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1. ADVANCED CARE PARAMEDIC (ACP) STRATEGY STRATÉGIE CONCERNANT LES PARAMÉDICS DE SOINS AVANCÉS |
That Council approve that the Ottawa Paramedic Service continue to hire at the projected rate of
new Advanced Care Paramedic (ACP) availability until the 60/40 ratio of
Advanced Care Paramedics to Primary Care Paramedics (PCPs) is attained.
Recommandation du comité
Que le Conseil autorise le Service paramédic d’Ottawa à continuer de recruter des paramédics de soins avancés en fonction du taux de disponibilité projeté jusqu’à ce que le ratio paramédics de soins avancés/paramédics de soins primaires atteigne 60/40.
Documentation
1. Emergency and Protective Services
Committee report dated 5 May 2005 (ACS2005-CPS-OPS-0002).
Report to/Rapport au :
Emergency and
Protective Services Committee
Comité des services de protection et d'urgence
and Council / et au Conseil
Submitted by/Soumis par :
Steve Kanellakos, Deputy City Manager/Directeur
municipal adjoint,
Community and Protective Services/Services communautaires et de
protection
Contact Person/Personne ressource : Anthony
Di Monte, Chief
Ottawa Paramedic Service/Directeur, Services paramédic
(613) 580-2424 x22458,
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SUBJECT: |
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OBJET : |
REPORT
RECOMMENDATION
That the Emergency and Protective Services
Committee recommend that Council approve that the Ottawa Paramedic
Service continue to hire at the projected rate of new Advanced Care Paramedic
(ACP) availability until the 60/40 ratio of Advanced Care Paramedics to Primary
Care Paramedics (PCPs) is attained.
RECOMMANDATION DU RAPPORT
Que le Comité des services de protection et d’urgence
recommande au Conseil d’autoriser le Service paramédic d’Ottawa à continuer de
recruter des paramédics de soins avancés en fonction du taux de disponibilité
projeté jusqu’à ce que le ratio paramédics de soins avancés/paramédics de soins
primaires atteigne 60/40.
As an outcome of the Mid-Year Review report
received by Emergency and Protective Services (EPS) Committee (October 14 and
28, 2004) and subsequently at Council, the Ottawa Paramedic Service has
prepared an Advanced Care Paramedic (ACP) Strategy to hire more Advanced Care
Paramedics. Advanced Care Paramedics
are required to reach the goal of 100% Advanced Life Support (ALS) capture on
all Code 4 (life-threatening) calls in accordance with the service delivery
model and accepted by Committee and Council
Advanced Life Support (ALS) is a service
delivery model recognized as an industry standard of care for high performance
(clinically sophisticated) paramedic systems.
The Ottawa Paramedic Service requires a 60/40 ACP/PCP ratio to attain
100% ALS capture. This will permit
Advanced Life Support to be consistently available for all critical
patients. Currently, the Ottawa
Paramedic Service averages an 80% ALS capture rate on Code 4 calls. It is proposed that the Ottawa Paramedic
Service continue to hire at the projected rate of new ACP availability (3 or 4
per year) until the 60/40 ratio is attained. The proposed development of
a continuous Advanced Care Paramedic training program at Algonquin College
would increase the City's opportunities to hire ACPs locally and help the City
overcome challenges in hiring sufficient numbers of ACPs.
RÉSUMÉ
Par suite du rapport d’examen de mi-année dont le Comité des services de protection et d’urgence a pris connaissance les 14 et 28 octobre 2004 et qui a ensuite été soumis au Conseil, le Service paramédic d’Ottawa a élaboré une stratégie concernant les paramédics de soins avancés qui prévoit le recrutement d’un plus grand nombre de ces techniciens. En vertu du modèle de prestation de services accepté par le Comité et le Conseil, les paramédics de soins avancés doivent avoir pour objectif de répondre à la totalité des appels de code 4 (cas où la vie est en danger), ce qui permet d’avoir l’assurance que les patients bénéficient de techniques spécialisées de réanimation.
