EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

MINUTES EPSC-2009-1

The Emergency and Protective Services Committee met on Thursday, January 29, 2009 at 10:38 a.m., in the Council Chamber, Regional Administrative Headquarters, 10 Peel Centre Drive, Suite A, Brampton.

________________________________
* See text for arrivals
¨See text for departures

Chaired by Councillor Morrison.

1. DECLARATIONS OF CONFLICTS OF INTEREST - Nil

2. APPROVAL OF AGENDA

RECOMMENDATION EPSC-1-2009:

That the agenda for the January 29, 2009 Emergency and Protective Services Committee meeting be approved.

3. DELEGATIONS/PRESENTATIONS

a) Dedicated Offload Nursing Project
Presentation by Peter F. Dundas, Director, Peel Regional Paramedic Services

Received

Peter Dundas, provided an overview of the Peel Regional Paramedic Services, System Response in the community.

Peter Dundas outlined the principles of the paramedic service in the province of Ontario as outlined by the Ministry of Health and Long-Term Care. Paramedic service must be seamless in order to provide emergency coverage for all Ontario citizens. As a result of this policy, the most available ambulance by time, not distance will be directed by the Central Ambulance Communications Centres (CACCs) to respond to an emergency call regardless of municipal borders. The CACCs are operated by the Ministry of Health and Long-Term Care and paramedics are not permitted to refuse a call from communications centres. CACC also captures all emergency call data which is provided by the Ministry of Health and Long-Term Care to the Region. Region of Peel staff review the data provided from the CACCs for accuracy and use the information to manage the paramedic system and develop future budget requirements. The Region of Peel adopted the current deployment strategy for emergency coverage in 2005. The deployment strategy directs paramedic staff to cover a specific catchment area within the region in order to respond to calls in the shortest period of time.

Peter Dundas provided detailed definitions of the four levels of response codes used in the paramedic system.

• Code 1 is a non-urgent, unscheduled patient transfer for a patient requiring ongoing medical care or a low acuity response back to the hospital;
• Code 2 is a scheduled inter-facility transfer of a patient requiring ongoing medical care, usually from one acute care facility to another;
• Code 3 is a prompt, non-life threatening call where the patient is in pain and suffering from broken bones, sprains, falls, minor bleeding or burns, nausea or vomiting and chronic abdominal pain;
• Code 4 is an urgent, life threatening situation where the patient has suffered a cardiac arrest, lost consciousness, has difficulty breathing, suffers severe bleeding or burns as well as child birth.

Peter Dundas stated that under Ministry of Health and Long-Term Care legislation, there can be a delayed response to a Code 3 call but there can be no delay in responding to Code 4 calls.

Peter Dundas reported that Code 4 (life threatening) calls make up 80 per cent of the dispatches coming from the CACCs. This has a severe impact on paramedic services meeting the legislated response time of 9:32 minutes for a Code 4 call. From November 1, 2007 to October 31, 2008 there were 63,798 Code 4 dispatches in the Region of Peel with only 7,000 of these calls returned to local hospitals as a Code 4 case. As a result, there is an urgent need to review how the CACCs triage calls.

Peter Dundas provided an outline of the Region of Peel deployment strategy. The objective of the deployment strategy is to provide balanced coverage and response to the citizens of Peel. There are two key elements to the deployment strategy. The first key element is coverage, which refers to the paramedic units being available for the next emergency call. As resources respond to calls, the remaining units are redistributed throughout the Region based on highly predictable statistical data which allows paramedic staff to plot where the next emergency call will come from. Coverage is secondary to the other key element of the deployment strategy which is response. In 1996, the Ministry of Health and Long-Term Care implemented a legislative standard, directing municipalities to respond to Code 4 calls within 9:32 minutes. Response times for Code 3 calls can be delayed if the paramedic system is overloaded.

Councillor Paterak departed at 11:00 a.m. due to other municipal business.

