Essex Windsor EMS Reduces Code Blacks by 24%

In Ontario’s Windsor Essex region — comprising Essex County and the City of Windsor across the river from Detroit — “Code Black’ is an EMS term that no one wants to hear. That’s because Code Black means that there are no Essex Windsor EMS ambulances available to take calls. This is because insufficient staffing and facility shortages in Canada’s underfunded public hospitals result in EMS crews waiting hours to turn their patients over to ER personnel.

Moving Resources for Code Black

Despite this reality, Essex Windsor EMS has found a way to cut its number of Code Blacks by 23% in 2023, compared to the previous year. In a report filed with Essex County Council during their March 6, 2024 meeting. Essex Windsor EMS County Chief Justin Lammers outlined how they did it.

According to the Essex Windsor EMS report, the secret lay in rearranging EMS personnel work schedules to better align with high incidences in Code Blacks and Code Reds (between one and three ambulances available.)

“On September 25, 2023, Essex Windsor EMS re-rostered all start times to align with periods of high volume and increased frequencies of code red and black,” the report explained. “In an attempt to reduce the amount of code red and black occurring in the late afternoon to early evening, resources were moved from the morning to cover this period. As a result, incidents of code red and black in the afternoon and early evening were reduced, but incidents of code red and occasionally code black were occurring in the early morning, signaling the need for more resources in the morning hours. For clarity, the amount of code red and black in the afternoon before the re-rostering far outweighed the amount of code red and black that is now occurring in the morning.”

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

The Paramedic Offload Program

Another way that Essex Windsor EMS is freeing up more ambulances for service is through its Paramedic Offload Program. This is another solution that is as simple as it is elegant — along with working within current budget and staffing limitations.

“The Paramedic Offload Program is where one ambulance crew takes over up to three additional offload delays for a total of up to four patients, thereby releasing up to three additional units back into the community,” Chief Lammers said during the council meeting. “For clarity, we started the Paramedic Offload Program two years ago to combat rising periods of Code Black.” Since implementing this process with local hospitals, Essex Windsor EMS has achieved a decrease in offload hours of 75%.

A third way that Essex Windsor EMS is reducing Code Blacks is through its Community Assessment Triage Teams, which were launched in August 2023. This approach uses two of the service’s Primary Care Paramedics based in Windsor. They are dispatched to calls where patients can be treated on scene without admitting them to hospital. “We deployed some resources that are responding to lower duty calls and diverting them," said Chief Lammers. 

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

Inadequate Government Funding

This being said, the above measures are workarounds to the real problem dogging Canadian healthcare, which is inadequate government funding. This means that the free public healthcare that Canada’s citizens take pride in continues to decline in quality and availability. In this case, a lack of family physicians — caused by poor pay and working conditions compared to other areas of Canadian medicine — has resulted in ERs serving as walk-in clinics for millions. This overload is pushing underfunded hospitals to their limits.

Unfortunately, addressing healthcare funding is a matter for the politicians. All Canadian EMS and hospital managers can do is to do the best with the resources that currently have at hand.

For the people in the Windsor Essex region, EMS ambulance availability has been improved by the creative efforts of Essex Windsor EMS and local hospitals, through staff rescheduling and the Patient Offload Program. This being said, Chief Lammers isn’t too happy about using this last measure. He described it as “a good process to leverage in a crisis such as a mass casualty incident, but] it is not a process that we want to be a regular process.”