CLI ENT LOGO
APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES “SITUATIONAL OVERVIEW”
APEXPRO CONSULTING INC. NOVEMBER 2019
REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
Table of Contents
Preface ...... iii
1 Introduction ...... 1
1.1 Service Area ...... 1 1.2 Service Profile ...... 1 1.3 Community Paramedicine Program...... 3 1.4 Unique Services & Collaborations ...... 4
2 Service Demand Trends ...... 5
3 Response Time Performance Plan (RTPP) ...... 7
4 CTAS Priority Distribution ...... 8
5 Pickup Locations ...... 9
6 Destination Locations ...... 11
7 Resource Utilization ...... 12
7.1 Time on Task ...... 12 7.2 Unit Utilization ...... 12 7.3 Ambulance Availability for Next Call ...... 13
8 Hospital Offload Delay ...... 14
9 Drivers of Service Demand ...... 15
10 Response Volume Forecasts ...... 17
11 Forecast Resourcing Requirements ...... 18
12 Paramedic Service Costs ...... 19
12.1 Operating Costs 2014-2019 ...... 19
APEXPRO CONSULTING INC. i REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
Table of Contents (cont’d)
12.2 Expenditure Profile (2018)...... 20 12.3 Operating Costs by Revenue Source (2018)...... 21 12.4 Financial Metrics (2018) ...... 22 12.5 Projected Operating Costs to 2024 ...... 23
13 Definitions ...... 24
APEXPRO CONSULTING INC. ii REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
Preface
The Eastern Ontario Wardens’ Caucus (EOWC) acting on behalf of the participating members, commissioned a Review of Eastern Ontario Paramedic Services with the following as principal objective … “to perform an environmental scan of the existing paramedic services including 5-year predictive forecasts”. The findings of the environmental scan are reported in a “Situational Overview” report. This appendix to the “Situational Overview” report, should be read in concert with that document. The appendix contains the findings of our environmental scan of the subject paramedic service, including a service profile; response volumes trends; response time and other service performance metrics; financial information related to the service; and 5-year predictive forecasts. APEXPRO assembled this information from data and documentation provided by the subject member, including Ambulance Dispatch Reporting System (ADRS) records covering the past five years. As the work progressed, multiple work-in-progress drafts were distributed for the member’s review and feedback. This appendix does not include service level / resourcing recommendations, as such items are beyond the project scope.
APEXPRO CONSULTING INC. iii REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
1 Introduction
Peterborough County/City Paramedic Services (PCCP) provides emergency and non-emergency out-of-hospital paramedic care for the County of Peterborough.
1.1 Service Area
Peterborough County consists Exhibit 1.1: PCCP Service Area of nine local municipalities. The City of Peterborough (a separated city) is the main urban community. Rural communities are the townships of Asphodel- Norwood, Cavan Monaghan, Douro-Dummer, Havelock- Belmont-Methuen, North Kawartha, Otonabee-South Monaghan and Selwyn; and municipality of Trent Lake. Peterborough County covers an area of 3,848 sq. km and it houses approximately 145,400 residents. The residential density is approximately 37.8 persons per sq. km. During peak season, with the influx of visitors, cottagers et al, the County’s population can surge in excess of 170,000 persons. 1.2 Service Profile
Health Care Delivery setting ⋅ LHIN: Central East ⋅ CACC: Lindsay ⋅ Base Hospital: Central East Prehospital Care Program (CEPCP) operated by Lakeridge Health ⋅ Hospital(s): Peterborough Regional Health Center located in the City of Peterborough
Service Profile ⋅ Chief of paramedic services reports administratively to County CAO; albeit, the ‘County-City Joint Services Commission’ bears responsibility for
APEXPRO CONSULTING INC. I - 1 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
