Emergency rooms across Canada are facing a growing crisis — staffing shortages, burnout, worsening wait-times, closures, a lack of adequate funding and a surge of patients seeking urgent care, all threatening to overwhelm a system on the brink of collapse.
This isn’t the same type of pressure they faced during the COVID-19 pandemic, but doctors and nurses across the country who spoke to CBC News say the current strain on ERs can feel worse now than it was during the past few years.
Dr. Yogi Sehgal, an ER physician at Dr. Everett Chalmers Regional Hospital in Fredericton, said his emergency department narrowly avoided disaster a few weeks ago when multiple critically ill patients arrived in a packed waiting room at the same time.
If those patients had come in just three hours later, he would have been forced to call a Code Orange — typically reserved for extreme situations like plane crashes — where every available health-care worker in the community is called in to try to help keep patients alive.
“We would have been scrambling to get as many of the interventions done with each of the patients that were simultaneously crashing with basically no staff,” he said.
“Thankfully, I think all of them did well in the end. But again … had it been in the next shift — who knows what would have happened?”
Unfortunately, the situation can be dire for some, with reports from Quebec, Alberta, Manitoba, British Columbia, New Brunswick and Nova Scotia during the past year of patients tragically dying after waiting for hours in crowded hospitals, unable to get the care they need.
Health-care workers are seen at North York General Hospital in Toronto on May 26, 2020. Hundreds of emergency physicians in Calgary and British Columbia have signed open letters in recent weeks to sound the alarm about the worsening ER crisis. (Evan Mitsui/CBC)
A patient went into cardiac arrest last week while an on-call doctor wasn’t on site at Soldiers Memorial Hospital in Middleton, N.S. Paramedics and firefighters attempted life-saving measures until the doctor arrived, but the patient did not survive.
Health-care workers are fed up with the situation, and hundreds of emergency physicians in Calgary and British Columbia have signed open letters in recent weeks to sound the alarm about the worsening ER crisis.
Last week, 15 national medical organizations representing doctors and nurses across the country published a joint statement, calling on the provinces to make reforming the health-care system their top priority at a meeting of the premiers in Winnipeg next month.
Dr. Urbain Ip, a leading emergency room physician at Surrey Memorial Hospital, came forward last month to speak openly about the growing crisis in one of B.C.’s busiest ERs and the toll it was taking on staff.
“I live in the community, and I said this is personal for me — I cannot confidently send my loved ones to my hospital,” he told CBC News. “I don’t have to explain more when I’ve worked there for 30 years and I cannot trust that the hospital can take care of my family.”
‘Unprecedented challenges’ facing health-care system
Niagara Health announced earlier this month that as of July 5, it will permanently close two urgent care centres between 10 a.m. and 10 p.m. so doctors can be redeployed to ERs, with a shortfall of 274 physician shifts between June and August alone.
And a hospital in Prince George, B.C., was forced to call a Code Orange this week after a nearby fatal bus crash involving 30 people pushed staff beyond capacity; the city asked anyone without life-threatening injuries to avoid visiting the ER.
“Canadians are rightfully concerned, and so are we. No one should lose a loved one because they couldn’t get timely medical attention,” the office of federal Health Minister Jean-Yves Duclos said in a statement to CBC News.
“The last few years have presented unprecedented challenges for our health-care system. Health workers, including those that work in hospitals and emergency rooms, are overwhelmed. Patients also feel the strain when they cannot access the care they need.”
Data from the Canadian Institute for Health Information (CIHI) shows 90 per cent of patients waited over four hours in ERs before being seen by a doctor between March 2021 and April 2022. That’s a jump from a wait of over three hours between 2017 and 2018.
Ontario ER wait times hit record highs
New figures from May show patients in Ontario emergency rooms are waiting longer than ever to be seen by a doctor. Some are questioning whether family doctors need to be part of the solution by seeing more patients in person.
For patients who were admitted to hospital, 90 per cent waited almost 41 hours before getting a bed in the period between 2021 and 2022, up from 33 hours in 2017 to 2018.
The longest wait time — over 74 hours — was in Prince Edward Island’s ERs in 2021 to 2022.
A new editorial in the Canadian Medical Association Journal is calling for “practical and immediate steps” to be taken to “mitigate harms caused by long wait-times for emergency care” and “protect the emergency health-care providers” shouldering the crisis.
“One of the things that front-line providers are extremely good at doing is creating workarounds, so the impacts of parts of the system that are falling apart are not felt by the patient,” said Dr. Alika Lafontaine, president of the Canadian Medical Association.
