EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

MINUTES EPSC-2009-3

The Emergency and Protective Services Committee met on Thursday, September 17, 2009, immediately following the Regional Council Meeting in the Council Chamber, Regional Administrative Headquarters, 10 Peel Centre Drive, Suite A, Brampton.

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* See text for arrivals
¨See text for departures

Chaired by E. Kolb

1. DECLARATIONS OF CONFLICTS OF INTEREST - Nil

2. APPROVAL OF AGENDA

RECOMMENDATION EPSC-2-2009:

That the agenda for the September 17, 2009, Emergency and Protective Services Committee meeting be approved.

3. DELEGATIONS/PRESENTATIONS - Nil

4. REPORTS

a) Peel Regional Paramedic Services 2008 Annual Report System Update
Presentation by Peter Dundas, Director, Peel Regional Paramedic Services

Received

Peter Dundas provided an overview of the Peel Regional Paramedic Services 2008 Annual Report System Update.

Peter Dundas reported that of the 74,258 emergency calls received in 2008, 59 per cent were from Mississauga, 38 per cent from Brampton and 3 per cent from Caledon. There were 955 cardiac arrest calls received in 2008 and of those, 36 survivors fully recovered. Peter Dundas attributed the increase in cardiac arrest survivors to the partnerships with emergency and hospital staff in the Region of Peel. The 90th response time to emergency calls increased to 12.38 minutes in 2008. This increase is the result of a continued increase in call demand, offload times at area hospitals and increased traffic congestion in the Region of Peel. The 90th response time for each of the three municipalities within the Region of Peel were as follows:

• Caledon - 14.24 minutes;
• Brampton - 11.38 minutes;
• Mississauga - 11.55 minutes.

Peter Dundas stated that the Unit Hour Activity (UHA) for 2008 was 0.45. This figure is the result of increased call demand and continued offload time for paramedics at area hospitals. The goal over the next five years is to reduce the Unit Hour Activity to 0.35. Peter Dundas reported that the Ministry of Health and Long-Term Care met its commitment to provide 50 per cent of paramedic operating costs in 2007 and 2008.

Peter Dundas provided a 2009 system update. The Greater Toronto Area (GTA) Central Ambulance Communication Centre (CACC) review will be completed in October 2009. The focus of the final report which is being prepared by consultants will be on governance models, technology and triage tools.

Peel Regional Council approved funding for an additional 29,000 paramedic hours in 2009. Two-thirds of those 29,000 approved additional hours were implemented in the spring of 2009. During the period of January to July 2009 call volumes increased by three per cent for emergencies and two per cent for non-emergency calls. Patients required transportation to a hospital on 60 per cent of calls made to emergency services. Offload delays for paramedic staff at area hospitals continue to be an issue. The number of paramedic offload hours for 2009 increased by three per cent when compared to the totals for 2008. The Offload Nurse program played a major role in holding the paramedic offload hours to only a three per cent increase in 2009.

Peter Dundas reported that the additional paramedic hours approved by Regional Council has resulted in a reduction of Unit Hour Activity to 0.41 by the end of 2009. Response times to emergency calls continue to increase. From January to July, 2009 approximately 6,867 paramedic hours were passed on to offload nurses. The result of the $370,000 investment by the Region of Peel in the Offload Nurse program will potentially save over $2 million in paramedic services by the end of 2009. There are however, 44,000 hours of paramedic time still spent on offload at area hospitals. Senior staff continue to meet regularly with both Local Health Integration Networks and hospitals to address offload delays and support the implementation of the Emergency Room wait time strategy.

Peter Dundas provided details on the Paramedic Rapid Response plan. The program involves a single paramedic in a vehicle, strategically located within the Region of Peel, based on demand. Paramedics respond to emergency calls only and do not transport patients to hospital. The single paramedic is authorized to cancel transport ambulances when not required and will immediately clear the call when the transport unit arrives and be ready for the next emergency call.

Benefits of rapid response include:

• Fast response to the patient;
• No entanglement with hospital offload delays;
• Alleviates system pressures and improves UHA;
• Reduces legislated response time;
• Maintains coverage for each municipality within the Region;
• Prepares for the 2011 Response Time Framework accountability for mandatory public reporting;
• Reduction of code capacity and critical capacity.

Peter Dundas reported that funding for the rapid response plan would come from the remaining one-third of the 29,000 additional paramedic service hours approved by Regional Council for 2009.

Councillor Mullin expressed concern regarding the amount of information being presented and directed staff to provide material for presentation to EPSC members, prior to the meeting. Peter Dundas responded that materials for future EPSC meetings will be included with distribution of the agendas, one week prior to the meeting.

Councillor Mullin requested details on the GTA Central Ambulance Communication Centre (CACC) review and inquired if the Region of Peel would be assuming responsibility for ambulance communications. Peter Dundas responded that it was unlikely that each municipality in Ontario would receive provincial funding for their own individual communications centre. Currently, there are three provincial communication systems within the GTA and the CACC review will be looking at which system would best serve the area.

