'Red alert' concerns continue, correspondence suggests

There is continued concern among health-care officials about ambulance availability on the northeast Avalon, documents obtained through access-to-information suggest.

Correspondence between the province and its largest health authority reveals that the problem of red alerts appears to be worse here than in other Canadian cities.

And those Eastern Health numbers may be actually underreported, because dispatchers are too busy to properly track them.

Officials at the health authority say they are aware of the issue, and are working on it.

What we want to do is lessen the red alerts, and ensure [that during] the times that we dont have an ambulance available in that red alert, we have a system to respondand provide care," said Corey Banks, manager of the paramedicine and medical transport division at Eastern Health.

Red alerts occur when there is no Eastern Health ambulance available on standby to take emergency and non-emergency calls on the northeast Avalon.

A year ago, CBC Investigates reported that red alerts were climbing again after a previous infusion of resources had cut the number.

• Eastern Health 'red alerts' back on the rise

Red alert minutes have since levelled off, according to Banks.

Statistics obtained by CBC Investigates put Eastern Health on track to log more than 11,000 red alert minutes this fiscal year, or an average of roughly 27 minutes per day.

Some red alerts last just minutes. Others drag on much longer.

"Really it's a result of demand versus resources, and we've recognized that for the last while, Banks said.

A consultant has been studying those resources, and expects to report back in February several months later than initially expected.

But emails between Eastern Health and the province over the past year highlight some of the issues.

No red alerts benchmark

On Nov. 14, 2013, the Department of Health asked Banks via email whether Eastern Healths red alert numbers were above or below the average.

Banks replied that there is no average or benchmark for red alerts, but noted that a prior survey of other ambulance services showed we were extremely higher.

The next morning, Nov. 15, 2013, Banks provided more detail.

Red alerts indicate a problem in the system and lack of capacity, he wrote.

For example, benchmarking service performance on red alerts would be an analogy to a fire department benchmarking performance by how many house fires they could not respond to. The goal is that every call for service gets a response, only in exceptional circumstances should a system be unable to respond (i.e. major event or major storm, etc.).

Banks referenced that prior survey, carried out in 2009, about red alert data across Canada.

The vast majority of services replied they do not experience such events, the email noted.

Some of those which did report red-alert type events included Calgary (seven in the entire 2009 fiscal year), Edmonton (115, which resulted in additional funding being approved) and Saskatoon (1,237 red alerts, which still accounted for just 43 per cent of the total time experienced by Eastern Health the same year).

We have not conducted another survey since that time as the data we gathered [indicated] a significant divergence from the national experience and system performance, Banks wrote.

Working hard within our system

In an interview Monday, Banks downplayed any national comparisons, stressing that it is difficult to compare different ambulance services with different operations and different definitions for red alerts.

What we know in our system is that red alerts are a concern and we've been working hard within our system to actually improve our system not only in terms of resources, but in terms of how we're using those resources to lessen those red alerts, Banks said.

Banks says resources have been added, citing a number of changes announced four to five years ago.

Those include the addition of two paramedic satellite stations, to get ambulances closer to potential calls, and a hiring increase to 51 full-time staff from 20 since 2007.

Those moves coincided with a sharp reduction in red alert minutes after the 2009-10 fiscal year. But the numbers have since begun to creep back up.

In addition, there have also been some more recent moves. This September, another ambulance was added to the weekday 4 p.m. to midnight shift. A support person was also hired to prepare equipment and stock ambulances, with the aim of keeping paramedics on the road.

But any other changes will likely have to wait for the release of the consultants report.

Red alert correspondence

The provincial Department of Health has corresponded regularly with Eastern Health on red alert issues over the past year, according to the documents obtained through access-to-information.

Email traffic between the health authority and government included regular monthly updates on red alert numbers.

It also addressed:

• a spike in red alerts in December 2013, when the number of sick calls that month challenged us to fully staff units, according to a March 2014 email from Eastern Health vice-president Carmel Turpin.
• an explanation, in July 2014, of when other ambulance services and the fire department are called in to assist.
• a request the same month from the department seeking more detailed data on how patients in emergency situations were affected by red alerts.

According to Banks, Eastern Health has had no reports of a red alert ever having a negative impact on a patient.

Just over a year ago, the then-minister of health, Susan Sullivan, said the acceptable number of red alerts at Eastern Health is zero.

That would certainly be the target, Sullivan told reporters in October 2013.

This week, Health Minister Steve Kent declined an interview request, steering inquiries back to Eastern Health.