Report to/Rapport au:

Community and Protective Services Committee

Comité des services communautaires et de protection

17 February 2011 / le 17 février 2011

Submitted by/Soumis par:

Steve Kanellakos, Deputy City Manager/Directeur municipal adjoint,

City Operations / Opérations municipales

Contact Person/Personne ressource : Anthony Di Monte, Chief / Directeur

Ottawa Paramedic Service/Services paramédic d’Ottawa

(613) 580-2424 x22458, Anthony DiMonte@Ottawa.ca

City-wide/ À L'échelle De La Ville

Ref N°: ACS2011-COS-EPS-0006

SUBJECT:	ottawa paramedic service 2009 Annual Report and 2010 Performance Trends Report - INFORMATION SUPPLEMENTAL TO THE BUDGET ESTIMATES
OBJET :	SERVICE PARAMÉDIC D’OTTAWA Rapport Annuel 2009 et tendances en matière de performance 2010 - Renseignements supplémentaires aux prévisions budgétaires

REPORT RECOMMENDATION

That the Community and Protective Services Committee receive this report as supplemental information to the 2011 Draft Budget.

RECOMMANDATION DU RAPPORT

Que le Comité des services communautaires et de protection prenne connaissance de ce rapport à titre d’information supplémentaire au budget préliminaire de 2011.

EXECUTIVE SUMMARY

In 2001, the new City of Ottawa assumed responsibility for the delivery of Paramedic Service as defined by the Ambulance Act of Ontario. The City was given the opportunity to improve the quality of paramedic services provided to the community. The design of Ottawa’s performance-based Paramedic Service is founded on five key hallmarks: clinical excellence, response time reliability, patient and community satisfaction, economic efficiency and performance accountability. The simultaneous achievement of these principles is the foundation for continued service excellence.

At its meeting of October 28, 2004, the Emergency and Protective Service Committee directed as follows:

“That staff report back to Committee and Council prior to budget each year on performance trends, mitigation strategies, and associated financial impacts to ensure the service can maintain its baseline performance targets”

The 2009 Annual Report and 2010 Performance Trends Report demonstrate that the Ottawa Paramedic Service remains dedicated to improving the quality of life to all City of Ottawa residents and visitors. The Ottawa Paramedic Service regularly exceeds industry standards regarding quality and best practices and is recognized as an international leader through many aspects of its operations. The mandate of the Ottawa Paramedic Service extends beyond the boundaries of the City of Ottawa. It is responsible for dispatching across 10,000 square kilometres of Eastern Ontario (including Cornwall and Hawkesbury) and coordinates/participates in several high profile events outside of the City, such as the G8 & G20 summits and dignitary visits.

Despite the challenges of the health care system and annual increases to call volumes, the contents of this report will confirm the Ottawa Paramedic Service as progressive and reliable. The number of calls responded to by Ottawa paramedic’s climbed 8% in 2009 and is forecasted to increase by another 2.9% for 2010. Notwithstanding these increases the average response time improved to 8 minutes and 23 seconds for 2009 in high-density areas.

The Ottawa Paramedic Service works closely with its stakeholders to maintain and develop strong partnerships to enhance the delivery of service. These stakeholders include but are not limited to:

· The Ottawa Police Service

· The Ottawa Fire Services

· The RCMP

· All hospitals in the Nation’s Capital

· The Ministry of Health and Long Term Care

The Paramedic Service continues to be innovative by ensuring that medical best practices are being applied and that it remains current with the latest research. The Ottawa Paramedic Service gained international notoriety for developing a STEMI protocol, which has drastically reduced wait times to receiving life-saving treatment for patients that are in cardiovascular distress. The Service has a strong commitment to continuous medical education, which ensures that the industry’s highest standards are being met in order to provide all patients with the best quality of care.

Over the past two years the Ottawa Paramedic Service has tracked the progress of a variety of innovative programs and services, such as:

· Coordinating & providing medical coverage for high-profile special events

· The evolution & expansion of the Paramedic Response Unit

· Renewed funding of the Off-Load Nurse pilot project

· Advancements within community medicine (i.e. public access defibrillators)

· Introducing environmental initiatives, such as installing Espar auxiliary heaters in ambulances to reduce gas omissions

· Development of specialty teams (i.e. Tactical, Marine and Bike Units)

· Grand opening of the new Ottawa Central Ambulance Communications Centre

The demographics of the City of Ottawa impact the Ottawa Paramedic Service and result in escalating requests for service. The Service continues to maintain and develop programs and initiatives that focus on efficiently managing its resources without negatively impacting the quality of patient care or survivability. Increased staffing and innovative Branch initiatives have helped stabilize this period of growth.

