Canadian paramedics are in crisis

PTSD, burnout, and a pandemic. How COVID pushed the country’s overworked first responders into emergency territory

There are too many patients: too many people with COVID, people who can’t breathe, people who are in psychiatric crises or feel chest pain or have overdosed or fallen or crashed their cars. They want nurses, family doctors, home care, psychiatrists and social workers. They need hospital beds, long-term care homes and affordable mental health programs—all of which are in short supply. But there is 911; there is always 911. The problem is there are not enough paramedics to answer the call.

Emergency medical services across the country are in serious trouble. One COVID surge after another piled even more stress onto a system that was riddled with cracks long before the pandemic began. The number of 911 calls has been rising for at least a decade. At the same time, rampant overcrowding in emergency departments means paramedics get backed up in hospitals, where doctors and nurses are already swamped. During these periods, known as offload delays, they care for patients in hallways and ambulance bays, unable to move on to the next person in need.

A 2017 report commissioned by Defence Research and Development Canada’s Centre for Security Science identified approximately 38,000 paramedics across the country. One-third of respondents said they’d taken a medical leave in the two years leading up to the survey; just over 10 per cent said they’d taken one for their mental health.

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The instability in EMS has roots in a system dating back nearly 200 years. In 1832, a cholera outbreak in the town of York—now Toronto—led to the creation of the first known ambulance service in what would become Canada. The town approved a wooden “cholera cart” to tow sick patients away from crowded areas, sometimes straight to funeral homes. These carters, as they were called, did not provide medical care. They simply carried the dead and dying away from the living. Modern paramedics aren’t just ambulance drivers; the scope of their practice has broadened. In a single shift, they might pull someone out of a wrecked car, lift someone else off the floor and find a social worker for an unhoused person.

Lindsey Boechler, a former advanced care paramedic and a researcher at the Centre for Health Research, Improvement and Scholarship at Saskatchewan Polytechnic, studied paramedics across Canada in the early months of the pandemic. She hadn’t planned on doing a mental health study, but that’s what her research became. Paramedics told her that they anguished over how to care for patients in uncertain times. The rules changed from shift to shift, they said. One participant described a chaotic scene: “Four paramedics showed up and everybody had a different care plan. That’s how many times policies have changed.”

Many EMS services told their paramedics to stop intubating patients or using airway tools during COVID’s first wave, when PPE supplies were in question and the virus was poorly understood. To some, this seemed like a violation of their obligation to patients. “They believed they were inflicting harm and holding that burden on themselves,” says Boechler. EMS workers told her that they turned to alcohol. They missed going to the gym to blow off steam. Some separated themselves from their kids for months, uncertain of what they might bring home. One paramedic said she cried in her truck, undone because she couldn’t find a place to pee. All the public bathrooms were closed.

In the past 12 months, cities all over Canada have reported code reds, meaning there are no ambulances or paramedics available to help—no matter how critical the emergency. Toronto called one in January, and Waterloo, Ontario, called 11 in December alone. Between August 1 and December 6, 2021, Calgary and Edmonton were issuing red alerts every 90 minutes. Out east, Nova Scotia’s Standing Committee on Health heard the same story. The business manager of the local paramedics’ union said, “Today, the system is nearing the point of failure.”

The Canadian Occupational Projection System has estimated the need for another 4,000 paramedics by 2028. In addition to more personnel, experts and workers on the ground have proposed intuitive solutions to the EMS crisis: more trucks; more hospital beds; more of everything. Other ideas, like investments in community paramedics—those who provide care on a regular, non-emergency basis—are gaining traction. Mostly, paramedics seem to want recognition that they are skilled health care professionals, not carters, and that their work is a matter of life and death.

In January, a 95-year-old Vancouver man spent six hours on the floor of his apartment and survived. The next month, an elderly Québécois man died in an ambulance in a hospital garage as he waited to be tended to by staff. Each paramedic has a life, too, full of stories of resilience, coping and, sometimes, barely that. Here, they share their own.

(Photograph by Grady Mitchell)

Dave Deines

Vancouver, B.C.

