2.             OTTAWA PARAMEDIC SERVICE –– 2008 TRENDS REPORT

 

SERVICE PARAMÉDIC D’OTTAWA – TENDANCES DU RENDEMENT 2008

 

 

 

Committee Recommendation

 

That Council receive this report for information.

 

 

Recommandation du Comité

 

Que le Conseil prenne connaissance de ce rapport à titre d’information.

 

 

 

Documentation

 

1.   Deputy City Manager's report Community and Protective Services, dated 8 October 2008 (ACS2008-CPS-OPS-0003).

 

2.   Extract of Draft Minutes, 16 October 2008.

Report to/Rapport au:

 

Community and Protective Services Committee

Comité des services communautaires et de protection

 

and Council / et au Conseil

 

8 October 2008 / le 8 octobre 2008

 

Submitted by/Soumis par:

Steve Kanellakos, Deputy City Manager/Directeur municipal adjoint,

Community and Protective Services/Services communautaires et de protection 

 

Contact Person/Personne ressource : Anthony Di Monte, Chief / Directeur

Ottawa Paramedic Service/Services paramédic d’Ottawa

(613) 580-2424 x22458, Anthony DiMonte@Ottawa.ca

 

 

City-wide/ À L'échelle De La Ville

                   Ref N°: ACS2008-CPS-OPS-0003

 

 

SUBJECT:

ottawa paramedic service –– 2008 TRENDS REPORT

 

 

OBJET :

SERVICE PARAMÉDIC D’OTTAWA – TENDANCES DU RENDEMENT 2008

 

REPORT RECOMMENDATION

 

That Community and Protective Services Committee and Council receive this report for information.

 

RECOMMANDATION DU RAPPORT

 

Que le Comité des services communautaires et de protection et le Conseil prenne connaissance de ce rapport à titre d’information.

 

EXECUTIVE SUMMARY

 

At is meeting of October 28, 2004, the Emergency and Protective Service Committee directed as follows:

 

“That staff report back to Committee and Council prior to budget each year on performance trends, mitigation strategies, and associated financial impacts to ensure the service can maintain its baseline performance targets”

 

 

In 2001, the new City of Ottawa assumed responsibility for the delivery of Paramedic Service as defined by the Ambulance Act of Ontario. The City was given the opportunity to improve the quality of paramedic services provided to the community. 

 

The design of Ottawa’s performance-based Paramedic Service is founded on five key hallmarks: clinical excellence, response time reliability, patient and community satisfaction, economic efficiency and performance accountability. The simultaneous achievement of these principles is the foundation for continued service excellence.

 

The City of Ottawa Council has made significant investments to bring the Service towards medically acceptable response times and clinical care from the previous operation.   Since amalgamation, the City has increased its staffing of paramedics from 254 to 345 – an increase of 36 percent.

 

At the same time:

·        Response volumes have significantly exceeded the assumptions of the original system design – increasing from 65,000 (pre-amalgamation) to a projected total of 103,414 by the end of 2008 – an increase of 59% when the original design called for annual 2% increases.

·        Hospital wait times have risen from an average of 36:44 in 2001 to 1:07:34 as of June 2008 – an increase of 84%.

 

Response volume increases greater than those contemplated by the original design, as well as systemic challenges (i.e., hospital wait times) beyond the control of the City – have been greater than the capacity of the service to respond.  These system pressures have been significant contributors to the increasing gap between response time targets and actual response times.

 

Presently, the City of Ottawa does not meet its Council approved response times (8:59 high density and 15:59 low density) and is in danger of not meeting the less stringent minimum legislated response time standard established by the Ambulance Act [which is an overall response time of 12:41 (T2-T4) based on 1996 response times in the Ottawa area].

 

The Ottawa Paramedic Service has worked with CAE Professional Services (a world leader in providing simulation, modelling technologies and integrated training solutions for the aviation industry around the globe) as part of a pilot project endorsed and supported by the Ministry of Health to develop a predictive tool for assessing resource requirements under a range of different operating scenarios.

 

Accordingly, CAE provided assessments of the number of paramedic resources required to meet target response times as well as to maintain existing response times.  The impact of hospital wait times, which are not within the control of the City, were included in these assessment scenarios.

 

In order to immediately address the gap between actual and Council approved response targets, CAE modelling determined that 192 additional paramedics would be required to achieve high-density (8:59) and low-density (15:59) response targets at the 90% of the time; 120 of those paramedics would be attributable to fixing growth in calls and 72 of would be attributable to compensating for hospital wait times. 

 

In addition, the CAE analysis determined that 25 additional paramedics would be required to address the 5% increase in call volume growth projected to year-end 2008.

 

Given that the City should only address the response time gap within its control, and recognizing the staffing challenges associated with bringing 120 new paramedics on-line, the Department proposes a three-year staffing strategy which also contemplates call volume growth in future years. 

 

The three year plan calls for the hiring of 65 paramedics in 2009 followed by the hiring of 40 additional paramedics in each of 2010 and 2011 plus any additional paramedics required due to projected growth in each of those years.

 

Details of the analysis and proposed spending plan are set out in the following report.

