7.

EMERGENCY MEdICAL SERVICES

What is the Service?
Emergency Medical Services (EMS), often referred to as ambulance or paramedic services, provides emergency care to stabilize a patients condition, initiates rapid transport to hospitals, and facilitates both emergency and non-emergency transfers between medical facilities. Specific objectives include: All citizens should have equal access to ambulance service Ambulance services are an integrated part of the overall Emergency Health Care Services Closest available and appropriate ambulance responds to a patient regardless of political, administrative or other artificial boundaries Ambulance service operators are medically, operationally and financially accountable to provide service of the highest possible caliber Ambulance services must adapt to the changing health care, demographic, socio-economic and medical needs in their area

What should you consider when reviewing the results?

Each municipalitys results are influenced to varying degrees by a number of factors, including: Demographics Governance Hospital Delay Non Residents Specialized Services

Age and health status of the population has an impact on number and severity of calls. An older population can increase the demand for services, as can seasonal visitors and the inflow of workers from other communities during the day.

Budgeted resources, Local Response Times Standards or Deployment Plans are mandated by Council. Services face varying lengths of delays in the off-load of passengers at local hospitals, which can impact the resources required and availability to respond to calls. Visitors, workers, tourists and out of town hospital patients not reflected in the measures (population is that of municipality only). Tactical teams, multi-patient transport units, bike and marine teams are increasingly being provided by the larger municipalities. Also, costs can be impacted by higher wage rates of advanced care (ADP) vs. primary care (PCP) paramedics. Mix of urban versus rural geography can influence response time and cost factors. Congestion can make navigating roads more difficult, resulting in significant delays. Urban centres with taller buildings can impact response times, i.e. responses to high level apartment/condo units. Large rural geographic areas can make it challenging to provide cost-effective, timely emergency coverage. Services use a varying mixture of response vehicles which have differing levels of staffing.

Urban vs. Rural

Vehicle Mix

PARTNERING FOR SERVICE EXCELLENCE

31

EMERGENCY MEdICAL SERVICES What are the results?

Fig. 7.1 total eMS Responses Reponses per Fig. 7.1 - Total EMS per 1,000 Population 1,000 population

How many calls were responded to by EMS providers?

200 150

Fig. 7.1 - Total EMS Reponses per 1,000 population

50 200 0 150 DUR
84 83 87

100

HAL
63 65 63

HAM
121 123 127

LON
95 96 98

MUSK
85 89 72

NIAG
97 98 102

OTT
113 120 108

SUD
181 149 138

TBAY
167 175 183

TOR
112 107 115

WAT
65 67 65

WIND
116 116 119

YORK
64 62 62

MED
97 98 102

100 2008 50 2009

2010

0 Fig. 7.2 - EMS TO-2 Code 4, 90th Percentile Response Time (EMDS 419B and 419C)
Source: eMDS229 (Service Level)

DUR

HAL

HAM

LON

MUSK

NIAG

OTT

SUD

TBAY

TOR

WAT

WIND

YORK

MED

Fig. 7.2 - EMS TO-2 Code 4, 90th Percentile Response Time (EMDS 419B and 419C) 5:00
4:00 How long does it take to dispatch a call? 2:00 8:00 1:00 7:00 0:00 6:00 5:00 4:00 3:00 2:00 1:00 0:00 3:00 Fig. 7.2 eMS to-2 Code 4, 90th Percentile Response time (mm:ss)

Figure 7.1 illustrates how many calls the EMS provider is receiving per capita. The services in Sudbury and 8:00 Thunder Bay do more non-emergency patient transfers than the other services (which are generally done 7:00 by private contractors in other municipalities) which explains their much higher call volumes. Overall, EMS 6:00 responses have increased by 3.7% in the last year.