recommended service changes (e.g., changes to resourcing and deployment). ⋅ Deployment model: PCCP operates a fluid deployment model in which rural based ambulances are periodically re-deployed throughout the County and City to maintain emergency coverage. ⋅ Staffing: The service employs about 155 staff, including 112 primary care paramedics (PCP) and 23 advanced care paramedics (ACP). ⋅ Bargaining Unit: Paramedics are represented by CUPE 4911. The collective agreement expires December 31, 2019. ⋅ Ambulance stations: The service operates from 6 ambulance stations. The Headquarters (Armour Road), Apsley and Buckhorn stations are owned by the County. Norwood and Lakefield stations are owned by the respective local municipalities. Clonsilla station is leased from a private sector owner. ⋅ Fleet: The service operates with a fleet of 21 vehicles including 15 ambulances. The ambulance fleet is in transition, evolving from Crestline Fleetmax Commanders to the more fuel-efficient Crestline New Era vehicle model. In addition, PCCP has recently purchased a bariatric ambulance with delivery expected in the fall. ⋅ PCCP ambulances are equipped with electronic mapping through the MOHLTC ‘Locator’ application. The ambulances are typically turned over on a 5-year cycle. ⋅ Stretchers: The service uses Stryker PowerPro stretchers. Ambulances are not equipped with power load systems. ⋅ Defibrillators: The service uses Physio Control Life Pak 15 defibrillators. ⋅ Electronic Patient Care Record (e-PCR) system: I-Medic
⋅ Paramedic Service Coverage
Exhibit 1.2: Staffed Vehicle Coverage 2014-2019
Vehicle Hours Change in Vehicle Hours Amb's PRU Amb's PRU 2014 63,510 0 -- -- 2015 63,510 0 0 0 2016 63,510 4,380 0 4,380 2017 63,510 8,760 0 4,380 2018 67,014 1,752 3,504 -7,008 2019 74,460 0 7,446 -1,752
APEXPRO CONSULTING INC. I - 2 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
1.3 Community Paramedicine Program
⋅ Presently no formal program. However PCCP will, within the service’s capacity, perform in-home referrals. ⋅ In discussions with Peterborough Regional Health Center (Health Team) to establish a Community Paramedicine program, as described below based on available documentation. Program implementation is contingent on securing requisite funding.
- PCCP is uniquely positioned to support patients transitioning to home after an ED visit. The proposed Transitional Care Paramedic Program will provide patients with linked pathways to available services and likely mitigate return ED visits and hospital admissions.
- PRHC ED will identify “at risk” patients discharged to home who do not have home care or where CCAC is not immediately available. Additionally, patients will be identified by responding paramedic crews and referred internally through the PCCP CREMS program.
- “At risk” patients will be identified by the following criteria or as having one or more of the following conditions:
o COPD o CHF o Diabetes o Asthma o Ischemic Heart Disease o >65 who are classified as frail elderly o Patient determined to be high risk for return within 72 hours by ED ⋅ PCCP supports the Peterborough Police Service in their efforts to secure funding through Health Canada, Substance Use and Addictions Program to improve the community response to the opioid/drug poisoning/overdose crisis in Peterborough City and County. ⋅ PCCP was involved in a Community Paramedicine Remote Patient Monitoring (CPRPM) program trial, which used Bluetooth enabled devices to wirelessly monitor patients with chronic illness, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM); keeping them safe at home and out of the hospital. The trial, which demonstrated a reduction 911 calls, is complete.
APEXPRO CONSULTING INC. I - 3 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
1.4 Unique Services & Collaborations
⋅ Offload nursing program: The existing program, in concert with Peterborough Regional Health Center, involves offload nurse staffing of about 8,760 hours annually. The program cost, of about $458,500 a year, is funded almost entirely by MOHLTC. ⋅ Involved in research projects ⋅ Opioids data share with health unit ⋅ CCAC referral Program (could connect with Community Paramedicine Program) ⋅ About to begin Tactical paramedic Team with Peterborough Police ⋅ Bariatric Truck ⋅ Four (4) county deployment plan developed in concert with Haliburton County, Northumberland County and City of Kawartha Lakes, to enhance CACC’s deployment of their respective ambulance resources. ⋅ Also share information on best practices, KPI and professional standards ⋅ Works with other eastern Ontario services to optimize I-medic (e-PCR) dashboard and KPI ⋅ Can easily build on the above to include joint training for in-service CME ⋅ Willingness to share use of PCCP’s new bariatric ambulance with other services.