 

RÉSUMÉ

 

À sa réunion du 28 octobre 2004, le Comité des services de protection et d’urgence a donné la directive suivante :

 

« Que le personnel fasse connaître sa décision au Comité et au Conseil chaque année avant la présentation du budget concernant les tendances du rendement, les stratégies d’atténuation et les répercussions financières connexes pour veiller à ce que le service puisse maintenir ses objectifs de rendement de référence. »

 

En 2001, la nouvelle Ville d’Ottawa a assumé la responsabilité du service paramédic, tel que défini par la Loi sur les ambulances de l’Ontario. La Ville s’est vu donner la possibilité d’améliorer la qualité des services paramédicaux offerts à la collectivité.  La conception du Service paramédic d’Ottawa, qui est axé sur le rendement, repose sur cinq éléments clés : excellence clinique, fiabilité des délais d’intervention, satisfaction des malades et de la collectivité, efficacité sur le plan économique et responsabilité à l’égard du rendement. L’application simultanée de ces principes est à la base de l’excellence continue du service.

 

Le Conseil municipal d’Ottawa a consenti des investissements importants afin que le Service paramédic se rapproche davantage des délais d’intervention et des normes de soins cliniques médicalement acceptables par rapport à l’ancien service.  Depuis la fusion, le nombre de paramédics à la Ville d’Ottawa est passé de 254 à 345, ce qui représente une augmentation de 36 p. 100.

 

Parallèlement :

·        Le nombre d’interventions a largement dépassé les chiffres prévus au moment de la conception du système. Alors qu’il était de 65 000 avant la fusion, on prévoit qu’il atteindra les 103 414 d’ici à la fin de 2008, soit une hausse de 59 p. 100, alors que le concept initial prévoyait des augmentations annuelles de 2 p. 100.

·        Le délai d’attente à l’hôpital est passé de 36 min 44 sec en moyenne en 2001 à 1 h 07 min 34 sec au mois de juin 2008, soit une hausse de 84 p. 100.

 

Le fait que le nombre d’interventions a augmenté plus vite qu’il était prévu à l’origine ainsi que les contraintes systémiques (délais d’attente à l’hôpital) indépendantes de la volonté de la Ville font en sorte que la capacité d’intervention du service est maintenant insuffisante. 

Les pressions systémiques sont en bonne partie responsables de l’écart grandissant entre les délais d’intervention visés et les délais d’intervention réels.

 

À l’heure actuelle, la Ville d’Ottawa ne respecte pas les délais d’intervention approuvés par le Conseil (8 min 59 sec dans les secteurs à forte densité et 15 min 59 sec dans les secteurs à faible densité) et risque de ne pas pouvoir respecter la norme minimale moins rigoureuse prescrite par la Loi sur les ambulances [soit un délai d’intervention général de 12 min 41 sec (T2-T4), calculé en fonction des délais d’intervention de 1996 pour la région d’Ottawa].

 

Le Service paramédic d’Ottawa collabore avec CAE Services professionnels (chef de file mondial en simulation, techniques de modélisation et solutions de formation intégrées pour le secteur de l’aviation) dans le cadre d’un projet pilote bénéficiant de l’approbation et du soutien du ministère de la Santé. Ce projet vise à élaborer un outil de prédiction pour l’évaluation des besoins en ressources dans différents scénarios d’intervention.

 

Ainsi, la société CAE a évalué le nombre de paramédics requis pour atteindre les délais d’intervention visés et pour maintenir les délais d’intervention existants.  L’évaluation a tenu compte de l’effet des délais d’attente à l’hôpital, qui échappent au contrôle de la Ville.

 

D’après le modèle établi par la société CAE, il faudrait, pour combler immédiatement l’écart entre les délais d’intervention réels et ceux approuvés par le Conseil, pouvoir compter sur 192 paramédics supplémentaires, ce qui permettrait d’atteindre dans 90 p. 100 des cas les délais d’intervention cibles de 8 min 59 sec pour les secteurs à forte densité et de 15 min 59 sec pour les secteurs à faible densité. En outre, 120 de ces paramédics serviraient à répondre à l’augmentation du nombre d’appels, alors que 72 serviraient à compenser l’effet des délais d’attente à l’hôpital. 

 

L’analyse effectuée par la société CAE a aussi permis d’établir qu’il faudrait 25 paramédics de plus pour répondre à l’augmentation de 5 p. 100 du nombre d’appels prévue pour la fin de 2008.

 

Étant donné que la Ville doit s’appliquer uniquement à combler la partie de l’écart dans les délais d’intervention sur laquelle elle exerce un contrôle et compte tenu de la difficulté de porter 120 nouveaux paramédics à l’effectif, le Service propose une stratégie échelonnée sur trois ans qui prend également en considération l’augmentation du nombre d’appels au cours des prochaines années. 

 

Ce plan triennal prévoit le recrutement de 65 paramédics en 2009, suivi du recrutement de 40 autres en 2010 et autant en 2011, en plus des paramédics supplémentaires requis pour faire face à la croissance projetée au cours de chacune de ces années.

 

Le rapport qui suit présente l’analyse de la situation ainsi que le plan de dépenses projeté.

 

DISCUSSION

 

2008 Trends

 

Response Volume

 

Since 2004, code-4 response volume has significantly exceeded the assumptions of the original system design of 65,000 requests for service per year with annual projected increases of 2% per year.  The total projected increase in response volume for 2008 is 5 percent. The increase in response volume is a significant factor in the challenge to meet response time targets.