“What you’re really seeing in the last couple of years is an inability of front-line providers to do that anymore, either because they themselves feel such a heavy burden that they physically, emotionally and mentally just can’t do it, or that the stresses on the system are too great.”
Peggy Holton, a nurse at Surrey Memorial Hospital with decades of experience, said it’s important for Canadians to understand that the unsustainable pressures facing ERs are affecting patients, as well as health-care workers.
“We’re very resilient as nurses and doctors — we’re a very good team. But the constant demand has certainly taken its toll. It’s morally and ethically very demanding on patients and on the health-care staff,” she said.
“Sometimes the demand is just so high that we can’t get to everybody. And so it’s causing a lot of mental and moral distress … to the point where that’s why people are leaving.”
A new editorial in the Canadian Medical Association Journal is calling for ‘practical and immediate steps’ to be taken to ‘mitigate harms caused by long wait-times for emergency care’ and ‘to protect the emergency health-care providers’ shouldering the crisis. (Evan Mitsui/CBC)
Part of the problem, Holton said, is nurses aren’t brought to the table to discuss solutions, but they’re on the front lines of the crisis and often the first place where anger and abuse is directed in a dysfunctional system.
“We need to have stronger policies in place that will support the nurses with violence in the workplace. We also need to sit together and look at how do we recruit staff, how do we retain staff?” she said.
“One nurse told me the other day that ‘there isn’t a day that I go to work that I’m not either verbally, physically or sexually assaulted by either a patient or a family member.’ And that’s really sad.”
‘Running on hope’
Ip’s decision to come forward earlier this month, alongside dozens of colleagues, about the dire situation at Surrey Memorial led the B.C. government to take immediate action to hire more staff and address growing shortfalls in funding and expand services in key areas.
“We are running on hope right now,” said Ip, adding he and his colleagues began taking on more shifts again after the announcement. “This raises morale, and when morale is good, people will step up to the plate. And no matter how short we are, we are going to make it.”
But hospitals shouldn’t have to be pushed to the brink for changes to be made to address the crisis, he said. And while there’s no easy answer to the long-standing problem, there are tangible areas that need addressing to help ease the problems plaguing ERs.
A key part of the problem is funding, but there are deeper issues that need to be addressed beyond the hospital, front-line health-care workers said, including a lack of access to family doctors, as well as beds in long-term care and home care that force patients to turn to the ER.
Almost half of adults across Canada’s 10 provinces had difficulty accessing health care in 2020 and 2021, while close to 15 per cent said they didn’t receive all the care they needed, according to a 2021 survey from Statistics Canada.
Why it’s so hard to find a family doctor in Ontario
Some communities in Ontario are turning into ‘doctor deserts’ due to a spike in retirements of family physicians and not enough young physicians to replace them. The CBC’s Mike Crawley zeros in on the crisis in a province where 1.8 million people don’t have a family doctor.
“Even if you said, we’re going to graduate double the number of physicians now, it’s at least five to 10 years away before we could have enough physicians,” said Sehgal, in Fredericton.
“In the interim, and even long term, you’re going to need people like physician assistants, nurse practitioners, nurses, pharmacists … [and] medics working beyond what they’re doing right now.”
Dr. Marc Beique, an ER physician at the McGill University Health Centre, said there isn’t an easy answer to the worsening problems facing ERs, but there has to be a comprehensive rethink of how care is provided, how patients are supported and where they choose to access care.
“We’re not in a dynamic where you can solve 80 per cent of the problems with one solution. The reality is that you’re gonna have to solve 10 per cent here, 10 per cent there and 10 per cent there — and it needs to be a concerted, intelligent and thoughtful endeavour,” he said.
“I strongly believe that we can get there, I think it is possible. And personally, I believe in the public system and I think that’s the way to go.”
Lafontaine said the fact that provincial and territorial governments have not been required to spend funding that they receive from the federal government for health care directly on the system for the past several decades is worsening the problem.
A scathing report from the Financial Accountability Office of Ontario earlier this year found hospital capacity will continue to fall by 2027-2028 due to increased demand for services, an aging population and the underfunding of the health sector by $21.3 billion.
A bustling nursing station in the Humber River Hospital intensive care unit, in Toronto, is pictured on Jan. 25, 2022. (Evan Mitsui/CBC)
“The ER is the last line of defence. Mainly because the ER, in the whole health-care system, is the only place where you can’t say no,” said Beique. “So a lot of patients will end up in the emergency for non-emergency reasons, but mostly because they have nowhere else to go.”
The situation has become so challenging that almost one in five patients showing up to the University of Montreal Health Centre’s emergency department leave before ever being seen by a doctor, according to a new report obtained by the Montreal Gazette.
