EMERGENCY AND PROTECTIVE SERVICES COMMITTEE

MINUTES EPSC-2010-1

The Emergency and Protective Services Committee met on Thursday, April 29, 2010, at 9:05 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 M. Morrison

1. DECLARATIONS OF CONFLICTS OF INTEREST - Nil

2. APPROVAL OF AGENDA

RECOMMENDATION EPSC-1-2010:

That the agenda for the April 29, 2010, Emergency and Protective Services Committee meeting be approved.

3. DELEGATIONS/PRESENTATIONS - Nil

Councillor Adams arrived at 9:10 a.m.

4. REPORTS

a) Regional Fire Coordination - Annual Report

RECOMMENDATION EPSC-2-2010

That the 2009 Annual Fire Coordinator’s Report of Andy MacDonald, Fire Chief, City of Brampton, dated March 17, 2010, and attached as Appendix I to the report of the Chief Financial Officer and Commissioner of Corporate Services, dated March 31, 2010, titled “Regional Fire Coordination – Annual Report”, be received;

And further, that Chief MacDonald be thanked for his efforts during 2009.

b) Paramedic Services 10 Year Facility Plan Update

Received

Councillor Mullin asked if the Region is still on schedule for completing the projects outlined in the 10 Year Facility Plan. Peter Dundas responded that the Region is currently on target for all capital projects in the facility Plan.

c) Peel Regional Paramedic Services 2009 Annual Report
Presentation by Peter Dundas, Director, Peel Regional Paramedic Services

Received

Peter Dundas provided an overview of the Peel Regional Paramedic Services 2009 Annual Report.

Peter Dundas reported that Paramedic call volumes continue to grow at four to five per cent per year. The Region received over 80,000 calls in 2009. There were 270,000 paramedic coverage hours for 2009. The additional hours approved by Council will increase this number to over 300,000 hours for 2010.

Peter Dundas stated that, in the Region of Peel, cardiac arrest survival rates are among the highest in Canada. In 2009 there were 35 patients who survived cardiac arrest. These levels of cardiac arrest survival rates are the result of paramedic and fire response defibrillators being available in public places and an increase in the number of people trained in Cardiopulmonary Resuscitation (CPR).

Peter Dundas reported that two significant medical advances were introduced in 2009. The Continuous Positive Airways Pressure (CPAP) procedure allows the airway of a patient to be managed without intubation. CPAP provides better patient outcomes and a reduction in hospital stay times. To date 115 patients have received CPAP intervention. The ST Elevated Myocardial Infarction (STEMI) procedure was used to treat 75 patients in 2009. Currently the majority of patients in the Region of Peel can be transferred to the Trillium Hospital in less than 60 minutes to receive the STEMI treatment. Region of Peel staff are working with Brampton Civic Hospital as they seek to establish a therapeutic centre similar to Trillium Hospital.

Peter Dundas reported that response times in the Region of Peel have been reduced by one minute in 2009. This reduction is the result of additional resources made available by the Region of Peel, and with the funding made available for 2010, response times should continue to decrease.

Peter Dundas stated that offload delay continues to be a challenge to the Paramedic program with over 41,000 hours of offload time in 2009. The Offload Nurse program has helped cap the increase in offload hours to a one per cent growth rate in 2009. The next challenge is to find new methods to reduce the total number of offload hours.

Peter Dundas reported that Unit Hour Activity (UHA) for 2009 was 0.407. He noted that the significant reduction was made possible through additional services and strategic management of the Paramedic program.

Peter Dundas stated that Paramedic Services staff will continue to work on the 10 year capital facility plan as well as the implementation of the Council approved increase of 12,775 staff hours. There will also be a continued focus on addressing offload delays and the expansion of the Offload Nurse program. The Rapid Response program will be implemented in 2010 and Paramedic Services staff will continue to work with the Ministry of Health and Long-Term Care (MOHLTC) to move forward on the Greater Toronto Area (GTA) Central Ambulance Communication Centre (CACC) recommendations. A report related to the GTA CACC recommendations will be presented to the Emergency and Protective Services Committee in September 2010. Paramedic Services staff will continue analyzing historical and projected growth trends and the impact of growth on future budgets and response times.

Councillor Mullin asked what areas in the Peel Region are currently not being serviced by the STEMI program. Peter Dundas responded that due to the increased distances in Caledon there are situations where paramedics are unable to transport patients to the Trillium Hospital in less than 60 minutes. STEMI service for the residents of Caledon will improve dramatically when Brampton Civic Hospital comes on line with a therapeutic centre similar to Trillium Hospital.

