Paramedic Changes in CaledonIt IS About Life and Death

Paramedics deal with life and death every day. That's why we run a system designed to best maintain community safety while considering the cost to the taxpayers. The full implementation of our divisional model addresses the growing health care needs of the Peel community, while ensuring system sustainability and improving efficiency.

Questions and Answers

Divisional Model and Its History

What happened in January 2019?

In January 2019, we fully transitioned to our divisional model. That means paramedics that used to report to work in Caledon now report to work at one of our four reporting stations. Twenty-four-hour emergency coverage for all parts of Peel, including Caledon, is being maintained like before.

Aren’t the divisional model and the deployment plan the same thing?

No. The divisional model is about buildings (stations) and deployment is about placing paramedics in the community.

The divisional model includes the number, size and location of stations. In January, our fourth and final reporting station opened and we now use the divisional model across all parts of Peel.

Our deployment plan puts the right number of paramedics in the right place at the right time to get to medical emergencies as fast as possible. It's fluid which means it changes with the number of ambulances available in the region, increased call volumes, large-scale events and other factors.

Since moving to the divisional model in January, our deployment plan continues to prioritize Caledon because of its unique geography.

Why a divisional model and not another style?

Expert consultants recommended a divisional model to best maintain community safety while considering the cost to the taxpayers. Specifically, it was adopted because it was the best way to:

  • meet the growing health care needs of the Peel community,
  • get paramedics to emergencies faster,
  • improve efficiency and
  • achieve system sustainability.

Regional Council adopted the divisional model in 2007.

How does the divisional model help paramedics get to emergencies faster?

All stations are strategically located in areas with a higher volume of emergency calls. When paramedics are not with a patient, they will wait for their next emergency at a satellite station – shortening the distance between paramedics and emergencies.

Wasn't the divisional model just for Brampton and Mississauga?

No. It was to be first introduced in Brampton and Mississauga. Caledon was to remain with stand-alone stations until such time that call demand increased and it made sense to move to the divisional model there. That decision happened in late 2008 when it became clear that call volumes were increasing faster than original projections.

How do you create your deployment plan?

It's a mathematical model that best predicts where and when 911 calls are most likely to occur. It factors in time of day, population/location, historical trends, geography and our Council-approved response time framework (mandated time targets to get to calls). A regular team of union, paramedics and operational staff meet regularly to adjust the deployment plan, as needed.

Our plan is used by the Provincial Dispatch Centre to optimally place ambulances where calls are likely to come in and backfill zones when ambulances respond to 911 calls.

How will you make sure there are no gaps in ambulance coverage?

There are multiple shift start times built into the deployment plan, both in the morning and at night. That means the oncoming paramedics will be in Caledon before the paramedics ending their shifts are back at the reporting station. During each shift, ambulances are moved into zones to cover other ambulances that respond to calls. This is done on a minute-by-minute basis to make sure paramedics are in the right place at the right time.

How We Respond to Calls and Our Response Time Targets

What happens when I call 9-1-1?

When you dial 9-1-1, a trained professional will answer your call and then connect you to Ambulance, Police or Fire depending on the emergency.

When you ask for an ambulance, you will be connected to the Provincial Dispatch Centre. If the situation is life threatening, the person will send help and provide immediate life-saving instructions by phone. If the situation is not life threatening, more questions will be asked to help guide responders.

When paramedics arrive on the scene, they'll need to know the injured/ill person's medications, past medical history and Ontario Health Card number.

Visit 9-1-1 Emergency Service for more information about 9-1-1 calls.

Where will help come from?

Minutes matter for all life-threatening emergencies, such as a cardiac arrest, so both paramedics and firefighters are sent to your location. It's part of a signed agreement between us and all local fire services.

If firefighters arrive on scene first, they will start life-saving measures, including the use of CPR, a defibrillator, Epi pen or Naloxone. Paramedics will take over when they arrive.

The provincial dispatchers control the minute-by-minute movement of ambulances and will send the closest available one to the scene. That means that the paramedics providing coverage in Caledon will respond to a Caledon emergency.

The important part is that medical help arrives fast, not which ambulance service it is.

Will fewer paramedics and ambulances serve Caledon in the divisional model?

No. The same number of paramedics and ambulances are assigned to serve Caledon each day as are assigned today. That number will increase as call volume increases over time.

What is the definition of response time for emergency calls?

Response time is measured from the time the paramedics get the call from the Provincial Dispatch Centre to the time they arrive on scene. Response times are set for all of Peel and then approved by Regional Council every year.

What are your response times?

Our historic response time rates can be found here (please select Peel from the list marked UTM/DDA/FA). Current targets (2017 and Jan-May 2018) can be accessed here (page 287 of the PDF).

What will happen if an ambulance heading to Caledon at shift change is immediately sent to a life-threatening call, either in Caledon or elsewhere?

The next available ambulance will be quickly sent to replace it. And the ambulances still on shift in Caledon will be required to stay in the town, even if it means overtime. Safety matters most.

What happens if a life-threatening call comes in during a shift?

The closest ambulance responds. Then the next available ambulance replaces it, just like happens today in the current system. If the replacement ambulance gets a call, another one is sent to cover. Dispatchers will also look for the closest ambulance in Dufferin, Simcoe, York and/or Halton to move closer to Caledon's border. This will shorten the distance to respond to a potential emergency in Caledon.

This is all part of our deployment plan, which puts the right number of paramedics in the right place at the right time to get to medical emergencies as fast as possible.

