Essex Windsor EMS, hospitals reduce Code Blacks in 2023

Essex Windsor EMS is seeing an annual decrease in time spent in Code Black as the service goes through systemic changes alongside area hospitals.

A Code Black occurs whenever there is no available ambulance to respond to an emergency situation. 

Data shared with Essex County council at a recent meeting showed that the amount of time the service was in Code Black fell by 24 per cent in 2023 compared to 2022.

The issue was declared an emergency by Essex county council in October 2022 with now retired EMS chief Bruce Krauter saying at the time he had "never seen our local health-care system in such a state of crisis."

New Chief Justin Lammers said the service is on the right path and is noticing some changes. 

"We're doing everything we can collectively to get us out of this," Lammers told county council. 

Staff shifts help ease pressures

There's been a series of changes that the hospitals and EMS have implemented since the emergency was declared that have helped decrease the amount of time Windsor-Essex doesn't have an ambulance to respond to calls. 

In September, EMS re-rostered their paramedics so more were working during the afternoon and evening hours when data showed Code Blacks occur more often. 

The shift in staff resulted in a cut to Code Blacks in the afternoon and evening that "far outweighed" the slight increase to Code Blacks in the morning, according to Lammers. 

"Overall, we're trending down. Moving the resources of the afternoon absolutely helped you know and the signals of depleted resources that we're getting in the morning are are not nearly as much as it was in the afternoon," he said.

Lammers said council has approved additional staff increases that will help handle the morning call volumes. 

The service also changed the definition of Code Red from two or fewer ambulances available to between one and three ambulances available.

Lammers said the adjustment alerts staff to resource issues before they happen. 

"When we work our way up to a period of Code Red or Code Black, it's all hands on deck. We do everything we can to get out of it," said Lammers.

The service is also noticing with its Community Assessment Triage Team, first introduced last August. 

These teams see two Primary Care Paramedics operate out of Windsor and dispatched to calls where they can treat patients without admitting them to hospital. 

"We deployed some resources that are responding to lower duty calls and and diverting them," said Lammers.

"We've seen a 57% reduction in transport to hospital with those alone."

Increase year over year in offload delays

Paramedics must stay with patients while they're being admitted to hospital, something that can tie up EMS staff for hours.

EMS has worked with area hospitals on ways to decrease that delay so that it falls within a 30 minute accepted window. 

The paramedic offload program was started two years ago during the Code Black emergency.

An ambulance crew will manage up to four patients brought to a hospital and stay with those patients until they're admitting, releasing up to three ambulance units back to service. 

"This is a good process to leverage in a crisis such as a mass casualty incident, it is not a process that we want to be a regular process," said Lammers. 

Early data from 2024 shows that the EMS is relying on the program less than before. 

"Some of the early signals show were able to decrease our paramedic offload program by about 75% last month," he said.

Lammers called it a "big win" thanks to the work hospitals have done, which includes daily huddles with staff from both organizations and a designated offload nurse program. 

"EMS and hospital teams have been working together non stop and multiple times a day for many years to address volumes coming from the community and also what the hospitals are already addressing," said Windsor Regional Hospital CEO David Musyj. 

"It is a collaborative effort that does result in positive progress."

Cyber-attack adds to delays

Both Lammers and Musyj acknowledge that offload delays increased in late October after a criminal cyber attack took down hospital systems across southwestern Ontario, including WRH and ErieShores Health Care. 

"The cyber-attack significantly affected the speed at which ambulances could turn around at hospitals," said Lammers, while commending the hospital staff's efforts to keep things running as smooth as possible while reverting to paper charting. 

"Unfortunately, the recent criminal cyber attack did impact turnaround time for things like diagnostic and laboratory tests to be longer. Now that the major clinical IT services are back online this ongoing collaborative work continues to make positive strides," said Musyj.