Peter Dundas outlined how the deployment strategy is developed. Call volumes and response time data is applied to a map of the Region. Paramedic vehicle positions are determined based on the frequency of call volumes and the ability to achieve required response times. These vehicle positions are defined as zones. Paramedic services have developed a formula to adapt these zones to maintain as much coverage as possible as units respond to emergency calls. As Regional resources are assigned calls and coverage is decreased, the CACC will contact paramedic units in other municipalities to respond to calls in the Region of Peel. In 2007, there were 78 events where the Region of Peel reached code capacity, where there were no Peel ambulances available to respond to emergency calls. In 2008, with the data available, there were 35 events where code capacity was reached.

Chair Kolb departed at 11:17 a.m. due to other municipal business.

Peter Dundas reported that Code 3 and Code 4 response times continue to increase in the Region of Peel. Response times in Caledon are greater than those in Mississauga and Brampton due to the greater distances paramedic units are required to travel to emergency calls.

Councillor Morrison thanked Peter Dundas for his presentation and stated that she has a concern that when the Region reaches code capacity, that paramedic units from neighbouring municipalities are required to respond to calls who are not familiar with the distances and topography of the Caledon area.

Councillor Morrison requested data that captures the severity of emergency calls for Mississauga, Brampton and Caledon. Councillor Palleschi asked if it would be possible for Paramedic staff to break down the Code 3 and Code 4 calls by municipality in order to provide Councillor Morrison with the information she required. Peter Dundas responded that Regional staff would provide this data to the committee.

Councillor Morrison asked if the four per cent of calls in Caledon where response time is more than twenty minutes are the result of the Region of Peel reaching code capacity. Peter Dundas responded that there are a variety of reasons why response times are over twenty minutes in those cases, ranging from a lack of proper addresses to the greater distances that need to be travelled in order to respond to emergency calls.

Councillor Mullin requested further details on the process involved with the MOH supplying the Region of Peel with emergency call data. Peter Dundas responded that there are regular delays in the monthly data supplied by the MOH. Once the month data is provided by the CACC, Regional staff would then review the material for accuracy and return the clean data to the CACC.

Councillor Mullin stated that new business model for the provincial CACC system is required and enquired as to the timelines set for adopting changes. Peter Dundas responded that the provincial government is currently operating a five year pilot project in the Niagara region which will be concluded in June, 2010. The provincial government plans to study the results of the pilot project before making any changes to the current CACC system. The Region of Peel along with the Halton, Durham, York regions and the County of Simcoe awarded a joint contract to Polmax and Stantech Communications, a company that specializes in emergency service delivery and communications. They are in the process of studying the current CACC system and will deliver a report including a recommendation for a future model for dispatch service in the spring of 2009. The report will be brought before the councils in all five of the municipalities for review and direction.

Councillor Mullin requested that Regional staff provide all members of Regional council with the details related to the current study undertaken by Polmax and Stantech Communications. Peter Dundas responded that Region staff would provide Regional council members with this information.

Councillor Adams asked if the cleaned data provided by Region of Peel staff to the CACC is used to update their statistics. Peter Dundas reported that the CACC makes occasional updates to their statistics based on the information from the Region but there is not an established system in place for consistent changes.

Councillor Adams requested Regional staff provide data on comparing average response times in Malton to those in the rest of Mississauga. Peter Dundas undertook to provide this data to the committee.

Councillor Adams requested data related to the number of times Toronto paramedics respond to emergency calls in the Region of Peel. Peter Dundas responded that Regional staff will provide this data to the committee.

Councillor Palleschi asked if neighbouring municipalities experience the similar levels of code capacity as those found in the Region of Peel. Peter Dundas indicated that neighbouring municipalities have a variety of deployment strategies and that makes comparing the levels of code capacity difficult to compare.

Councillor Adams departed at 11:48 a.m. due to other municipal business.

Councillor Morrison departed at 11:48 a.m. due to other municipal business.

Councillor Mullin departed at 11:48 a.m. due to other municipal business.

A quorum of voting members was lost and in accordance with Section 111-4 of the Procedural By-law 57-2006, as amended, the meeting stood adjourned at 11:48 a.m.

 The items of business listed on the agenda as published, and which were not dealt with, shall be placed on the agenda of the Emergency and Protective Services Committee meeting to be held on May 21, 2009.