Chair Kolb asked for an update on the pilot projects underway in Ottawa and the Niagara Region. Peter Dundas responded that the Ottawa program is a contract arrangement similar to communication centre operations across Ontario. The Niagara Region pilot will not release results of a review of the program until the end of 2010 or early 2011.

Councillor Mullin expressed concern that the Offload Nurse program is not generating the anticipated results and asked when Paramedic Services will be reporting to the Ministry of Health and Long-Term Care (MOHLTC) on the program. Peter Dundas responded that Paramedic Services is required to report quarterly to the MOHLTC and that staff will continue to meet with LHINs and hospitals on maximizing the benefits of the Offload Nurse program.

Councillor Mullin requested that staff provide further detail on how the Region of Peel will report to the MOHLTC on the challenges with the Offload Nurse program. Janette Smith indicated that the Offload Nurse Program was raised by members of Intergovernmental Relations Advisory Committee (IRAC) and senior staff at the recent AMO meeting and a follow up meeting is being held with the MOHLTC.

Councillor Adams asked if the Rapid Response Paramedic plan is currently operating in other municipalities in Ontario. Peter Dundas responded that the Rapid Response Paramedic program is currently operating in Ottawa, Toronto, York Region, Hamilton and the Niagara Region.

Councillor Adams requested information on the type of equipment each Rapid Response Paramedic would carry with them. Peter Dundas responded that each Rapid Response Paramedic would carry similar medical equipment to the ones on board an ambulance.

Councillor Adams enquired if the Rapid Response Paramedic will reduce the transport time for patients suffering from cardiac arrest. Peter Dundas responded that the Rapid Response Paramedic and the transport vehicle are both dispatched to an emergency call. The Rapid Response Paramedic would reach the patient first, assess the situation and begin treating the patient. The result of the work by the Rapid Response Paramedic would make the cardiac patient ready for transfer to the hospital when the transport ambulance arrives.

Councillor Adams asked if paramedics could be placed on fire vehicles in order to improve response times. Councillor McFadden noted that in Winnipeg, Manitoba paramedics are currently part of the fire emergency team and this model should be studied. Peter Dundas responded that staff would follow up with the Medical Director on this issue.

Peter Dundas reported that the 2010 Paramedic Services budget will focus on infrastructure and transition; paramedic service hours and annual capital needs. The 2010 budget related to infrastructure and transition includes supports for the successful implementation of the facility plan that has been developed to address issues related to response time; growth, paramedic stressors and effectively matching skills and competencies to the paramedic position. A key component of the infrastructure and transition section of the 2010 Paramedic Services budget will be hiring technicians who will be responsible for maintaining all fleet vehicles; controlling inventory and restocking; decontaminating ambulances and maintaining essential equipment. Internal Audit recommendations to Paramedic Services included hiring additional staff to measure, manage and mitigate risk. There will also be a need to bring on a Contract Project Manager and supports for approximately three years to manage implementation of the organizational and delivery change. In the area of paramedic service hours, the 2009 UHA projection is 0.41. The 2010 target for UHA is a reduction to 0.38 with an additional 28 paramedic positions. There will be no additional funding required for the 2010 Facility Capital Plan.

b) Paramedic Services 10-Year Facility Plan

RECOMMENDATION EPSC-3-2008

That The Regional Municipality of Peel enter into a Memorandum of Understanding with The Corporation of the City of Mississauga to commence design and construction of a co-located Fire and Paramedic Satellite Station located at 1355 Winding Trail, in the City of Mississauga;

And further, that The Regional Municipality of Peel enter into a Memorandum of Understanding with The Corporation of the City of Mississauga to commence design and construction of a co-located Fire and Paramedic Satellite Station at 7101 Goreway Drive, in the City of Mississauga;

And further, that the Commissioner of Health Services be given the delegated authority to execute the Memorandums of Understanding and any and all other documents and agreements relating to the co-locate Fire and Paramedic Stations referred to herein, including but not limited to the construction agreements, agreement of purchase and sale, design agreements, leases, project payments, and/or co-tenancy/joint ownership agreements.

Councillor Mullin requested details on the divisional facilities model and inquired where the $45 million in capital funds will be invested. Peter Dundas responded that the divisional facilities model approved by Regional Council originally called for six reporting stations. He advised that program staff have reviewed the proposal and determined that four reporting stations would provide the required coverage. The 10 year capital plan will be revised to incorporate improved program cost estimates. These estimates will be included in the 2010-2019 Capital Budget for council’s consideration.

Councillor Mullin requested a chart that includes the federal and provincial infrastructure investments along with the 10-Year Facility Plan.

5. COMMUNICATIONS - Nil

6. IN CAMERA MATTERS - Nil

7. OTHER BUSINESS - Nil

8. NEXT MEETING

The next meeting of the Emergency and Protective Services Committee is scheduled for Thursday, November 26, 2009 at 10:30 a.m., Regional Administrative Headquarters, Council Chamber, 5th floor, 10 Peel Centre Drive, Suite A, Brampton, Ontario.

Please forward regrets to Ralph Martin, Legislative Specialist, (905) 791-7800, ext. 4330 or at ralph.martin@peelregion.ca

9. ADJOURNMENT

The meeting adjourned at 2:05 p.m.