Councillor Mullin requested further information on the status of the by-pass agreement with Brampton Civic hospital. Peter Dundas reported that a by-pass agreement with Brampton Civic was completed in late 2009. As a result, patients in the Brampton Civic catchment area can now be transferred to Trillium Hospital for STEMI treatment.

Councillor Mullin asked if it is anticipated that the Brampton Civic Hospital will have a therapeutic centre similar to the one at the Trillium Hospital. Peter Dundas reported that he anticipates that Brampton will have a therapeutic centre within the next year.

Councillor Paterak stated that a significant number of patients in Caledon are transported to Headwaters Hospital in Dufferin County and requested staff to provide response times to Headwater Hospital. Peter Dundas undertook to provide response times for Headwater Hospital to the committee.

Councillor Paterak asked if the Region of Peel contributes financially to the Headwaters Hospital for paramedic ambulance services. Peter Dundas responded that there is currently no cross-border billing agreement for paramedic ambulance services.

Councillor Paterak requested the offload hours for the Etobicoke Hospital be provided to Emergency and Protective Services Committee as Peel Paramedics transport a number of patients to that facility each year. Peter Dundas undertook to provide the information at an upcoming meeting.

Councillor Morrison asked why paramedic response times in Brampton are higher than those in Mississauga. Peter Dundas responded that higher population growth rates in Brampton could be a contributing factor.

Councillor Morrison enquired if the number of unwarranted calls for paramedic service contributes to an increase in response times in Brampton. Peter Dundas reported that 23 to 27 per cent of paramedic calls in the Region of Peel do not result in transporting patients to medical facilities and this situation does contribute to an increase in response times in all three municipalities in Peel.

Councillor Morrison asked if the Region is charging patients for frivolous calls for ambulance service. Peter Dundas responded that the Region does not charge for frivolous calls. The Legal Services Division at the Region looked at the billing issue in 2009 and concluded that the Region could bill for ambulance service but there is no method of enforcement in place.

Councillor Morrison requested an update on the Tactical Paramedic Program. Peter Dundas reported that the Tactical Paramedic Program that involves paramedics working with Peel Police to respond to potentially high risk calls has been a success. Demand for the service has reached a level where staff has been trained for a second unit.

Councillor Morrison asked if the Tactical Paramedic Program is available in Caledon. Peter Dundas responded that Ontario Provincial Police are responsible for Caledon and they have their own tactical paramedic program.

Councillor Paterak stated that lower income levels can have an affect on health status. Poor public health can result in an increase in calls for ambulance services. Janette Smith stated that another contributing factor to the level of emergency calls is the ratio of family physicians and walk-in clinics versus the population. Epidemiology staff in Public Health are working with Paramedic staff to identify the level of inappropriate calls. The Provincial government continues to invest resources to reduce Emergency Room (ER) wait times. The Mississauga-Halton Local Health Integration Network (LHIN) produced a brochure that provides people with other options instead of going to the ER. This brochure was distributed to homes in the Mississauga-Halton LHIN area.

d) New Paramedic Response Time Performance Standards
Presentation by Peter Dundas, Director, Peel Regional Paramedic Services

Received

Peter Dundas reported that the New Response Time Framework standards are scheduled to come in to play on January 1, 2011.

Peter Dundas stated that he will present a report to the Emergency and Protective Services Committee in September 2010 that will identify the critical times that need to be identified for 2011.

Peter Dundas reported that currently the fixed targets for response times for Code 4 emergency calls are based on 1996 performance standards. Eighty per cent of ambulance calls are dispatched as Code 4 emergency calls. The target that was assigned to the Region of Peel to respond to emergency calls was set at 9:32 minutes. Under this system the Region is required to report each year to the Ministry of Health and Long-Term Care (MOHLTC) on the response time for the 90 th percentile. Three to four smaller municipalities are able to meet the 1996 standards while the remaining municipalities in the province continue to have response times for Code 4 calls that are above the targets set for them by the province.

Peter Dundas reported that under the new response time system municipalities will establish targets for response times and report to the Provincial government on those targets each year. The new response time system establishes multiple response time targets based on the acuity levels set by the Canadian Triage Acuity Scale (CTAS). The program requires that the target response times be maintained or modified on an annual basis based on direction from Regional Council. Each municipality will report the results of their target response times to the provincial government by March 31, 2012. The results will be posted on a MOHLTC website.

