It was a nightmare scenario for those watching the growing number of emergency room closures across the country.
Following a triple stabbing at a house party in Clinton, Ont., on July 30, a driver took the wounded teenagers less than two kilometres to Clinton Public Hospital, only to find out the emergency department was closed after 6 p.m.
The teens, who'd been at a Sweet 16 party and were 15, 16 and 17 years old, instead had to be driven to another hospital 20 kilometres away.
“We are playing Russian roulette here,” said Jim Ginn, mayor of Central Huron, where the Clinton hospital is based.
He said he's worried that the ongoing rural hospital closures are dangerous.
“Sooner or later something is going to happen here, and it’s going to cost someone their life. It came close this time,” he said.
This emergency room shutdown was part of a large and likely record-setting number of temporary ER closures across the country in 2023 so far, with CTV News finding more than 1,284 instances where a hospital emergency unit, usually in a rural community, has been shut down for hours or days.
The number is approximate and could be higher.
While some provinces post details online, others were unable to offer numbers or didn't respond to CTV's inquiries. Some data was taken from health authority websites or news stories reporting ER service interruptions.
“There is absolutely no doubt that this is the most closures we have ever seen,” said rural emergency physician Alan Drummond in an email to CTV News.
“Service interruptions,” as they are called by hospitals, were in past years rare and had a limited impact. But with an estimated 7.1 million Canadians now living in rural areas as of 2022, these closures, he says, now jeopardize the health of many.
“Clearly, nobody's taking this seriously enough… These kinds of closures mean that government has failed to meet their end of the social contract for Canadians in terms of providing them assured access to quality emergency care,” said Drummond.
It's not just an inconvenience having to drive another 20 kilometres or half an hour to the next emergency department. There are circumstances in which minutes matter and lives depend on fast treatment, such as when a patient is having a stroke or heart attack.
A minister who lives near Chelsey, Ont., and doesn't have a family doctor was critical of the situation in his area.
"I mean, how do they think that this is improving my health-care situation at all? It boggles the mind," said Rev. Craig Bartlett.
Bartlett has been unable to find a family doctor for more than two years, since returning from work in South Korea.
His closest emergency unit is in Chesley, run by the South Grey Bruce Health Centre, where he gets medical care and prescriptions renewed. It's been closed an estimated 157 times so far this year.
"I want to see the service here at the very least maintained, if not expanded, until such time as we can get as we can get enough doctors around here," said Bartlett.
An emergency physician in Thunder Bay, Ont., explained, "In small rural centres, when your ER closes well, you're cutting off their access to not only the emergency care, but also to some of that primary care that they would receive in the ER.”
Dr. David Savage said he started counting Ontario's emergency room closures after the ER in Red Lake, in northwestern Ontario, closed for 24 hours in 2022.
There were two people who had to be taken by ambulance to another ER more than 200 kilometres away during the closure.
"Every time an ER closes and then reopens, and closes and reopens, I count that as a closure," said Savage, who is also a professor at the North Ontario School of Medicine.
In 2022, he counted 848 closures across the province. So far this year, that figure stands at 498, as of Aug. 31. That includes the permanent ER shutdown in Minden.
Savage often wonders what happens to patients who have to travel for urgent care.
"I'm not sure if anybody's actually examining the harms that are coming about from this,” he said.
"In Northern Ontario, where the average distance between an ER could be upwards of 100 kilometres, and the Red Lake example of more than 200 kilometres, the travel burden for these patients can be quite significant," said Savage.
He hopes to track the closures and the possible effects on health outcomes that follow.
"This becomes a significant access-to-care issue. When your ER closes and patients can't access care, the possibility of a poor outcome or something being missed, it goes up significantly," said Savage.
For Drummond, who's been in medicine for 45 years, this year has been the worst for emergency medicine that he's seen.
"We have an unprecedented number. While we despair for our patients, governments pretend it is business as usual and that this is a temporary glitch. It is not," he told CTV News.
Experts told CTV they predict continuing ER closures because finding people to work there is the key problem, with Savage noting a large percentage are related to the nursing shortage.
"There's no easy solution to getting well-trained nurses into emergency departments and there's a pretty considerable time lag from when you start training to when you actually start practising," he said.
Health is one of the biggest services provided by provincial and federal governments, and agencies were warned there was a looming shortage because of a growing and aging population, long before the COVID-19 pandemic.
A 2018 analysis predicted a shortage of 117,600 nurses in Canada by 2030.
“It was predicted to happen…and here we're in 2023. And this is already happening. So if we knew this was going to happen, why weren't we planning, you know, 10 years ago?” said Dawn Peta, a registered nurse in Lethbridge, Alta., and co-president of the National Emergency Nurses Association of Canada.
In 2008, the Canadian Medical Association estimated the country needed 26,000 more doctors at that point to bring Canada up to the Organisation for Economic Co-operation and Development average of four to five doctors per 100,000 people. Canada stands 17th on the OECD list, below the United States, France and Norway, to name a few.
It baffles Rev. Bartlett, who said in South Korea he had almost immediate access to his health-care team, and that he's shocked by how the Canadian system is functioning.
"I'm not convinced that there's been very much forward planning to say, 'Yeah, we're probably going to have this problem in a few years. How are we going to deal with it?'” said Bartlett.
Across much of Canada, health authorities are trying to recruit nurses from elsewhere, including overseas.
The consensus among those interviewed for this story is that retention of existing nurses, rural or urban, is essential.
"Retention is a bird in the hand," said Nova Scotia-based doctor Tania Sullivan. "Retention is keeping what you already have. Recruitment is the promise of something you might have."
Sullivan, who oversees a small regional hospital and five other rural sites, believes creative planning is needed.
"We're working on a strategy to be open seven days a week, but for now, we can be open three days a week, and we're going to make that standardized so that the community has some sort of safety expectation of what days can we be open," she said.
Her team is also boosting training, using simulators to keep rural health workers' skills up to date, and looking at putting doctors and nurses on the road.
"One of the things that we are hoping to pilot as well in … the coming months is looking at having providers who are willing to travel around (their) region and provide coverage in more than one site," said Sullivan.
Boosting retention bonuses and improving working hours and conditions will also keep nurses – urban and rural – working, said Peta.
But without immediate changes in all hard-hit rural areas, Savage is less than hopeful.
"I don't want to predict too far out, but yeah, there's the potential that, if we can't get staffing up and going many of these centres, these closures may be happening for quite some time.”
The Canadian Association of Emergency Physicians will meet with Canada's Deputy Ministers of Health in Toronto on September 12th, to talk about problems faced by emergency departments. and the call for a nationwide forum to push for solutions quickly.
The following is a list of provincial and territorial data received by CTV News about the number of rural hospital ER closures so far in 2023. As much data as was made available by the health ministries is included.
Where data has not been provided, the entries will be updated if that information is received.
Newfoundland and Labrador: Undetermined.
CTV News has not received a response, but in 2022, ERs were closed for thousands of hours.
P.E.I.: 76 full or partial closures.
Nova Scotia: Undetermined.
Data will not be available until December.
New Brunswick: No ER closures this year.
Quebec: 37 closures.
Ontario: 484 closures.
This statistic is based on data from Dr. Savage and includes one permanent closure in Minden.
Manitoba: 311 full or partial closures.
There are five regions, and CTV News received responses from four.
Saskatchewan: 33 temporary closures.
Alberta: More than 100 temporary closures.
B.C.: Undetermined.
No data was provided, but local media reports suggest the total may be more than 240.
Nunavut: No noted closures.
Northwest Territories: Undetermined.
Yukon: No noted closures.
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