OTTAWA PARAMEDIC SERVICE

2014 ANNUAL REPORT OTTAWA PARAMEDIC SERVICE

ANNUAL REPORT 2014 2465 Don Reid Dr, Ottawa, ON K1H 1E2 - 613-580-2424 NOTES OF APPRECIATION

...In every case your people are polite, professional We feel great appreciation and respectful of the patient’s dignity. They clearly for our Paramedic Service. care. I don’t know how or where you find these It is only when there is a superb individuals but please, keep doing exactly real need for help that we what you’re doing! can fully understand what a My sincere thanks to your entire team. vital service it is to our city and community. I would like to thank the Paramedics that Our family recently responded when my father suffered a recent experienced this real need heart attack. They diagnosed the issue and for help. We want to relay transported him quickly and safely to the our thanks to the two Heart Institute. Paramedics who came I recognize that there are a lot of times you to our rescue and to the attend a call and brush off what you do as Ottawa Paramedic Service, “just my job”. I want them to know that my for all the good work you do. father is still with us today because of the care they provided. Thank you to all Paramedics for the work they do in our city every day. I had a recent interaction Be proud. with one of your Communications Officers I recently had an acute heart attack in my and want to commend them home. I was not aware of any heart condition, for their calmness, ability to but I felt it was necessary to call 9-1-1. In connect with the patient, and doing so, the excellent and immediate service immediate ability to assess the provided by the Paramedics in getting me location by asking a number to the Heart Institute, saved my life. The of questions, since the exact Paramedics are to be commended for the life location was unknown by the saving procedures that enabled me to be treated caller. The Communications immediately upon arrival at the hospital. Officer helped ease our tension Please convey my gratitude and best wishes to by assuring us that help was those responsible, I will be eternally grateful. on the way. Table of Contents 1 2 3 4 5 7 7 9 11 20 19 19 10 12 13 14 16 17 18 ......

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...... Letter from the Chair Letter from Looking Ahead ...... Appendix Letter from the Chief ...... Letter from ...... Our Service Values Vision, Mission, Our People ...... System Performance ...... Response Volume Standards Response Time Unit Paramedic Response Care Certification Term and Long Ministry of Health Centre System Performance Communications Clinical Excellence Research & Innovation Community Partnerships Significant Events Offload Nurse Program Public Accountability As the Chair of the A testament to these service offerings is Community and when I hear from residents who want to share Protective Services their positive experiences and commend the Committee, I am Paramedic staff member who saved a loved pleased to receive one’s life, reassured a worried parent or the 2014 Ottawa provided a calming voice on the other end of Paramedic Service a 9-1-1 call. Annual Report. Response volumes continue to rise as a City Council result of population growth and an aging and the Ottawa demographic, which further demonstrates Paramedic Service the importance of our Paramedic Service. remain dedicated to On behalf of the Community and Protective improving the quality Services Committee, please join me in of life of Ottawa’s residents. The services noted acknowledging the extremely important work of within this report are indicative of the ongoing the Ottawa Paramedic Service and thank them commitment to the community. for providing the highest level of immediate medical care to our residents in need. Council is proud of the investments made to ensure the highest standard of care to our residents. This is demonstrated through providing advanced medical care to critically ill patients, providing life saving instructions over the phone, teaching CPR and First Aid to members of our community, training and responding to specialized events with valued emergency service partners, participating in ground breaking research trials or implementing innovative solutions to provide the highest level of medical care to patients in the most timely manner.

Diane Deans, Chair Community and Protective Services Committee Letter from the Chair

Ottawa Paramedic Service - 2014 Annual Report Letter from the Chief

It is with great pride Notable highlights from 2014 include: that I present the • The successful community paramedicine Ottawa Paramedic pilot partnership with the West Carleton Service 2014 Family Health Centre that assists the Annual Report to elderly population in maintaining their the Community and independence and reducing their calls to Protective Services 9-1-1. Committee and • Several research programs that aim to residents of the improve paramedicine through innovative City of Ottawa. and evidence based practices such as the The members Targeted Engagement Diversion Program of the Ottawa and the Canadian C-Spine study. Paramedic Service • Successful re-certification of the Ottawa are committed Central Ambulance Communications to serving the residents and visitors of the Centre. City of Ottawa through providing the highest • Direct consultation with all staff that sought level of immediate medical care. This report their input regarding the establishment of highlights the performance of the Service the Service’s priorities over the next term over the previous year and shares the many of Council. successful programs and services delivered by our members. They are not only responsible As we look to the future, we recognize some for providing emergency response, triage, of the challenges we face as demand for our treatment and transport for patients during service grows. The members of the Ottawa their time of need but also provide community Paramedic Service remain committed to paramedicine programs, first aid and CPR finding innovative ways in providing the highest instruction as well as emergency dispatching standard of care to all patients. and 9-1-1 call taking for all of Eastern Ontario. Together, the work of the administrative staff, Communications Officers, Equipment and Supply Technicians and Paramedics results in the provision of progressive paramedic care to the residents and visitors of the City of Ottawa.