 

The table below illustrates the response volume for the first six months of 2008 (January to June)

 

Response Volume - January 2008 to June 2008

Call Type

Jan

Feb

Mar

Apr

May

June

TOTAL

Code 4 (urgent)

6,302

6,240

6,696

6,603

6,741

7,057

39,639

Code 3 (prompt)

1,104

1,009

1,185

1,056

1,008

1,278

6,640

Code 2

550

594

558

589

612

433

3,336

Code 1

274

205

177

159

143

150

1,108

Code 8

126

192

147

147

171

201

984

Total

8,356

8,240

8,763

8,554

8,675

9,119

51,707

  Source: ADDAS DATA - September 2008

 

The table below illustrates the response volume patterns and increases since 2004 by call code and the 2008 projection.

 

Response Volumes 2004 - 2008 (Projected)
Call Type

2004

2005

2006

2007

 

2008

Projected

Code 4

55,890

57,266

69,779

73,027

79,278

Code 3

20,974

22,200

12,409

13,441

13,280

Code 2

6,576

6,324

5,597

7,058

6,672

Code 1

6,618

4,350

3,011

2,683

2,216

Code 8

N/A

N/A

1,758

2,296

1,968

Total

90,058

90,140

92,554

98,505

103,414

Source:  ADDAS DATA – September 2008

 

The projected increase in code 4 calls is 8.5 percent from 2007.  It is imperative to note that code 4 calls require more sophisticated and time consuming interventions by paramedics.  Thus, affecting the paramedic’s time on task and availability for the next life-threatening call.

 

Response Time

 

City of Ottawa Response Time Standards

 

Response time were developed for the City of Ottawa taking into account international industry standards, medical appropriateness and community expectations. The internationally recognized targets are set at 8 minutes 59 seconds 90 percent of the time for life threatening calls in Ottawa’s high-density[1] urban area and a Council target set at 15 minutes 59 seconds 90 percent of the time for life threatening calls in Ottawa’s low-density[2] rural area. 

 

The comparison table below demonstrates the response times at the 90th percentile for 2007 and Q1-Q2 2008.

 

Response Times – 90th Percentile

Area

Response Time Targets

Response Time Achieved in 2007

Response Time Achieved

Jan-June 2008

High-Density

8:59

12:49

13:48

Low-Density

15:59

21:15

21:31

  Source: ADDAS September 2008

 

The increasing response volume is straining the response time performance of the Paramedic Service with the present resource level.

 

The comparison table below demonstrates the 90th percentile rank for response times for 2007 and Q1-Q2 2008

 

Response Times – Percentile Rank

Area

Response Time Targets

Response Time Achieved in 2007

Response Time Achieved

Jan-June 2008

High Density

8:59

65.5%

59.8%

Low-Density

15:59

71.7%

64.4%

  Source: ADDAS September 2008

 

The percentile rank measurement represents the percentage of calls when the Paramedic Service reached its target of 8 min 59 seconds in the high-density area and 15 minutes and 59 seconds in the low-density area or better. The decrease in the 90th percentile rank in the January to June 2008 period from 2007 highlights the extreme effect of a system under pressure. 

 

Minimum Response Time Standard – Ambulance Act

 

As part of the provincial transfer of land ambulance services, 90th percentile response time standards were originally established for each municipality based on ambulance response times that existed in the municipality in 1996.  For the City of Ottawa, the 1996 legislated time standard was 12:41, which encompassed the entire Ottawa response area.  It is important to note that this standard is based on a T2-T4 time segment, not the T0-T4 time segment typically measured and reported by the Paramedic Service.  The T2-T4 time measure does not incorporate the call-processing time in the Communication Centre (i.e. time 911 call received to time paramedic unit notified). In 2007, the City of Ottawa achieved an overall T2-T4 response time of 12:04 (as reported in its 2007 OMBI results outlined later in this report).  At present, Ottawa Paramedic Service is meeting its legislative requirement, however is at risk of not meeting it in the future, if response time performance continues to decline.

 

Hospital Wait Times

 

The provincial benchmark for ambulance off-load time (defined as time of ambulance arrival to hospital Emergency Department (ED) to time the patient is placed on ED stretcher) is 30 minutes at the 90th percentile[3]. The Ottawa Paramedic Service uses a T6-T7 measure that is defined as ‘paramedic at hospital’ time.  T6 is time arrived at destination and T7 is time cleared destination. 

 

Across Canada, paramedic services are experiencing an increase in hospital wait time. In Ottawa, in Q1 & Q2 of 2008, the average wait time was 67 minutes and 34 seconds – an increase of 11 minutes and 54 seconds from the previous in 2007.  Increasing wait times negatively impact paramedic unit availability and response times given that paramedic crews are not available for assignment or deployment until the patient has been transferred into the care of hospital staff. 

 

The following chart illustrates the increasing average hospital wait times (T6-T7) since 2004 including the 2008 January to June data.

 

Average Hospital Wait Time (T6-T7)

 

2004

2005

2006

2007

 

2008

Jan - June

Wait Time

00:49:00

00:49:55

00:53:31

0:55:40

1:07:34

Source: ADDAS DATA – September 2008

 

The following chart illustrates the increasing hospital wait times at the 90th percentile since 2004 including the 2008 January to June data.