The 24 positions requested in the 2011 budget is equal to 2 additional paramedic units on the road 24 hours a day, 7 days a week. These new positions will help stabilize some of the challenges that are currently being faced by the Ottawa Paramedic Service.

RÉSUMÉ

En 2001, la nouvelle Ville d’Ottawa a assumé la responsabilité du Service paramédic, tel qu’il est défini dans la Loi sur les ambulances de l’Ontario. La Ville s’est vu donner la possibilité d’améliorer la qualité des services paramédicaux offerts à la collectivité. La conception du Service paramédic d’Ottawa, qui est axée sur le rendement, repose sur cinq éléments clés : excellence clinique, fiabilité des délais d’intervention, satisfaction des malades et de la collectivité, efficacité sur le plan économique et responsabilité à l’égard du rendement. L’application simultanée de ces principes est à la base de l’excellence continue du service.

À la réunion du 28 octobre 2004, le Comité des services de protection et d’urgence a donné la directive suivante :

« Que le personnel fasse connaître sa décision au Comité et au Conseil chaque année avant la présentation du budget concernant les tendances du rendement, les stratégies d’atténuation et les répercussions financières connexes pour veiller à ce que le service puisse maintenir ses objectifs de rendement de référence. »

Le rapport annuel 2009 et le rapport de 2010 sur les tendances en matière de rendement ci-joints démontrent que le Service paramédic d’Ottawa demeure déterminé à améliorer la qualité de vie des résidents de la Ville d’Ottawa et des visiteurs. Le Service dépasse régulièrement les normes de l’industrie pour ce qui est de la qualité et des pratiques exemplaires; il est reconnu comme un chef de file international dans de nombreux aspects de ses opérations. Son mandat s’étend au-delà des frontières de la Ville d’Ottawa; en effet, il assure la répartition des services dans un secteur de 10 000 kilomètres carrés dans l’est de l’Ontario (ce qui comprend Cornwall et Hawkesbury). De plus, il coordonne plusieurs événements d’envergure à l’extérieur de la ville, comme le G8, le G20, ou encore des visites de dignitaires, en plus d’y être présent.

Malgré les problèmes du système de santé et les augmentations annuelles du volume d’appels, le rapport indique que le Service paramédic d’Ottawa s’adapte au contexte et demeure fiable.

Le nombre d’appels traités par le Service paramédic d’Ottawa a grimpé de 8 % en 2009, et devrait augmenter de 2,9 % en 2010. Malgré ces augmentations, le délai d’intervention moyen s’est amélioré pour se situer à 8 minutes et 23 secondes en 2009 dans les secteurs à forte densité.

Le Service paramédic d’Ottawa travaille étroitement avec ses intervenants pour maintenir et établir des partenariats solides visant à améliorer la prestation de services. Voici une liste non exhaustive des intervenants :

· le Service de police d’Ottawa;

· les Services des incendies d’Ottawa;

· la GRC;

· les hôpitaux de la capitale;

· le ministère de la Santé et des Soins de longue durée.

Le Service continue d’innover tout en s’assurant qu’il applique les pratiques exemplaires médicales et tient compte des dernières recherches. Il a acquis une notoriété internationale en mettant au point le protocole STEMI, qui a permis de réduire de manière radicale le temps d’attente des patients en détresse cardiovasculaire qui sont en danger de mort. Le Service accorde une grande importance à la formation médicale continue, qui permet d’assurer le respect des normes les plus élevées de l’industrie et la prestation de soins de qualité supérieure à tous les patients.

