EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

The Emergency and Protective Services Committee met on Wednesday, September 1, 2004 at 9:00 a.m., in the Council Chambers, Regional Administrative Headquarters, 10 Peel Centre Dr., Brampton.

Councillor P. Palleschi presided

1. DECLARATIONS OF CONFLICTS OF INTEREST

2. APPROVAL OF AGENDA

RECOMMENDATION EPSC-5-2004:

That the agenda for September 1, 2004 Emergency and Protective Services Committee meeting be approved.

3. DELEGATIONS/PRESENTATIONS

a) Kent Gillespie, Commissioner of Corporate Services and Regional Solicitor and Mary Ellen Duff, Manager of Administration, Peel Regional Ambulance and Emergency Programs on behalf of Peter Dundas, Director of Ambulance and Emergency Programs, Corporate Services, Providing an Ambulance Transition Status Update

Received

Kent Gillespie, Commissioner of Corporate Services and Regional Solicitor, informed the Committee that Peter Dundas, Director of Ambulance and Emergency Programs, was unable to attend the meeting due to illness. Kent Gillespie introduced Mary Ellen Duff, Manager of Administration, Peel Regional Ambulance and Emergency Programs, who would assist with the presentation in place of Peter Dundas.

Kent Gillespie introduced James Kilgour, the new Emergency Management Coordinator for the Region of Peel, briefly outlining his educational and previous employment experience. Councillor Paul Palleschi welcomed James Kilgour on behalf of the Emergency and Protective Services Committee.

Kent Gillespie provided a high level Ambulance Transition Status Update to the Committee. He stated that the negotiations for the sale of business with the current Ambulance Service Operators had been successful and that collective bargaining with the unions representing the paramedics were currently underway with the goal of achieving a three year contract settlement.

Kent Gillespie reviewed the current transition initiatives which focused upon the areas of Human Resources, Information and Technology, Property Services and Ministry of Health and Long Term Care Certification. He indicated that the Region is on target to ensure all paramedics, management and systems are ready for the transition date of December 1, 2004. He further noted that the Operators are working in cooperation with the Region to ensure there are no interruptions in service delivery during the transition process.

4. PEEL REGIONAL AMBULANCE SERVICES

a) Funding Proposal to the Ministry of Health and Long Term Care (MOHLTC) for Additional Service Hours

RECOMMENDATION EPSC-6-2004:

That a proposal for increased funding for the provision of Land Ambulance Services by the Region of Peel be submitted to the Emergency Health Services Branch of the Ministry of Health and Long Term Care;

And further, that without prejudice to the position of the Region of Peel, that funding should be at the amount of 50 per cent of the true cost of delivering the Land Ambulance Service, this proposal will be based on 50 per cent of the cost per service hour that was established by the Ministry for response time funding purposes in 2002 being $37.36 per hour, subject to annual adjustments established by the Ministry;

And further, that the funding proposal shall include payment for unfunded service hours for the years 2001 to 2004 inclusive, and that the funding base be adjusted to reflect proposed service hours for 2005.

Kent Gillespie explained that the proposal to the Ministry of Health and Long Term Care (MOHLTC) is an important step in addressing the shortfall for Ambulance Services created by the MOHLTC funding formula. The current funding formula provides for 50 per cent funding of Ministry approved costs and not 50 per cent funding of actual costs. Further, this proposal addresses the incremental shortfall in Ministry funding that resulted from Council approval of increased Ambulance Service hours based on expert advice regarding service demand for the years 2001 through 2004 inclusive, and to reflect the proposed service hours for 2005.

Councillor Morrison questioned if all Regions were running Ambulance Services and whether the Regions were all facing similar funding issues. Kent Gillespie confirmed that all other Regions were operating Ambulance Services and they all shared similar funding concerns. Councillor Morrison suggested that the Regional Chairs should act in unison on this issue, approaching the large number of Liberal Members of Provincial Parliament (MPPs) that represent constituencies within the Regions, seeking action from the Province to change the current funding formula for Ambulance Services in Ontario.

Councillor Mullin stated that Council has been struggling with the issue of funding for some time and she sought clarification of why the terms of funding were not clearly set out prior to the Region assuming control of Ambulance Services. Kent Gillespie explained that Ambulance Services were downloaded as a result of the "Who Does What" exercise, and the original intent of the government of the day was to have municipalities fund 100 per cent of the costs. A compromise was offered by the Province whereby 50 per cent of approved costs would be funded. Kent Gillespie continued, explaining that this formula did not result from negotiations, it was simply the terms put in place when the Province downloaded the service to municipalities. Councillor Mullin suggested that it was an appropriate time to propose change to the current funding formula and supported the call for a united approach from Councillor Morrison.

