lack of staff and infrastructure has led to frequent “Code Red” statuses, meaning there are no ambulances available at certain times on some days across the GTA. There is no legal duty for the City to report this to the public. CUPE Local 416, which represents Toronto’s paramedics, has obtained this information largely through Access to Information requests; however, these are far from immediate, up-to-date information.
“The average was about 30 to 70 [Code Reds] per year [pre-pandemic]. In 2021 it was 1136,” said Charles Labelle, a paramedic and steward with CUPE Local 416, which represents paramedics in Toronto. “We’re sitting at about 5 ambulances available in the city 90 per cent of the time.” According to the 2013 Pomax Report on emergency services, this number was 35 ambulances a decade ago.
The 2023 budget for Toronto’s paramedic services is $315.7 million. By comparison, the budget for Toronto Police Services is over $1.1 billion.
Andrew Lamarch has worked as a paramedic for 17 years. He has fond memories of his early 20s, both his college days and his early years on the job where he developed strong connections with his coworkers. Back then, Toronto’s paramedics were all on one set schedule.
“When I got hired, there was a camaraderie with everybody. You started to learn everybody who was on your shift. You went through tough calls together. We used to go out and have drinks, have breakfast after night shifts together,” said Lamarch, reflecting on his early years on the job. “The camaraderie was what made me enjoy it at the beginning.”
Much of that has been removed. In the last two decades, and especially since 2012, there has been an erosion of the working conditions for paramedics in Toronto. Inevitably, this means the city also suffers as it decreases access to lifesaving care.
The target arrival time to the scene of an emergency was 8 minutes and 59 seconds prior to the pandemic. This is now upwards of 11 minutes. According to the 2013 Pomax Report Toronto’s paramedic service, “has not had a 90th percentile response time better than 10 minutes and 24 seconds since 2002.” This issue has been raised regularly to City Council and has gotten worse in recent years. Labelle said this number is now about 13 minutes.
Paramedics are now called from areas of the city far from the location of the emergency. Lamarch sometimes gets calls in North York to attend to an emergency in Scarborough as there is no one closer available.
“I noticed there’s calls on the board that were upwards of 12 hours old,” said Lamarch, describing calls from nursing homes during the peak of the Omicron COVID wave. In these cases, on-site staff could monitor the patient. Dispatch would call back every few hours, but staffing was so low that the call would be unattended for many hours. “Paramedics had COVID, all the nurses had COVID. We had no staff. And we weren’t able to offload at the hospitals, because the hospitals had no staff.”
Trained professionals are leaving for other paramedic services in Ontario, and the City of Toronto is having trouble keeping up with increased service demands as a result of population growth, the pandemic, and increased time servicing calls. “We’re probably losing about [one paramedic] a week. Resignations or retirement,” said Labelle.
There are some difficulties enrolling new students in paramedicine as well. “Paramedic programs in Ontario have been highly over-subscribed for many years,” said Michael Thomas, professor and coordinator of Centennial College’s Paramedic Programs. “At Centennial alone, we have several thousand applicants for approximately 45-50 seats in our diploma program through the Ontario College Application System (OCAS)”. Thomas said that their joint program with the University of Toronto has similar issues, as applications far exceed spaces there as well.
In addition to this, Thomas said that students face a lack of available field practicum spots in locations such as long-term care, paramedic services, and acute care hospitals. “It has become increasingly difficult to secure placements for all students with our industry partners, yet the demand for paramedics continues to grow.”
Thomas added that there has been a notable rise in paramedic students entering school with declared mental health issues and previous traumas. Coupled with the nature of their work, regularly being exposed to traumatic events, this “[has] been shown to increase the likelihood of paramedics developing Post-Traumatic Stress Disorder (PTSD) and exiting the profession prematurely.”
