Even on a relatively quiet night, it only took about 30 minutes for the city of Sault Ste. Marie to go from having full paramedic coverage to not a single ambulance available.
SooToday followed Sault Ste. Marie Paramedic Services (SSMPS) commander David Culina as he supervised paramedic crews during a recent 5 p.m. to 5 a.m. night shift in the city.
“There will be times, quite often, when you will call 911 and the dispatcher will have to say to you, we do not have any ambulances available. It’s not a good thing,” said Culina. “Don’t take it out on us, we are not on break. It’s just there is a lot of call volume and the hospital is very busy.”
This particular late-night shortage began when the first crew was called away at about 2:30 a.m., when a call came in to dispatch for assistance needed at a local nursing home.
Soon after, Sault Area Hospital called Culina directly to request another crew for an emergency patient transfer to an out-of-town hospital.
In general, SSMPS doesn’t do hospital patient transfers after 11 p.m., but in this case Culina was told by the Emergency Department’s charge nurse that it was a matter of life or limb and an air ambulance was not available.
Still hours away from the first of the morning shift paramedic arriving, Culina knew it was up to the on-duty paramedics to do the transfer. He asked the on-duty crews to volunteer to make the transfer, because whoever choses to make the round trip would be clocking in significant overtime hours.
As the hospital prepared the patient for transfer, Culina convened the available paramedics at Sault Ste. Marie Fire Station 4 on Old Garden River Road to break the news and ask for volunteers.
In the end, the two paramedics who were attending the nursing home were reached by phone and took up the transfer job, heading to the hospital.
Culina met them in the ambulance bay to prepare for the patient transfer when another call came in, this time in Searchmont.
“That’s two down,” said Culina of the two out-of-town calls.
As the hospital transfer was being completed and the second crew was on its way to Searchmont, two more calls came in almost simultaneously. Now, all four of the ambulances stationed at Old Garden River were on the road, forcing the one ambulance at the Garden River station to move to the Husky on Trunk Road, so it could be closer to the city in case it was needed.
Then another call came in, leaving all five ambulances unavailable to take calls.
As a paramedic supervisor, Culina doesn’t generally go on calls. He has over 20 years of experience, but the modified pickup truck he uses is not made to carry patients. It’s loaded with equipment to support the front line paramedics.
But when yet another call came in, Culina headed out in the supervisor vehicle as all other paramedic crews were busy.
It was a hectic end to his 12-hour shift.
The ‘no ambulance available scenario is one SSMPS and many other paramedic services in Ontario have been dealing with for years.
In 2021 there was 227 local occurrences of no ambulance available over more than 18,000 calls for service. That ratio may seem low, unless you have a loved one waiting for one of those ambulances that are delayed.
“That’s something people should know, because it’s a pretty frustrating thing,” said Culina of how often it occurs.
Almost a full 12 hours earlier, Culina arrived at the station to assume command of the on-duty paramedics from the day shift supervisor Brian Haines.
The two discussed offload delays experienced earlier in the day shift and some holes in the schedule that need to be filled due to staff shortages.
Offload delays refers to the times a paramedic crew takes a patient to the hospital, but hospital staff is unable to accept the patient right away.
In the first quarter of 2022, SSMPS transported an average of 812 patients to hospital per month. The average number of minutes spent by paramedics at the hospital was about 26, but in some cases offload delays can hold paramedics up at the hospital for hours while patients wait for a bed.
During Culina’s night shift there were two instances of paramedic crews being held up at the hospital due to offload delays.
“That’s pretty good, actually,” Culina said in an interview near the end of his shift. “There are times you will have offload delays the entire shift, all day long.”
Sometimes Culina has to get creative.
In one instance during the shift he was contacted by the charge nurse at Sault Area Hospital’s Emergency Department with a request for an in-city patient transfer. Culina suggested an exchange — the crew waiting with a patient on offload delay could take the transfer if SAH admitted theirs.
“The hospital staff does a great job trying to do their best, and so do we. Our struggles are when they are unable to accept our patients we are now removed from the road and it happens quite frequently,” said Culina. “So in essence you have paramedics that are supposed to be driving around in ambulances responding to emergency calls who are unable to because they are sitting with patients they already brought in at the hospital, that the hospital is unable to accept due to a variety of reasons that are out of our control, and are also out of theirs.”
Paramedics Amanda Crosby and Christian Gassi made up one of the crews on this night shift. Both paramedics were in the same class at CTS Canadian Career College’s Sault Ste. Marie campus and began their careers in the early days of the COVID-19 pandemic.
Thirty-seven years old and a mother of four boys , Crosby came to the career later than most.
“I was a PSW before I had kids,” said Crosby. “After I had my kids I didn’t want to go back to that, so I ended up being a stay-at-home mom for three or four years and then I had to decide what I was going to do with the rest of my life.”
With a new challenge to meet every single day, she said her career as a paramedic has so far exceeded her expectations.
“I absolutely love it. I never thought there would be a job that I would enjoy coming to work so much, but I love it. When I am off for a few days I can’t wait to go back to work,” said Crosby.
Gassi spent years at university working toward becoming a doctor before making the decision to pivot and train as a paramedic.
“I had some friends who were paramedics and their stories were always amazing so I thought I would look into that,” he said. “I feel like some people don’t really understand our scope of practice and the large list of the things we do to help people get through mental health crisis or to save a person’s life if they are dying or overdosing — there’s so many things we do that people don’t really know.”
That reminded Crosby of one of her pet peeves about the job — when people refer to them as ‘ambulance drivers.’
“I hear that all of the time and I hope people understand what we do is a lot more than that. We have quite a bit of medical training,” she said, before admitting, “but driving the ambulance is one of the most fun parts of the job.”
Culina said the profession is evolving.
“We have a lot of young staff but they are very bright, very passionate and they all want to do a good job and improve their skills. It’s great to see,” he said.
When he began as a paramedic 20 years ago, there was less consideration for worker mental health and much more of an emphasis on ‘sucking it up’ and not speaking about difficult calls with each other on the job. That started to change about a decade ago with one-on-one peer support programs that were put in place to help paramedics deal with the stresses of the job.
That formal program still exists, but Culina said a new culture has emerged over the years in which everyone is encouraged to talk about their mental health and how they have been affected by difficult calls. He calls it debriefing and it happens constantly within the service.
“That is something we really try to encourage because it’s a part of your overall health. It’s exercise,” he said. “It helps every day.”
Crosby said paramedics often see and experience difficult things most people will never experience in their lifetime.
“When you get off a bad call there’s always someone here asking if you are okay and you have so many people you can talk to about it, people who are more senior who have been through similar situations and know what you’re going through,” she said.
Speaking near the end of his shift, Culina couldn’t help but wonder about the patient who was transferred out of town. Unfortunately paramedics rarely hear about the outcomes for the patients they see.
“You do your best to help them and take them to the hospital, but you never find out actually what was going on,” said Culina. “If you don’t know, then you can’t learn. That’s kind of frustrating but there’s nothing we can do about that.”