I always knew I wanted to be a paramedic. I loved watching old episodes of Emergency! on TV when I was growing up. I joined the Canadian Forces as a medic in 1990. I was never deployed overseas with the military, but I’ve been deployed five times as a volunteer with the NGO Canadian Medical Assistance Teams. I went to Indonesia after the tsunami, then Pakistan, Bangladesh and China. I also went to New Orleans after Hurricane Katrina hit.

When I started working in Victoria in 1995, if I did more than eight calls in a 12-hour shift, that would be extremely busy. Now, in Vancouver, crews regularly do 10, 12 or 14 calls every shift. The skills we have today are light years ahead of what we did when I was starting out. In some cases, we’re doing procedures that were historically reserved for physicians—like intubating a patient, or putting a needle into someone’s chest to relieve pressure in their lungs.

I’m the president of the Paramedic Association of Canada, and the provincial vice-president of the Ambulance Paramedics of B.C. I still get out and ride with crews, and I’m part of the urban search-and-rescue team here in Vancouver—that’s when I can just be a paramedic. My stress is different now than it was when I didn’t have these leadership roles. Back then, it was focused on individual patients or catastrophic calls. Now, my stress is more about trying to advance the entire profession.

We’ve seen a dramatic increase in the volume and complexity of the calls. That drives the frustration that front-line paramedics feel on a daily basis. For instance, we’ve been dealing with overdoses forever. What’s new is the substances we’re encountering. We see more potent drugs on the street. Toxic opioids are going around. Drug dealers don’t subscribe to quality control. In B.C., we’re seeing a trend in poly-overdoses, which involve opioids mixed with illicit drugs or other substances. Those patients are difficult to treat, because the respiratory depression can be more profound.

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What makes the current moment unique is a combination of the last three years: not just the opioid crisis, not just COVID, but climate disasters, too. We had the heat dome at the end of June. More than 800 people died, putting a huge strain on the paramedic service. In November, we had flooding and rainstorms. Any external factor that increases call volume puts additional demands on a service that’s operating at close to 100 per cent most of the time.

It’s exhausting to continually operate at those levels. Five years ago, you’d have time after a call to sit down and talk with your partner. We refer to them as “bumper chats,” conversations that allow you to physically, emotionally, psychologically place that call behind you and get ready for the next one. Now, those aren’t there.

Paramedics are resilient. We’re used to working in stressful situations. But from a national perspective, we need more boots on the ground. If you were to ask paramedics, “What’s the number-one thing that can be done?” it would be to recognize what we do, and provide support to help them do their job. It doesn’t matter where you go in Canada. The issues are generally the same. There are too many calls and not enough ambulances.

(Photograph by Erin Leydon)

Natalia Marijke Bourdages

Brampton, Ontario

I was born and raised outside of Tkarōn:to, and I did my undergraduate degree at the University of Guelph in biological sciences. I was thinking about medical school when I noticed an application deadline for a paramedic program at Humber College. I got in and instantly loved it. The job is fast-paced and unpredictable. I now work for Peel Regional Paramedic Services, covering the area where I grew up. Sometimes I even see someone I know during a shift.

For me, the most rewarding calls are the ones where I can get somebody access to the help they need. Before the pandemic, I went to a call for a trans woman who was having a mental health crisis and couldn’t reach her usual support people. She didn’t know what to do but knew she didn’t want to go to the hospital. I sat with her and listened. I opened up about also being a member of the queer community. I asked what helped with her anxiety and she said music, so we found some songs on her phone.

That’s the kind of call where someone is lost in the system. Those calls also put the paramedic in a weird place, because bringing someone to the hospital is what we are trained to do—but maybe that’s not always the best thing. It is an extreme balancing act to sit and listen to a patient when there are so many calls coming in. Of course, that’s not how paramedicine is taught: you learn what medications to administer and how to perform CPR, but the reality is more like community care. And you’re still needed out on the road. There’s no easy answer.