 

90th Percentile Hospital Wait Time (T6-T7)

 

2004

2005

2006

2007

 

2008

Jan - June

Wait Time

1:12:14

1:15:52

1:15:48

1:31:49

1:52:04

Source: ADDAS DATA – September 2008

 

Although, solutions to the current hospital wait times are the responsibility of the hospital administration and the Ministry of Health and Long Term Care (MOHLTC), it remains a contributing factor in the paramedic availability and therefore negatively impacts response times.  The provincial funding announcement in May 2008 has sparked hope for paramedic services across the province that this initiative will prove to be an effective short-term mitigating strategy to the existing hospital wait time. Ottawa’s nursing pilot project commenced on September 29th 2008.

 

The provincial government has also implemented major changes in reporting requirements for hospitals with clear targets to be achieved. This is, in essence, the government’s clear commitment to solve the emergency department wait time issues over the next several years.  A complete discussion of the provincial program initiated by the government of Ontario is documented in a separate report.

 

CAE (CANADIAN AVIATION ELECTRONICS)

 

Operating a performance-based paramedic service means that patients receive the highest quality of pre-hospital care.  With this in mind, the Paramedic Service engaged in a federally funded partnership with CAE in order to analyze and provide key statistics for resourcing levels at the Paramedic Service.

 

CAE Company Profile

 

CAE is a world leader in providing modelling and simulation technologies and services and integrated training solutions for the aviation industry around the globe. CAE was founded in 1947 and is headquartered in Canada. With clients in over 100 countries, CAE has the broadest global reach of any simulation and training equipment on the market.


CAE Professional Services

 

CAE Professional Services is CAE’s global consulting group that provides simulation based support services across the lifecycle of a program. CAE’s analysis, design, experimentation and lifecycle management services support the development, management and sustainment of capabilities and complex systems. The CAE team provides strategic guidance and technical expertise in the fields of capability engineering, human factors, modeling and simulation, emergency management, project management and integrated logistics support.

 

Partnership

 

Over the past two years, the Ottawa Paramedic Service has collaborated with several partners lead by CAE Professional Services, Actenum, a federal government funding agency, Simon Fraser University, and McGill University, to develop an operational decision support tool (CAE Deploy) to optimize the deployment of Paramedic resources.  Through the development of CAE Deploy, a great deal of time has been spent understanding the current deployment strategy, as well as investigating alternative deployment approaches that consider both patient survivability and geographic coverage.

 

CAE Deploy

 

CAE Professional Services has collaborated with the paramedic community; lead by the Ottawa Paramedic Service, to develop CAE Deploy, a decision support tool, to facilitate communications (i.e., dispatch) staff in making challenging deployment decisions in the demanding and complex environment of EMS.    Integrated with the Paramedic Service’s existing communications and dispatch systems, CAE Deploy provides the Communications Officer with real-time deployment recommendations, which adhere to the organization’s adaptive deployment strategies. 

 

While CAE Deploy was developed as an operational decision support system, the technology backing the system has been adapted to support operations analysis.  Through the use of modeling and simulation, the system can be used to support the Paramedic Service in making difficult resourcing and strategic operational decisions.

 

The Ministry of Health has endorsed this project and once the pilot is completed and validated, the objective is to roll out both the predictive and operational tools in Communication Centers throughout the province of Ontario.  It has been recognized that this tool will allow for better resource management for the Paramedic Service performance-based system.

 

These new innovative tools allow for a definitive resource predictor that is statistically valid based on the simulation of Paramedic responses in the community it evaluates.

 

Analysis of Resources to Meet Target Response Times - Under Existing System Parameters

 

From the findings provided by CAE through the use of the predictive analysis simulation model, the Paramedic Service is presenting, as directed by Council, the resource level requirements reflecting the actual system parameters. 

 

To answer the question of the number of additional resources that are required to meet the 90th percentile response time targets (Scenario A), an evaluation was conducted using 2007 incident data to identify the number of resources that would be required to meet a high-density response time of 8 minutes 59 seconds and a low-density response time of 15 minutes and 59 seconds if all other parameters remained constant. 

 

In light of the August 21, 2008 Community and Protective Services Committee, the Paramedic Service was asked to provide data reflecting its true needs for resourcing in achieving the response time targets.  The table below illustrates the resourcing analysis results provided by CAE. 

 

Scenario

Description of Analysis Parameters

Paramedic Unit Resource Requirement

Paramedic Staff Resource Requirement

Hours/Day

A

 

Achieve 8:59 & 15:59

(Uses 2007 data)

 

 

16

192

24/7

To Meet Growth: 10

Hospital Wait Time Fix: 6

To Meet Growth: 120

Hospital Wait Time Fix: 72

 

The results revealed that with all other parameters kept constant, 16 additional paramedic units per 12 hours shift and 192 paramedics are required to meet the internationally recognized response time targets. 

 

10 paramedic units per 12-hour shift, representing 120 paramedics would be required to meet the growth, while 6 units per 12-hour shift, representing 72 paramedics would be required to compensate for hospital wait times (assumes a hospital wait time of 30 minutes).

 

Given that hospital wait times are not the responsibility of the City of Ottawa, the property tax base should not be used to fund the gap attributable to hospital wait times.

 

The provincial government has acknowledged their responsibility in managing hospital wait times.  Many short and long-term initiatives will be rolled out in the next five years in the hospitals to alleviate paramedic at hospital wait times.   This is discussed in a separate report to Committee and Council.

 

The Paramedic Service is accountable to the community and its needs.  The changing demographics and the demands on service are the responsibility of the City of Ottawa. 