DUR

HAL

HAM

LON

MUSK

NIAG

OTT

SUD

TBAY

TOR

WAT

WIND

YORK

MED

DUR
02:15

HAL
02:43

HAM
03:09

LON
02:39

MUSK
07:35

NIAG
01:50

OTT
02:25

SUD
02:20

TBAY
02:05

TOR
03:24

WAT
03:33

WIND
03:35 03:37

YORK
02:37 02:43

MED
2:39 2:48

Fig. 7.3 -02:34 Revised T203:01 02:44 Percentile Response Time03:28 02:20 408, 408A) EMS 02:50 - 4 Code 4, 90 (EMDS 415A, 03:15 03:36 2010 01:51 02:46
Source: eMDS419B and eMDS419C (Customer Service)

2009

Fig. 7.3 - EMS Revised T2 - 4 Code 4, 90 Percentile Response Time (EMDS 415A, 408, 408A) 15:00
10:00 5:00 25:00 0:00 20:00 DUR HAL HAM LON MUSK NIAG OTT SUD TBAY TOR

Figure 7.2 shows the time from a phone call being received to the EMS unit being notified (dispatched) 25:00 for the highest priority calls (Code 4). The 90th percentile means that 90% of all calls of the service have a 20:00 dispatch time within the period reflected in the graph, thus limiting extreme situations.

15:00 10:00

WAT

WIND

YORK

MED

32

5:00 2010 PERFORMANCE BENCHMARKING REPORT 0:00 DUR HAL HAM LON MUSK NIAG OTT SUD TBAY TOR WAT WIND YORK MED

0:00

DUR

HAL

HAM

LON

MUSK

NIAG

OTT

SUD

TBAY

TOR

WAT

WIND

YORK

MED

How long does it take to respond to a dispatched call?

Fig. 7.3 eMS Revised t2-4 Code 4, 90th Percentile Response time (mm:ss)

EMERGENCY MEdICAL SERVICES Fig. 7.3 - EMS Revised T2 - 4 Code 4, 90 Percentile Response Time (EMDS 415A, 408, 408A)
25:00

20:00 Fig. 7.3 - EMS Revised T2 - 4 Code 4, 90 Percentile Response Time (EMDS 415A, 408, 408A) 15:00 10:00 25:00 5:00 20:00 0:00 15:00 10:00 1996 5:00 2009 0:00 2010

DUR
10:04 10:46

HAL
10:32 10:33 10:16

HAM
10:03 10:17

LON
9:29 9:10

MUSK
20:44 19:00

NIAG
10:48 09:37

OTT
12:33 11:51 10:59

SUD
12:12 10:23

TBAY
10:14 10:48

TOR
9:59 10:09

WAT
10:30 11:47

WIND
10:23 09:49

YORK
11:33 12:37

MED
10:30 10:33

Source: eMDS415A and eMDS408 and eMDS408A (Customer Service) (Response) Note: As set out by the Province, the 1996 information is considered to be the base year standard that service is expected to match.

DUR

10:43

HAL

HAM

10:15

LON

9:21

MUSK

19:00

NIAG

09:45

OTT

SUD

10:26

TBAY

11:33

TOR

10:38

WAT

12:02

WIND

09:45

YORK

12:52

MED

10:38

Fig. 7.4 - Percent of Ambulance Time Lost to Hospital Turnaround

Figure 7.3 indicates how long it takes from the time a call is received to when the EMS unit arrives on the scene for the highest priority calls (Code 4).

Fig. 7.4 - Percent of Ambulance Time Lost to Hospital Turnaround

20% What percent of time do ambulances spend at the hospital? 15% Fig. 7.4 Percent of Ambulance time Lost to Hospital turnaround 10% 30% 5% 25% 0% 20% 15% 10% 5% 0% DUR HAL HAM LON MUSK NIAG OTT SUD TBAY TOR WAT DUR HAL HAM LON MUSK NIAG OTT SUD TBAY TOR WAT

30% Muskoka results are noticeably higher primarily due to a very large geographical area with a relatively small population base, and they service a high volume of seasonal residents and visitors. 25%