“If nothing happens that’s different than what we’re doing today, the entire system will burn down until there’s nothing left. And I know that that’s a very heavy thing to say. But that is the reality,” said Lafontaine.
“We either intervene, or we do nothing, and things will degrade to the point that we will not have a health-care system in this country.”
UNITED NATIONS (AP) — A high-powered U.N. advisory body said Thursday that global governance of artificial intelligence is “imperative” and urged the United Nations to lay the foundations for the first inclusive global institutions to regulate the fast-growing technology.
In a 100-page report, the group said AI “is transforming our world,” offering tremendous potential for good from opening new areas of science and accelerating economic growth to improving public health, agriculture and optimizing energy grids.
But left ungoverned, it said, AI’s benefits could be limited to a handful of countries, companies and individuals, while even more powerful systems than exist today “could upend the world of work,” create autonomous weapons, and pose risks to peace and security.
The advisory body outlined principles that should guide formation of new institutions to govern AI including international law, and especially human rights law. It calls on all governments and parties involved in AI to work together to protect human rights.
The group made wide-ranging recommendations including establishing an international scientific panel on AI to create a global understanding of its capabilities and risks, and a global dialogue on AI governance at the U.N. to anchor future institutions on human rights principles and international law.
The recommendations also call for a global AI fund to ensure that the technology bridges the divide between rich and poor nations and promotes achievement of U.N. development goals for 2030, and a “Standards Exchange” to foster technical compatibility.
At present, the report said, only seven of the 193 U.N. member nations are party to seven recent prominent AI governance initiatives while 118 countries, primarily in the global South, “are missing entirely” from any conversation.
Among the initiatives are the European Union’s first-ever legal framework to regulate AI, which entered into force on Aug. 1. This month,. the Group of 20 leading world economies agreed to establish guidelines for developing artificial intelligence, calling for “ethical, transparent, and accountable use of AI,” with human oversight and compliance with privacy and human rights laws. And lawmakers in California — home to many of the world’s biggest AI companies — recently adopted legislation to regulate AI which is before the governor.
The advisory board’s report concluded on a positive but cautious note.
“As experts, we remain optimistic about the future of AI and its potential for good,” the report said. “That optimism depends, however, on realism about the risks and the inadequacy of structures and incentives currently in place.”
The board stressed that “The technology is too important, and the stakes are too high, to rely only on market forces and a fragmented patchwork of national and multilateral action.”
U.N. Secretary-General Antonio Guterres appointed the advisory body last October, saying coordinated action is needed to keep the threat of artificial intelligence from becoming an uncontrolled “monster.”
The group comprises 39 prominent AI leaders from 33 countries — chosen from over 2,000 nominations. They represent all regions of the world, are serving in their personal capacity, and include experts from government, the private sector and civil society.
Guterres commended the group’s work Thursday, expressing full support for its recommendations “which provide a blueprint to build on existing efforts and together, shape an international AI architecture that is inclusive, agile and effective – for today and the future.”
When the secretary-general told reporters last year that he planned to appoint the advisory body, Guterres said he would react favorably to a new U.N. agency on artificial intelligence and suggested as a model the International Atomic Energy Agency, which is knowledge-based and has some regulatory powers.
But the advisory body said it wasn’t recommending establishment of an agency.
Amandeep Singh Gill, the secretary-general’s chief’s envoy on technology and a member of the advisory body, told a news conference launching the report that for now an agency isn’t needed, “but it’s not saying that we would never need something like that.” The board wants that possibility to be studied, he said.
The report was issued ahead of the Summit of the Future starting Sunday which Guterres has called to try to unite the world’s divided nations and address the challenges and threats confronting humanity from conflicts and climate change to artificial intelligence and reforming the U.N.
BEIRUT (AP) — The leader of Hezbollah vowed Thursday to keep up daily strikes on Israel despite this week’s deadly sabotage of its members’ communication devices, and said Israelis displaced from homes near the Lebanon border because of the fighting would not be able to return until the war in Gaza ends.
Hezbollah and Israel launched fresh attacks across the border as Hassan Nasrallah spoke for the first time since the mass bombing of devices in Lebanon and Syria that he described as a “severe blow” — and for which he promised to retaliate.
The two days of attacks targeting thousands of Hezbollah pagers and walkie-talkies have been widely blamed on Israel, heightening fears that 11 months of near-daily exchanges of fire between Hezbollah and Israel will escalate into all-out war. Israel has neither confirmed nor denied involvement in the attacks.