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When the pandemic began, I jumped at the opportunity to go into nursing homes to do testing. At the same time, as an Afro-Caribbean person, I was dealing with the anti-Black racism that became more visible after the murder of George Floyd. It was an extremely hard time to be a racialized person on the front lines. I had to take a mental health leave from work and was later diagnosed with PTSD.

I’m married, and my partner is an Indigenous birth worker. It was scary, trying not to bring the virus home. We’re lucky in that we have similar realms of work and a similar likelihood of exposure during the pandemic. We have been able to lean on each other during the difficult times.

After returning from my leave, I had the opportunity to do some shifts in the vaccine clinics. We were in the middle of the Delta surge, when Peel was hit hard. We were getting calls for people who had oxygen saturations lower than anything I’d ever seen before. Young people were dying. By the time Omicron arrived, all the paramedics were catching COVID. Many of us were already feeling extremely burnt out, and then we started losing our people. It’s a tough time, but I don’t want to make it sound like we’re not here. We are here. You can call 911 and we will be there to help.

(Photograph by Dustin Veitch)

Paul Hills

Saskatoon, Saskatchewan

I’ve been doing this work for about 22 years now. When I started, I didn’t fully understand the gravity of what it would be like to deal with people in their most difficult hours. The idea was: This is a tough job, but you suck it up and do it. We didn’t talk about PTSD back then. It was just like, “Oh, he’s stressed.”

I joined the union leadership 15 years ago and became president about eight years ago. I began advocating for mental health awareness and provisions for our workers. We knew paramedics were struggling with stress, but I didn’t realize the stress going on inside me until it hit a crisis point. In 2016, I was called to the scene of a serious accident. After that, I started having short-term memory problems: I couldn’t even remember the name of my son’s school. My wife is a counsellor, and she’s been an amazing advocate for me, but I felt like I couldn’t even tell her. I was making plans for how to kill myself. I knew who I was going to text so they could come find me, instead of my family. I realized I needed help. I reached out to my family doctor for treatment. Four years later, I found myself in that position again, and got back into treatment. My faith helped me get through it all, too.

Right now, paramedics aren’t getting breaks. The added pressure of COVID is exposing cracks—lack of staff, lack of trucks, lack of adequate mental health treatment within a helpful timeline. It also added time on calls for PPE and decontamination.

Anytime the phone rings, it’s an emergency. And that person’s emergency might trump the ability of the paramedic to do something as basic as eat a meal. It affects our sleep. It affects our home lives. I see ephedrine abuse. I see caffeine pill abuse. If I’d invested in energy drinks 15 years ago, I would be retired by now; first responders drink those like water. These are things that people are using to cope.

It’s common for my dispatchers to call patients every 20 minutes when they’re waiting for an ambulance to say, “How are you doing? We’re really sorry. We’ll get you an ambulance as soon as we can.” Before COVID, we received about 30,000 calls annually. As of late 2021, we were at 38,000.

Some paramedics are working in the back hallways of hospitals, which is a band-aid on a system that’s broken. If we are backed up like that, the emergency department is flooded. If that’s happening, it’s because the hospital wards are full. It was going on before the pandemic, but COVID exacerbated all the existing problems. Hallway medicine is the canary in the coal mine.

(Photograph by Grady Mitchell)

Terrilyn Good

North Delta, British Columbia

When I was little, my dream was to be a doctor. Things panned out differently. I did a course in emergency childcare first aid in 2013, after my baby son had a seizure. After that, I worked as a youth-program coordinator in my home community of Gitanyow, a First Nations reserve along the Skeena River in northwestern British Columbia. I pushed for my employer to get me more first aid training because I spent so much time with kids. I kept thinking, “What if something happens?” My community is a long distance from help.

One evening, I was eating dinner with my kids and I got a call that someone had fainted. I did everything I could with my basic training, and stayed for 45 minutes until the ambulance came. The patient lived, and as the truck drove away, I realized that’s what I wanted to do. I started working with BC Ambulance in Kitwanga in December of 2016, and now I live and work in Delta.