Chief Anthony Di Monte Ottawa Paramedic Service

2 Our Service

In 2001, the new City of Ottawa assumed paramedic care in the nation’s capital. The Service responsibility for the delivery of paramedic strives to be a dynamic leader in delivering and services as defined by the Ambulance Act of improving paramedicine, continuously seeking Ontario. The Province of Ontario funds 50% of new knowledge and applying innovation. As land ambulance services and 100% of the cost for an employer, the Ottawa Paramedic Service the Ottawa Central Ambulance Communications champions a safe and supportive work Centre (OCACC). environment based on the core values of trust, integrity and respect. Since 2001, the Service has emerged as a leader, both provincially and nationally, in progressive The Ottawa Paramedic Service provides paramedic service delivery. Through the emergency medical coverage to 2,791 square professionalism and dedication of Equipment kilometers while the OCACC provides dispatching Supply Technicians, Communication Officers, services to over 10,000 square kilometers of Paramedics and administrative staff, a dynamic Eastern Ontario. The Service provides a fully organizational culture of service excellence has integrated advanced life support system delivering been created. state of the art medical services to over one million residents and visitors to the City of Ottawa every The Ottawa Paramedic Service is dedicated to its day. community and patients by providing progressive Table 1: Ottawa Paramedic Service Profile: Area Served City of Ottawa Geographic Coverage 2,791 km2 Base Population 927,118 Daytime Population 997,845 Percentage of Population over age 65 13% Services Provided Advanced Life Support (ALS) Community Paramedicine Program Public Access Defibrillator (PAD) Program

Ottawa Paramedic Service - 2014 Annual Report Mission, Vision, Values

Our Quality Service Model serves to focus all members’ efforts in achieving success and guides all decision making within the organization. It reflects our coordinated goals of meeting patient and community expectations for excellence in out- of-hospital patient care, service reliability, public safety, and accountability.

There are five drivers within the Quality Service Model:

• Our People • Business Processes and Performance • Research and Innovation • Partnerships • Technology and Information

Mission The Ottawa Paramedic Service is dedicated to its community and patients by providing progressive paramedic care in the nation’s capital.

Vision To be dynamic leaders in delivering and improving paramedicine, continuously seeking new knowledge and applying innovation.

Values Safe & Supportive Work Environment Trust - Integrity - Respect

This Quality Service Model ensures day-to-day decisions align with the mission, vision and values and provides direction for the future of our service

4 Our People

Our people are the greatest asset within the diagnosis of the patients they serve. This ensures Ottawa Paramedic Service. The 598 members the residents of Ottawa receive the highest level work in one of four unique divisions: Operations, of care, even in complex medical emergencies, Communications, Technical Services and Special when utilizing the Paramedic Service. Ottawa Operations. Collectively, front-line Paramedics, continues to have one of the highest percentages Communications Officers and critical “behind the in Ontario of responses where an Advanced Care scenes” support staff provide a wide range of Paramedic was present. In 2014, an Advanced expertise that results in the delivery of exceptional Care Paramedic attended 82.8% of all responses. medical care to our community. There are a variety of backgrounds and skill sets that contribute to the successful delivery of paramedicine within the City of Ottawa.

All Ottawa Paramedics are college graduates and are delegated by the College of Physicians and Surgeons to perform medical interventions under the regulated Health Professions Act. As such, they are certified to administer numerous medications and perform an extensive list of controlled medical acts for patients experiencing acute injury or illness. The complement of Paramedics includes approximately 45% being certified as Advanced Care Paramedics (ACP), who are licensed and trained to administer an expanded list of medications, advanced airway management and cardiac interventions, initiate several clinical therapies and have an advanced ability to conduct early identification and

Ottawa Paramedic Service - 2014 Annual Report privy to a behind the scenes experience as they learned the day-in-the-life of an Ottawa Paramedic Service employee. • Day of Pink, where staff members showed up for work at Paramedic Headquarters with a bit more colour than usual to show their desire to stop bullying. International Day of Pink is a day where communities across the country, and across the world, unite in celebrating diversity and raising awareness to stop Homophobic, Transphobic & all forms of bullying.