Les techniques spécialisées de réanimation constituent un modèle de prestation de services reconnu comme la norme de référence pour les systèmes paramédicaux à rendement élevé (soins spécialisés). Le Service paramédic d’Ottawa exige que le ratio paramédics de soins avancés/paramédics de soins primaires soit de 60/40, afin que la totalité des patients dont la situation est critique bénéficient de techniques spécialisées de réanimation. À l’heure actuelle, le Service paramédic d’Ottawa parvient à assurer le recours à de telles techniques pour 80 p. 100 des appels de code 4 en moyenne. Il est proposé que le Service continue de recruter des paramédics de soins avancés en fonction du taux de disponibilité projeté (3 ou 4 par année), jusqu’à ce que le ratio de 60/40 soit atteint. L’élaboration proposée d’un programme continu de formation de paramédics de soins avancés au collège Algonquin augmenterait la possibilité pour la Ville de recruter de tels paramédics à l’échelon local et l’aiderait à surmonter les problèmes de recrutement auxquels elle est confrontée.
BACKGROUND
As an outcome of the Mid-Year Review report of 2004, the Ottawa Paramedic Service is required to complete a report to EPS Committee (May 12/05) regarding a strategy to hire more Advanced Care Paramedics. Since the amalgamation and the download of the Land Ambulance Service, the City of Ottawa has made substantial investment in the Ottawa Paramedic Service in a commitment to improve patient care.
The system design[1] recommended 100% Advanced Life
Support (ALS)[2] capture for all life threatening
(Code 4) calls (i.e., to ensure that an ACP is in attendance at 100% of Code 4
calls) to improve patient survivability and provide improved on-scene medical
services. The City invested heavily in
hiring additional Paramedics, obtaining equipment and supplies and training
Primary Care Paramedics (PCP) to the Advanced Care Paramedics (ACP) level in an
effort to reach 100% ALS capture, at a total cost of $3.75M. Today, the Ottawa Paramedic Service has an
80% ALS capture[3] for Code 4 calls. This investment
in ALS has led to new approaches in medical care.
The STEMI protocol, for example, facilitates
direct transfer of cardiac patients from the scene to the Ottawa Heart
Institute, is one example of recent service improvements provided to the
community. Advanced Life Support allows
for the fundamental change in a paramedic system from a transport or conveyance
concept to a medical care and treatment service. The Advanced Life Support system involves the treatment of the
patient on-scene and en route to hospital, so that “the emergency room is taken from the hospital and brought to the
patient’s side”. A Primary Care
Paramedic and an Advanced Care Paramedic[4] in the patient’s home now perform
many of the medical interventions previously only performed in the hospital
emergency room.
Specialized medical treatments are delivered by
Advanced Care Paramedics for those who are suffering from collapsed lungs,
irregular heart rhythms, respiratory emergencies, cardiac failure or
full-arrest, foreign body airway obstructions and severe traumatic injuries. With a number of life-saving medications at
their disposal, Advanced Care Paramedics have an increased ability to stop
seizure activity, reverse a diabetic coma, return a heart to its normal rhythm,
open airways for asthmatic patients, and assure that the effects of a bee sting
do not result in death.
Between 2002 and 2004, the Ottawa Paramedic
Service through a fee-for-service contract with Durham and Algonquin Colleges
successfully trained 48 Ottawa Paramedic Service Primary Care Paramedics to the
Advanced Care Paramedic level. Since
2001, the number of Advanced Care Paramedics in Ottawa has increased to 124
ACPs in 2004 with a target of 130 in 2005 (42% of all paramedics). This increase is greatly attributed to the
Ottawa Paramedic Service, Durham College and Algonquin College collaboration
delivering a tri-party ACP training program.
The industry standard recommends a 60/40
ACP/PCP mix as ideal to ensure a 100% capture of code 4 life threatening
calls. As noted in Figure 1, the Ottawa
Paramedic Service requires 58 additional ACPs beyond the 2005 targets to meet
the 60% staffing threshold. The additional ACPs can be trained and recruited
while maintaining the same overall staffing numbers (312).
Figure 1
ACPs as a Percentage of All Paramedics
|
Paramedics |
2001 |
2002 |
2003 |
2004 |
2005 Target |
Program Target |
|
PCP |
90 |
152 |
154 |
152 |
182 |
124 |
|
ACP |
57 |
96 |
108 |
124 |
130 |
188 |
|
Total Paramedic FTE |
147 |
248 |
262 |
276 |
312 |
312 |
|
ACP as a percentage of all
Paramedics |
39 |
39 |
41 |
45 |
42 |
60 |
Across Canada, Advanced Care Paramedics are in
high demand. Recent changes in
legislation and inter-provincial cooperation[5] have facilitated the movement of
ACPs from Province to Province.
Nevertheless, the overall availability of ACPs remains in short supply
and the number of those willing to move without significant incentives is
limited.