Au cours des deux dernières années, le Service paramédic d’Ottawa a suivi de près l’évolution de programmes et de services novateurs comme :

· la coordination et l’offre de soins médicaux dans le cadre de grands événements;

· l’évolution et l’expansion du programme d’intervention rapide des paramédics;

· le renouvellement du financement du projet pilote de réduction de la charge de travail du personnel infirmier;

· les avancées en médecine communautaire (par exemple, l’accès public aux défibrillateurs);

· l’introduction d’initiatives environnementales, comme l’installation de chauffage d’appoint Espar dans les ambulances pour réduire les émissions de gaz;

· la mise en place d’équipes spécialisées (par exemple, l’unité tactique, l’unité marine et l’équipe à vélos)

· l’inauguration du Centre intégré de répartition des ambulances d’Ottawa.

La situation démographique de la Ville d’Ottawa a une incidence sur le Service paramédic d’Ottawa et entraîne une augmentation des demandes de services. Le Service continue de maintenir et d’élaborer des programmes et des initiatives qui mettent l’accent sur une gestion efficace des ressources, mais qui ne compromet pas la qualité des soins prodigués ou le taux de survie. Le recrutement et les initiatives novatrices de la Direction ont permis de stabiliser cette période de croissance.

Les 24 postes attribués dans le budget de 2011 correspondent à deux unités paramédicales supplémentaires sur la route en tout temps. Ces nouveaux postes aideront le Service paramédic d’Ottawa à relever certains des défis auxquels il est confronté.

DISCUSSION

2009 ANNUAL REPORT

CLINICAL EXCELLENCE

In 2009, the Ottawa Paramedic Service continued to demonstrate its commitment to clinical excellence by being attuned with the latest medical best practices and research. In 2005, Ottawa paramedics gained international notoriety for implementing a pre-hospital identification protocol of a specific type of heart attack, known as a STEMI (ST elevation myocardial infarction). Ottawa paramedics have been trained to identify a STEMI patient at the scene and then transport the patient directly to the Ottawa Heart Institute. The paramedic’s clinical decision permits the patient to receive life-saving treatment immediately. This best practice is commonly referred to as the “Ottawa STEMI protocol” and has been written up in prestigious medical journals such as The New England Journal of Medicine.

Originally it was estimated that this protocol would be applied to 150 patients per year but in 2009 there were 278 occurrences that resulted in a STEMI diagnosis. The volume of cardiovascular responses continues to rise which indicates that protocols such as the STEMI positively affect patient survivability.

Table 1 shows the volume of STEMI occurrences, along with other cardiovascular responses by the Ottawa Paramedics for 2009 and 2010.

TABLE 1

Cardiovascular Responses

CARDIAC ARREST			STEMI			STROKE
Age Group	2009	2010	Age Group	2009	2010	Age Group	2009	2010
0 - 14	10	16	0 - 14	1	0	0 - 14	1	1
15 - 29	21	27	15 - 29	1	1	15 - 29	2	8
30 - 44	52	56	30 - 44	32	27	30 - 44	27	37
45 - 59	155	196	45 - 59	103	106	45 - 59	116	99
60 - 74	206	205	60 - 74	86	84	60 - 74	219	231
75 - 89	242	246	75 - 89	43	55	75 - 89	460	448
90 – 100 +	57	60	90 – 100 +	5	7	90 – 100 +	91	115
No Age	40	37	No Age	7	0	No Age	15	17
Totals	783	843	Totals	278	280	Totals	931	956

In order to provide patients with the highest quality of care, the Ottawa paramedics receive continuous medial education to ensure that they meet or exceed industry standards. The past two years have included developmental training opportunities and participation in medical studies such as:

· The Canadian C-Spine Rule

· Paramedics assessing Elders at Risk of Independence Loss

· Paramedic and Community Care Team

· Paramedic Study of Airway Management

· Stroke Prompt Card Evaluation

· Resuscitation Outcome Consortium

RESPONSE VOLUME

Since 2001, the Paramedic Service has experienced consistent, year-over-year increases in call demand and responses. Response volume has increased 53.6% from 2001 to 2009 and has significantly exceeded the assumption of the original system design of a projected annual increase of 2%.

In 2009, response volume increased 8% from the previous year. The 2009 annual call ratio per paramedic was 280.3. There is a marginal reduction forecasted for 2010, set to be 278.6 calls per paramedic. Despite additional staffing the paramedic call ratio remains constant due to the sheer increase of response volume.

Table 2 below demonstrates the increase in response volume.