Regional Chair Kolb advised the Committee that the Regions, some counties and some single-tier municipalities, have started the process of requesting the Province to change the Ambulance Services funding formula. He stated that all municipalities which provide Ambulance Services currently have strong data to support the call for increased funding. With help from the Association of Municipalities of Ontario (AMO), a strong presentation to the Province will be put forward to address common concerns about the funding formula for Ambulance Services in Ontario.

Roger Maloney, Chief Administrative Officer for the Region of Peel, stated that nothing was signed with the Province regarding funding at the time Ambulance Services were downloaded to municipalities, confirming the remarks made earlier by Kent Gillespie. Roger Maloney noted that this item is on the agendas of both the Regional Chairs and the Chief Administrative Officers and that they are seeking to meet with the Minister and the Deputy Minister of the MOHLTC.

b) Peel Base Hospital Merger

Received

Rob Theriault, Paramedic Program Manager, Peel Base Hospital, stated that the merger talks between William Osler Health Centre Peel Base Hospital with Sunnybrook and Women's College Health Sciences Centre Base Hospital began a year ago in response to a request from the Emergency Health Services Branch (EHSB) of the MOHLTC to seek greater efficiencies in the provision of Base Hospital services. The merger will occur in November of 2004, creating one of the largest base hospital programs in North America. This merger will result in improved service and greater efficiencies for the residents of Peel.

Regional Chair Kolb inquired about how the wait time for paramedics in hospital emergency rooms could be decreased. Rob Theriault, explained that the Base Hospital program has a small role to play in this issue; the primary function of the program is to certify paramedics, develop and monitor the use of protocols by paramedics and, where necessary, investigate and discipline paramedics. He explained that the function is similar to that of the College of Physicians and Surgeons or the College of Nurses. Councillor Paul Palleschi drew the Committees attention to the role the Base Hospital program has played in the Emergency Room Nurse Triage program, which has successfully contributed to a reduction in wait time for paramedics.

Councillor Morrison asked what advantage the merger with the Sunnybrook and Women's College Health Sciences Centre Base Hospital provided and whether it allowed a paramedic in the field to speak directly with a doctor at a hospital. Rob Theriault, explained that the program was not currently at the stage of facilitating direct communication between the paramedic and the doctor at the hospital. He further noted that in addition to the certification role of the Peel Base Hospital program, it is a North American leader in research involving paramedic procedures and treatments, having published 26 papers in the past few years. Rob Theriault concluded that the Peel Base Hospital program is unique because of its rural and urban mix and its strong continuing education program, factors which were attractive to Sunnybrook and Women's College Health Sciences Centre Base Hospital. Tom Reid, Dufferin-Caledon Ambulance, added that the merger between the Peel Base Hospital with Sunnybrook and Women's College Health Sciences Centre Base Hospital is a local solution that will enhance the current program and serve the community well.

Regional Chair Kolb raised a concern about two cases that had been brought to his attention where an ambulance was directed to a different hospital from the hospital requested by the patient or their family. Kent Gillespie stated that he was aware of the incidents in question and they were currently under investigation. Tom Reid, Dufferin-Caledon Ambulance, explained that there is legislation in place that requires the Ministry of Health Dispatch to direct ambulances to the nearest available appropriate hospital. Further, he noted that the dispatch centre is aware of additional information about the status of the hospital, including information on the resources currently available at that facility, which impacts the hospital an ambulance will be directed to. Rob Theriault, noted that the Base Hospital program is currently developing policies that will allow paramedics to by-pass the nearest available appropriate hospital so that a patient can be taken to a hospital that provides service specific to the condition of the patient.

