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	Corporate Report
DEPARTMENT/	CAO's Office
DIVISION	Emergency Medical Services	REPORT NO.	2006.181
DATE PREPARED	August 28, 2006	FILE NO.
MEETING DATE	September 11, 2006
SUBJECT	Implementation of twelve hour shifts in ten remote and rural EMS stations

RECOMMENDATION

THAT with respect to Report No. 2006.181 (Emergency Medical Services), we recommend Option 3. This option to take effect during the next posted schedule would result in EMS stations in Upsala, Conmee, Shuniah, Red Rock, Beardmore, Nakina, Longlac, Manitouwadge, Terrace Bay and Schreiber to be transitioned from ten hour on site to twelve hour on site staffing schedules;

AND THAT any necessary by-laws be presented to Council for ratification.

Since 2001 staffing schedules with twelve hour on site and twelve hour on call service have become the more common minimum Emergency Medical Service (EMS ) level provided in small and remote northern communities with low call volumes. Large urban centres and many smaller centres across the province provide twenty four hour EMS coverage. Superior North EMS is one of the very few systems in Ontario still providing ten hour on site EMS coverage.

In 2003 the Province provided additional funds to improve response times. These funds were used to improve service in the City of Thunder Bay and increase service in the District to provide a minimum of ten hour on site service at all existing locations. There was insufficient Provincial funds to provide a minimum of twelve hour on site service at all locations.

In 2004 Council approved increases to provide twelve hour on site service for the ten communities still providing ten hour shifts conditional upon the Province funding their 50% share of additional costs.

On March 1, 2006 the Province approved funding increases starting in 2006 and escalating such that the Province will be funding 50% of eligible EMS costs by 2008. Our ultimate funding is based on providing a minimum of twelve hour on site service at all existing locations.

The value of changing from ten hour on site shifts to twelve hour shifts in all our remote and rural communities is substantial. Being on call for fourteen hours a day remains a significant negative aspect of working in a small community. Having twelve hour shifts allow paramedics to spend more time with their family as well as reduce their time on call. It improves response times to calls and makes it much easier for management to effectively schedule across the system.

During the 2004 budget process Council approved increasing EMS coverage so that there would be a minimum of twelve hour on site coverage at all existing stations in the District of Thunder Bay. This approval was conditional on the Province funding their 50% share of additional costs. Subsequent business case submissions to the Ministry of Health and Long Term Care for their portion of the additional funds were not approved. In February 2006 the Premier suddenly announced the Province would move to 50/50 funding of approved EMS costs over the next three years. Our approved costs include the additional costs associated with implementing a minimum of twelve hour on site shifts at all existing stations in the District of Thunder Bay.

On March 1, 2006 the Province sent us our first installment of $690,393 towards their 50/50 cost sharing commitment. While it was the Province’s intent to bring all municipalities immediately to at least a 60/40 funding level, the District of Thunder Bay is now at a 53/47 funding level in part due to prudent management which has minimized cost increases and because the twelve hour on site shifts have yet to be implemented.

The life of on call paramedics in small communities is very challenging. For $2.50/hr paramedics must be ready to respond to the station from home or anywhere else in the community within 8 minutes. This means maintaining a quality vehicle to respond to calls and never being alone with your young children who may need adult supervision on short notice. As well while on call you may receive a page at any time of day or night to respond to emergencies that can last for hours. If you don’t live within 8 minutes of the station, you have to stay at the station for your on call shift. For those reasons, being on call is resisted and many busier systems have gone to twenty four hour operation to address this concern.

Being on ten hour shifts compounds the issue to some extent. Labour laws with respect to hours of work make scheduling ten hour shifts more limiting. Many of our paramedics now live in one community, but commute hundreds of kilometres to various stations. Working ten hour shifts poses challenges during the shorter or longer blocks of shifts. Most paramedics would prefer to work four twelve hour shifts and then be off for four days. It also simplifies the assigning of regular partners and sharing of staff from station to station. There is also less reliance on part time workers in remote communities.

The move to twelve hour shifts is one that benefits patients by improving response times to over a hundred emergencies, improves paramedic’s quality of life and makes scheduling much easier.

Having regard for all of the above the City of Thunder Bay has the following options: .