TABLE 2

Response Volume Growth 2008 vs. 2009
	Call Code	2008	2009
Emergency	Code 4	78,900	79,126
	Code 3	14,419	23,653
Non-Emergency	Code 2	5,363	4,202
	Code 1	2,125	1,716
Stand-by	Code 8	1,904	2,604
Total		102,711	111,301
Response Volume Growth		+ 8%
Source: MOHTLC ADDAS December 21, 2010

RESPONSE TIME

Response time targets were developed for the City of Ottawa taking into account international industry standards, medical appropriateness, and community expectations. The performance targets for life threatening calls in Ottawa are set at:

HIGH-DENSITY 8 minutes 59 seconds at the 90^th percentile

LOW-DENSITY 15 minutes 59 seconds at the 90^th percentile

The Paramedic Service reports response time targets at the 90^th percentile, which translates to the response time by the service 9 times out of 10. Some emergency services in the country report average response times, which translates to the response time by the service 5 times out of 10. All paramedic services have continued to report and strive to achieve response time targets at the stringent 90^th percentile due to medical appropriateness and higher degree of accountability and reliability to its community. The 90^th percentile is the international standard for emergency medical services.

Table 3 below demonstrates that in 2009 response times for life threatening calls improved in high-density zones for code times T0-T4 (receipt of call to arrival on scene).

TABLE 3

Response Times & 90^th Percentile

Ranking for High-Density Zones

RESPONSE TIME PERFORMANCE (HIGH-DENSITY ZONE)
Year	90^th Percentile Target	90^thPercentile Actual	90^th Percentile Rank	Average Response Time
2008	8:59	13:11	63.4%	8:30
2009	8:59	12:50	64.1%	8:23
Source: MOHLTC ADDAS December 21, 2010

Table 4 below demonstrates that in 2009 average response times for life threatening calls improved in low-density zones for code times T0-T4 (receipt of call to arrival on scene).

TABLE 4

Response Times & 90^th Percentile

Ranking for Low-Density Zones

RESPONSE TIME PERFORMANCE (LOW-DENSITY ZONE)
Year	90^th Percentile Target	90^thPercentile Actual	90^th Percentile Rank	Average Response Time
2008	15:59	21:34	65.1%	14:46
2009	15:59	21:39	64.5%	14:36
Source: MOHLTC ADDAS December 21, 2010

In 2009 the high-density areas accounted for 89.2% of all code-4 responses and the low-density areas accounted for 10.8% of code-4 responses.

COMMUNITY MEDICINE

The Ottawa Paramedic Service provides City of Ottawa residents with programs and safety initiatives that relate to community medicine. Registrations for CPR and First Aid training, the Paramedic Public Access Defibrillator Program and Safety and Safe Behaviour sessions continue to rise.

Chart 1 below demonstrates the volume of courses rendered by the Ottawa Paramedic Service from 2005 to 2009.

In 2009, there was a total of 541 training courses rendered, which was a 40% increase over the previous year.

The Public Access Defibrillator Program is one of the largest and most extensive in North America. Most defibrillators exist within City of Ottawa facilities, however the number of private facility defibrillators continues to rise.

Table 5 below displays the total number of public access defibrillators that the Ottawa Paramedic Service have installed and maintained.

TABLE 5 Ottawa Paramedic Service Public Access Defibrillator Program
City Buildings	21
Ottawa Public Libraries	26
Community Centers	40
Other Public Places (i.e. University of Ottawa, etc.)	62
Pools & Beaches	50
Arenas	32
Home Loaner Program	7
Rural First Aid Community Groups	6
High Schools	42
Police Service	161
Fire Service	70
OC Transpo Mobile Supervisors & Transit Police	25
Private Oversight (i.e. Dental Clinics, etc.)	74
TOTAL	616

SPECIAL EVENTS

The Ottawa Paramedic Service regularly assumes responsibility for coordinating various high profile events across the City to ensure that the highest level of care is readily available. In 2009 there were a total of 398 special events that required dedicated paramedic service, a 7% increase from 2008. There was extensive medical coverage in 2009 for various special events, such as:

· The visit by the President of the United States of America, Barack Obama

· The visit by Prince Charles, Prince of Wales

· Canada Day celebrations

· Remembrance Day and other Veterans Affairs events

· Various festivals such as Bluesfest and Winterlude

· Various rural fairs

· The National Capital Marathon

· Ottawa Senators hockey games and other events at Scotiabank Place

· World Junior Ice Hockey Championships

OFF-LOAD NURSE PILOT PROJECT

In May 2008, the Ministry of Health and Long Term Care recognized the health care challenges realized by paramedics in Ontario and approved the funding for the hiring of additional nurses in hospital Emergency Departments. Having these dedicated nurses has helped reduce wait times by easing off-load delays, which in turn has improved patient satisfaction. This Provincial initiative has allowed paramedics to return more quickly to the community and be available to respond to the next request for service.

