New standards get sickest patients help faster

The city is adopting a series of new standards for how long it should take ambulances to respond to emergency calls.

The existing standard, set in 1996, is 12 minutes, 12 seconds, in 90 per cent of the cases. However, that standard was based on the average response time for 1996, and had no medical rationale.

Aaron Archibald, deputy chief of Greater Sudbury’s Emergency Medical Service Operations, said the response time in Greater Sudbury since 2007 has been well within the standard.

“We’ve been well under 11 minutes (since 2007),” he told councillors at a Sept. 17 meeting of the community services committee.

However, response times vary greatly depending on where you live. Archibald said the average ambulance response time for the former City of Sudbury was about 8 minutes, 20 seconds. But if you live in Nickel Centre, the average response time jumps to about 20 minutes; about 19 minutes if you live in Walden; and, just under 16 minutes if you live in Onaping Falls.

Also, the current standard doesn’t rate the calls according to how seriously ill a person calling for help is. So every emergency call they receive is rated as the highest-priority.

“The new response time standard sets multiple response time targets,” Archibald said.

The new standard adopts a scale used by paramedics to judge how seriously ill a patient is. The most severe are patients suffering a heart attack – termed sudden cardiac arrest (SCA). Studies have shown that heart attack patients have much higher rates of survival when they receive help within six minutes, the new response time standard the city is adopting.

With this standard, he said it needn’t be an ambulance arriving to stop the clock – it stops as soon as anyone trained on using a defibrillator arrives.

“It could be a police officer or a firefighter or a paramedic,” Archibald said.

The standard, as set by the Ministry of Health, is to get heart attack patients help within six minutes, 70 per cent of the time. Level 1 patients should get help within 8 minutes 80 per cent of the time. The province allows the city to establish standards for patients Level 2 and lower. Level 2 patients should get help within 10 minutes 85 per cent of the time, while patients ranked Level 3-5 should get help within 15 minutes 80 per cent of the time.

While the new standard makes more sense from a medical point of view, Archibald said meeting the standard in a city as spread out as Greater Sudbury is a huge challenge, particularly when you lose two minutes from when a call is received to when emergency crews are dispatched.

“It’s very difficult to reach the response time given the geography we’re up against,” he said.

In 2011, ambulances would have made it to heart attack calls within the six-minute limit 66 per cent of the time, Archibald said. But the results were far worse, depending on where you live. There were seven emergency cardiac arrest cases in Walden in 2011, and help arrived in six minutes or less zero per cent of the time. That compares to 78 per cent for the old City of Sudbury and 51 per cent for Rayside-Balfour.

Crews were able to hit the eight-minute standard for Level 1 calls 98 per cent of the time in Sudbury, compared to 30 per cent for Walden and 38 per cent for Capreol.

“Our geography is one of our main challenges,” Archibald said.

So they have come up with strategies to improve response time for the more severe cases. Ideas include more public access to defibrillators, such as the ones available at local ice rinks. Provincial funding for an emergency room nurse whose sole job is to ensure ambulances aren’t waiting around to drop off patients should also help by putting more ambulances on the road, rather than sitting around the hospital.