EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

The Emergency and Protective Services Committee met on Thursday, June 7, 2007 at 9:40 a.m., in the Council Chamber, Regional Administrative Headquarters, 10 Peel Centre Dr., Brampton.

________________________________
* See text for arrivals
¨See text for departures

Chaired by Councillor R. Paterak

1. DECLARATIONS OF CONFLICTS OF INTEREST - Nil

2. APPROVAL OF AGENDA

RECOMMENDATION EPSC-6-2007:

That the agenda for the June 7, 2007 Emergency and Protective Services Committee meeting be approved.

3. DELEGATIONS/PRESENTATIONS - Nil

4. REPORTS

a) Internet Audio Broadcasting of the Emergency and Protective Services Committee Meetings (Oral)
Presentation by Peter F. Dundas, Director, Peel Regional Paramedic Services

Peter Dundas, Director, Peel Regional Paramedic Services (PRPS) noted that several requests were received from Peel Paramedics to provide internet audio broadcasting of the public portions of Emergency and Protective Services Committee (EPSC) meetings. He explained that due to the nature of their work, Peel Paramedics are usually unable to attend Committee meetings in person.

EPSC members supported the staff recommendation to provide internet audio broadcasting of the public portion of EPSC proceedings.

RECOMMENDATION EPSC-7-2007:

That Internet audio broadcasting of the public portions of the Emergency and Protective Services Committee meetings held in the Council Chamber, commence with the June 7, 2007 Emergency and Protective Services Committee meeting.

b) Update on Feasibility Study (Oral)
Presentation by Peter F. Dundas, Director, Peel Regional Paramedic Services

Received

See also Items 4c and 4d

Peter Dundas provided a status update on the HealthAnalytics Feasibility Report with the primary focus on the "Response Time Framework and Facilities" projects. Peter Dundas further requested direction from EPSC members regarding the timing of the three remaining feasibility projects namely the "Hospital Medic Study", "Deployment and Scheduling" and "System Oversight and Reporting".

Councillor Mullin expressed concern with the direction requested by staff, in light of the fact that a number of EPSC members were absent. She further suggested that it would be helpful if staff provided copies of presentations in advance of the meeting, to allow EPSC members an opportunity to review and raise matters of interest or concern. Janette Smith, Commissioner of Health explained that staff had briefed EPSC Chair Palleschi regarding the presentations and the proposed recommendations. She further committed to briefing EPSC Vice-Chair Morrison regarding the subject matter. Peter Dundas undertook to send copies of the presentations to all EPSC members.

c) Feasibility Study Project: Response Time Framework (Oral)
Presentation by Joe Freedman, Principal, J.D. Freedman and Associates

Received

See also Items 4b and 4d

Joe Freedman, Principal, J.D. Freedman and Associates, provided a summary of HealthAnalytics recommendations on "Response Time Framework". EPSC members were provided with feedback from the stakeholder group sessions and front line paramedics with regard to appropriate response times for Emergency Medical Services (EMS) calls.

Councillor Mullin noted that Fire Chief G. Morden, City of Mississauga Fire and Emergency Services expressed a willingness to explore having qualified paramedics assigned to fire trucks.
He explained that fire departments are most concerned about responding to Code 4 calls which are critical or life threatening emergencies. He noted that fire department staff are also interested in examining other Canadian models, namely, the model that is going to be implemented in Winnipeg. He added that in terms of additional resource investment, staff would need to be cross trained, in addition to the need to develop infrastructure for paramedics.

Councillor Mullin inquired if the Winnipeg model includes joint fire and paramedic facilities. Fire Chief G. Morden responded that as far as he was aware, Winnipeg is using a joint facility model for paramedics and fire services. He further added that there are many successful joint facility models in the United States. He expressed the willingness of Mississauga Fire and Emergency Services to work in partnership with PRPS to implement a solution.

Dr. Sheldon Cheskes, Medical Director, Peel, SunnyBrook Osler Centre for Pre-hospital Care (SOCPC), responded that he is not entirely in support of Fire Chief Morden's comments regarding the Winnipeg model. Dr. Cheskes cautioned that there is no evidence that demonstrates it would be beneficial having trained paramedics on fire trucks. Further, Dr. Cheskes noted that there are a number of American fire - paramedic models, but there are several factors that affect the delivery of medical services in Ontario that do not apply in the United States.