Analysis of Resources to Meet Target Response Times Analysis of Resources to Maintain Existing Response Times – with 5% Growth and Anticipated Pilot Project Hospital Wait Times

 

As a follow up to the above results, the Paramedic Service asked CAE to provide a subsequent analysis to illustrate the number of resources required to maintain the 2007 response times as well as target response times within the context of 2008 projected growth as well as the anticipated impact of the hospital pilot project.   This analysis assumes anticipated response volume growth of 5% from 2007 as well as hospital wait time reduction at the Ottawa Hospital the same as Toronto’s reduction of 50% at the Sunnybrook Hospital (given that the Ottawa nursing pilot project will only be implemented beginning on September 29, 2008).

 

The results are illustrated in the table below

 

Scenario

Description of Analysis Parameters

Paramedic Unit Resource Requirement

Paramedic Staff

 Resource Requirement

Hours/Day

B

Maintain 2007 response times of

12:49 & 21:15

 

Includes 5% growth and anticipated pilot project hospital wait times

2

25

24/7

 

The results reveal that 2 ambulances and 25 paramedics are required to maintain existing response times in keeping with the budget pressure presently identified in 2009 budget. 

 

OMBI Results

 

Municipality

 Area SQ KM

Population Density per sq. km

T0-T2

T2-T4

Response time
Code 4 (T0-T4)

EMS Cost per patient transported

Niagara

1896

228

0:01:52

0:09:54

0:11:22

$771.44

London

423

840

0:02:28

0:09:52

0:11:41

$649.10

Toronto

634

4306

0:03:12

0:09:36

0:11:58

$749.30

Sudbury

3627

44

0:02:23

0:10:54

0:12:43

$614.69

Halton

972

466

0:03:46

0:10:26

0:13:23

$874.11

Windsor

147

1478

0:03:47

0:10:08

0:13:25

$751.20

Ottawa

2796

318

0:01:50

0:12:04

0:13:40*

$731.80

Hamilton

1128

459

0:02:50

0:11:40

0:15:02

$532.86

Peel

1254

988

0:05:38

0:12:02

0:15:43

$845.34

Durham

2535

238

0:02:43

0:10:53

0:12:33

$843.30

Thunder Bay

328

332

0:02:11

0:11:12

0:12:47

$453.33

Brant

845

37

0:04:46

0:12:26

0:16:42

$726.09

Waterloo

1382

373

0:02:33

0:12:41

0:14:51

$598.25

York

1775

554

0:03:12

0:13:02

0:14:56

$958.13

* blended high density & low density

The OMBI 2007 results illustrate that the City of Ottawa has one of the largest response areas of any Ontario municipality.  Despite the very large response area, which requires the longest travel distances in the province, the City of Ottawa response times are competitive with more densely populated centres due to the efficient dispatch processing time T0-T2 which is the best in the province. 

 

3-Year Plan

 

As indicated earlier in this report, Scenario A(10 paramedic units and 120 paramedic staff) is the option that assures the Paramedic Service’s appropriate medical response to their community. 

This scenario will retroactively address past growth gaps and assure to keep up with future growth.  The community’s expectation is the Paramedic Service acknowledges the demographic demands and manages the municipal service delivery accordingly.

 

The proposed strategic staffing initiative is a 3-year hiring plan.  This staffing strategy will only allow for bringing the Paramedic Service to resourcing levels adequate for the differential in increased demand over the last 5 years.  It will also have to hire for 2009, 2010 & 2011 paramedics to account for response volume growth in all 3 years.   That being said, the three-year hiring will include 40 paramedics per year plus the number of paramedics included in the yearly budget for growth.  

 

The table below illustrates the staffing strategy for 2009-2011

 

YEAR

Required Staffing

 

Growth Staffing from 2009-2011

TOTAL YEARLY

TOTAL

COST

 

2009

 

40

25

65

$2.5M

2010

40

Growth staffing

40 + Growth Staffing

TBD 2009

2011

40

Growth staffing

40 + Growth Staffing

TBD 2010

 

Recruitment Initiative

 

The Paramedic Service in partnership with the two Ottawa colleges, Algonquin College and La Cité Collégiale, will work collaboratively to staff the Service.  Realistically, there are enough graduates each year from both city colleges to fulfill the staffing requirements for 2009-2011 presented in the table above. The Ottawa Paramedic Service is proving to be a very attractive employer to new college graduate paramedics. The past hiring cycles have indicated both out-of-town candidates and even out-of-province candidates are interested in coming to Ottawa. 

 

In order to manage the hiring of 65 paramedics in 2009, the Paramedic Service proposes to hire 24 paramedics in May; 18 paramedics in September; and, 23 paramedics in November.

 

The majority of new hires are recent college graduates. 

 

While the hiring of 65 paramedics per year will require a significant commitment by the Paramedic Service, the capacity of the Service will allow the intake of the new hires in this phased model.

 

CONCLUSION

 

Despite the best efforts and optimal deployment, the rising response volume, hospital wait times, and limited resources continue to strain the Paramedic Service system in achieving targets and improving current response times. 

 

The Paramedic Service is hopeful that the announcement of funding for dedicated “off-load” nurses in the Ontario Hospital will allow for increased availability of paramedic units to respond to medical emergencies in the community.  This funding could significantly impact response times and service levels.  A complete discussion of the provincial program initiated by the government of Ontario is documented in a separate report.