APEXPRO CONSULTING INC. I - 4 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
2 Service Demand Trends
Recent call volume trends are shown in Exhibit 2.1. The current (2018) response volume of 24,445 is an increase of 38% over the 2014 response volume of 17,668. Over the corresponding timeframe patient transports from scene to hospital emergency department increased by 23% to 16,451.
Exhibit 2.1: Response Trends, 2014-2018
In addition to the 24,445 ambulance responses completed in 2018, PCCP also performed 9,731 temporary Priority 8 relocations (i.e., standby’s) to maintain emergency coverage. Reporting fractile percentage response times to medical calls (i.e., 80th or 90th percentiles) is not a legislated requirement; however, tracking such metrics is a useful means for measuring land ambulance service performance. Exhibit 2.1 shows 90th percentile response times to Priority 4 medical emergencies for 2014-2018 (i.e., responses with flashing lights and siren). In 2014, the 90th percentile response time to medical emergencies was 16:15, meaning that 90 percent of all calls dispatched as Priority 4 (i.e., with lights and siren) were responded to in under 16 minutes and 15 seconds. By 2018, the 90th percentile response time had declined by almost 5%, to 15:29.
APEXPRO CONSULTING INC. I - 5 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
PCCP’s ability to manage response time despite a 38% increase in call volume, is attributed to the Service’s periodic re-deployment of resources in line with hourly and geographic call pattern variations, and to County council’s investment in Service resourcing. These investments include an additional station in Peterborough’s west end in 2017 (with relocation of existing resources), addition of trial Paramedic Response Unit (PRU) in 2016-17 and an additional 3,504 ambulance coverage hours in 2018.
APEXPRO CONSULTING INC. I - 6 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
3 Response Time Performance Plan (RTPP)
Exhibit 3.1 presents the Response Time Performance Plan (RTPP) approved by Peterborough County Council; also, the performance levels that PCCP achieved during the period 2014-2018. Overall, PCCP is performing well in regard to response times - with trends in most categories moving in a positive direction.
Exhibit 3.1: Response Time Performance Plan
Reported Levels of Performance CTAS Target Resp. Target Category Time (min's) Fractile % 2014 2015 2016 2017 2018
SCA 6 * 50% 59% 51% 60% 71% 68%
CTAS 1 8 * 66% 64% 64% 71% 78% 72%
CTAS 2 10 65% 73% 75% 76% 77% 77%
CTAS 3 10 65% 69% 70% 73% 75% 74%
CTAS 4 10 65% 71% 72% 70% 76% 76%
CTAS 5 10 65% 69% 71% 68% 76% 75%
* MOHLTC sets the response time targets for SCA and CTAS 1 categories. County sets response time targets for CTAS 2-5 & fractile percentages for all categories.
APEXPRO CONSULTING INC. I - 7 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
4 CTAS Priority Distribution
MOHLTC CACC’s are outfitted with a call screening tool which is known to overly dispatch calls as Priority 4. As shown by Exhibit 4.1, almost 73% of all PCCP responses are dispatched code 4 with flashing lights and siren whereas, CTAS-based evidence shows that only 33% of the calls required aggressive / urgent medical intervention.
Exhibit 4.1: Call Priority Distribution (2018)
APEXPRO CONSULTING INC. I - 8 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
5 Pickup Locations
Exhibit 5.1 shows a breakdown of PCCP responses (priority 1-4) by call origin for year 2018. The County of Peterborough generated 97% of the calls to which PCCP responded with the City of Peterborough accounting for 71%. Three percent (3%) of all PCCP responses were to calls of external origin.
Exhibit 5.1: Responses by Pickup Location
Percentages may be off slightly due to rounding.
In 2018, for the whole of Peterborough County, the paramedic service response rate per capita was 177 responses per 1,000 residents; this based on responses dispatched as priority 1 to 4. 1 The maps in Exhibit 5.2 (next page) show the geographic distribution of incidents by pick up location.