The MOHLTC has continued to commit funding for the off-load nurse pilot project, which has benefited the City of Ottawa. By the end of March 2009, the off-load nurse pilot project included all Ottawa adult hospitals. The pilot is fully funded by the Ministry of Health and Long Term Care and since its inception the total number of paramedic hours gained in Ottawa is 13739.5 hours. Even with the overall increase in service response and transport volumes the pilot project has stabilized the adult hospital wait times while alternative solutions to the hospital system are resolved.

The funding for the OLN pilot project is completed on an annual basis. The yearly funding allotment is determined through a business case submission to the Ministry of Health and Long Term Care. For fiscal year 2009-2010, the funding amount was $550.1K.

Chart 2 below demonstrates the total paramedic hours saved due to the off-load nurse pilot project in 2009 in comparison to the previous year.

PARAMEDIC RESPONSE UNIT PROGRAM

The Ottawa Paramedic Response Unit pilot project commenced in July 2005 with a first response mandate to provide a basic life support standard of care until transport and/or advanced care paramedic arrived on scene. The main objective of the pilot project was to reduce the paramedic to patient time in order to have a positive impact on overall response times and patient outcomes in Ottawa.

The Paramedic Response Unit is a single responder unit staffed by a Primary Care Paramedic. The primary function is to provide a first paramedic responder capacity, arriving rapidly on scene and initiating patient care. A transport unit is subsequently dispatched to provide back up if transport is required. This allows the Paramedic responder to downgrade or defer the transport unit, thereby allowing the paramedic crew (ambulance) to respond to the next emergency call. Also, it allows continual coverage in the assigned area, as it does not transport patients to hospital and is immediately available upon clearing a call. The Paramedic Response Unit’s are not subject to off-load delays at hospitals and therefore remain readily available in their assigned area. The single paramedic rapid responder initiative is the industry’s best practice for deployment and has been adopted by many other paramedic services in Ontario and across Canada.

The data in Table 6 below demonstrates that the Paramedic Response Unit has been responding to a greater amount of emergency calls. In 2009, the Paramedic Response Unit response time continued to exceed the performance target of 8 minutes 59 seconds at the 90^th percentile. Call volumes for the unit have increased 69% from the previous year and their arrival on scene in the 90^th percentile is 1 minute and 10 seconds better.

Table 6 below displays the total responses and 90^th percentile response time for the Paramedic Response Unit for code times T2-T4 (paramedic crew notified to arrival on scene) .

TABLE 6

Paramedic Response Unit

Response Volume &

90^th Percentile Response Time

	2008	2009
Response Volume	3, 568	6,024
90^th Percentile Response Time	8:42	7:32
Source: MOHLTC ADDAS October 2010

The historical data presented above supports the establishment of an expanded, permanent Paramedic Response Unit program. In 2009, single Paramedic responders have been placed in selected zones to help improve response times, patient care and service to the community. The prioritization of zones is based on highest call demand per zone. Zone-based deployment provides for smaller coverage zones, which reduces drive times and allows team members to leverage their familiarity of the area and positively impact response times.

2010 PERFORMANCE TRENDS REPORT

On October 28, 2004, the Emergency and Protective Service Committee directed as follows:

“That staff report back to Committee and Council prior to budget each year on performance trends, mitigation strategies, and associated financial impacts to ensure the service can maintain its baseline performance targets”.

Operating a performance-based paramedic service means that patients receive the highest quality of pre-hospital and out-of-hospital care. This report is to ensure the service has the appropriate number of staff for response volume to maintain baseline performance targets. In October 2008, CAE Professional Services presented the sophisticated modelling and the rational of their resource simulation at the Community and Protective Services Committee meeting. At that time, the Paramedic Service 3-year strategic staffing strategy was proposed and received by the CPS Committee.