The Ottawa Paramedic Service
remains committed to its mandate to provide an Advanced Life Support service on
all life threatening code 4 calls. The
ALS system is in the best interest of patients. It is recommended that
the Ottawa Paramedic Service continue to hire at the projected rate of new ACP
availability of 3 or 4 per year until the 60/40 ACP/PCP
ratio is achieved. An associated risk
is that it will be difficult to achieve 100% ALS capture due to insufficient
community-based training opportunities and potential attrition.
Algonquin College has
informally committed to the delivery of an Advanced Care Paramedic
Program. The proposed course start-up
is scheduled for fall 2005 or fall 2006.
This program would increase the ability to recruit ACPs locally, and
help offset potential attrition because Ottawa would already be home to most
students graduating from the program.
The program would likely consist of one class annually, graduating up to
20 ACPs per year. The City of Ottawa
would have to compete to hire new graduates. The proposed strategy maintains
the current practice of hiring ACPs based on availability without additional
costs for training or incentives.
The Ottawa Paramedic Service reviewed two options
for the recruitment of ACPs to the Service and community that are not
recommended. These options involve
expenditures on program components such as paid tuition and recruitment
incentives.
Under the first option, the Ottawa Paramedic
Service would provide training to existing staff to upgrade their skill level
from Primary Care Paramedic to Advanced Care Paramedic. The program would be similar to the
Paramedic Service’s previous experience with the internal ACP training program
(capital project 901047) that was undertaken with Durham and Algonquin
Colleges. The 2002-2004 capital
project, which resulted in 48 PCPs attaining the ACP certification, was an
example of City investment in its staff.
Under this option, it is expected that 100% ALS capture could be
achieved in 36-60 months at a cost of approximately $3.0M. However, because the cost of training is
substantial, the in-house training option is not the preferred option at this
time.
Under the second option, the Ottawa Paramedic
Service would offer incentives including paid tuition, moving expenses and
salary top-ups. It is expected that
100% ALS capture could be achieved in 24-84 months at a cost of $1.1M. This approach has substantial costs and
associated risks. The timeframe to
implement this option would be based primarily on the availability of ACPs from
across the country willing to relocate (there is no established research on
labour mobility rates for ACPs) and the number of current PCPs who would be
able to take advantage of paid tuition without salary remuneration while in
training. Lastly, moving expenses and
salary top-ups do not address the overall supply of trained ACPs (regionally or
provincially); rather, the Ottawa Paramedic Service may be removing an ACP from
another community. ACPs are often tied
to their communities and their desire to relocate is limited. This option is not recommended.
The City of Ottawa has made a significant
investment since amalgamation to increase the number and proportion of Advanced
Care Paramedics (ACPs) within the Ottawa Paramedic Service. The number of ACPs has increased from 57 to
124 since 2001 and the City of Ottawa is presently in attendance at
approximately 80% of Code 4 calls (ACPs were in attendance at fewer than 50% of
calls prior to amalgamation). The
availability of ACPs at code 4 calls has increased the sophistication of
medical assistance both on-scene as well as en-route to the hospital resulting
in improved medical care and survivability of patients. The City is committed to continued hiring of
ACPs until its ACP targets are attained.
Consultation
No consultation was required in association
with the development of this report.
The 2005 budget identified continued budget
pressures for 2006 and 2007 event after considering rate of inflation increases
in fees and service charges and taking into account assessment growth from new
properties. Without adding any new
programs or capital projects the 2006 tax increase is approximately 7%.
As in the 2005 budget there are basically four
means of funding additional program requests:
(1) identify new sources of revenue, (2) through offsetting program
reductions (3) increase existing fees and (4) increase taxes.
This report will not result in any new
expenditures and will not result in a tax increase.
Disposition
The Ottawa Paramedic Service will continue to
recruit Advanced Care Paramedics to support the continued enhancement of
medical care to patients in our community.
[1] Paramedic Service system design as approved by Ottawa City Council, July 2000
[2] Advanced Life Support combines professional care providers (ACPs) with appropriate supplies and equipment to support the care provider.
[3] Prior to 2001, the ACP capture rate was <50%.
[4] One Primary Care Paramedic and one Advanced Care Paramedic constitute an ALS crew (team).
[5] Ontario has signed a Mutual Recognition Agreement for Paramedics as part of their commitment to the Labour Mobility Provisions of the Federal Agreement on Internal Trade.