Our Bureau of Investigation compiled and analyzed the average delays between an urgent call to 911 and the arrival of ambulances in the 112 municipalities with more than 10,000 inhabitants in Quebec, over a period of one year. Result: nearly 85% of them are unable to provide an ambulance in the required time to a person whose life is threatened.
The Minister of Health, Christian Dubé, considers the long response times of ambulances in Quebec unacceptable and announces that he will table an action plan on pre-hospital services “in the coming days”.
“The situations reported by The newspaper are unacceptable, we cannot compromise on patient safety,” the Minister of Health declared on Friday on X, in reaction to the reports from our Bureau of Investigation.
- Listen to Alexandre Dubé’s editorial on Benoit Dutrizac’s show via QUB :
“Ambulance coverage must be adapted to the reality of each territory. Each establishment must assess its needs and communicate them to us so that we can make the necessary adjustments,” he continued.
In an interview earlier with our Bureau of Investigation, Martin Forgues, Deputy Director General, Prehospital Service and Medical Staff at the Ministry of Health, made the same speech. He assured that he wanted to correct the situation, without however being able to indicate when he would achieve this.
Stevens LeBlanc/JOURNAL DE QUEBEC
Mr. Forgues, however, affirmed that he was not “surprised” by the fact that paramedics are generally unable to get to a patient in distress in time in nearly 85% of Quebec municipalities.
However, he was unaware that in more than twenty towns with more than 10,000 inhabitants, paramedics were not able to arrive in less than 15 minutes to a citizen whose life was threatened.
“You astonish me. I am surprised at the average you give me in these cities. If we found this assessment acceptable, we would not currently be working on the measures we are putting in place,” he insisted.
Because of the measures, Mr. Forgues assures that he has put several in place in order to resolve this problem (see below).
“We are no longer in writing, we are no longer in reflection, we are in action,” assures Mr. Forgue.
To achieve this, several municipalities are calling for additional staff. In the National Capital alone, the ambulance union is calling for up to 15 additional vehicles to adequately serve the area, something that Mr. Forgues was also unaware of.
“When we are asked for an increase, generally it is always authorized. But we must not underestimate the labor shortage”
– ,
Photo Stevens LeBlanc / JOURNAL DE QUEBEC
Thus, the improvement of pre-hospital services cannot rely solely on ambulance services. “We must expand our actions,” argues Mr. Forgues, referring in particular to the addition of first responders and automated external defibrillators (AEDs).
Personal drama
The ministry refused to react to the cases of citizens whose loved ones died while waiting for the ambulance, as our Bureau of Investigation has reported since Friday.
Emotional, Mr. Forgues, however, said he was “very aware” of the impact that these delays can have, he who personally experienced the wait when his wife was struck down by an aneurysm last year in Italy. She died from it.
“The MSSS is made up of men, fathers, mothers, grandfathers, grandmothers. We are not insensitive to this situation. »
– ,
Photo Stevens LeBlanc / JOURNAL DE QUEBEC
Mr. Forgues says that the personal tragedy he experienced “adds” to his desire to improve the system.
Why is it long?
Not enough ambulances on the roads
Paramedics have hammered it home on every platform in recent years: we need more ambulances on our roads to better serve the population. In the Capitale-Nationale alone, the ambulance union is demanding 15 additional vehicles. The Ministry of Health estimates that adding an ambulance resource costs $2M per year.
The labor shortage
It hits all of Quebec and the emergency prehospital worker is no exception. In Montreal and Laval, the situation is particularly difficult, with Urgences-santé unable to fill all its shifts, despite overtime and the use of private agencies.
Paramedics stuck in hospital
As the hospital network is overloaded, paramedics sometimes have to wait several hours at the hospital before their stretcher becomes available, which reduces the availability of vehicles on the road.
Non-urgent calls
Paramedics arrive late at the site of emergency calls because they are sometimes mobilized by cases that do not require transport to the hospital. “While the ambulance is on a lower priority call, it is not on cardiac arrest or a major accident,” summarizes Réjean Leclerc, president of the Federation of Health and Social Services union.
Profit
The prehospital sector represents expenditures of approximately one billion dollars in Quebec, while it was only 396 million in 2012. According to Michel C. Doré, who analyzed the Quebec prehospital system from top to bottom, companies private companies “reap a minimum of $300 million in profit” out of this billion. “We are convinced that this money could translate into better service,” he summarizes.
Little accountability
Reports on prehospital services have deplored for at least 10 years that the network lacks performance targets. Already in 2014, the Ouellet report noted “the absence of a culture of performance and accountability” in this sector. Six years later, the National Committee for the Transformation of the Emergency Prehospital System came to the same conclusion.
Ministry solutions
Financial penalties
The new contract between ambulance companies and the ministry, in force since October 2023, now provides for financial penalties in the event of a breakdown in service or when start-up times are too long. The managers of ambulance companies and Urgences-santé will also be evaluated based on deadlines.
Better vehicle management
In order to use resources wisely, the MSSS launched a “regulation” project, which allows a clinical assessment of the patient to be made to ensure that their condition requires an ambulance. This project has so far demonstrated that 20% of calls did not require ambulance transport and could go to another resource, a CLSC for example, according to the ministry.
More first responders
Barely 30% of Quebec municipalities offer a first responder service. Worse: the absence of first responders is a reality in cities where average ambulance delays are very long, according to our data. The MSSS therefore set up a working committee with the Union of Municipalities of Quebec and the Fédération québécoise des municipalities in order to increase municipal membership of this service to 80%.
More paramedics
An analysis by the most recent prehospital committee highlighted that the profession of ambulance driver was poorly valued and that it offered limited career advancement, contributing to its low power of attraction. If the MSSS is not tackling the promotion of the profession, it is nevertheless in discussions with the Ministry of Education to increase training on campus.
Less time in the hospital
In 2023, paramedics spent an average of five minutes more in hospital compared to four years earlier, which is the equivalent of taking seven full-time ambulances off the road, the ministry estimates. In January 2024, the MSSS published a practice guide to reduce intrahospital time and is now targeting a maximum average delay of 45 minutes.
Bas-Saint-Laurent, great champion of speed
Citizens of Rivière-du-Loup, Matane and Rimouski can sleep soundly: these three municipalities in Bas-Saint-Laurent have the fastest ambulance times in the province.
In Rivière-du-Loup, it took an average of 5 minutes 31 seconds for an ambulance to be dispatched to a patient in danger of death over the course of a year. This delay makes this city of some 20,500 inhabitants the best on our list. It is followed by the cities of Matane and Rimouski, where ambulance crews responded to urgent calls in less than 6 minutes 22 seconds, i.e. below the 8 to 10 minutes targeted to maximize the chances of survival.
The CISSS du Bas-Saint-Laurent was unaware that it was setting an example in Quebec.
“We are not in the habit of comparing ourselves with others! We are not in a competition from one region to another. But so much the better if our figures are good,” said the spokesperson, Gilles Turmel.
He attributes this performance to various factors, including the strategic and dynamic positioning of ambulances in the territory. Rivière-du-Loup, Rimouski, Matane being small towns, emergencies are less congested and the ambulance flow is also lower than elsewhere. Furthermore, the population is concentrated geographically.
“The urban environment is small, 80% of the population is close to an ambulance,” summarizes Mr. Turmel.