A Paramedic Shortage Is Putting Lives—and Workers—at Risk

The night Zachary Green responded to the call that sidelined him for six months with post-traumatic stress, he was asked if he wanted to finish his shift. It was May 2021, and he had just witnessed the death of a child. Green chose to go home but found his deputy commander’s question “ridiculous.” Most paramedic services pull staff from duty, which “is how it should be.” Instead, there was the expectation he would keep working. “This call is going to stick with me for the rest of my career,” he says. “You shouldn’t be going back to the ambulance after something traumatic.” That choice, however, reflects the harsh reality of working in Rainy River, a remote Northwestern Ontario town near the Minnesota border. Even by the standards of a province where paramedic services are regularly short staffed, Rainy River paramedics face gruelling conditions. Covering four communities over 15,000 square kilometres, paramedics often drive more than an hour to meet patients, longer if one of their ambulatory stations is closed or down staffed—which was the case for 170 days last year. Sometimes, they must respond to calls alone, operating equipment meant for two, increasing the risk of physical injury. “To operate based off our current service delivery model, to staff all our ambulances around the clock and ensure people get their time off, we need forty-six full-time equivalent paramedics,” says Joshua Colling, the chief of the service. “We’re currently sitting at thirty-one.” With too few staff, “constant overtime” has become “the only means to maintain sufficient coverage,” says Malcolm Daley, a paramedic and local union president. Collectively, they worked more than 6,000 hours of overtime in 2023 and reached that number by July of 2024.

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For those facing mental stress injuries at work, limited options make timely help harder to access. Each jurisdiction must have a PTSD prevention plan for traumatic incidents, but protocols differ widely based on local capacity. In places like Rainy River, even basic assistance—such as access to an employment insurance specialist—can be scarce. After the 2021 incident, Green wasn’t connected with a specialist to help navigate his Workplace Safety and Insurance Board claim, he says, leading to delays in his first payments. It was a month before he could begin accessing psychological support. Larger jurisdictions, like Toronto, have a psychologist on staff and a peer support team. Depending on the incident, there are different plans. “The death of a child patient,” for example, is considered a category two, requiring intervention. Rainy River’s modus operandi, says Green, is to leave paramedics to tend to their own mental health. “I was given the impression that resources weren’t available because we were up in Northern Ontario, but there are a few very good psychologists in Thunder Bay, Kenora, even Fort Frances,” he says. “That excuse doesn’t work anymore.” Rainy River is far from the only community in Ontario where paramedic demand exceeds supply. A study published in The Journal of Emergency Medicine found that ambulance transports increased by more than 25 percent across the board between 2010 and 2019. And that was before the COVID-19 pandemic. Greg Sage, a Halton paramedic and president of the Ontario Association of Paramedic Chiefs, acknowledges that while the early days of the pandemic were filled with uncertainty, paramedic services “pivoted very quickly” to meet the moment. Beyond emergency response, he notes, many paramedics played a crucial role in testing and vaccinations, acting as “that anchor for the health care system outside of the hospital sector.” According to Sage, paramedics are taking on broader responsibilities through community paramedicine, assisting vulnerable populations, including the unhoused, and treating chronic mental and physical health conditions as well as substance use disorders. And yet paramedics are often the least well paid among first responders—a long-standing frustration that contributes to high turnover, especially in northern and remote communities (the union in Thunder Bay put up billboards last year to draw attention to the issue, noting in TV interviews that they are paid $8 to $10 less per hour than police officers and firefighters, despite responding to the same calls). Provincially, there is scant data on the number of paramedics leaving the profession. The data, however, is clearer on two fronts: paramedics are logging excessive overtime, and ambulances are still frequently unavailable to respond to calls. Depending on the district, these instances can be called code zeros, code blacks, or code reds. But from the numbers that are available, a picture emerges. Eighty-three percent of paramedics surveyed by the Canadian Union of Public Employees in 2021 said their workload was harming their physical or mental health. A study of Workplace Safety and Insurance Board data found that paramedics had the highest proportion of mental stress injury claims between 2017 and 2021 among public safety personnel (the same study also found that paramedics were the most likely to return to work after experiencing those injuries). Easier to find are figures for individual paramedic services. In Manitoulin-Sudbury, there was an eighteenfold increase in the number of overtime hours served between 2019 and 2023. In Toronto, staff turnover rates for call takers and dispatchers more than tripled in that same period, while front-line paramedics saw a three-percentage-point increase, meaning the loss of more than 500 paramedics in that division alone. In Peel, another study found that a paramedic was physically or sexually assaulted every forty-six hours and injured every nine days. Paramedics reported being hit, punched, scratched, grabbed, and choked. “The assumption is that violence is part of the job, but that you need to figure out a way to deal with it or it’s going to eat you alive,” says Justin Mausz, a Peel-region paramedic, educator, and lead author of that study. The current state of Ontario’s emergency medical services is the result of provincial policy failures decades in the making. In 1998, Mike Harris’s Tory government downloaded the responsibility for land ambulance services from the province to municipalities. Despite injections of additional provincial funding over the intervening years, this funding arrangement leaves municipalities liable for unforeseen expenditures and means they often contribute more than their fair share. The Ministry of Health and Long-Term Care currently shares half the costs of emergency medical services with municipalities. This, according to an analysis commissioned by the Ontario Paramedic Association, “holds municipalities in a perpetual state of underfunding for current year requirements.” “There needs to be a complete re-evaluation of how paramedic services are funded and rostered,” says Joel Usher, a paramedic from Northumberland County who serves as the chair of the Ontario Public Service Employees Union ambulance division, a sector within that union that represents paramedics and ambulance communications officers. “This funding to the bare bones to have enough ambulances for your average Tuesday afternoon needs to be looked at a little more closely.” The current Tory government, under Doug Ford, planned another round of restructuring in 2019, proposing a major overhaul to reduce the province’s fifty-nine local ambulance services to ten. The backlash stayed his hand, and last year, the province instead modestly increased ambulance funding to municipalities, as well as invested $32 million in a new mental health support program. Ontario had already added 300 paramedic training spots in 2023, with graduates set to enter the field this year. Its Learn and Stay grant also offers tuition reimbursement in exchange for time served in priority communities. These investments, while welcome, have not brought wage parity, restored staffing, improved retention, or relieved the breakneck conditions paramedics are forced to endure. “Paramedics are very resilient,” says Green. “But you hit a breaking point.” Six months after the harrowing event, Green went back to work in Rainy River. He started with four hours, on his psychologist’s advice, gradually increasing to six, then twelve. “I pushed things a bit,” he says. “I probably could have held off a lot longer, but I got worried if I was ever going to be able to go back.” Upon his return, he found some colleagues had been gossiping about him faking his injury for time off. Last year, Green left Rainy River for a job in London to be closer to family, but he remains a paramedic. When asked what keeps him in the profession, he admits, “It’s a cheesy answer, but I just like to help people.” He isn’t in it for gratitude, he explains—his satisfaction comes from knowing he’s made a difference, even in small ways. “If I can get someone from point A to point B feeling slightly better than when I found them, that’s enough. Or just knowing that if paramedics never showed up, who knows what could happen.” The post A Paramedic Shortage Is Putting Lives—and Workers—at Risk first appeared on The Walrus.