How often do Peel Paramedics get life-threatening calls?

More than 70% of all calls to our paramedics are dispatched as life threatening. But under 15% are transported to hospital as life threatening. Dispatchers routinely over-prioritize calls because the triage tools they use are very limited and they have no other option.

In areas like Toronto and Niagara where dispatchers have better tools, the number of life-threatening calls is significantly lower (approx. 40% and moving toward even lower targets). This means there is less unnecessary stress on the system and the people who work in it.

We are working with the Provincial dispatch to get dispatchers the tools they need to better triage 9-1-1 calls. This has been a key advocacy priority for Regional Council for several years.

Centralized Ambulance Cleaning and Stocking

Why can't paramedics clean and stock their own ambulances?

They can. But like you, we want every paramedic on shift to be immediately available to save lives, not cleaning ambulances after bad calls. We have special experts trained to look after cleaning and stocking. Not only does centralization of this task free up paramedics, but it also saves taxpayers money because we can better manage inventory and maintain equipment, including stretchers, defibrillators and more.

Caledon paramedics already take their ambulances to a divisional reporting station for major cleaning by our logistics technicians. There, they pick up a clean, stocked ambulance and get back on the road quickly. Of course, our deployment plan makes sure Caledon is well covered when these switches are made.

Is your centralized restocking process reliable?

Yes, and it is continuously evaluated for improvements. Logistics Technicians at our reporting stations follow a standardized process to make sure every ambulance and paramedic bag is filled with the appropriate supplies.

Errors or omissions are corrected immediately and the process is revised, if appropriate. This helps prevent human errors that could occur in stand-alone sites where standardization is harder. There are no medical supplies stored in satellite stations.

Why is centralized stocking and cleaning done by skilled technicians better than having paramedics do it?

Centralized stocking and cleaning done by skilled experts allows paramedics to do what they do best – save lives. It also allows for us to have strong quality control measures in place that catch human errors. The quality control measures currently in place in Caledon aren't as strict as in the reporting stations.

Questions from Caledon Residents

What is the out of deployment pilot project?

To help maintain community confidence, Peel Regional Paramedic Services created a pilot project as we transitioned to the new divisional model in Caledon.

The pilot involves the first two ambulances leaving the reporting station on Fernforest Drive in Brampton at 5:30 a.m. heading directly to Caledon. Those ambulances will be out of deployment until they are into Caledon. An ambulance will only be diverted while on route in the case of an urgent (code 4) call at which point another ambulance will be assigned for coverage.

This pilot will further prioritize paramedic coverage in Caledon within the larger system during this time of transition. We will carefully evaluate this pilot project with our front-line paramedics and the Ministry of Health and Long-Term Care to determine its utility.

Why are you taking away Caledon's paramedics?

We aren't. We save lives. We don't put them at risk. We are only changing the place paramedics report to work. There will still be paramedics in Caledon every day, ready to respond to medical emergencies there. Caledon will continue to have priority in our deployment plan (the method to assign paramedics around Peel) because of its unique geography.

Why isn't there a reporting station in Caledon, just like in Brampton?

It takes about 35,000 calls each year to add a reporting station to the system. Right now, there are about 7,000 calls in Caledon every year. Caledon may be large in geography, but right now, call demand doesn't support a reporting station. That may change in the future if call demand increases significantly.

Why build smaller stations in Caledon if they are always empty?

Our stations in Bolton, Caledon East, Valleywood and Caledon Village are an important part of our system. These stations are places where paramedics can complete their paperwork or take a much-needed break. Paramedic services are fluid. Ambulances may be out on a call or moving around the community or geographic zone where they are assigned. That's why the stations may be empty at the time you drive by. At other times, you may see an ambulance parked inside.

What happens when ambulances in Caledon are busy with calls?

Dispatchers constantly move ambulances to make sure every area is well covered in the event of an emergency. They will move available ambulances from further south into Caledon to provide emergency coverage in case another call comes in.

Isn't it better to have paramedics who know Caledon roads than someone from the city?

It is impossible for every paramedic to know every road in every city or town, even if they live there. That's why paramedics across Peel rely on information from their dispatcher and navigational technology to get to locations. During a 911 call, it's important to give the street address and the closest crossroad/intersection to help the dispatcher guide the paramedics in.

Have you factored bad weather and rural driving into your plan?

Yes. The multiple shift start times built into the deployment plan means the oncoming paramedics will be in Caledon before the paramedics ending their shifts are back at the reporting station. We also severe weather protocols built into our deployment plan.

Why do you feel you have to “sell” your model by advertising it?

In September, Council reinforced its support of the divisional model and directed staff to participate in community education and communicate with Caledon residents as the divisional model moves forward.

To fulfill Council’s direction, we developed an education program that includes public education events, community outreach, paid advertising and social media. We want to reach as many residents as possible and using a wide range of options will help us do that.

Why is your advertising so direct? It feels aggressive.

We would rather be criticized for being direct or blunt than have residents live another minute in fear.

Some residents, including many seniors, interpreted other advertising and rumours during the recent municipal election to mean there would be no ambulances in Caledon at all starting January 14! That is simply not true.

NO-ONE should live with that kind of fear.Paramedics are NOT leaving Caledon. The same number of ambulances and paramedics that are in Caledon today will be there when the new divisional model starts January 14, 2019. The divisional model changes where paramedics report to work and end their shifts.

Peel Region Emergency Program911 Emergency Service

In an emergency, always call 9-1-1

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