The Paramedic Service hosted another The Paramedic Service remains committed to the successful graduation ceremony for new Diversity Champion Program which aims to: Paramedic recruits that have replaced retirees • Support current diversity within the Ottawa or filled positions made vacant. All new recruits Paramedic Service; successfully complete a rigorous hiring process • Engage and build relationships with diverse and Orientation and Mentorship programs before communities in Ottawa, allowing the becoming a Paramedic within the City of Ottawa. Paramedic Service to learn how to better meet These new Paramedics were formally recognized their unique needs and to educate them on the for this achievement in front of their family and role of the Paramedic Service within the city; peers. and • Improve diversity through recruitment and In acknowledgement of varying expertise and retention strategies to help ensure that the experiences, an extensive staff engagement Ottawa Paramedic Service is diverse and exercise was conducted to gain insight into the representative of the community it serves. Service’s priorities over the next term of Council. The result of this direct consultation was the Some of the highlights in 2014 include; generation of numerous suggestions in the areas of operational process, financial accountability, • Paramedic Awareness Week Camp for First client and stakeholder relations and employee Nations, Métis and Inuit youth who spent engagement. Many of the initiatives have been a week at Paramedic Headquarters with embedded into the Service’s plan for this next Paramedics, communications officers and term of Council. equipment supply technicians. They were

6 System Performance

PARAMEDIC RESPONSE VOLUME The highest priority for the Ottawa Paramedic Service is to provide the best possible clinical care to the residents and visitors of the City of Ottawa. In order to achieve this, our staff continuously analyze response times, response volumes and patient outcomes in order to maximize the deployment and usage of paramedic resources. The 3 primary measures that determine service demand and associated resource requirements are: • Total number of calls: Total number of 9-1-1 calls received at Ottawa Central Ambulance Communications Centre. • Total number of clinical incidents: Total number of patients assessed and treated. • Total response volume: Total number of Paramedic resources required to respond, which is initially determined by a Communications Officer who obtains and assesses the caller’s information and continuously evaluated by Paramedics once they arrive on scene. An example to illustrate the interdependencies amongst these indicators is a single 9-1-1 call for a vehicle collision with multiple patients requiring multiple resources. Table 2: Paramedic Response Volume by Year

The greatest indicator of system utilization is the response volume. In 2014, the Paramedic Service response volume was 127 883, representing a 7.2% increase over the previous year. The five year trend demonstrates a 21.3% overall increase.

Ottawa Paramedic Service - 2014 Annual Report 2014 City of Ottawa Paramedic Response Density Map

The map above shows the Ottawa Paramedic Service response volume by ward. Generally speaking the more densely populated a ward is the higher the response volume.

8 System Performance

PARAMEDIC RESPONSE TIME STANDARDS Despite the increase in volumes, the Ottawa Paramedic Service was successful in achieving the provincially-legislated and Council approved response time standards in 2014. This is the second year the Ottawa Paramedic Service utilized the new response time reporting framework, therefore providing limited comparison to previous years’ performance.

The current response time reporting framework is defined as the elapsed time from when the first Paramedic Unit is notified to the arrival of a Paramedic Unit on scene. Response times across Ontario are all measured and publicly reported in the same manner by the Ministry of Health and Long Term Care.

Table 3 outlines the legislated response time standard targets and results based on a CTAS (Canadian Triage Acuity Scale) score which is the level of care required for a patient (CTAS Score I being of highest priority). The percent rank target represents the percentage of times that a Paramedic crew has arrived on-scene to provide paramedic services to patients within the established target response time.

Table 3: Paramedic Response Time Standard

Category Target Time Percent Rank 2013 2014

(Minutes) Target Performance Performance

CTAS I 8 Minutes 75% 83.6% 79.5% CTAS II 10 Minutes 75% 85.5% 82.9% CTAS III 15 Minutes 75% 95.4% 93.5% CTAS IV 20 Minutes 75% 98.7% 98.0% CTAS V 25 Minutes 75% 99.6% 99.2%

The level of care required by a patient (CTAS) can dispatched is defined by a Code (Code 4 being only be determined once the Paramedics have the highest priority) which is determined by the arrived on scene to conduct a medical assessment Communications Officer using a medical algorithm and initiate care. The acuity is defined through a call-taking process. 73% of all responses are CTAS score as noted within the response time dispatched as a Code 4 to ensure that the sickest standard. The priority of the Paramedic being patients receive treatment in a timely manner.

