits in Ontario, according to a new study from ICES and McMaster University.

The increased rates of paramedic transports could be a contributing factor to overcrowding and long wait times in hospital EDs. There is a gap in the research exploring changes in paramedic transports compared to population growth and walk-in ED visits.

In the study published in the Canadian Journal of Emergency Medicine, changes in annual paramedic transports in the 10 years prior to the COVID-19 pandemic were examined. Patients triaged in the ED who arrived by paramedics or walk-in were included and clustered by geographical region.

The data suggests that paramedic services, like EDs, are experiencing similar operational pressures to provide timely health care amid a consistently growing demand for services. Growth of paramedic transports is an unreported contributor to ED overcrowding, as paramedics are restricted from transporting patients to non-ED alternatives.

“Our findings highlight the need for health policy makers to re-evaluate paramedic service organization to reduce ED overcrowding and build sustainable models for prehospital care for the future — especially as transports continue to rise,” said lead author Ryan Strum, PhD candidate of the Department of Health Research Methods, Evidence, and Impact (HEI) at McMaster University.

In the 10 years prior to the pandemic, Ontario’s overall paramedic transports increased consistently by 38.3 per cent, far outpacing population growth at 9.6 per cent and walk-in visits to the ED at 13.4 per cent.

Patient characteristics and reasons for ED visits remained consistent across the study period, with the largest users of paramedicine being persons aged 65 or older (43.7 per cent) and living in urban areas. However, paramedic transports also increased substantially in rural and northern regions.

“The majority of transports in 2019 had non-emergent triage scores and there was a lot of growth in non-urgent transports, which suggests that citizens are also using paramedics as a means of accessible health care, but not strictly for emergency purposes,” said Strum.

The study’s findings support workforce planning and models of care development to better address the needs of patients who use paramedic services.

“Paramedicine should cultivate new care models that incorporate more primary care integration, with a focus on older adults. By providing more primary care integration, referrals in the community, as well as alternate sub-acute destinations, some patients may not require ED transport, thereby reducing the burden in our EDs,” said senior author Andrew Costa, associate professor of HEI and an adjunct scientist at ICES.

The study is in the Aug. 18, 2022, issue of the Canadian Journal of Emergency Medicine.