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When the Train Tracks Cut Off the Ambulance Route
How ALTO’s southern corridor threatens emergency response times, hospital access, and continuity of care in rural Eastern Ontario.
ALTO HSR is asking for public comments on its southern corridor by April 24, 2026 — before any final route has been selected and before any analysis of road crossing impacts has been published. The question of which roads will be closed, and which will get bridges, will not be answered until at least late 2026.
Communities are being asked to evaluate a project whose most direct local health and safety impacts have not been disclosed. ALTO’s own VP of Engineering confirmed on record in February 2026 that the organization’s goal is to “limit the number of overpasses.” No EMS response time analysis, no fire suppression access study, and no Health Impact Assessment has been conducted or published.
High-speed rail must run behind a fence. Nothing crosses it except at designated bridges or underpasses — and international experience shows that 30–60% of rural road crossings on HSR corridors are permanently closed rather than replaced with a bridge. In Eastern Ontario, where ambulances are already stretched across vast distances and residents can be 45–90 minutes from a hospital, permanently closing hundreds of concession road crossings means every ambulance call that requires crossing the corridor takes longer. Not sometimes — every time.
Every additional kilometre of detour adds 37 seconds to an ambulance response time. Every additional minute reduces the chance of surviving a cardiac arrest by 6–10%. These are not estimates — they are peer-reviewed measurements. ALTO has not published any analysis of how its corridor will affect these numbers.
The clinical stakes of adding minutes to rural response times
These figures are drawn from peer-reviewed research. They explain why road network changes in rural areas are not a planning inconvenience — they are a life-safety issue.
What “grade separation” means for your road network
High-speed rail travelling at 300 km/h cannot share crossings with road traffic. Every road that crosses the track must either get a bridge, or be closed. There is no in-between. In cities, closing one road is an inconvenience. In rural Eastern Ontario, where concession roads are spaced 2 km apart, closing a road creates a real barrier. The nearest alternative crossing could be 4–8 km away. For a car, that’s a few extra minutes. For an ambulance responding to a cardiac arrest, it can be the difference between life and death.
Why bridges don’t always get built. A rural overbridge spanning a double-track HSR corridor costs $5–$12 million to construct. For low-traffic gravel roads and private farm laneways — the majority of rural crossings — that cost far exceeds the value of the road. International experience on HSR projects, including HS2 in the UK, shows that 30–60% of rural crossings on comparable corridors are permanently closed, with landowners and communities left to route around the gap.
“The issue about grade separations along the corridor has to be looked at. Some areas there may be more, some areas there may be less… So try and limit the number of overpasses that we’ll need to get created for sure.”
The organization responsible for building the crossings has stated on record that its goal is to build as few as possible. No standard crossing distance was committed to. The crossing criteria will not be finalized until at least late 2026 — after the public consultation closes.
What Transport Canada’s own documents confirm. A Transport Canada briefing note prepared for a Parliamentary committee in March 2023 states that a full high-speed rail system would require complete grade separation on an alignment that currently has over 1,000 public and private crossings. That figure was for the northern corridor. The southern option passes through a denser agricultural concession road grid — it would cross more roads, not fewer.
When every minute counts, every added kilometre matters
Cardiac arrest is the clearest example of why ambulance response time is a life-or-death variable — but it applies equally to stroke, severe trauma, and other time-critical emergencies. The math is simple and documented by decades of research: the longer an ambulance takes to arrive, the lower the chance of survival.
Ontario law — Ontario Regulation 257/00 under the Ambulance Act — requires every paramedic service to meet a target of reaching sudden cardiac arrest patients within 6 minutes, and highest-priority (CTAS 1) patients within 8 minutes from dispatch. In rural Eastern Ontario, many services already struggle to meet these targets due to geography alone.
Already missing targets — before any HSR corridor. The 2022 annual report from Paramedic Services of Manitoulin-Sudbury District records: “Our vast geography continues to be the largest contributing factor to our response time challenges.” On-call stations across rural Ontario regularly miss the legally mandated 6-minute cardiac arrest and 8-minute CTAS 1 targets — simply because of the distance involved. Adding permanent road network closures to an already-stretched system will make this worse. This cost has not appeared in any ALTO project document.