1 PCCP estimates the City / rural split for 2018 to be: City - 214 responses per 1,000 residents; and rural - 116 responses per 1,000 residents. These figures are based on priority 1-4 responses.
APEXPRO CONSULTING INC. I - 9 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
Exhibit 5.2: Incidents by Pickup Location (2018)
Dispatch Priority 4
Dispatch Priority 1-3
APEXPRO CONSULTING INC. I - 10 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
6 Destination Locations
Exhibit 6.1 shows a breakdown of PCCP transports by destination location. Ninety-one percent (91%) of PCCP transports were destined to medical facilities in the City of Peterborough; 5% to medical facilities in Northumberland County; and 4% were destined to medical facilities in other jurisdictions.
Exhibit 6.1: Responses by Destination Location
Percentages may be off slightly due to rounding.
APEXPRO CONSULTING INC. I - 11 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
7 Resource Utilization 7.1 Time on Task
Time on task trends, measured from the time the crew is notified (T2) to the time that a call is concluded (Tmax), are shown in Exhibit 7.1. Figures shown have been adjusted to include return travel from destination locations in other jurisdictions. Service-wide, time on task increased by 37% from 16,993 hours in 2014 to 23,298 hours in 2018. The time on task increase is attributed mainly to a 38% increase in response volumes over the same time period, adjusted for a slight decrease in average call duration.
Exhibit 7.1: Time on Task Trends
7.2 Unit Utilization
Exhibit 7.2 (next page) presents two annualized UU trendlines for PCCP. One trendline is derived using ‘staffed ambulance’ shift durations, whereas the other trendline includes ‘staffed ambulances and PRU’. Both trendlines are generated using time on task T2-Tmax. Since PRU do not have patient transport capability (their role being mainly first response), one may reasonably argue that the UU trendline labelled ‘staffed ambulances’ is a more accurate representation of the current operating environment.
APEXPRO CONSULTING INC. I - 12 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
PCCP’ current unit utilization (UU) based on ‘staffed ambulances’ are: 43% daytime; 25% night; and 35% for 24-hours. Annualized 24-hour UU based on ‘staffed ambulances’ have increased from 27% in 2014 to 35% in 2018.
Exhibit 7.2: Annualized Unit Utilization Trends
7.3 Ambulance Availability for Next Call
With UU for ‘staffed ambulances’ currently trending at 35%, the likelihood that an ambulance will be available for the next call is 65%, as shown by Exhibit 7.3. Note - this calculation shows the ‘likelihood’ of availability of a resource but not the location of that resource. While an ambulance may be available in the City of Peterborough, there may be no ambulance available to respond to the next call if that call originates elsewhere. Exhibit 7.3: Ambulance Availability
APEXPRO CONSULTING INC. I - 13 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
8 Hospital Offload Delay
Exhibit 8.1 shows recent hospital offload delay (OLD) trends for PCCP. In 2018, PCCP incurred 1,089 OLD hours during which, its paramedics were unavailable to respond to other calls for medical assistance.
Exhibit 8.1: Hospital Offload Delay Trends
The OLD impact is shown more clearly in Exhibit 8.2. At the current annualized UU of 35%, the 2,089 OLD hours consumed the equivalent of 3,133 annual hours of ambulance staffing coverage. Stated more simply, this equates to the consumption of about 0.7 shifts a day (each of 12 hours duration).
Exhibit 8.2: Offload Delay Impact
2015 2016 2017 2018
Offload Delay (Hrs) 1,187 885 1,423 1,089
Annualized UU 29% 31% 34% 35%
Amb. Staffing Coverage 4,045 2,812 4,130 3,133 Equivalent (Hrs)
Annual Hours in a 12-Hr 4,380 4,380 4,380 4,380 Amb. Shift Amb. Shifts per Day 0.9 0.6 0.9 0.7 Equivalent
APEXPRO CONSULTING INC. I - 14 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
9 Drivers of Service Demand
Prior experience affirms that the demand for paramedic services is based mainly on two contributing factors – population growth and an ageing of the population. Exhibit 9.1 shows the population growth forecast to 2024 for Peterborough County. 2 Total population increased at an annual rate averaging 1.0% between 2014 and 2018. Seniors population (aged 65+) over the same timeframe increased at 2.7% annually. Seniors population, 2018 to 2024, is forecast to increase at an annual rate averaging 3.1%; substantially outpacing the total population growth rate, which is forecast to average 0.8% per annum.