PERFORMANCE TRENDS

The trends for 2010 are proving to be similar to that of the 2009 Annual Report. Response volume continues to increase while response times are improving to where Ottawa paramedics are arriving on scene more rapidly. Innovative programs, such as the off-load nurse pilot project and the Paramedic Response Unit, along with additional staffing have helped stabilize this period of growth.

Chart 3 below demonstrates response volume growth versus the 90^th percentile response time.

The call volume is forecasted to increase by a total of 11% since the last report to CPS Committee in 2009 and responses are anticipated to rise year-over-year.

Table 7 below demonstrates the response volume forecast for 2010. Volumes for 2010 are forecasted because the information resides in a Provincial database that is not downloaded to the City until the end of the first quarter of 2011.

Table 7

Response Volume Growth 2009 vs. 2010 Forecast
	Call Code	2009	2010 Forecast
Emergency	Code 4	79,126	80,975
	Code 3	23,653	24,996
Non-Emergency	Code 2	4,202	4,138
	Code 1	1,716	1,904
Stand-by	Code 8	2,604	2,529
Total		111,301	114,542
Response Volume Growth		+ 2.9%
Source: MOHTLC ADDAS – December 21, 2010

The 2010 trends are demonstrating that response time continues to improve in both the 90^th percentile and average target range. These improvements are attributed to sustained staffing over the last two years and to innovative systematic solutions. Also in 2010, the Ottawa Paramedic Service was able to increase the threshold for the number of scheduled units during peak periods from 32 units to 40 units to better serve the community. Over the course of the year the modified threshold has been met in 99% of instances, which means staff scheduling was effectively sustained in order to maintain baseline performance targets.

Table 8 below demonstrates that in 2010 response times for life threatening calls in the 90^th percentile improved in high-density zones for code times T0-T4 (receipt of call to arrival on scene).

TABLE 8

Response Times & 90^th Percentile

Ranking for High-Density Zones

RESPONSE TIME PERFORMANCE (HIGH-DENSITY ZONE)
Year	90^th Percentile Target	90^thPercentile Actual	90^thPercentile Rank	Average Response Time
2009	8:59	12:50	64.1%	8:23
2010 Forecast	8:59	12:30	63.4%	8:25
Source: MOHLTC ADDAS December 21, 2010

Table 9 below demonstrates that in 2010 response times for life threatening calls in the 90^th percentile improved in low-density zones for code times T0-T4 (receipt of call to arrival on scene).

TABLE 9

Response Times & 90^th Percentile

Ranking for Low-Density Zones

RESPONSE TIME PERFORMANCE (LOW-DENSITY ZONE)
Year	90^th Percentile Target	90^thPercentile Actual	90^th Percentile Rank	Average Response Time
2009	15:59	21:39	64.1%	14:36
2010 Forecast	15:59	20:16	63.4%	13:40
Source: MOHLTC ADDAS December 21, 2010

MITIGATION STRATEGIES

The Ottawa Paramedic Service mitigation strategies have been further realized in 2010. The off-load nurse pilot project’s funding was renewed based on a business case submission by the City to the Ministry of Health and Long Term Care. The continuance of this project has eased off-load delays and allowed paramedics to be available for the next life-threatening call sooner. The Paramedic Response Unit program has revised its deployment plans to positively impact response times to where a paramedic arrives on the scene under the 8 minutes 59 seconds target in the 90^th percentile. These initiatives demonstrate how the Paramedic Service mitigates industry challenges and strives to better meet the needs of patients in the community.

In 2010, the Ministry of Health and Long Term Care doubled their contribution to $1.05M for the off-load nurse pilot project. The improved funding for 2010-2011 has increased off-load nurse hours, which have saved paramedic hours in off-load delay resulting in paramedics being available for the next request for service.

From October 2008 to November 2010, a total of 13,739.5 paramedic hours were recovered from the Ottawa adult Emergency Departments. In 2010, the total unit hours recovered increased 27% from the previous year for a total of 7,056 hours. It is recognized that the funding provided by the Ministry of Health and Long Term Care has significantly benefited the Ottawa Paramedic Service.

Chart 4 below demonstrates the total paramedic hours saved annually since the start of the off-load nurse pilot project in October 2008.