 

The CAE analysis results illustrates a Paramedic Service significantly resource deficient.  The heavily under resourced Paramedic Service is struggling to attain response time target.  There are 2 major components that need to be addressed in order to bring the Paramedic Service to a resource level allowing for response time improvements: 1) retroactive staffing for response volume growth in the past 5 years and 2) staffing for future growth in yearly budget. 

 

The Paramedic Service is proposing a 3-year plan in order to phase in the hire of 120 paramedics over the next 3 years to account for the past growth differential and 25 paramedics in 2009 for projected growth. This will allow the Paramedic Service to move towards the medically recognized international response time targets.  

 

CONSULTATION

 

There was no consultation undertaken as part of the preparation of this information report.

 

FINANCIAL IMPLICATIONS

 

The 2009 budget contains $2.5 Million for the hiring of 65 paramedics in 2009 per the hiring plan outlined in this report. 

 

SUPPORTING DOCUMENTATION

 

Document 1 – Staffing Plan – Impact of Investments on Response Times

 

DISPOSITION

 

Community and Protective Services Department, Paramedic Service Branch will action any direction received as part of consideration of this report.

Document 1

Staffing Plan – Impact of Investments on Response Times

 

 

Target

 

 

8:59

15:59

Scenario Description

Paramedic Resource Requirement

Estimated Response Time

HD

LD

Response Time 2007

 

12:49

21:15

Current Response Time (June 30, 2008)

 

13:48

21:31

2009

No New City Investment

(based on projected 5% increase in call volume in 2008 as well as anticipated pilot project hospital wait times improvements)

-

 

14:25

 

21:47

2009

Paramedic resources required to maintain the 2007 achieved response times
(based on projected 5% increase in call volume in 2008 as well as anticipated pilot project hospital wait times improvements)

25

12:49

21:15

40 (total 65)

12:08*

18:10*

2010

 (response targets if hospital wait times are reduced to an average of 30 min.)

40 + Growth

 10:10*

15:59**

2011

Paramedic resources required to meet 8:59 and 15:59

(response targets if hospital wait times are reduced to an average of 30 min.)

40 + Growth

8:59*

15:59*

*Estimated response times based on an extrapolation of the simulated data and an estimation of the call volume increases in 2009 – 2011.

**It is projected that in 2010 with the addition of 105 Paramedic resources (65 in 2009 + 40 in 2010) plus the resources required to meet the growth in call volume in 2009, that the LD response target of 15:59 will be achieved.  Only 15% of the calls received by the Paramedic Service are in the LD area.  As such, it is estimated that the additional resources will result in a more rapid improvement in response times in the LD response area than in the HD area where 85% of the calls for service are received.

OTTAWA PARAMEDIC SERVICE – 2008 TRENDS REPORT

SERVICE PARAMÉDIC D’OTTAWA – TENDANCES DU RENDEMENT 2008

ACS2008-CPS-OPS-0003                                            CITY WIDE / À L'ÉCHELLE DE LA VILLE

 

This item and item 3 were addressed concurrently and reflected in the minutes under this report.

 

Chief Tony DiMonte, Ottawa Paramedic Services stated that are two reports before the Committee.  The presentation given was to supplement the reports.  He introduced the team that has worked with him on these reports: Deputy Chief Pierre Poirier, Ottawa Paramedic Services, from CAE Inc. was Ms. Jana Lee Tryan and Mr. Gord Youngson. 

 

Deputy Chief Poirier and the representatives from CAE delivered a PowerPoint presentation.  A copy of their presentation is held on file with the City Clerk.

 

In conclusion Deputy Chief Poirier stated that the information presented originated through a project that has been funded by the Federal Government along with CAE, other companies as well as McGill University and Simon Fraser University.

 

Chief DiMonte gave a brief summary on the dispatch system in Ontario stating that it was a seamless system of 13 centres run by the Province of Ontario very similar to the OPP.  Ottawa Paramedic Services runs the dispatch centre in Ottawa for the Province at 100% their cost and covers all of eastern Ontario.  The Ottawa Dispatch Centre is also the best performing dispatch centre in the Province of Ontario.  There is a medical algorithm used at all dispatch centres around the world, which places calls in priority and type.  In Ontario the standard is called Dispatch Priority Card Index (DPCI).  It is medically based and set by medical professionals and updated regularly.  The other tool used is Advanced Medical Priority Dispatch System (AMPDS) and is used in Toronto and a pilot project in the Niagara Region.  The results of the pilot project will determine what the rest of the province will use in the future. 

 

He summarized the four groups of groups of calls from Code 4 which are life threatening such as cardiac arrest, Code 3 which are urgent calls such as broken legs, Code 2 are scheduled calls such as moving a patient from one institution to another for scheduled tests, etc. and Code 1 which may be movements from institution to another but without need of set times.

 

Councillor Chiarelli asks what might happen if a dispatcher is on the line and no other is available for the next call.  Chief DiMonte stated that there are processes in place and happens very rarely.  However, if a call were in the queue a supervisor would take the call.

 

In response to Councillor Chiarelli’s question on the number of zero ambulance availability events, Deputy Chief Poirier stated that from June to September there were 135 occurrences.  However, Chief DiMonte stated that those were for all calls and therefore if a Code 4 or Code 3 call comes in it still takes priority and is responded to immediately.