During Nasrallah’s speech, Hezbollah struck at least four times in northern Israel, and two Israeli soldiers were killed in a strike earlier in the day. Israeli warplanes flew low over Beirut while Nasrallah spoke and broke the sound barrier, scattering birds and prompting people in houses and offices to quickly open windows to prevent them from shattering.
Israel also launched attacks in southern Lebanon on Thursday, saying it struck hundreds of rocket launchers and other Hezbollah infrastructure, though it was not immediately clear if there were any casualties. The army claimed the launchers were about to be used “in the immediate future.”
At the same time, the army ordered residents in parts of the Golan Heights and northern Israel to avoid public gatherings, minimize movements and stay close to shelters in anticipation of possible rocket fire.
In recent weeks, Israeli leaders have stepped-up warnings of a potential larger military operation against Hezbollah, saying they are determined to stop the group’s fire to allow tens of thousands of Israelis to return to homes near the border.
In a Thursday briefing, the Israeli defense minister said Hezbollah would “pay an increasing price” as Israel seeks to make conditions near its border with Lebanon safe enough for residents to return.
“The sequence of our military actions will continue,” he said.
The attack on electronic devices appeared to be the culmination of a monthslong operation by Israel to target as many Hezbollah members as possible all at once — but civilians were also hit. At least 37 people were killed, including two children, and some 3,000 wounded in the explosions Tuesday and Wednesday.
Nasrallah said the group is investigating how the bombings were carried out.
“Yes, we were subjected to a huge and severe blow,” he said. “The enemy crossed all boundaries and red lines,” he said. Pointing to the number of pagers and walkie-talkies, he accused Israel of intending to kill thousands of people at one time. “The enemy will face a severe and fair punishment from where they expect and don’t expect.”
He said Hezbollah will continue its barrages into northern Israel as long as the war in Gaza continues, vowing that Israel will not be able to bring its people back to the border region. “The only way is stop the aggression on the people of Gaza and the West Bank,” he said. “Neither strikes, nor assassinations nor an all-out war will achieve that.”
Earlier Thursday, Hezbollah said it had targeted three Israeli military positions near the border, two of them with drones. Israeli hospitals reported eight people lightly or moderately injured.
Hezbollah says its near daily fire is a show of support for Hamas. Israel’s 11-month-old war with Hamas in Gaza began after its militants led the Oct. 7 attack on Israel.
Israel has responded to Hezbollah’s attacks with strikes in southern Lebanon, and has struck senior figures from the group in the capital Beirut. The exchanges have killed hundreds in Lebanon and dozens in Israel and forced the evacuation of tens of thousands of residents on each side of the border.
Israel and Hezbollah have repeatedly pulled back from an all-out war under heavy pressure from the United States, France and other countries.
But in their recent warnings, Israeli leaders have said they are determined to change the status quo dramatically.
Speaking to Israeli troops on Wednesday, Gallant said, “We are at the start of a new phase in the war — it requires courage, determination and perseverance.” He made no mention of the exploding devices but praised the work of Israel’s army and security agencies, saying “the results are very impressive.”
He said that after months of fighting Hamas in Gaza, “the center of gravity is shifting to the north by diverting resources and forces.”
Israel began moving more troops to its border with Lebanon on Wednesday as a precautionary measure, Israeli officials said. Israel’s army chief, Lt. Gen. Herzi Halevi, said plans have been drawn up for additional action against Hezbollah, though media reported the government has not yet decided whether to launch a major offensive in Lebanon.
Lebanon is still reeling from the deadly device attacks of Tuesday and Wednesday.
The explosions have rattled anxious Lebanese fearing a full-scale war. The Lebanese Army said it has been locating and detonating suspicious pagers and communication devices, while the country’s civil aviation authorities banned pagers and walkie-talkies on all airplanes departing from Beirut’s international airport until further notice.
The attack was likely to severely disrupt Hezbollah’s internal communication as it scrambles to determine safe means to talk to each other. Hezbollah announced the death of five combatants Thursday, but didn’t specify if they were killed in the explosions or on the front lines.
The blasts went off wherever the holders of the pagers or walkie-talkies happened to be in multiple parts of Beirut and eastern and southern Lebanon — in homes and cars, grocery stores and cafes and on the street, even at a funeral for some killed in the bombings, often with family and other bystanders nearby.
Many suffered gaping wounds on their legs, abdomens and faces or were maimed in the hand. Tuesday’s pager blasts killed 12 people, including two children, and wounded some 2,300 others. The following day’s explosion killed 25 and wounded more than 600, Health Minister Firas Abiad said, giving updated figures.