Councillor Lyons stated that the current capacity of the hospital emergency rooms was not sufficient and that it was responsible for many of the delays experienced by paramedics and the system as a whole. He expressed the importance of getting the new hospital in Brampton built, explaining it was long overdue. Councillor Paul Palleschi informed the Committee, that in his capacity on the William Osler Health Centre Board, he was aware that the agreements were signed and that construction on the new hospital is anticipated to begin in October of 2004. Councillor Palleschi commented that abuse of hospital emergency rooms by non-emergency cases; the failure to quickly move patients out of emergency and into the various units at the hospital; and the reliance on paramedics to provide primary care in the emergency room while staff tend to other cases were all contributing factors to delays currently experienced by the system. He further added that we have seen governments change, but have not seen resolution to this issue. Councillor Palleschi expressed that perhaps the bigger issue is with the bureaucrats within the MOHLTC and that is where the change needs to occur.

Rob Theriault, explained that one of the ethical issues faced by emergency room administrators is how to provide preferential care to the case that has arrived by ambulance so that the paramedics can return to duty when there are a number of patients, all having equally serious conditions, already in the emergency room. Councillor Palleschi said that he understood the current protocol did allow for priority treatment so that the paramedic could return to duty. Kent Gillespie confirmed that to be the current protocol noting that it is currently being monitored for effectiveness.

c) Peel Regional Ambulance Services 2003 Annual Report

Received

Kent Gillespie provided the Committee with an overview of the 2003 Annual Ambulance Services. He included detailed information on factors including Emergency Response Demand; External and Internal Responses (by other services into Peel/by Peel into other areas); Service Coverage Hours; Response Times; Actual Costs and Provincial Funding.

Councillor Palleschi asked for an explanation of the difference between the operating cost per service hour of $140.00 and the incremental cost of $74.72 per service hour. Kent Gillespie explained that the incremental cost does not include overhead, labour market wage increases or additional pay for advanced care paramedics. The Province did include overhead in the base funding, but it has not included it in the funding provided for the increased service hours, making up this shortfall in actual funding cost is the objective behind the request to the MOHLTC for additional funding.

Councillor Morrison questioned why the cost of tiered response was being funded through the Ambulance program. Kent Gillespie explained that the cost of tiered response noted was strictly related to medical supplies for the Fire Services First Responder program which was also downloaded from the Province.

Councillor Palleschi inquired if there would be any transition cost in 2004. Kent Gillespie confirmed that there would be some transition costs associated with bringing the Ambulance Service in house.

5. EMERGENCY PROGRAMS

a) 2003 Annual Report of the 9-1-1 Advisory Committee

RECOMMENDATION EPSC-8-2004:

That the members of the 9-1-1 Advisory Committee be thanked for their ongoing support to the Regional 9-1-1 Emergency Number Service.

Councillor Paul Palleschi expressed thanks to the Members of the 9-1-1 Advisory Committee for their hard work and dedication on behalf of the Emergency and Protective Services Subcommittee (EPSC).

Regional Chair Kolb expressed concern about the fact that 60 per cent of calls received by the 9-1-1 service were miss-dials, non-emergency or prank calls. Councillor Palleschi added that these issues demonstrate the need for more public education in an effort to reduce these occurances.

Councillor Morrison stated that she was very concerned about the issues surrounding "Voice Over Internet" technology and the resulting problems for the 9-1-1 system related to caller information, caller location and local routing of the 9-1-1 call. She asked how this problem might be overcome. Kent Gillespie replied that currently there is no answer to this problem. Councillor Palleschi inquired if "Voice Over Internet" providers are required to provide any notification to users of their service that it is not currently compatible with 9-1-1 service. Kent Gillespie indicated that he did not have sufficient information to answer the question at this time. Councillor Palleschi suggested that the 9-1-1 Advisory Committee needs to lobby for action to address the issues raised by the use of this new technology.

b) Regional Fire Coordinator's 2003 Annual Report

RECOMMENDATION EPSC-9-2004:

That Fire Chief Verrall Clark (Chief Clark retired in August 2003), and his successor, Terry Irwin of the City of Brampton be thanked for their efforts during 2003 in ensuring that the plans of the Fire Departments of the Region of Peel were fully coordinated.

6. IN CAMERA MATTERS

Committee moved In Camera at 10:50 a.m.

a) The receiving of information regarding labour relations or employee negotiations

Committee moved out of In Camera at 11:15 a.m.

7. SCHEDULE OF FUTURE MEETINGS

Thursday, December 16, 2004 - 9: 30 a.m. to 11:30 a.m.
Regional Council Chambers
5th Floor
10 Peel Centre Dr., Brampton, Ontario

8. OTHER BUSINESS

9. ADJOURNMENT

The meeting adjourned at 11:20 a.m.