In 2010 the Paramedic Response Unit is projected to have responded to a greater number of emergency calls than the previous year and yet has improved their response time. In September 2010, the single paramedic responder’s year-to-date response time in the 90^th percentile is 28 seconds better than 2009.

Table 10 below displays the total responses and 90^th percentile response time for the Ottawa Paramedic’s Paramedic Response Unit for T2-T4 (paramedic crew notified to arrival on scene) .

TABLE 10

Paramedic Response Unit

Response Volume &

90^th Percentile Response Time

	2009	2010 YTD (Jan-Sept)
Response Volume	6,024	5,657
90^th Percentile Response Time	7:32	7:04
Source: MOHLTC ADDAS October 2010

NEW LAND AMBULANCE ACT RESPONSE TIME FRAMEWORK

The new Land Ambulance Act will require paramedic services throughout the province to establish annual performance plans respecting response times based on the Canadian Triage Acuity Scale (CTAS).

The CTAS is considered to be a more precise tool for categorizing life threatening calls, than the Code 1-4 levels utilized by dispatchers. Use of the CTAS will provide better data to ensure more accurate reporting of response times to life threatening calls as determined by a paramedic professional based on factual evidence at the patient’s side. This will allow municipalities to enhance their reporting capacity and make performance based decisions using more refined data.

These new standards will afford Council the opportunity to revisit and review the performance plan targets of the Paramedic Service. The Ottawa Paramedic Service will be bringing forward a proposed Response Time Performance Plan to Committee and Council before the end of 2011.

FINANCIAL IMPACTS

The demographics of the City continue to impact the Ottawa Paramedic Service. The population growth and aging society impacts generate annual increases for service requests (calls and responses). Based on the 2010 projected response increase of 2.9% and year-over-year growth, staff has identified 24 FTEs to help sustain call volume demands. These new positions will help stabilize some of the challenges that are currently being faced by the Service.

CONCLUSION

In the last two years, the Ottawa Paramedic Service maintained its commitment to enhancing its services and improving the quality of life to patients in the City of Ottawa. The 2009 Annual Report and 2010 Performance Trends Report have revealed the growth and progression of comprehensive programs, services and initiatives, such as:

· Clinical Excellence Initiatives

· Development of Community Medicine

· Extensive Coverage & Coordination of High-Profile Special Events

· Evolution of the Paramedic Response Unit

· Benefits of the Off-Load Nurse Pilot Project

Response volumes continued to increase by 8% in 2009 and are forecasted to increase by 2.9% in 2010. The Paramedic Service has observed an improvement in response times which can be attributed to developing innovative solutions and to effective resource management; based on new staffing rotations and revised deployment plans. The positions requested in the 2011 budget will support the sustainability of call volume growth, allow the service to maintain baseline performance targets and provide greater quality of patient care to the community.

CONSULTATION

There was no consultation undertaken as part of the preparation of this information report.

FINANCIAL IMPLICATIONS

Financial implications of this report will be included in the 2011 budget deliberations for council consideration

SUPPORTING DOCUMENTATION

Document 1 – Definitions of terms

DISPOSITION

Emergency and Protective Services Department, Paramedic Service Branch will action any direction received as part of consideration of this report.

Document 1

Definitions of Terms

High-density: High-density call areas are defined as areas with greater than or equal to 24 calls per sq km per year in groups of 6 contiguous sq km.

Low-density: Low-density call areas are defined as areas that do not meet the high-density criterion. (Greater than or equal to 24 calls/sq km/year in 6 contiguous sq km ) – see high-density

Code-1: A non-urgent call which may be delayed without being physically detrimental to the patient

Code-2: Any call which must be done at a specific time due to the limited availability of special treatment or diagnostic/receiving facilities.

Code-3: Any call which may be answered with moderate delay. All patients classified in this priority group are stable or under profesisonal care and are not in immediate danger

Code-4: This calls refers to situations of a life or limb threatening nature and time is critical

MOHLTC: The Ministry of Health and Long Term Care

Percentile: A percentile is the value of a variable below which a certain percent of observations fall.

Percentile Rank: The percentile rank of a score is the percentage of scores in its frequency distribution which are lower than it.

STEMI (ST elevation myocardial infarction): A specific type of heart attack.