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Mac adult ER closure impacts paramedic response times

Originally published Thursday. Dec. 5, 2013

 By Craig Campbell, Dundas Star News

Closure of McMaster’s emergency room to adults has increased ambulance response times for adult Dundas and Ancaster patients, and negatively affected local availability of ambulances, according to a city staff report.

But Brenda Flaherty, Hamilton Health Sciences executive vice-president of clinical operations, said the Access to the Best Care plan is a success.

“Time is important, but what’s most important is getting patients to the right place with the expertise for the best care,” Flaherty said.

In a report to the City of Hamilton’s Emergency and Community Services Committee last week staff reported an average response time of nine minutes for 605 patients in Dundas between Oct. 2012 and Sept. 2013. Only 47 patients, most likely children under 17, were taken to McMaster — the closest emergency room.

The report states average response time for 339 Ancaster patients in the same period was 11 minutes, with 115 of those patients taken to McMaster.

Flaherty said total visits to McMaster’s children-only emergency room have doubled, exceeding the number of anticipated visits. She said emergency room visits across the city have increased 5.7 per cent, largely due to out of town patients because of the regional service Hamilton Health Sciences provides.

The Dundas average response of nine minutes is more than three minutes longer than the average ambulance response time to Dundas in 2008, three years before the McMaster emergency room was closed to adults by Hamilton Health Sciences.

The Access to the Best Care program established specialized centres of excellence at each of Hamilton’s hospitals. McMaster became a pediatric centre of excellence with a children-only emergency room.

The staff report concludes the change to McMaster’s emergency room “appears to have negatively impacted transport ambulance availability and the average response time performances in the former (McMaster University Medical Centre) catchment area.”

The report states approximately 2,400 patients that would previously have been taken to McMaster each year are now taken to one of Hamilton’s other hospitals.

“These changes have added pressure on ambulance availability through increased travel time to hospital, a longer time at the hospital than is typically experienced at the (McMaster) site, and additional travel time to relocate the ambulance back to availability in their coverage area,” the report states.

Flaherty said Hamilton Health Sciences and the city address these issues on a steering committee and a two-year-old operations committee.

“We certainly do work together,” she said.

She said the success of the Access to the Best Care plan is demonstrated by the creation of centres of excellence, the west Hamilton urgent care facility and better co-ordination of hospital services across the city.

Mario Posteraro president of OPSEU local 256 — which represents Hamilton paramedics and ambulance attendants — warned in Feb. 2011 that Code Zero events (where no ambulances are available) would only get worse when McMaster’s emergency room closed to adults.

He said planned financial investments in Hamilton’s emergency services were only expected to maintain the status quo at that time, and more resources would be necessary to keep minimum service after the McMaster change.

“The elastic has been stretched, and will break,” Posteraro told Hamilton Community News more than two years ago.




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