 

Councillor Chiarelli’s last question dealt with the number of dispatchers hired in the last 6 years.  Chief Dimonte stated that a number of dispatchers have been hired but do not necessarily correlate to the number of paramedics hired and the correlation would not change if the City changed to the AMPDS. 

 

Mr. Kanellakos stated that the Auditor General has done a report on the Paramedic Service and he is very pleased with the outcome of that audit and should be released to Council soon.  The conclusion he has reached is that it is a lack of resources for call volume and therefore cannot meet standards as set by Council.  The fear at the present time is that the City of Ottawa may not be able to meet the legislative requirements within the year.  The analysis before the Committee is there for information and what is needed to meet the volume.

 

In response to Councillor Chiarelli’s concern with regards to resources and if hiring an extra dispatcher would solve the problem of hiring more paramedics Mr. Kanellakos stated that the analysis and audits demonstrates that the resource issues are not in dispatch but in paramedics.  The new system (AMPDS) would only help in the re-allocation.

 

Chair Deans stated that a number of years ago Councillors went to visit the dispatch centre and was wondering if that exercise would be useful again.  The consensus was that it would be of help and the Chair asked if the Chief could arrange such a visit before budget time.

 

Councillor Feltmate asked if an analysis is available concerning the number of calls from the ageing and the homeless.

Chief DiMonte responded by saying that he does not have the numbers at the present time but he could attain them.  They have been keeping more records on patient for approximately one year now electronically so in the New Year they will be able to get information based on patient sub-sets. Councillor Feltmate would like to see this information in the reports in the New Year.

 

In response to Councillor Feltmate’s question on the OMBI report and comparing adequately other municipalities Chief DiMonte stated that Ottawa’s geography is unique in that there are really two areas, high and low density, that being urban and rural.  The urban target is 8 minutes and 59 seconds (international standard) and a Council directed standard of 15 minutes and 59 seconds for the rural areas.  The problem is that the law provides for only 1 standard for a City despite Ottawa’s unique geography.  The OMBI comparators are put in the report to show the effectiveness of the Ottawa service and some comparators have very little value especially on patient cost for transport.

Councillor Feltmate asked how the service was dealing with perception from the public when so many vehicles respond to an accident or emergency when one specific vehicle is only necessary.  At the present time we might get a fire truck, police, ambulance, etc. for one incident.

 

Chief DiMonte stated that direction from Council was that the right vehicle and the right team are sent to the needs of the citizen and the model that Ottawa uses is being used by other cities.  It is a tiered response protocol and the Chief described examples where the Fire Service may call the paramedics or where the police may call both fire and the paramedics.  However when a resident calls 911 they may state that there are multiple injuries and the various services are dispatched.  The first on the scene may assess the needs differently and may call to cancel some of the other services and stand down.  The services are very sensitive to that issue.  There is a working group of all services that meet to discuss these issues.  The goal is to send the right resources and the right skills for any incidences however; occurrences will take place depending on what is received at the dispatcher centre and the resident who places the call.

 

Chair Deans asked if a caller states that only one ambulance is needed at the scene would that recommendation be followed.

 

Chief DiMonte responded by saying probably not since there is an issue of risk management and ensuring that all needs are met and the caller not having the expertise to determine those needs.

Councillor Bédard described incidences where all 3 services may show up for someone who may only be inebriated.  He considers this excessive.  Is there a possibility for a rapid response vehicle to be stationed in the downtown area to deal with the number of calls in that area which may only be cases of intoxication.

 

Chief DiMonte stated that it is always a challenge when calls are received from the public since many do not want to approach the victim to see what the case may be.  It becomes a risk management issue.  The rapid response vehicles are being added to the downtown core due to lower costs; however, the closest ambulance will still appear at the scene first.

 

Councillor Bédard inquired if a nurse could operate out of a shelter in the hot zones and if this would not be a better solution to some of the call problems.

 

Chief DiMonte stated that this could be explored but at the end of the day if a 911 call is received it must be responded to.  Councillor Bédard urged the services to meet with the coalition of agencies and shelters in the core.

 

Councillor Bellemare questioned some of the charts in the report where no matter how many resources are added, service does not improve, there appears to be a plateau.  What are other factors that seem to be gumming up the system to improve the timing?

 

Ms. Tryan of CAE stated that there is a point where the resources become saturated and a completely revamped deployment strategy would have to be done. 

 

Chief DiMonte also responded by saying that a complete redesign of the system would have to be done such as building more stations, etc.  The analysis is based on the existing stations (11 urban).

 

Councillor Bellemare asked if placing the vehicles in various locations or on patrol rather than building stations would not solve some of these issues at a much lower cost.

 

Chief DiMonte stated that the service is presently doing some of those initiatives over the years but if many ambulances are busy and you have 1 left where do you place that 1.

 

In response to Councillor Bellemare’s question on level zero incidences and keeping an ambulance in reserve Chief DiMonte stated that that was being done now and at critical levels if a hospital were to call for transport a patient they would be told no because all ambulances are meeting Code 4 and 3 calls. 


Mr. Kanellakos also stated that all ambulances are deployed to pre-determined areas where calls may be expected.  The model and expectations are built on the standard of meeting 8:59.  Change the design to having an ambulance every 4 blocks and the time would definitely go down but the analysis is built on meeting the 8:59.

 

Councillor Holmes asked CAE how many cities they have worked with on this system.  Ms. Tryan stated they have worked with Ottawa Paramedic services for over two years but Ottawa is the first city they have worked with so closely on this system.  Deputy Chief Poirier stated that this is a new science and a frontier of modelling simulations. 