The same arithmetic applies to fire trucks and police. Volunteer fire departments in rural Ontario depend on the concession road grid to cover their response zones. A closed crossing doesn’t just add travel distance — it eliminates the option of approaching a structure fire or farm accident from more than one direction, which incident commanders rely on for safety and effectiveness.
What the U.S. Federal Highway Administration says. The FHWA’s Highway-Rail Crossing Handbook states explicitly that crossings “frequently utilized by emergency vehicles should not be closed” and “should be candidates for grade separations.” Identifying every EMS-critical crossing across hundreds of kilometres of rural corridor requires systematic engagement with paramedic services, fire departments, and police — engagement that ALTO has not yet reported undertaking.
Building a 1,000 km HSR network takes years — possibly decades. During that entire period, road closures, bridge construction, and concession road re-routing will intermittently change the routes that ambulances and fire trucks depend on. Unlike the permanent closures that follow completion, these disruptions can happen without warning and change frequently. There is currently no formal requirement to maintain updated EMS detour protocols during construction.
This region’s healthcare system is already under pressure
The impacts described above don’t occur in a healthy, well-resourced healthcare system with lots of spare capacity. They occur in a rural region where finding a family doctor is already a challenge, where the nearest emergency department can be more than an hour away, and where the population is older and more health-vulnerable than the provincial average.
Physician shortage. Rural communities across Canada are served by only 8% of physicians while making up 18% of the population. In Ontario, 1.8 million people currently have no family doctor — with rural areas most acutely affected. In Frontenac County — directly in the southern corridor study area — physicians are concentrated in Kingston, with limited clinic access in communities like Sharbot Lake and Verona.
Distance to hospital. Residents across the southern corridor counties depend on hospitals in Napanee, Perth, Smiths Falls, Belleville, and Kingston. Many rural residents are already 45–90 minutes from the nearest emergency department under normal road conditions. Adding even 5–15 minutes to those journeys can push travel times past the clinical thresholds that determine outcomes for heart attacks and strokes.
Older, more vulnerable. Rural populations in Canada are, on average, older, less wealthy, and carry a higher burden of chronic illness than urban populations. They have fewer vehicles, less access to alternatives, and more health conditions that make time-sensitive emergencies more likely. Infrastructure changes that add distance to healthcare journeys hit this population hardest.
No part of the ALTO corridor in Eastern Ontario has a planned station. The townships of South Frontenac, Rideau Lakes, Tyendinaga, Stone Mills, and others through which the corridor would pass receive no direct transit benefit from the line. The communities most affected by road severance are the same communities that gain nothing from the train.
Forced relocation severs something healthcare can’t easily replace
Losing your doctor when doctors are scarce. For elderly rural residents who have lived in a community for decades, being moved means losing their established relationships with local physicians, nurses, pharmacists, and specialists. In a healthcare system where many rural family doctors have patient lists in the thousands and finding a new family doctor can take years, displacement can mean losing chronic disease management, medication continuity, and early intervention for developing conditions.
The mental health cost of waiting. Route selection for ALTO will not be finalized until at least late 2026. Between now and then — and potentially for years afterward — residents in the study area face the uncertainty of not knowing whether their property will be expropriated. Research on infrastructure expropriation documents significant mental health impacts including anxiety and depression arising from prolonged uncertainty, before any physical relocation occurs.
Health impact assessments: standard practice that hasn’t happened. A formal Health Impact Assessment (HIA) examines how a major project will affect human health — including access to care, response times, displacement effects, and population vulnerability. HIAs are standard practice for large infrastructure projects in many jurisdictions. No HIA has been conducted or published for the ALTO project. This means no one has formally modelled how the corridor will affect the health of the communities it passes through.