Dr. Cheskes questioned the feasibility of including paramedics as part of fire truck crews. Dr. Cheskes identified the following concerns:

• He explained that the paramedics are required to work a designated number of hours to meet the educational obligations and maintain their skills, and that the paramedics might not meet the required working hours if they are assigned to fire services; and
• Hiring and training costs.

Dr. Cheskes summarized that fire services are an important component in the provision of emergency medical services but, in his opinion, paramedics in the fire service is not the answer.

Councillor Thompson expressed concern with paramedic resources being encumbered by hospital emergency room off load delays. Senior governments need to recognize that the status quo is not an effective use of resources. Dr. Cheskes responded that hospital off load delays for paramedics are tied to hospital procedures with respect to the admission and discharge of patients as well as other pressures for service. Councillor Paterak commented that the misuse of Paramedic Services when staff is inappropriately deployed is very frustrating. He requested that this message be emphasized and reiterated to the Province, in particular, as it relates to Central Ambulance Communication Centre (CACC).

Fire Chief G. Morden responded that he understood the philosophy of Dr. Cheskes. He noted that with regard to the HealthAnalytics report findings that the area municipal Fire Services want to work in partnership with PRPS to find solutions to the issues identified. He suggested that a cost and benefit analysis be undertaken in order to gain a better perspective on the utilization of fire resources for priority medical calls. He further added that as far as answering the question if paramedics will make a difference in the fire service, it is important that the life safety of the patient is considered and prioritized accordingly.

Members of the Committee supported the following recommendation.

RECOMMENDATION EPSC-8-2007:

That Regional Council decline the following HealthAnalytics recommendations:

• for the highest priority emergency calls (Code 4 Tiered response) where both ambulances and fire trucks are dispatched using red lights and sirens (i.e. life threatening emergencies) the emergency medical services (EMS) first system response be set at six minutes, at least 90 per cent of the time;
• where Fire departments are the first responders, the EMS first response standard be set at six (6:00) minutes and the Peel Regional Paramedic Services (PRPS) response standard be set at twelve (12:00) minutes, and that these timeframes be achieved at least 90 per cent of the time;
• for all other emergency responses of a non-life threatening nature (Code 4 Non-Tiered Response) where only an ambulance is dispatched using red lights and sirens, HealthAnalytics recommends a response time standard of twelve (12:00) minutes, at least 90 per cent of the time

And further, that the Ministry of Health and Long-Term Care implement a new call triage protocol based on the Medical Priority and Dispatch System (MPDS) model that will allow improved call triaging;

And further, that the Regional Chair contact the Minister of Health and Long-Term Care to express the need for the Ministry to act expeditiously in this regard;

And further, that the implementation of any revised EMS or ambulance response time targets for the Region of Peel be established upon the implementation of the new call triaging and vehicle dispatch system which accurately delineates and triages emergency calls, and effectively integrates the call intake and vehicle dispatch functions;

And further, that in the context of developing an effective call triaging system, the Region work towards, and provide the resources necessary to achieve response times of five (5:00) minutes at the 90th percentile for EMS system first response;

And further, that these targets apply to the most urgent conditions which may include the following:

a. Cardiac Arrest/VSA
b. Major Trauma (including penetrating trauma)
c. Shock
d. Near Death Asthma
e. Severe Respiratory Distress
f. Unconscious/Unresponsive
g. Seizures
h. Real or apprehended heart attack/chest pain.

And further, that at such time as the call triaging and vehicle dispatch system is available for implementation, a process be undertaken by program staff, in consultation with identified stakeholders, to establish appropriate response time targets for all other call triaging classifications, and report these targets to EPSC for direction;

And further, that Regional Council reaffirm its position as set out in Resolution 2006-1149 that the Province implement a media campaign to prevent the misuse of Paramedic Services for calls which can be addressed through other healthcare agencies.

d) Feasibility Study Project: Facilities (Oral)
Presentation by Joe Freedman, Principal, J.D. Freedman and Associates and Alan Tregebov, Architect, AJ Tregebov

Received

See also Items 4b and 4c

Councillor Adams arrived at 10:40 a.m.