Reverse the 2004 decision to implement twelve hour on site shifts at the remaining ten hour on site shift stations. This would likely result in the Province re-adjusting their funding downwards to a more accurate 50/50 balance. The City of Thunder Bay is expecting approximately $600,000 in increased Provincial funding over the next two years to move towards 50/50 commitment. This additional funding would be reduced to $200,000 without the implementation of twelve hour on site shifts. There is also the possibility the Province could reduce the 2006 funding as it is based on the twelve hour shifts already being in place.

This recommendation would result in on-going scheduling challenges due to the different staffing patterns of twelve and ten hour shifts. Staff morale would be severely affected. It is a significant quality of life issue for many paramedics and there is a very strong aversion to being on call. Reducing the on call by 2 hours a day would boost morale and bring Superior North EMS in line with the rest of the province with respect to having staff work twelve hour shifts. All of our surrounding EMS providers in the north operate on twelve hour on site and twelve hour on call shifts in their rural stations except for the Rainy River District which went to twenty four hour on site operation on site a few years ago.

Option 2

Implement twelve hour shifts effective January 1, 2007 at a total cost of $589,400. There could still be a claw back in the increased funding for 2006 as in Option 1. Benefits would be reduced callbacks, improved response times, increased morale and improved scheduling.

Option 3

Implement twelve hour shifts immediately to ensure best use of the increase in funding. Benefits are as per Option 2, but with immediate results. Another advantage is that it should eliminate the chance of any claw back in funding. Superior North EMS had projected a surplus for the City worth $547,540 in 2006 because of the increase in funding. This surplus would be the City’s share to keep. The implementation of the twelve hour shifts on October 1st, would reduce this surplus to $400,190. The implementation cost from October till December 31st of this year is $147,350. The ongoing cost for a full year will be $589,400 in 2007.

The total gross cost of this enhancement is $598,400. The province will be paying 50% of this cost leaving a municipal portion of $299,200 to be shared between the City of Thunder Bay and regional municipalities at 79% and 21% respectively. Net annual cost for the City would therefore be $236,368 and the regional municipalities would contribute $62,832. The cost sharing ratio with the province for 2006 is 53% municipal and 47% provincial. The increases in funding from the province for 2007 would result in the ratio remaining the same. The implementation of twelve hour shifts on site will be fully funded by the increases in revenue from the province.

For 2006 the City would have benefited from a $547,540 surplus (assuming EMS expenditures are on target) which will become $400,190 if twelve hour shifts are implemented by October 1st, 2006. For 2007, based on projected revenues from the Province, the City would have a $312,000 increase in new provincial funds over 2006 budget to implement twelve hour shifts. In other words, increased revenue streams would offset increased costs.

For District municipalities, they had their 2006 invoices reduced based on their share of provincial increases in funding after the March 1st funding announcement. Implementing twelve hour shifts in 2006 and 2007 will result in a regional municipality levy increase of $31,035 and $124,144 respectively. Pending Council approval, a meeting should be held with regional municipalities to advise them of this improvement in service to their municipality and what their share of the costs will be.

It is concluded that the implementation of twelve hour on site shifts in all remote and rural stations will benefit patients, staff and management.

It is further concluded that with increased funding from the Province this expansion can be accommodated within the approved 2006 EMS budget.

In 2001 responsibility for the delivery of Emergency Medical Service was transferred to local or regional Designated Delivery Agents across the Province. The City of Thunder Bay became the Designated Delivery Agent for EMS service in the District of Thunder Bay. At that time large urban centres including the City of Thunder Bay provided 24/7 on site service while most rural northern communities increased staffing to provide twelve hour on site and twelve hour on call service. Service increases were not implemented in the District of Thunder Bay. These more rural and remote stations continued operating on a multitude of schedules with busier stations like Armstrong, Nipigon, Marathon and Geraldton providing twelve hour on site service, Terrace Bay and Schreiber providing ten hour on site service and the rest providing 8 hour on site service with some limited weekend shifts

In 2003 when the Province provided additional funding to improve response times the City introduced another full 24/7 ambulance and a Paramedic Response Unit in Thunder Bay. The remainder of the funding was used to transition existing stations with 8 hour on site service to ten hour on site service seven days per week. There were insufficient funds to increase all locations to twelve hour on site service.

In 2004 Council approved increases to provide twelve hour on site service for the ten communities still providing ten hour shifts conditional upon the Province funding their 50% share of additional costs.

None.