As a municipal service, paramedics are not capped by Bill 124 to a 1 per cent salary increase in their contracts. Labelle said that regardless, the increases laid out in their contracts are “not even close” to keeping up with inflation, which has been between 3 and 7 per cent during the pandemic. “As of 2012, we gave up the right to strike at all,” said Labelle. Before this, a portion of these workers could go on rotating strikes during contract negotiations.
Labelle said that occupational stress and assaults on paramedics have risen steeply during the pandemic. And long before COVID-19, the City made structural changes that decreased paramedics’ sense of community and support. In addition to this, Labelle said that occupational stress and assaults on paramedics have risen steeply during the pandemic.
“Ten years ago they decided to ‘optimize’ our schedules. They got a company to come out and provide seven different schedules,” said Lamarch. Under the pre-2012 system, there was one set schedule with six shifts. “You knew everybody on your shift, you knew the shift in front of you, you knew the shift behind you.” From 2012 to 2022 there were seven schedules with six shifts each. As a result, paramedics did not get familiar as they used to.
“You’d notice if somebody was off. You’d be able to check on them,” Lamarch said, describing the peer support that was common among the teams. “Now, people just get lost…We have quite a few people that are off on stress.”
The City of Toronto confirmed that it has, “completed an initiative to move frontline operations staff to a harmonized schedule,” closer to the old one-schedule system. “That brings us back to the building of platoons and teams, getting back to that,” said Labelle.
“It took them 10 years to realize that it doesn’t work,” said Lamarch who added that this hurt morale for himself and the people he knows in this service.
Both Labelle and Lamarch say the cost of living crisis in Toronto is making it difficult to keep workers who live in the city. Commuting from a more affordable area is also impractical as wages in surrounding areas are similar to those in Toronto. Durham Region now pays their paramedics more than the City of Toronto.
Many paramedics use Toronto as a stepping stone after college, learning their craft and then applying to services outside the city. “By far the paramedics in Toronto see the most, and they’re the most experienced. They’re probably the best paramedic service in Canada,” said Labelle, who attributes this to the higher volume of life-threatening emergency calls in Toronto compared to smaller municipalities. “We’re able to bring those people back and get a lot of survivors because of the incredible medics that work here.”
“We can’t even find paramedics anymore…before it used to be like 1000 people would apply for Toronto and 45 got hired,” said Lamarch. “Now we don’t even have enough people applying to work in the city.” The City currently wants to hire 66 new paramedics per the 2023 budget.
Understaffing has worsened working conditions throughout. “No breaks. You don’t even expect to get back to the station. You try to eat a little bit in between calls sitting in the front of the ambulance, which people in other services find disgusting,” said Lamarch. The presence of community paramedic services around the city has also suffered due to a lack of staff.
“They were supposed to be having appointments with clients providing injections, immunizations, and then they got pulled away last minute from that to service calls on the road.” Often times the service has to pull ambulances out of hospitals to take calls on the road, a practice that was not done in recent years.
There is also a problem of a lack of infrastructure. The City announced a new paramedic station in the East End years ago, but it has not been constructed. The City told The Hoser via email that, “no ground-breaking has taken place and the architectural plans are currently under review”. The former bus station at 610 Bay Street downtown that was shut down in 2021 has been converted into an ambulance garage. The repurposing of this former bus station is, “in the planning phase, and not yet operational,” according to the City.
Lamarch keeps in touch with other paramedics through various group chats. They say what Toronto’s paramedics need in order to be convinced to stay long-term is retention pay. Paramedics with decades of experience are leaving for York, Durham, and Peel Region instead of staying in the GTA. They are sacrificing years of vacation and seniority to work in a different service. Like most public services, wages were not keeping up with inflation before the pandemic. This has gotten worse since 2020.
“I know people that have gone over to York. They seem to be staffing appropriately and buying new equipment, new PPE throughout the pandemic,” said Lamarch. York Region has plans to expand paramedic staffing by 344 positions over 10 years, albeit while serving a much smaller population than the GTA.
“You tie in COVID with a broken system, that’s a perfect storm,” said Lamarch.