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	Corporate Report
DEPARTMENT/	CAO's Office
DIVISION	Emergency Medical Services	REPORT NO.	2004.193
DATE PREPARED	July 17, 2004	FILE NO.
MEETING DATE	July 26, 2004
SUBJECT	Response Times Review Interim Report

REPORT SUMMARY

A report to outline progress to date of a review of response times by Emergency Medical Services; as committed to in the New Foundation Living Strategic Plan.

During the Local Services Realignment exercise in 2000, the Ministry of Health and Long-Term Care legislated that response times for high priority emergency calls should not be longer than those experienced in 1996. Based on this concept, there is no consistent across the Province response time “standard” but rather a unique standard for each service area.

The following summarizes historical Emergency Medical Services response time information for the City of Thunder Bay and for the District including the City:



This data indicates that the lowest response times occurred in 1996 when the average 90th percentile response time for the City of Thunder Bay was 10 minutes and 14 seconds and 12 minutes and 41 seconds for the District of Thunder Bay. The average 90th percentile response times for both were higher in 1995, 1997, 1998, 1999 and 2000 when this program was under Ministry of Health and Long Term Care control.

A 2002 survey of select Ontario municipalities indicated their average 90th percentile response time was 11 minutes and 21 seconds while the average 90th percentile response time for these same municipalities was 10 minutes and 54 seconds in 1996. Many urban centres aspire to a 90th percentile response time of 7 minutes and 59 seconds as is widely used in the U.S.

At the same time demand for high priority emergency medical services has generally increased in Thunder Bay.



In 2002-2003, EMS providers across Ontario faced severe staff shortages. These shortages result in “downstaffing” where less than a full complement of vehicles is provided from time to time. While selective scheduling of available staff during higher demand periods can minimize the impact of downstaffing it can also increase response times particularly if downstaffing occurs during high demand periods.

In September 2001, the Ministry of Health and Long-Term Care introduced their Response Time Framework initiative that provided additional funding to municipalities to help reduce response times. Thunder Bay’s proposal was partially approved in late 2002, early 2003. Report No.2002-363 detailed that process. The awarding of funds was based on proposed measures to improve response times throughout the district.

Notwithstanding the increased demands for service, a number of staff initiatives and the application of additional Provincial Response Time Framework funding has resulted in ongoing improvement to Emergency Medical Service response times since 2002. Since 1996, emergency demands for service (Code 4s) have increased 46% with one of the largest annual increases (18%) occurring between 2002 and 2003. Average response times decreased by 6% during the same year.

Changes in management structure and scheduling practice along with creative recruitment techniques have helped address downstaffing and response time.



Under the Provincial Response Time Framework initiative funding to provide one additional ambulance and one paramedic response unit 24 hours per day in Thunder Bay along with funding for increased hours of on site coverage in the District have also reduced response times.

As part of the New Foundation process, six initiatives to improve response times were identified.

1. Monitor 90th percentile response times per station, per rural community and per square kilometre for the City of Thunder Bay on a monthly basis. These reports will be posted at each station on monthly and YTD basis.


Early in 2004, EMS identified response time measures that address Ministry of Health and Long Term Care needs and provide meaningful performance feedback to staff. This information is now being collected and circulated to all stations in the District. This performance information will be reviewed with staff on an ongoing basis for the purpose of identifying and developing measures that will improve response times. Comparative response time performance information will also be included as part of the budget process.

2. Monitor 90th percentile crew reaction times on monthly and YTD basis to see if they meet the objective of 90 seconds on site and 8 minutes on call. Data to be posted at all stations and managers to address deficiencies.

Reaction times measure how long it takes to have an ambulance mobile. This information will be significantly different when a crew is on duty versus on call. Target reaction times have been set and actual deviations are being monitored. These reports are now issued monthly for review and appropriate action. Early data indicates a downward trend in the reaction times for the majority of stations.

3. Monitor and address downstaffing activities by hiring more staff to lower incidences of reduced staffing.

Downstaffing levels across the District are being monitored and reviewed on an ongoing basis. Recent recruiting and hiring of newly graduated staff to fill vacancies has had a major impact on reducing downstaffing hours. In spring of 2003 new operating procedures were also introduced in Thunder Bay to reduce downstaffing hours.

4. Review the impact of closing the two hospitals in Thunder Bay and relocating to one site on utilization and any related response time impacts.

The impact of the recent consolidation of two hospitals to one site remains to be assessed. A reduction in call volume is anticipated as a result of a reduced need for patient transfers between hospitals. At the same time some increase in per call time may occur as a result of potentially longer transport and drop off times. More data needs to be tabulated before the impact of this significant change to our health care system can be assessed and appropriate courses of action developed.

5. Review the urban call distribution and the response times based on current station locations and optimal station locations.

The impact of the number and location of ambulance stations on response times is being studied using Geographic Information Systems (GIS) data for the City of Thunder Bay. The proximity of each station to high demand areas directly impacts response time. The recent addition of Automatic Vehicle Locator (AVL) data for EMS responses in the City of Thunder Bay will also be incorporated in the analysis.

6. Explore the concept of System Status Deployment for current EMS resources to reduce response times

Once sufficient data has been collected to complete the analysis identified in steps 4 and 5 an implementation plan for addressing resource needs and optimizing deployment to reduce response times will be recommended. These recommendations will be forwarded to Council by November of 2004 so that they can be considered during 2005 budget deliberations.

Despite ongoing increases in the demand for high priority emergency medical services, changes in management structure and practices, recruiting efforts to reduce downstaffing and the additional resources provided under the Provincial Response Time Framework Initiative have improved emergency medical services response times. More recent efforts to collect and review response time performance measures on a regular basis throughout the District have also improved response times.

More data is needed to assess the impact of recent significant changes to our health care system and make recommendations on the optimum location, number and deployment of emergency medical services that will reduce response times. These recommendations will be presented to Council in November 2004 so that they can be considered during 2005 budget deliberations.

FOR INFORMATION ONLY.

None.