 

Councillor Holmes stated that there are specialists in the United States that work with fire and police in many cities and wondered if they would also deal with ambulances services.

 

Mr. Kanellakos stated that they have looked at other companies and have worked with a firm that developed the system design at the time of amalgamation. However, there are not many specialists and those out there are not great.  This is a new model.

 

Councillor Holmes asked if it was possible to break down the graph on page 30 by ward.  Chief DiMonte said that it would be a challenge since the centres are provincially run and are grids of 1 square kilometre so it could be done but may take some time.

 

With regards to the nurses in the hospital program and the disappointing results as stated by Councillor Holmes, Chief DiMonte stated that the new program started in September 2008 and appears to be working well but results not quite available yet.  Deputy Chief Poirier responded by saying that the funding for the Off Load Nurse Project was received by the province and services are bought by the hospital and nurses are dedicated to that project and so far the data is very encouraging.  Mr. Kanellakos stated that the simulations and modelling were done with the nurses.

 

Councillor Leadman inquired on the process or procedures for Code 3 or Code 4 patients on the way to the hospital and at the hospital.

 

Chief DiMonte responded by saying that the patient is evaluated in triage, the hospital is called from the scene and received medical orders from the physician and on the way the ER nurse is called and told what has been done with the patient and time to arrival.  The hospital mobilizes and the patient is unloaded and cared for.  The biggest challenge is for those patients who are evaluated at a lower priority and there is little room at the hospital and the patient remains on the stretcher not allowing the ambulance to move on.  The off load nurse will now look after that patient.

 

Councillor Qadri asked CAE if they have done this type of work before such as with fire.

 

Mr. Youngson responded by saying that the tools used for this project have been used on other projects such as with the RCMP or the military.  However, the use of this system for paramedic services is new.  Other jurisdictions are now beginning to use the same system that Ottawa is using.  Mr. Kanellakos stated that another consultant used in 2004 had a higher number of paramedics than the CAE data and this has been a benefit to the City of Ottawa.

 

Councillor Qadri asked if there were any union issues involved with the first responder on the scene and cancelling other services.

 

Chief DiMonte stated that there shouldn’t be but this is not a perfect world but for 99% of the time the system works and has no problems.  Generally the 3 services, fire, police and paramedics work well together and no great issues have arisen over first responder.

 

In response to Councillor Qadri’s question as to which system Ottawa started with if DPCI or AMPDS and which is better, Chief DiMonte stated that the City has always used DPCI and it is the Province of Ontario standard.  He personally feels that the AMPDS is better especially for benchmarking and is more specific.  It is used by more than 800 jurisdictions around the world.  Ottawa is more than ready to move to AMPDS when and if the province moves down that road.

 

Councillor Feltmate inquired on the financial implications for 2009.

 

Chief DiMonte stated the pressure is $2.5 million in operations only and there are capital amounts to consider as well and 2010 is approximately $5 million in operations.

 

Chair Deans stated that everyone realizes the critical nature of this service to the community and that the right amount of resources is being given to address the medical and emergency needs.  There is some frustration showing however since the City has committed significant resources to this service but little gains are being realized in getting to where the City would like to take this service.  The questions being raised are if the dollars given are being used judiciously.

 

In a personal experience Chair Deans required an ambulance but would like to know what exactly determines that and can the dispatcher say take your own vehicle.

Chief DiMonte stated that it is a matter of medical liability and that would never be said, at the scene that might be said once looked at.  Community expectations are also high especially if a child is urged for example in a hockey tournament and it is a Code 3 but ambulances are constantly being redirected to Code 4 calls.

 

Chair Deans asked if assisting the City of Gatineau had ever compromised the City of Ottawa service.

 

Chief DiMonte stated that it happens approximately a dozen times a year and those 12 times the city was not in a critical situation but if it had been Gatineau would have been told that Ottawa paramedics could not have assisted them at that time.  It must be noted that other local services such as from Renfrew or Stormont, Dundas & Glengarry back up the City of Ottawa service and this is mandatory in Ontario.

 

Chair Deans noted that this was the first report where it has stated that the targets could not be met.  She asked if a discussion was necessary on the issue if the present targets are realistic.

 

Chief DiMonte responded by saying that there is a legislative opportunity coming where this can be revisited since so many other jurisdictions are finding it difficult as well.  Next year it may be time to look at the design.  Mr. Kanellakos stated that the Auditor General’s report to be tabled soon will beg the question of whether the City is getting value for the money on this service which is a valid question but it must be remembered that the resources have been overwhelmed by volume.

 

That Community and Protective Services Committee and Council receive this report for information.

                                                                                                            RECEIVED

 


[1] High and low density areas refer to call volume in relation to geographical area.  High-density areas are defined as areas with greater than or equal to 24 calls per sq km per year in groups of 6 contiguous sq km.

[2] High and low density areas refer to call volume in relation to geographical area.  Low-density areas are defined as areas that do not meet the high-density criterion. (Greater than or equal to 24 calls/sq km/year in 6 contiguous sq km – see previous footnote)

[3] Improving Access to Emergency Services: A Service Commitment.  The Report of the Hospital Emergency Department and Ambulance Effectiveness Working Group Submitted to the Honourable George Smitherman, Minister of Health and Long Term Care Summer 2005.