I love not having a set script when I go to work. I see something different every day. It could be an elderly person who needs a lift off the floor or somebody in a life-or-death situation. Most of the time, people really appreciate what we’ve done, and they understand how challenging the job can be. I can see their relief when I walk in the door. Thank you. You’re here.

It’s hard to even remember what work was like before COVID—half of my career has taken place during the pandemic. When it started, I was just a baby medic trying to find my legs. Since then, I’ve visited hundreds of patients with COVID or COVID-like symptoms. Often, they’re very scared of the virus. Sometimes they don’t even want to go to the hospital. They just want reassurance, and someone to check that their vital signs are normal.

One of the first questions we ask now is, “Are you vaccinated?” Most people are, but people who aren’t can get very defensive. I’m not there to question somebody’s reasons for being unvaccinated; I’m there to help. We’re just required to ask so we can protect ourselves with proper PPE.

Everybody I work with seems like they’re one step away from taking leave. It’s not really an option for me because I’m a single mom. I’m proud to be a role model for First Nations women. I’m good at what I do, and I have some seniority in my job, even if it’s organized chaos. I want to do advanced life support training, but I’ll do that once my kids are older.

(Photograph by Ebti Nabag)

Patrick Suthers

Kingston, Ontario

I watched members of my family deal with cancer and chronic disease growing up, so I always wanted to work in health care. I stumbled across EMS through a friend who worked as a critical care paramedic. Five years ago, I decided to take the course at CTS Canadian Career College in Barrie, Ontario. I fell in love instantly. There aren’t many jobs where people willingly invite you into their houses, at any time of day. You meet them at their most vulnerable. It’s a huge privilege to do that.

I was primed to deal with high-acuity 911 calls, like car crashes, but it’s been much more of a social work job. We often deal with people who have fallen through the cracks, so to speak—people who regularly interact with the health care system, like the elderly and the marginalized. A small segment of the population makes up 90 per cent of our calls.

I was interested in why that was happening, so, about a year into my job, I decided to pursue an undergraduate degree in health sciences at Queen’s University. Currently, I’m doing a research project on community paramedicine. Plus, I work as a paramedic on the weekends.

At the beginning of the pandemic, there were so many unknowns, like, “Am I supposed to treat everyone as if they have COVID?” I understood the need for masks, but they made my work more difficult. I’m hearing-impaired and masks hamper my ability to communicate with patients and colleagues. I found that morally distressing. Early on, some services worried about PPE shortages and opted to use P100s, which look like construction masks. I worked on a resuscitation and I couldn’t hear a thing my partner was saying to me. It wasn’t the time to ask, “Can you repeat that?”

There’s not enough staff, not enough trucks, staff burnout and backlogs. The hardest calls now are probably the “VSAs,” which stands for vital signs absent. We tend to spend time with families in the aftermath, getting them a cup of coffee and easing them into the grieving process. Masks make it so much harder for us to be there for them in a non-clinical capacity—as people. We wonder whether we’d be putting people at risk by spending that time with them.

A big issue is that the public perceives us to be a scoop-and-go service, which our education prepares us for. Most calls are lower acuity—falls, mental health crises or the decline of the elderly. Some people are living in terrible conditions: I visited a man in his 80s who was waitlisted for long-term care. He called 911 because he fell off his couch, and it looked like he’d been sleeping there. Food was everywhere. School doesn’t prepare us for those challenges—and I’ve seen more of them as COVID has progressed.

(Photograph by Stephen Harris)

Noor Karfoul

Charlottetown, Prince Edward Island

I moved from Damascus, Syria, to Charlottetown in 2011 with my parents and younger brother. I was 15. My parents brought us here for more opportunity and a better education.

When I was in high school, my grandfather needed an emergency medical rescue back in Syria. He lived in the rural mountainside and got caught in an orchard fire. Military medics were able to stabilize him and get him to hospital. That opened my eyes to the value of EMS. My grandfather needed those medics to stay alive. He made it, but he has long-term health effects from smoke inhalation.

I wanted to go into EMS right after high school, but first I needed money. I worked as a culinary apprentice for a few years, and then went to Holland College to become a paramedic.

