EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

MINUTES EPSC-2009-4

The Emergency and Protective Services Committee met on Thursday, November 26, 2009, at 10:15 a.m. 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 Councillor P. Mullin

1. DECLARATIONS OF CONFLICTS OF INTEREST - Nil

2. APPROVAL OF AGENDA

RECOMMENDATION EPSC-4-2009:

That the agenda for the November 26, 2009, Emergency and Protective Services Committee meeting be approved.

3. DELEGATIONS/PRESENTATIONS

a) Dr. Sheldon Cheskes, Medical Director, Peel, Sunnybrook Osler Centre for Pre-Hospital Care, Providing the Paramedic Medical Director's Update

Received

Dr. Cheskes provided an overview of the Sunnybrook Osler Centre for Pre-Hospital Care. The Sunnybrook Osler Centre for Pre-Hospital Care is an amalgamation of the previous Sunnybrook Hospital and the Peel Hospital. Sunnybrook Osler Centre for Pre Hospital Care is responsible for medical oversight, training and certification of almost 1900 paramedics in seven regions across the province including Peel; Toronto; Halton; Simcoe; Muskoka; Beausoleil and Rama. A medical council made up of five physicians, a director and program managers oversees activities of the organization.

Dr. Cheskes stated there has been a paradigm shift in pre hospital care and that an increasing number of medical emergencies require Emergency Medical Services (EMS) input. As a result EMS is now integral to discussions on time sensitive medical and surgical emergencies.

Dr. Cheskes outlined a number of innovations taking place with EMS in the Region of Peel. The Resuscitation Outcomes Consortium (ROC) is a large multi-centre trial that is focussed on improving the survival rates for people requiring cardiac arrest and trauma care. The Region of Peel was the first municipality in North America to enrol in the ROC Primed study and the first to use the Cardiopulmonary Resuscitation (CPR) feedback as standard operating procedure. The research consortium has provided both fire and EMS with the most up-to-date defibrillators available and the Region have access to a world class cardiac arrest database. The result is an improvement in patient survival rates.

Dr. Cheskes reported that in the area of Acute Myocardial Infarction (AMI) there is a growing body of literature that indicates the Gold Standard for treatment is direct transfer to a catheter lab for what is known as a percutaneous coronary intervention or an opening of a clogged artery. The key to this treatment is paramedic diagnosis in the field. The Peel EMS has defibrillator technology and training for pre-hospital diagnosis for AMI. Training for this program began in Peel Region in 2008 and the program went into operation in August 2009. To date up to fifty patients have been transferred to the catheter lab for treatment. There has been positive feedback from both the patients and the paramedics and there is a growing acceptance by local interventional cardiologists of the skills Peel paramedics have developed in order to initiate the program. Dr. Cheskes noted that one of the biggest challenges with the program is that the Region has been unable to offer this service to citizens in Brampton. To date, the Region of Peel has been unable to come to a repatriation agreement with Brampton Civic hospital that would allow patients taken to the Trillium hospital where the percutaneous coronary intervention takes place and back to Brampton Civic hospital after treatment. Dr. Cheskes stated that this should be a Regional program that is available to all residents.

Dr. Cheskes provided details on EMS advances in handling acute neurological emergencies and stroke. There is a significant amount of evidence indicating significantly better outcomes for patients who are transferred to a stroke centre in less than 3.5 from the onset of the stroke. Peel EMS is one of the first to by-pass patients to stroke centres.

Dr. Cheskes provided an overview of the EMS response to acute respiratory emergencies. There are significant numbers of patients who are treated for shortness of breath by Peel paramedics. The previous standard of care for people who are short of breath is intubation, or putting a tube down their throat to allow them to breathe. There is new evidence that patients who receive Continuous Positive Airways Pressure (CPAP) for shortness of breath have better outcomes than those receiving intubation. The Region of Peel began developing a protocol in 2007 and training for the CPAP program began in late 2008. In early 2009 all vehicles in Peel Region now have the CPAP equipment. To date over 60 patients have received the CPAP treatment and the feedback has been extremely positive.

Councillor Adams requested a copy of the statistics related to response times and survival rates so that she could share the information with residents. Dr. Cheskes undertook to make the statistics available to Council members.

Councillor Paterak enquired if in a back-fill situation, EMS vehicles in neighbouring regions have the CPAP equipment.

Dr. Cheskes responded that EMS vehicles from neighbouring regions do not have CPAP equipment.

Councillor Paterak stressed the importance of making residents aware of the positive developments outlined by Dr. Cheskes and that a number of press releases from the Region would help get that message to residents.

Councillor Mullin noted that Councillors could include information on the advances made by Peel EMS in upcoming newsletters and asked Dr. Cheskes if he could provide material for that purpose.

Dr. Cheskes responded that he would be pleased to provide members of Council with information related to EMS Programs.

Councillor Mullin requested further information on the lack of progress on obtaining a repatriation agreement with Brampton Civic hospital and what steps Councillors could take to help resolve this situation.

Dr. Cheskes responded that without the repatriation agreement with Brampton Civic hospital the, residents of Brampton suffering from cardiac arrest will not receive the percutaneous coronary intervention that is available to people in Mississauga at the Trillium hospital. Any assistance from Regional Council in obtaining a repatriation agreement would be welcome.

Councillor Mullin asked Peter Dundas if a resolution could be brought forward to Regional Council with respect to a repatriation agreement with Brampton Civic hospital that would allow residents of Brampton access to the percutaneous coronary intervention available at the Trillium Hospital.

Peter Dundas undertook to prepare a recommendation for Regional Council consideration.

Councillor Adams asked why a repatriation agreement with Brampton Civic has not been completed.

Dr. Cheskes speculated that the primary goal of the Brampton Civic hospital is to obtain funding from the provincial government to be able to provide the same type of treatment as that of the Trillium hospital.

Janette Smith advised that a report which would include a recommendation be provided to Council and that there will be opportunities to raise this issue in upcoming meetings with LHIN officials.

Chief MacDonald offered to invite Dr. Cheskes to attend a meeting of the Brampton City Council in order to address the matter.

Dr. Cheskes agreed to speak to the Brampton City Council.

Chair Kolb stated that he has received complaints from residents in Caledon and North Brampton who have been transferred to the hospital in Orangeville instead of the Trillium hospital in Mississauga. He suggested that the matter be addressed with the LHINs.

Councillor Paterak enquired if Trillium hospital has a repatriation agreement with Headwaters hospital.

Dr. Cheskes responded that currently the Region does not have a repatriation agreement with Headwaters hospital.

Councillor Paterak asked if there is a potential capacity issue for Trillium hospital if acute myocardial infarction patients from Brampton begin receiving the percutaneous coronary intervention procedure in Mississauga.

Dr. Cheskes responded that Trillium hospital receives funding from the Provincial government for each percutaneous coronary intervention procedure they provide. There is the potential for capacity issues if a repatriation agreement with Brampton Civic hospital is not completed as myocardial infarction patients would remain at Trillium after they received treatment.

Janette Smith suggested Dr. Cheskes make a similar presentation to Regional Council so that all members of Council could be made aware of the important issues raised at the EPSC meeting.

Councillor Mullin agreed that Dr. Cheskes should make a presentation to Regional Council and that the presentation should take place on a day where there were few delegations scheduled.

4. REPORTS - Nil

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, January 28, 2010, at 9:00 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 11:02 a.m.