What ALTO says about healthcare access — and what it leaves out
ALTO and project proponents argue that high-speed rail will improve healthcare access by connecting rural communities to major urban centres faster. Their published materials reference “improved access to education, employment, healthcare options, and services” as a key benefit for Eastern Ontario. This argument deserves a direct response.
High-speed rail will improve healthcare access for Eastern Ontario residents by connecting them faster to major urban health centres.
The planned ALTO line has no stops in Eastern Ontario between Peterborough and Ottawa. Residents in South Frontenac, Rideau Lakes, Stone Mills, Tyendinaga, and other corridor-area townships receive no transit connectivity from the line. You cannot use a train that doesn’t stop near you.
The line will improve access to healthcare facilities in major cities.
The ALTO line does not stop in Kingston — home to Kingston Health Sciences Centre, the Cancer Centre of Eastern Ontario, and Queen’s University medical community. For many corridor residents, Kingston is the most important healthcare destination. The line passes it by entirely.
Affordable high-speed train travel will give rural residents new healthcare options.
The P3 structure creates incentives to maximize ticket prices. If fares are comparable to short-haul air travel — as international HSR experience suggests — the service will be inaccessible to lower-income rural residents. Elderly residents and those with disabilities cannot use a train for emergencies. Emergency patients need ambulances, not high-speed trains.
For Eastern Ontario, the claimed healthcare connectivity benefit applies to a narrow set of people — those who live near stations that don’t exist in this region, can afford fares that haven’t been set, and are travelling for planned medical visits rather than emergencies. The road severance impacts apply to everyone, every time.
Six things that should exist before this consultation closes
A project that will permanently reshape road access across hundreds of kilometres of rural Eastern Ontario is asking for community feedback before the most basic safety information has been published.
A road crossing assessment. How many roads will be closed? Which will get bridges? What criteria determine the difference? None of this has been published.
An EMS response time analysis. No ambulance response time modelling for the corridor has been published. No one has officially asked: “which road closures, at which locations, will add the most minutes to the most calls?”
Engagement with paramedic services. Local paramedic services, fire departments, and OPP detachments have not been publicly reported as having been consulted on crossing requirements. Their routes cross this corridor every day.
A Health Impact Assessment. No formal HIA has been conducted, despite this being standard practice for large infrastructure projects and a specific requirement recommended by public health experts.
Construction-phase EMS protocols. No plan has been published for maintaining emergency response coverage during the multi-year construction period, when road access will be intermittently disrupted.
A crossing protection commitment. ALTO’s VP of Engineering confirmed the goal is to minimize overpasses. No commitment has been made to protect crossings on established emergency response routes, regardless of traffic volume.
Communities are being asked to comment on a project whose most direct local impacts have not been determined, modelled, or disclosed.
Four demands — grounded in standard public health and safety practice
Require a formal Health Impact Assessment before corridor finalization
A Health Impact Assessment must be a mandatory condition of the federal Impact Assessment process for ALTO. It must examine EMS response time modelling, patient travel time impacts from road network changes, displacement effects on patient-provider relationships, and population vulnerability — conducted in consultation with local paramedic services, Ornge air ambulance, Ontario Health teams, and affected municipalities.
Publish a road crossing assessment before the consultation deadline
ALTO must publish — as part of the current consultation process — a preliminary assessment identifying the number and type of crossings on each corridor option, the criteria for deciding whether a crossing receives a bridge or is permanently closed, and the methodology for assessing whether alternative routes are adequate for emergency response. Without this, community feedback on health and safety impacts is meaningless.
Protect emergency crossings unconditionally
Every road crossing on an established EMS, fire, or police response route must be identified before corridor finalization and committed to receiving a full grade separation, regardless of traffic volume or cost. Emergency response access cannot be a value-engineering trade-off. This commitment must be made before, not after, the public consultation closes.
Require construction-phase EMS safety protocols
ALTO and the Cadence consortium must develop and maintain, in partnership with local paramedic services and fire departments, updated detour and response protocols for every phase of construction. Road access changes must be communicated to emergency responders in advance, with sufficient lead time to adapt dispatch procedures and station assignments.