COVID started during the last months of my schooling. The day it was declared a pandemic, I was on a truck doing on-the-job training in Nova Scotia. There was so much uncertainty. The school had to reassess the liability of having students on the truck. There were initial concerns about a shortage of PPE and the likelihood of exposures. In the end, we came back to P.E.I. to do schooling online for the last month. I graduated in May of 2020.

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In school, we heard stories about how there was the occasional hard-earned slow day. I missed out on that. Our generation never had those. We work in pairs, mostly doing 12-hour shifts. If you’re lucky, you get to go home after that; most of the time, you stick around a bit longer to help out.

P.E.I. is an interesting situation for paramedics because we send patients to neighbouring provinces for specialized services, like neurosurgery or cardiology. We handle a lot of care for the aging population on the island. For me, the most rewarding aspect is our palliative patient program. We help with symptom management—pain, lightheadedness, nausea. You can’t rush those calls. It’s about bedside manner and patience. Sometimes you find yourself supporting the family, too, because there is a lot of stress involved in caring for a loved one at home.

The nature of the work makes it easy to get drawn in and not see how much it’s drawing out of you. My friends and family are there to say, “You need to take a step back. Take a breath.” I think about my grandfathers a lot lately. One passed away a few months ago; I really wanted to see him before he died. The other, who survived the fire, is sick again, too. I hope I get to see him soon, but I don’t know how to make that happen.

(Photograph by Lindsay J Ralph)

Josh Fisher

Happy Valley-Goose Bay, Newfoundland and Labrador

 I grew up in the United States. I did my paramedic training at Creighton University in Omaha, Nebraska. After I graduated, I went to work in the middle of the state, which is basically the middle of nowhere.

I later ended up moving to Florida for work, where I met Jessica, a woman from Newfoundland who was visiting for holidays. That was that. We knew we wanted to get married, so I decided to move to Canada. I can work 40 hours here and make the same money as I made working 90 to 120 hours in the U.S.  I arrived in Newfoundland in September 2010, the same night that Hurricane Igor landed here. It’s fitting: I’ve been working around the weather ever since

I now work for the air ambulance program based out of Happy Valley-Goose Bay. My job is to serve the north coast and south coast of Labrador and get patients to hospitals—either Labrador Health Centre, which is in Goose Bay, or hospitals out of province. One of the quirks of Newfoundland is that, in the rural areas, they’re just starting to get around to naming streets. In some remote communities, homes have no address. It’s more like, Go to the white house and turn left and go three more houses and turn right and somebody will wave you down in the street.

Most hospitals in Newfoundland and Labrador don’t have intensive care units, and they’re not staffed to handle critical patients. For most of the pandemic, Newfoundland had a low COVID caseload, but the vrisu still affected us. Because there are so few facilities, the backlog and wait lists of patients built up quickly. We noticed our patients becoming sicker—much sicker than what we’re used to. The patients themselves didn’t think their complaints were severe enough to inundate the health system.

I hate having to say no to patients’ family members who want to travel with us. We move people over long distances, heading to hospitals that might be a full-day’s drive on remote roads, plus a ferry ride. We try to tell families that their loved one is in good hands. We call these separations “see ya laters” rather than “goodbyes.”

Paramedicine is kind of an offshoot of the healthcare system, yet never considered an integral part. So our workload has dramatically increased, but our resources have not. The stress is palpable. The quality of life isn’t great. We can’t keep staff. The turnover in the last two to three years is unprecedented. Schools are churning out paramedics as fast as they can but it’s not enough. You would think that as the pandemic winds down, things would ease up. In reality, it has gotten worse.

(Photograph by Colin Way)

Jessica Frith

Baker Lake, Nunavut 

I have been in EMS for almost 10 years and I’m not even 30 yet. I started working in very rural areas in Alberta and Northwest Saskatchewan, and then moved to the city for my Advanced Care Paramedic training in 2018. I ended up liking city life, even though I’m from a Saskatchewan town of 1200 people.

