Code Red — Alberta’s Ambulance Shortage

By Chris Zapisocky

The Province of Alberta, led by Kenney’s United Conservative Party (UCP), faces an ambulance shortage. Articles in 2019, well before the pandemic of Covid-19, described a sharp increase in code reds, where no ambulance is available to respond to a call. With increased rates of infection impacting both the number of healthcare workers isolating at home and the number of calls for ambulances coming in, the crisis of ambulance coverage in Alberta surpassed any reasonable notion of a tipping point. The existing system isn’t failing — it’s failed.

In Oct. 2021, Mike Parker, president of the Health Sciences Association of Alberta, again sounded the alarm. With an 50% increase in calls for emergency services in the previous 12 months and no increase in staffing, rural Alberta suffers without health coverage.

With the increase in call volume, the large cities of Edmonton and Calgary resort to calling in ambulances from smaller towns, which themselves then face an ambulance shortage. In one example, the town of Hardisty went without an ambulance for 24 days due to staffing shortages. Similarly, the northern communities of Barrhead and Westlock experienced a code red on Oct. 5, 2021. And during the recent holiday season, ambulances regularly stationed in Bow Valley, which includes the towns of Banff, Canmore, and Kananaskis, spent almost all their time in nearby Calgary leaving locals in the lurch. In 2021, Canmore paramedics responded to more calls outside the town than to local emergencies.

While ambulances meant to service smaller towns get diverted to larger cities, no person living in Alberta is guaranteed expedient healthcare. Even Calgary, the largest city in Alberta, saw 426 red alerts in the year between April 1, 2020 and March 31, 2021, which added up to 82.5 hours where no ambulance was available. Two years earlier, there were only 217 red alerts in Calgary for a total of 13 hours, which highlights how quickly this public health crisis is spiraling out of control.

Facing both a lack of support from the province or even media coverage, workers like Parker crowd-source information on ambulance shortages and share it directly with the public. According to the Alberta Health Services (AHS) Frequently Asked Questions on the EMS Performance Dashboard (updated March 11, 2019), they said they don’t report specific “red alerts,” leaving workers to pick up the slack.

This crowdsourced information means we know that Alberta experienced 139 red alerts in 41 communities during the most recent holiday season with wait times up to an hour.

While Covid-19 might be aggravating the crisis, it’s clear that years of budget cuts both eroded the baseline care that the province can provide and completely eliminated any surge capacity.

In the past decade, the Alberta government took over control of emergency services in small towns and in this process of consolidation, they slashed the number of ambulances running. In the community of Warner in southern Alberta, the number of ambulances was reduced from five to two. In 2009, the city of Airdrie, located north of Calgary, experienced a similar reduction from five ambulances to only three. No doubt that this contributed to the 21% increase in ambulance response time and increased variability in response time noted between 2019 and 2021.

The failures of the Alberta government to provide adequate healthcare to all people means volunteer firefighters in small communities desperately work to keep the system from collapsing.

And as noted by Sandra Azocar, executive director of advocacy group Friends of Medicare, “In the mid 90s, [Alberta] closed half of our hospital beds from 13,000 to 6,500 and the population was 2.6 million.” With a growth in population, there is now only one hospital bed for every 500 people living in Alberta compared with one bed for every 200 people previously.

Even in 2019, when the ambulance crisis first received news coverage, the provincial NDP party promised to come up with a solution. But rather than address and reverse the decades of austerity and budget cuts, Rachel Notley’s plan is to “post EMS professionals in emergency rooms (ERs) who would care for up to three individuals waiting for admission.” Currently, paramedics must wait with their patients at the hospital until a bed becomes available, which adds hours onto their call and prevents them from helping other people. Unimpressed, both healthcare advocates and the union representing EMS workers describe this proposal as a “short term solution at best.”

As the ambulance crisis reached record levels in 2021, Kenney’s government finally addressed the problem on Jan. 24, 2022, when they announced a new advisory committee at the same time that the AHS revealed a ten-point plan to increase capacity. While the NDP Opposition health critic David Shepherd correctly points out that the UCP plan includes no timeline, accountability, transparency, or targets, the Alberta NDP stop short of demanding the funding needed to ensure a robust healthcare and emergency system in the province.

While Parker expressed about a cautious optimism about the ten-step plan, particularly the intention to hire more paramedics and improve training programs, he also warned that some measures like non-ambulance patients transfers could further privatize the provincial healthcare system.

Years of budget cuts, an aging population, and the Covid-19 pandemic exposes the rot in our public healthcare system. This decades-long process might be more apparent in Alberta than anywhere else in Canada, but what remains a point of pride for Canadians, our single-payer healthcare system, is under attack from coast-to-coast-to-coast. Rather than continued privatization and free-market “solutions” that serve only make a few people filthy rich, we need robust investment in public services based on public need. Every person deserves access to accessible and expedient healthcare and our wealthy country can easily afford it. The chief obstacle is not one of resources but resource allocation. Rather than spending billions on the military, police, and corporate bailouts, we can invest in healthcare infrastructure, training, and workers. In this struggle for health, we will need to contend with greedy CEOs and shareholders who do not see healthcare as a human right but an opportunity for exploitation and profit.