In 2014, seniors represented 21.5% of the County’s total population. By 2018 seniors as a percent of the total population had increased to 23.0%, and it is projected to increase further, to 26.4% by 2024.
Exhibit 9.1: Forecast Population Growth
2 Source: Population forecasts updated annually by the Ontario Ministry of Finance.
APEXPRO CONSULTING INC. I - 15 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
Exhibit 9.2 shows the propensity of Peterborough County seniors (65+) to call for paramedic services. In 2018, seniors which accounted for 23% of the County’s total population, generated 49% of all PCCP ambulance responses. By 2024, seniors as a percent of the total population, is forecast to increase to 26.4% substantially increasing PCCP’ resourcing needs (as will be shown in Section 10 of this report). A rapidly ageing population is not unique to Peterborough County. It is occurring province-wide, posing significant challenges to all Ontario paramedic services.
Exhibit 9.2: Propensity of Seniors to Call for Paramedic Services
APEXPRO CONSULTING INC. I - 16 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
10 Response Volume Forecasts
Exhibit 10.1 presents two response volume forecasts for PCCP, to 2024. One forecast, which is referred to as the ‘trendline’ forecast, is based on an extrapolation of the past 3 years growth (2016-18). Under this forecast, response volumes (Pr 1-4) are projected to increase at an average rate of 5.6% per annum, increasing to 33,900 paramedic service responses by 2024. The other forecast, which is referred to as the ‘regression’ forecast, uses regression analysis to establish a statistical relationship between response volume and seniors population expressed as a percent of total population (this based on historical data 2016-18). It subsequently carries the relationship forward to 2024. Under the latter forecast, response volumes are projected to increase at an average rate of 6.2% per annum, increasing to 35,100 paramedic service responses by 2024.
Exhibit 10.1: Response Volume Forecasts
APEXPRO CONSULTING INC. I - 17 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
11 Forecast Resourcing Requirements
PCCP’s resourcing requirements to 2024 are discussed below for 2 scenarios. ⋅ Trendline scenario: which is based on the ‘trendline call forecast’ with PCCP’s UU (based on staffed ambulances) fixed at current levels - 43% daytime; 25% night; and 35% for the overall 24-hour day. The 2024 projected requirement is an additional 18,500 vehicle-hours of ambulance coverage, i.e., 4 additional 12-hour shifts a day and 1 additional spare ambulance. ⋅ Regression scenario: which is based on the ‘regression call forecast’ with PCCP’s UU (based on staffed ambulances) fixed at current levels. The 2024 projected requirement is an additional 21,750 ambulance-hours of coverage, i.e., 5 additional 12-hour shifts a day and 1 additional spare ambulance.
Exhibit 11.1: Forecast Resourcing Requirements
YEAR TRENDLINE FORECAST REGRESSION FORECAST
PROJ'D REQ'T - AMB. VEH-HRS 2019 70,750 72,250 2020 74,700 76,750 2021 78,950 81,700 2022 83,350 86,200 2023 88,000 91,300 2024 92,950 96,200 2019 (ACTUAL) 74,450 74,450 TOTAL ADDITIONAL TO 2024 - ANNUAL VEH-HRS 18,500 21,750 - DAILY 12-HR SHIFTS 4 5 - SPARE AMB'S 1 1
Vehicle-hours are rounded to the nearest 50. Shifts and ambulances are rounded to the nearest whole number.
APEXPRO CONSULTING INC. I - 18 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
12 Paramedic Service Costs 12.1 Operating Costs 2014-2019
PCCP operating costs for the period 2014 to 2019 are shown in Exhibit 12.1. Total operating costs are increasing at an average annual rate of 4.5%. Operating costs net of revenue (i.e., municipal portion of the costs) are increasing at an average annual rate of 4.1%.