Councillor Mullin inquired as to the average time per day paramedics spend at stand-a-lone paramedic facilities. Peter Dundas responded that paramedics on average, may spend two to three hours per 12 hour shift at stand-a-lone stations. He noted that this is part of the reasoning staff is proposing a divisional model for paramedic deployment.

Councillor Mullin asked if any of the 11 current sites need financial investment for renovations or upgrades. Peter Dundas replied that decisions will need to be made regarding some co-location opportunities with area municipalities as well as the future of the 52 Bramalea Road ambulance station in Brampton.

Councillor Mullin inquired as to why 40 parking spaces are required for reporting at a divisional station, as recommended in the presentation. Allan Tregebov, Architect, AJ Tregebov noted that parking would need to accommodate overlapping shift complement at the divisional station, along with the needs of administrative staff. The increased divisional parking requirements would then eliminate parking need at the satellite location, making co-location with fire services more manageable from a land uses perspective.

Councillor Mullin inquired as to how much current capital funding is allocated for paramedics facilities. Stafff advised that there is currently about 2.9 million in capital funding, which has been increased over the past two years. The capital contribution is funding a program of capital replacement which includes vehicles, equipment and facilities. The next step is a long term facility plan with a ten year capital plan brought forward during the budget process.

Councillor Mullin expressed concern that there may not be sufficient funding to meet the facilities needs and inquired if the Province is meeting its funding commitments. R. Kent Gillespie responded that the Province is meeting approximately 47 per cent of its funding commitment.

Dan Labrecque noted that one of the priorities for staff is to submit a report to Council regarding paramedic facilities funding options prior to the 2008 Budget process.

Councillor Mullin noted that Councillor Morrison had expressed concerns about the gaps in paramedic deployment resulting from off-load delays as well as deployment models for Caledon. Janette Smith, Commissioner of Health undertook to follow up with Councillor Morrison regarding her concerns.

Members of the Committee supported the following recommendation.

RECOMMENDATION EPSC-9-2007:

That a Divisional Model be adopted as the basis for development of EMS facilities in Mississauga and Brampton for the period 2008 to 2017;

And further, that the current Station-Based Model in Caledon be maintained;

And further, that staff work with Finance to develop a ten year capital plan for EMS facilities;

And further, that staff continue to investigate, with the appropriate municipal Fire Services or Peel Regional Police, EMS developments in the eight locations identified in Table 5 of the Feasibility Study Project: Facilities presentation.

5. COMMUNICATIONS

a) Terri L. Burton, President, Association of Municipal Emergency Medical Services of Ontario (AMEMSO), Letter dated May 1, 2007 to Malcolm Bates, Ministry of Health and Long-Term Care, Requesting Direct Electronic Access to the Central Ambulance Communications Centre (CACC) Data

Received

RECOMMENDATION EPSC-10-2007:

Whereas, the ability of Peel Regional Paramedic Services (PRPS) to obtain timely access to complete and accurate data from the provincially operated Central Ambulance Communication Centre (CACC) has been a major concern to the Region of Peel for several years;

And whereas, data from CACC related to PRPS continues to be corrupt or inaccurate;

And whereas, such data is essential for quality assurance and service planning;

And whereas, the Association of Municipal Emergency Medical Services of Ontario (AMEMSO) has written to the Ministry of Health and Long-Term Care (MOHLTC) to request that municipalities that provide EMS services be given direct access to CACC data;

Therefore be it resolved, that the request from AMEMSO to the MOHLTC to permit municipalities to have a direct electronic interface with CACC data, contained in the letter from the AMEMSO to the MOHLTC dated May 1, 2007, be endorsed;

And further, that the Regional Chair write to the Minister of Health and Long-Term Care in support of this request;

And further, that a copy of the subject resolution be forwarded to the AMEMSO and Peel area MPPs.

6. OTHER BUSINESS - Nil

7. SCHEDULE OF FUTURE MEETINGS

Thursday, October 11, 2007
9:30 a.m. to 12:00 p.m.
Regional Administrative Headquarters
Council Chamber, 5th Floor
10 Peel Centre Dr.
Brampton, Ontario

8. ADJOURNMENT

The meeting adjourned at 11:30 a.m.