Abiad told reporters that Wednesday’s injuries were more severe than the previous day as walkie-talkies that exploded were bigger than the pagers. He praised Lebanon’s hospitals, saying they had managed to deal with the flood of wounded within hours. “It was an indiscriminate attack. It was a war crime,” he said.
WARSAW, Poland (AP) — European Union chief Ursula von der Leyen on Thursday pledged billions of euros in aid for Central European countries that suffered enormous damage to infrastructure and housing during the massive flooding that has so far claimed 24 lives in the region.
She said funds will be made available quickly for infrastructure repair from the EU’s solidarity fund, as well as 10 billion euros ($11 billion) from what is called the cohesion fund — for the most urgent repairs. In a special approach, no co-financing will be required from these countries for the money to be released.
“Here we say it’s 100% European money, no co-financing,” von der Leyen told a news briefing. “These are extraordinary times, and extraordinary times need extraordinary measures. ”
Meanwhile, a massive flood wave threatened new areas and heavy rains also caused flooding and evacuation of some 1,000 people in the northern Italian region of Emilia-Romagna. In Central Europe, the receding waters revealed the scale of the destruction caused by exceptionally heavy rains that began a week ago.
Czech Interior Minister Vit Rakušan said one more person was reported killed on Thursday in the country’s hard-hit northeast, bringing the death toll there to five. There were also seven deaths each in Poland and Romania, and five in Austria — with the overall death toll now at 24.
Authorities deployed troops to help. In the northeastern Czech Republic, soldiers joined firefighters and other emergency crews to help with the recovery efforts. Army helicopters distributed humanitarian aid while soldiers were building temporary bridges in place of those that were swept away.
Some 400 people remained evacuated from the homes in the regional capital of Ostrava. In the southwest, the level of the Luznice River reached an extreme high but the evacuation of 1,000 people in the town of Veseli nad Luznici was not necessary for the moment, officials said.
Cleanup efforts were underway in Austria, where flooding washed away roads and led to landslides and bridge damage. Firefighters and soldiers pumped water and mud out of houses and disposed of damaged furniture, broadcaster ORF quoted fire department spokesperson Klaus Stebal as saying.
The governor of Lower Austria province, Johanna Mikl-Leitner, said reconstruction was expected to take years, according to the Austria Press Agency.
The Vienna public transport company has had to pump almost 1 million liters (260,000 gallons) of water since last weekend. Ten towns and areas were still inaccessible on Thursday, APA reported.
In Hungary, flood waters continued to rise as authorities closed roads and rail stations. Ferries along the Danube River halted. In the capital, Budapest, water spilled over the city’s lower quays and threatened to reach tram and metro lines. Some transport services were suspended.
Further upriver, in a region known as the Danube Bend, homes and restaurants near the riverbanks were inundated.
Nearly 6,000 professionals, including members of Hungary’s water authority and military, were mobilized, and prison inmates were involved in filling sandbags, Prime Minister Viktor Orbán said at a news conference Thursday.
The Danube stood at over 771 centimeters (25 feet), approaching the 891-centimeter (29.2 feet) record set during major flooding in 2013.
In southwestern Poland, the high waters reached the city of Wroclaw and an extended wave was expected to take many hours, even days to pass, exerting pressure on the embankments.
The water level on the Oder River just before Wroclaw was 6.4 meters (21 feet), some 2 meters (6.5 feet) above alarm levels but still lower compared to the disastrous flooding in 1997.
In the two most-affected towns, Stronie Slaskie and Ladek-Zdroj, tap water and power were restored, said Gen. Michal Kamieniecki, who was put in charge of the recovery operations there after an emotional appeal to Prime Minister Donald Tusk for help the day before by a young woman identified only as Katarzyna.
As concerns mounted, Tusk invited von der Leyen to Wroclaw to see the situation first hand. Government leaders from the Czech Republic, Slovakia and Austria were also there.
In Italy, rivers flooded in the provinces of Ravenna, Bologna and Forlì-Cesena, as local mayors asked people to stay on the upper floors or leave their houses. Those areas were hit by devastating floods in 2023, when more than 20 rivers overflowed, killing 17 people.
Italy’s vice minister for transport and infrastructure, Galeazzo Bignami, said Thursday that two people were reported missing in Bagnocavallo, in Ravenna province.
At least 800 residents in Ravenna and almost 200 in Bologna province spent the night in shelters, schools and sports centers. Trains were suspended and schools closed while residents were advised to avoid travel.
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Associated Press writers Justin Spike in Budapest, Hungary, Karel Janicek in Prague and Giada Zampano in Rome contributed to this report.