Exhibit 12.1: PCCP Operating Costs 2014 - 2019
APEXPRO CONSULTING INC. I - 19 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
12.2 Expenditure Profile (2018)
In 2018, the total cost to operate the PCCP service was $16.2 million. As shown by Exhibit 12.2, operational wages and benefits accounted for 80% of the total; with management and administration accounting for an additional 9%.
Exhibit 12.2: PCCP Expenditure Profile (2018)
APEXPRO CONSULTING INC. I - 20 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
12.3 Operating Costs by Revenue Source (2018)
Exhibit 12.3 presents the paramedic service cost broken down by revenue source. In 2018 the province covered almost 49% of PCCP’s total operating cost - this by way of a conditional operating grant. In comparison, provincial operating grants covered about 46% of the combined 2018 operating costs for all paramedic services operating in eastern Ontario. Considering additional provincial contributions for the Community Paramedicine and Offload Nursing programs, the province covered about 51.3% of PCCP’s 2018 operating costs.
Exhibit 12.3: PCCP Costs by Revenue Source (2018)
Peterborough County/City PS Eastern Ontario $ Million Percent
Provincial Operating Subsidy $7.8 48.5% 46.4%
Municipal Property Tax $7.4 46.0% 50.8%
Contracted Services $0.4 2.6% 1.2%
Community Paramedicine $0.0 0.0% 0.6%
Offload Nursing Program $0.5 2.8% 0.6%
Other $0.0 0.2% 0.4% Total $16.2 100.0% 100.0%
Figures may not total due to rounding
APEXPRO CONSULTING INC. I - 21 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
12.4 Financial Metrics (2018)
Shown below in Exhibit 12.4, are the financial metrics for PCCP derived using 2018 population for Peterborough County; as well as the 2018 PCCP call volumes (Pr 1-4), staffing level, and costs. Also shown are the comparable metrics averaged over all paramedic services operating in eastern Ontario.
Exhibit 12.4: PCCP Financial Metrics (2018)
Peterborough Eastern Ontario County/City PS
Responses (Pr 1-4) per 100 Capita 16.8 15.8
Staffed Amb. Hours per 100 Capita 46 60
Cost per Capita $111 $138
Cost per Call (Pr 1-4) $661 $875
Cost per Staffed Amb-Hr $241 $229
Cost per Staffed Veh-Hr $235 $216
Cost per Incremental Staffed Amb-Hr $192 $187
APEXPRO CONSULTING INC. I - 22 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
12.5 Projected Operating Costs to 2024
Projected operating costs to 2024 are presented in Exhibit 12.5 for 3 scenarios. ⋅ Expenditure trendline scenario: In this scenario, operating costs are projected forward at the historical average annual rate of 4.5% (2014-2018). The annual operating cost is projected to increase to $21.2 million by 2024. ⋅ Call trendline scenario: Future operating costs are estimated by applying a vehicle-hour metric of $192 to the projected additional vehicle-hour requirements for the ‘call trendline forecast’ presented in Exhibit 11.1. In this scenario, the annual operating cost is projected to increase at 3.9% per annum to $20.5 million by 2024. ⋅ Call regression scenario: Future operating costs are estimated by applying a vehicle-hour metric of $192 to the projected additional vehicle-hour requirements for the ‘call regression forecast’ presented in Exhibit 11.1. In this scenario, the annual operating cost is projected to increase at 4.5% per annum to $21.1 million by 2024. The figures shown are total costs without adjustment for provincial subsidy or other revenue sources. The figures are presented in current year dollars.