 The shortage of resources has become very noticeable in the last five years. Calgary and Edmonton make a lot of noise about red alerts—that’s when there are no ambulances available to respond to emergency calls—but other places are experiencing the same thing. They just don’t get as much attention. Offload delays are happening everywhere—not just Alberta, but across Canada and internationally, in the U.K. and Australia. It’s been like that for a long time, but it’s only been talked about by the public in the last six to nine months.

For paramedics [in general], there’s the obvious physical exhaustion, but I know so many personally who are off on mental-health leaves or are leaving ground ambulance altogether.

One of the straws that broke the camel’s back for me was hearing about a crew having to respond to a call in the very opposite end of Calgary— and it was for a cardiac arrest. There was desperation in their voices when asking dispatch if they were really the closest. A lot of people don’t move over, even when you’re coming with lights and sirens. 

I’d work overtime almost daily. I could be done work at 6:00 p.m., and if a call came in at 5:58 p.m. that was 45 minutes away, I would still do it. I’d often get into my vehicle at the end of a shift and, the next thing I knew, it had been 10 minutes and I’d still be sitting there, too dazed and tired to drive home. I’m incredibly fortunate that I don’t have a family at home waiting for me to pay them attention because at the end of a shift, I’m a zombie. I dissociate by watching reality TV.

During the pandemic, I responded to a fellow first responder’s suicide. That made me start thinking about my job and my mortality—like, Is this all worth it? It amplified everything that I had already been suppressing. I never had nightmares, but when I was awake, I would think about it a lot. Even now that I’m talking about it, my head is going through the entire scene walking through the building.

I took mental-health leave and worked hard to be able to go back to work. I saw an occupational therapist and psychologist—three appointments every week for about 12 weeks. I have a different job now. I needed a change of pace. I work in a health center in Nunavut. Last night, the entire sky was full of the northern lights. It’s been one of the greatest changes I’ve made.

(Photograph by Colin Way)

Heather Cook

Calgary, Alberta 

When I was a kid, my mom and her then-boyfriend started a private EMS service called Aeromedical. It’s still operating in northern Alberta. We would attend the rodeo and watch it sitting on top of the ambulance. When I got older, I did my own thing for a while: I trained horses. I lived in Europe. I had my kids. But I wanted a job with meaning. At 34, I trained as a primary care paramedic, while working full-time in an office as supervisor of a sales team. I later upgraded to advanced care paramedic in 2018, while working full-time as a paramedic. I took a short mental-health leave in late 2019. I’d been working non-stop. I think the skills I learned helped prepare me for the pandemic.

I don’t know how much more ‘frontline’ you can get than being in someone’s home during COVID. The hardest experience for me was at long-term care facilities. Pre-pandemic, you’d walk in and some resident would be playing a piano, and people would be watching TV together or walking the halls. They were small communities. Early on, I visited a home that experienced one of the first big outbreaks of the virus in Alberta. When I walked down the hall, I saw patients lying in their beds or sitting in wheelchairs. They couldn’t see their neighbours. It felt like they were just waiting to be ghosts. When I got to the hospital, I took off my PPE and sat down. A hospital pharmacist walked by and asked if I was okay. I shook my head and started to cry. I think that, as a society but also as a profession, we’re grieving our past lives. 

I will never forget my first COVID patient who died. He and his wife had COVID very early on, before there was any lockdown. They were married for more than 60 years. As we were getting him onto the stretcher, he said to his wife, “Don’t think you’re going to get rid of me this easy!” I already knew he was going to be intubated. I was literally fogging up my glasses with tears. He kissed his wife, and that turned out to be the last time they interacted. Visitors weren’t allowed in hospitals.

Even though we’re essentially a small emergency department that comes to your house, paramedics weren’t included in the first wave of vaccines in Alberta; I don’t know why. Maybe it’s because we are in an area of healthcare that isn’t thought about until we’re needed.

This article appears in print in the May 2022 issue of Maclean’s magazine with the headline, “Distress call.” Subscribe to the monthly print magazine here.