Peter Dundas stated that the new response time system changes the classification of dispatch priority calls. This current system designates a range of dispatch priorities from Code 4 – Life Threatening to Code 1-Deferable with the responsibility for triage of ambulance calls falling to the CACC. This system will be replaced by the CTAS levels ranging from 1 – Resuscitation to 5 – Non-Urgent with the Paramedic taking on the responsibility of triage through an assessment of the patient when they arrive at the scene. Cardiac arrest calls are part of the CTAS 1-Resuscitation category but are separated from the remainder of resuscitation calls.

Peter Dundas reported that the Region of Peel must determine the percentage of time within six minute response time mandated by the MOHLTC, to have a responder equipped and ready to use a defibrillator at the side of a patient determined to be in sudden cardiac arrest.

Peter Dundas indentified a number of challenges associated with the implementation of the new response time system. The CACC did not have the software to capture the CTAS levels until March 2010 and as a result are still not consistently collecting all CTAS levels. The CACC does not dispatch based on the CTAS system and currently there is no access to cardiac arrest defibrillator arrival data other than for fire emergency responders. Another challenge is related to the new response time system is that although the municipalities control the level of resources applied to meet the standards, those resources are deployed by the CACC. Offload delay and variables of demand can also dramatically affect response times.

Councillor Mullin expressed concern that under the new response time system the category of call for ambulance service will not be determined until the paramedic completes an assessment of the patient and that this system is more complicated than the current method. Peter Dundas responded that this issue has been raised with the MOHLTC.

Councillor Mullin asked what percentage of emergency calls in Peel is a responder able to reach a patient in cardiac arrest within the six minutes response time as set by the Provincial government. Peter Dundas responded that between the paramedics and the area fire services, the paramedics reach cardiac arrest patients in six minutes or less, 60 per cent of the time.

Councillor Mullin enquired if the new system of paramedics determining the CTAS category of the patient at the scene, and later recording that information, will significantly add to the paramedic workload. Peter Dundas responded that paramedics are currently required to complete a number of forms for each call. There will be a learning curve for paramedics as they take on the responsibility of providing additional information but it should not have a significant impact on paramedic workload.

Councillor Paterak stated that there needs to be greater public awareness regarding what drivers should do to move their vehicles out of the way of emergency response units. Peter Dundas responded that emergency vehicles do encounter problems making their way through traffic. There are information displays at local malls which instruct the public to pull over to the right in order to make way for emergency vehicles. Chief MacDonald stated that there is a lack of opportunity to get the message to the public.

Councillor Paterak enquired if people who fail to make way for emergency vehicles are charged with a traffic offence. Chief MacDonald responded that it is a challenge for fire and paramedic responders to record a licence number when they are responding to an emergency call. Chief MacDonald undertook to work with Peel Regional Police and Peel Paramedics to develop additional programs for raising public awareness on this issue.

Councillor Adams stated that the media will focus on the new reporting system and results in Peel will be compared to neighbouring municipalities.

Councillor Adams requested staff provide regular updates on response times in neighbouring jurisdictions through the EPSC. Peter Dundas responded that the MOHLTC will make the 2011 results available to the public on a website in 2012 and undertook to work with neighbouring municipalities to share information in order to provide updates on response times to EPSC meetings.

Councillor Morrison asked if the MOHLTC takes into account the impact rural response times have on the overall response time for municipalities like Peel. Peter Dundas responded that the Association of Municipal Emergency Medical Services of Ontario (AMEMSO) has held discussions with the MOHLTC regarding this matter and there is a working group within AMEMSO looking at categorizing rural, suburban and urban response times within municipalities in order to provide more accurate data.


5. COMMUNICATIONS

a) Deb Matthews, Minister of Health and Long Term Care , Letter dated March 31, 2010, Advising of the 2010/2011 Land Ambulance Subsidy Increase for the Region of Peel

Received

Janette Smith stated that the funding provided by the Provincial government through the Land Ambulance Subsidy was $1.8 million more than what was projected in the Regional budget. She will work with Norma Trim on how best to utilize this additional revenue from the province in terms of the 2010 budget.

Councillor Mullin stated that with the additional revenue provided to the Region, she hopes requests will not be made for major increases during the 2011 budget process.

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, September 23, 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 10:30 a.m.