Drummond: Canada's emergency physicians need someone to listen

The problems of emergency health delivery are national, but there are evidence-based solutions, if only governments would give us a hearing.

Published Oct 18, 2023 • Last updated 4 hours ago • 3 minute read

An ambulance waits outside the Emergency Department at the Ottawa Hospital Civic Campus. Photo by Justin Tang /The Canadian Press

It was with considerable hope that representatives of Canada’s emergency physicians met this past week in Prince Edward Island with various provincial health ministers, to discuss the crisis in Canada’s emergency departments. They had but a simple request: a funded National Forum on Emergency Health Care.

Coast to coast, there are now daily media reports of prolonged waits for emergency care, sometimes with tragic consequences of premature and unnecessary death; closed rural ERs leaving small communities with a sense of helplessness and despair; and ambulances stuck for hours on offload ramps and ER hallways, unable to respond to 9-1-1 calls.

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Here are but a few regional examples. They are enough to make you weep:

• In February, a 78-year-old man from Bonavista, N.L. died in an ambulance on the way to Clarenville. His local ER was closed, necessitating the prolonged trip.

• Last New Year’s Eve, a 37-year-old mother of three school-aged children died after a six-hour wait, with severe abdominal pain, in the Cumberland Regional Health Care Centre in Nova Scotia.

• Last December, a 67-year-old woman also waited in a Nova Scotia emergency department for seven hours before she gave up and went home, dying an hour later. Her case was recently publicized in an effort to highlight the growing number of Canadians who leave the ER without benefit of assessment because of prolonged waits for care.

• An 86-year-old woman died in February following a prolonged stay in the hallway of an emergency department in Lévis, Que. following a hip fracture. Her family has alleged that she was “left to die” without food or water.

• Also in February, a patient died waiting for care in the hallway at Winnipeg’s Health Sciences Centre. A critical incident review found that “patient flow challenges” prevented the man from being placed on a cardiac monitor.

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• And in July of last year, an Ashcroft, B.C. woman died of cardiac arrest. Her local ER was closed due to staff shortages and the only ambulance was a half-hour away.

These are but a few of the innumerable stories of heartbreak and despair played out daily in our nation’s emergency health system and it is not nearly good enough.

Prolonged waits for emergency care, contrary to the popular myth of the inappropriate use by non-urgent patients, is actually a reflection of woefully insufficient hospital ward capacity leading to prolonged stays, by admitted patients, in the ER. In Ontario and elsewhere, these waits can be routinely in excess of 30 hours. It is this lack of treatment areas in the ER that leads to the congestion in the waiting room and the inability of paramedic crews to offload their precious human cargo. Our ERs, big and small, have become warehouses and a vast sea of human misery.

Shuttered rural ERs are largely a function of the lack of a national rural health strategy, an abysmal failure to plan for adequate health human resources, a mean-spirited approach to the wellness concerns of our nursing colleagues and an unwillingness to aggressively consider regionalization of emergency health care.

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Canadian provincial health ministers have historically adopted one of three approaches: blaming and shaming the 15 million Canadians who annually seek care in the ER; suggesting that all will improve by the glacial change that is primary-care renewal; and lastly, seemingly hoping for divine intervention, or at least making it the next government’s problem.

The problems of emergency health delivery are not uniquely regional concerns; they are national in scope, with common root causes and articulated, evidence-based common solutions.

Canada’s emergency physicians, in concert with our nursing and paramedic colleagues, have some innovative ideas and surprisingly, despite decades of neglect, still some enthusiasm for making our emergency health-care system more responsive and equally, more reliable and equitable.

We need someone to listen: we need a National Forum.

Dr. Alan Drummond of Perth is with the Canadian Association of Emergency Physicians.