What ALTO has said — and what hasn’t been said
| Issue | ALTO’s public position | What hasn’t been published |
|---|---|---|
| Road crossing closures | “Working assumption is every road gets some sort of duct or overpass” — but the goal is to “limit the number of overpasses” | No crossing criteria, no crossing count, no methodology for assessing detour adequacy |
| EMS response times | No specific commitment made | No response time modelling; no engagement with paramedic services reported |
| Healthcare access benefits | “Improved access to healthcare options” cited as a benefit | No Eastern Ontario stops; no stop in Kingston; no fare structure published |
| Health Impact Assessment | Not referenced in public consultation materials | No HIA conducted or commissioned |
| Construction disruption | No specific EMS protocols referenced | No construction-phase EMS protocol framework published |
| Route finalization timeline | Final route not selected until at least late 2026 | Consultation closes April 24, 2026 — before crossing details are available |
Sources
- International crossing closure rates: HS2 Phase 1 built with 150+ overbridges; several crossings permanently stopped up. 30–60% closure rate plausible for a predominantly rural corridor. HS2 Ltd, “Notice of Closure — A4010 Risborough Road,” February 2024; Pickmere Parish Council Select Committee Report, July 2023.
- BMC Emergency Medicine (2025). “Modelling emergency response times for OHCA patients in rural areas of the North of England.” Each additional km adds ~37 seconds; rural response 3.5+ min slower than urban. doi: 10.1186/s12873-025-01170-7
- Multiple sources: PMC 12065030 (Bangkok EMS, 2025): 6% survival reduction per minute; NCBI NBK321505 (Larsen et al., 1993): 7–10% per minute; JAHA (Kitamura et al., 2018): 11% reduction per minute of EMS delay.
- Ontario Regulation 257/00 under the Ambulance Act, Part VIII. 6-minute target for Sudden Cardiac Arrest; 8-minute target for CTAS 1. ontario.ca
- Paramedic Services of Manitoulin-Sudbury District. “2022 Response Time Standards Issue Report.” Documents below-target performance at rural on-call stations due to geography.
- FHWA. (2019). Highway-Rail Crossing Handbook, Third Edition. U.S. DOT. highways.dot.gov
- Transport Canada. TRAN Committee Appearance Binder — Item 15: High Frequency Rail. March 7, 2023. tc.canada.ca
- David Cook, VP Systems Engineering, ALTO. Kingston City Council, February 17, 2026. Source: City of Kingston closed-captioning transcript.
- ALTO (Crown Corporation). (2025). Shaping Canada’s Future with a High-Speed Rail Network. altotrain.ca
- College of Family Physicians of Canada. (2020). Rural Road Map for Action, Phase II Update. Rural communities served by 8% of physicians; 18% of population.
- Ontario College of Family Physicians. (2024). Solutions for Today: Ensuring Every Ontarian Has Access to a Family Physician. ontariofamilyphysicians.ca
- Wilson, C.R., & Rourke, J. (2020). Progress made on access to rural health care in Canada. Canadian Family Physician, 66(1), 31–36. pmc.ncbi.nlm.nih.gov
- Farmtario. (October 7, 2022). Fixing Ontario’s rural healthcare crisis. farmtario.com
- County of Frontenac. (2025). Healthcare in Our Community. frontenaccounty.ca
- Ghaffari Dolama & Regehr. (2022). Review of road user mobility impacts and criteria for prioritising highway-rail grade crossings for grade separation. Transport Reviews, 42(5). Winnipeg emergency vehicle blockage rate 13.2%. tandfonline.com
- Ghaffari Dolama et al. (2025). Quantifying emergency response system risk caused by grade crossing blockages. Transportation, 52(3). tandfonline.com
- South Frontenac Township & Rideau Lakes. Municipal resolutions opposing the ALTO southern corridor, February 2026. obj.ca
- Belleville City Council motion, February 24, 2026. quintenews.com
- Kingston City Council, February 17, 2026. kingstonist.com
- Open Council. (2025). ALTO High-Speed Rail — Project Overview. opencouncil.ca