Exhibit 12.5: Projected Operating Costs
APEXPRO CONSULTING INC. I - 23 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
13 Definitions
Ambulance is defined to mean a vehicle for transport of a person(s) who has suffered a suffered a trauma which could endanger their life, limb or function; or has been judged to be in an unstable medical condition and to require, while being transported, the care of a health care provider and the use of a stretcher. Paramedic Response Unit (PRU) is intended to mean a vehicle operated by one fully certified paramedic, in lieu of a crew of two. PRU are not outfitted with a stretcher and have no patient transport capability. Their role is predominately to enhance service area coverage by providing an expedited initial response. CACC is intended to mean the provincially managed network of “Central Ambulance Communications Centres”. CACCs are responsible to quickly and efficiently evaluate incoming calls for medical assistance, and to rapidly dispatch municipally managed land-based paramedic services using the closest available, and most appropriate service resource. Call is intended to mean a request for medical assistance. Response is intended to mean a paramedic service response to a request for medical assistance that has been dispatched by CACC as a Priority 1, 2, 3 or 4 (as defined below). Note, while committed to a medical response, a paramedic crew is not available to take another request until their patient is formally released from their care - unless CACC re-assigns the crew to a higher priority call. ⋅ Priority 1: a non-urgent call that may be temporarily delayed if needed. ⋅ Priority 2: a scheduled non-urgent call, e.g., for a scheduled diagnostic at a medical facility. ⋅ Priority 3: an urgent but non-life-threating call, where a moderate delay can be accommodated if needed, e.g., if the patient is already under professional care, and in a stable condition. ⋅ Priority 4: an urgent call where the patient has a life-threatening or potential life-threatening condition. For such calls, a rapid response is crucial, and ambulances are dispatched with flashing lights and siren. Transport is intended to mean a paramedic service response involving patient transport, i.e., to a hospital emergency department. Standby or Priority 8 is intended to mean a temporary repositioning of paramedic service resources to maintain balanced coverage. Note, a standby is not a paramedic service response and while performing standby, a crew may be dispatched to respond to a call, if one arises.
APEXPRO CONSULTING INC. I - 24 REVIEW OF EASTERN ONTARIO PARAMEDIC SERVICES: SITUATIONAL OVERVIEW APPENDIX I - PETERBOROUGH COUNTY/CITY PARAMEDIC SERVICES
Response Time is intended to mean the interval T2-T4, where T2 is the time that a paramedic service crew is notified of the call, and T4 is the time of their arrival on scene. Time on Task is intended to mean the duration of a paramedic service response from start time to the time that the call is concluded. Start time is measured from T2, the time the crew is notified, and the time that a call is concluded is Tmax. Time-on-task does not include time for discretionary activities that are deferable if the crew is needed to respond to a medical emergency (e.g., time to complete documentation). Hospital Offload Time is intended to mean the time interval between a paramedic service crew’s arrival at hospital (T6) and the time at which formal transfer of patient care to the hospital took place. Hospital Offload Delay (OLD) is intended to mean hospital offload time in excess of 30 minutes. Unit Utilization (UU) is defined as time on task (i.e., committed to medical calls) expressed as a percentage of the shift duration. The percent calculation is based on paramedic service responses dispatched as a Priority 1, 2, 3 or 4. Ambulance Availability, defined as the converse of unit utilization (UU), is intended to mean the ‘likelihood’ that an ambulance will be available to respond to the next call. Likelihood of availability should not be interpreted as a guarantee that an ambulance will be available to respond to the next call. The vehicle may not be positioned in proximity to the next call origin; or it may be undergoing one of several functions integral to the operation, e.g., restocking or decontamination. Canadian Triage Acuity Scale (CTAS) is intended to mean the patient’s condition as reported by the paramedic on arrival scene, using the CTAS scale. CTAS classification levels are listed below in priority sequence from highest urgency (patient most ill requiring aggressive medical intervention) to calls of least urgency (where a delay in medical intervention can be accommodated if required). ⋅ SCA: Sudden Cardiac Arrest. ⋅ CTAS 1: Conditions that are, or may pose, an imminent threat to life or limb. ⋅ CTAS 2: Conditions that potentially threaten life, limb or function. ⋅ CTAS 3: Conditions that could potentially progress to a serious problem. ⋅ CTAS 4: Conditions often associated with patient age or distress. ⋅ CTAS 5: Non-urgent conditions generally attributed to a chronic problem.
APEXPRO CONSULTING INC. I - 25