WIND

YORK

MED

WIND

YORK

MED

Fig. 7.5 - EMS Actual Weighted Vehicle29.9% 8.3% 17.6% 23.8% 1,000 13.6% 20.6% 13.6% In-Service Hours per 17.7% population 2008 13.0% 13.1% 19.8% 13.5% 10.9% 12.4%
2009 800 15.5% 16.3% 14.1% 13.1% 20.7% 20.0% 13.4% 13.6% 5.7% 0.1% 12.2% 13.1% 27.2% 26.4% 8.6% 10.8% 19.3% 21.6% 21.1% 20.9% 18.3% 19.2% 14.4% 15.8% 19.8% 19.6% 15.5% 16.3%

600 Source: eMDS150 (Community Impact) 500 Fig. 7.5 - EMS Actual Weighted Vehicle In-Service Hours per 1,000 population 400 Figure 7.4 shows the percent of time ambulances are spending at the hospital. This includes the time it takes to300 transfer the patient, delays in transfer of care due to a lack of hospital resources (commonly referred to 800 200 as off-load delay), paperwork, and other activities. 700 100 600 The0significance of the time spent in the hospital is that the more time spent by paramedics in the hospital 500 process,DUR less time they are available onNIAG road to respondTBAY TOR WAT WIND YORK MED the HAL HAM LON MUSK the OTT SUD to emergency calls. 400 300 200 100 0 DUR HAL HAM LON MUSK NIAG OTT SUD TBAY TOR WAT In-Service MED Fig. 7.6 - EMS Actual Operating Cost per Actual Weighted Vehicle WIND YORK Hour

700 2010

PARTNERING FOR SERVICE EXCELLENCE

$250

33

0%

DUR

HAL

HAM

LON

MUSK

NIAG

OTT

SUD

TBAY

TOR

WAT

WIND

YORK

MED

EMERGENCY MEdICAL SERVICES

How many hours of ambulance service are provided in the community for every 1,000 people? Fig. 7.5 - EMS Actual Weighted Vehicle In-Service Hours per 1,000 population
Fig. 7.5 eMS Actual Weighted Vehicle In-Service Hours per 1,000 Population

Fig. 7.5 - EMS Actual Weighted Vehicle In-Service Hours per 1,000 population 800
700 800 600 700 500 600 400 500 300 400 200 300 100 200 0 100 0

DUR
306 DUR 297 303

HAL
250 HAL 251 249

HAM
363 HAM 349 368

LON
338 LON 343 349

MUSK
647 MUSK 638 628

NIAG
408 NIAG 399 438

OTT
290 OTT 307 326

SUD
628 SUD 644 652

TBAY
464 TBAY 462 450

TOR
266 TOR 244 248

WAT
194 WAT 196 193

WIND
425 WIND 410 412

YORK
238 YORK 264 263

MED
338 MED 343 349

2008 2009 2010

Fig. 7.6 - EMS Actual Operating Cost per Actual Weighted Vehicle In-Service Hour
Source: eMDS225A

Fig. 7.6 - EMS Actual Operating Cost per Actual Weighted Vehicle In-Service Hour
How much does it cost to provide one hour of ambulance service?
Fig. 7.6 eMS Actual operating Cost per Actual Weighted Vehicle In-Service Hour

$250

$200 $250 $150 $200 $100 $150 $50 $100 $0 $50 $0

2008 2009 2010

DUR DUR
$149 $160 $174

HAL HAL
$158 $164 $169

HAM HAM
$151 $168 $159

LON LON
$146 $146 $148

MUSK MUSK
$125 $147 $145

NIAG NIAG
$131 $149 $159

OTT OTT
$184 $196 $195

SUD SUD
$146 $154 $161

TBAY TBAY
$140 $147 $157

TOR TOR
$185 $205 $232

WAT WAT
$150 $159 $173

WIND WIND
$146 $175 $171

YORK YORK
$159 $163 $164

MED MED
$149 $160 $164

Source: eMDS305A (efficiency)

Figure 7.6 shows the cost per hour to have an EMS vehicle available to respond to patient calls. Although the full cost of the service including administrative costs, medical supply costs, building operating costs, supervision and overhead are included, only the hours that vehicles are available for service are used. As wages, fuel and other costs increase, this measure will also trend upwards.

34

2010 PERFORMANCE BENCHMARKING REPORT