A Summer Evening

In the heart of Dartmouth, N.S., Krista Veinot, an operations supervisor at EHS Operations, takes a moment outside her Single Paramedic Emergency Advanced Life/Basic Life Support (SPEAR) unit to juggle a vape pen, a cell phone, and a travel mug of coffee the size of a small barrel. It's a still summer August evening just past 6p.m., with ominous weather warnings of extreme thunderstorms and relentless rain later in the night.

"I love nights. Like, love them," Krista says. She revels in the tranquility, the absence of traffic, and the opportunity to catch up on paperwork. Yet, night shifts in emergency services come with a challenge — fewer ambulance units in service than forecast, reflecting a known challenge for the system. Those on service are represented as dots on a map, coloured-coded to their status and availability, stationed across the province.

Even though it’s the first night shift following a long weekend, the emergency call queue is oddly quiet. "Usually, when we come on for night shifts, there will be so many calls waiting," Krista says. "It's a weird night out there. I thought it would be way worse after a long weekend."

Versions of this are heard several times throughout the night, spoken cautiously, almost as if anticipating a sudden surge in activity. In the realm of emergency medicine, labeling a shift as "quiet" carries a superstitious weight that makes paramedics uneasy.

"We need to get down to the general because there are some day crews that are jammed down there," Krista notes, referring to Dartmouth General Hospital, which serves approximately 120,000 people in the region. Tonight, Krista says offload isn't too bad. There are only five trucks waiting.

Her Calling

On the way, Krista talks about what drew her to paramedicine. A competitive tomboy in her teenage years, she was drawn to the job since there was no one else she knew who did it. She considered becoming a lawyer, "but I couldn't sit in an office every day.”

A Delay

On the screen of Krista’s computer, the times the trucks have been sitting flash:

00:59
01:18
02:24

Offload delay is what happens when a patient arrives at a hospital via ambulance and there is no bed available. This starts a process where the paramedics stay with the patient in a hallway while waiting to find out if a bed will free up at that location or at another hospital.

"The wait time in the hallway is detrimental to their future condition," Krista says. Not only does offload delay mean units are not able to support emergency calls within their communities, but the delays also mean patients need to wait even longer for access to care.

Steps have been taken to mitigate some of the issues surrounding offload delay. For example, to improve patient transfers between hospitals, policies have been put in place to ensure that a unit doesn’t leave one hospital without confirming there’s an available bed waiting for their patient at the next hospital.

Stay Happy and Safe

Krista consults with the charge nurse at the Dartmouth General, hoping to expedite patient transfers and free up crews. A sign hanging in the nurses' station reads, "stay happy and safe."

Another weather warning pops up.

In the hallway, a paramedic puts down their phone, dropping their head on the back of the chair in frustration. The fatigue of offload wears on them. The grey area of focusing on one single patient but not being able to provide direct care becomes a wearisome cycle. It's a game of hurry up and wait.

The issues that crop up for Krista over a shift are myriad. A lack of Tylenol sends her to the fleet — where the emergency vehicles are maintained — so she can source some from the bags of ambulances awaiting repairs. There are systems issues with one of the trucks that she sends a paramedic in offload delay to address. Shortly afterward, that paramedic’s partner calls to tell her their patient was transferred, and they can now head back out — except her partner is still out dealing with the system issue.

“Of course,” Krista sighs.

From the Dartmouth General, Krista heads to the QEII hospital to repeat the process. In the paramedics' room, colleagues chat and work. When a call comes through, every paramedic subconsciously pauses, tilting their heads slightly to their radios, listening intently. If it's not for them, they resume their conversations seamlessly with no acknowledgement of the momentary delay.

“I don’t think they even notice they do it,” Krista says.

Unwinding

Thomas Whiteman, a Primary Care Paramedic just shy of his one-year work anniversary, is in a lighthearted conversation with his colleagues when we arrive. When he breaks, he discusses how he unwinds from his shifts.

The disconnect between the paramedics and the civilians in their lives can sometimes surface in everyday conversations.

“I've seen death today, but you're telling me you had to say 'no' to someone at work," Thomas says. "But if it sticks with me and I take it home, I have to recognize that. If I'm sitting on something, I talk to people on the platoon. Make sure you find people to lean on, or you get lost in the sauce,” he adds.

Eavesdropping on their exchanges, it's evident that amidst the fatigue, there’s camaraderie. Someone is leaving the shift and there's cake. There are nicknames lobbed around and references to memorable calls. There's a sense of deep dedication to their work, and both frontline paramedics and supervisors alike express a desire to do more and be everywhere at once.

As we return to base, a siren wails in the distance. Krista is scrolling through lists of ongoing calls. When she finds the unit, she says, “stroke call. They’re on the bridge.”

She zooms the map out on her computer, showing a swath of Nova Scotia that would take well over two and a half hours to drive across, dotted with red and black dots representing units tied up at hospitals and on calls, with any remaining green dots awaiting action.

Soon after, the storm begins.