Ottawa Paramedic Service - 2014 Annual Report PARAMEDIC RESPONSE UNIT The Paramedic Response Unit (PRU) is a vehicle staffed with a single Primary Care Paramedic. The primary function is to provide first response capacity with a single Paramedic arriving rapidly on scene to initiate patient care. A transport unit is simultaneously dispatched to provide back up, if transport is required. This allows the PRU to downgrade or defer the transport unit, thereby allowing the transport crew (Paramedic Unit) to respond to the next emergency call. The PRU provides continual coverage in their assigned area, as they do not transport patients to hospital and are immediately available upon clearing a call. The single Paramedic Rapid Responder initiative utilized by the Ottawa Paramedic Service is an industry best practice for deployment and has been adopted by many other Paramedic Services Table 4 displays the total responses and average in Ontario and across Canada. response time for the Paramedic Response Units. Table 4: PRU Response Volumes and Times Year 2010 2011 2012 2013 2014 Responses 5,863 8,488 10,666 13,051 10,561 Percent Rank 94.5% 94.8% 92.8% 91.6% 89.7% (8:00 Target) In 2014, deployment of PRU’s was modified in an effortto maintain resource availability across the city. Previously PRU’s were deployed to all Code 4’s. They are now deployed to those calls where they are likely to be the closest responding resource. COMMUNITY DEFIBRILLATOR RESPONSE TIME STANDARDS In cases of sudden cardiac arrest, response the arrival of Ottawa Paramedic, Police, Fire or time is defined as the elapsed time from when OC Transpo Security who are equipped with a the first Paramedic Unit is notified to the arrival defibrillator in their vehicles. Table 5 shows the of any person trained and equipped to provide Ottawa Paramedic Service’s performance against defibrillation. This response time is impacted by the legislated response time standard for Sudden whether there is a public access defibrillator on Cardiac Arrests. scene, such as a public recreational facility or .Table 5: Community Target for Cardiac Arrests Category Target Time Percent Rank 2013 2014 (Minutes) Target Performance Performance Sudden Cardiac Arrests 6 Minutes 65% 73.5% 63.0% (Defibrillator) Staff will be conducting a review of the defibrillator program in 2015 and will be reporting on the outcomes.

10 Ottawa Central Ambulance Communications Centre

MINISTRY OF HEALTH AND LONG TERM CARE CERTIFICATION The Ottawa Central Ambulance Communications inspection, OCACC provided evidence in the Centre (OCACC) provides 9-1-1 call taking and form of live observation, supporting materials and triaging and dispatches all Paramedic resources interviews that demonstrated compliance with for the City of Ottawa, the United Counties 23 elements. These elements are categorized of Prescott and Russell as well as the United by service delivery, quality assurance and Counties of Stormont, Dundas and Glengary. administration. The Ministry of Health and Long This equals a geographical area of over 10,000 Term Care found that OCACC successfully met km2. the Communication Service Review criteria and specifically commended their work in the following The Ottawa Paramedic Service manages these areas: dispatching services under contract for the Ministry • Preparation for the Ambulance Service Review of Health and Long Term Care. As such, OCACC • Comprehensive Quality Assurance Program must successfully meet the Communication • Training Service Review criteria and the legislated • Operations requirements to operate a Communication • Policy and Procedures Service in the Province of Ontario. The purpose • Liaison and Communication of the Communication Service Review is to ensure OCACC operates in a manner consistent with the Performance Agreement, Performance Standards, Manual of Practice and in compliance with legislation.

The legislated Service Review occurs every third year. 2014 marked a Service Review year where OCACC hosted the Ministry of Health and Long Term Care over 2 days. Throughout this on-site

Ottawa Paramedic Service - 2014 Annual Report Ottawa Central Ambulance Communications Centre

OTTAWA CENTRAL AMBULANCE COMMUNICATIONS CENTRE SYSTEM PERFORMANCE In 2014, the OCACC answered 121,964 calls for times) for all ambulance communications centres the City of Ottawa, the United Counties of Prescott in Ontario. This new standard applies to sudden and Russell as well as the United Counties of cardiac arrest and CTAS 1 patients only, as they Stormont, Dundas and Glengary. As a result, they are the most critically ill, and is measured as the performed critical dispatching functions based time difference between when the call is received on a response volume of 158,708 Paramedic at the communications centre and when a resources for emergency call assignments across Paramedic Unit has been notified of an emergency all municipalities. call. Staff must report annually on the percentage of time this performance is achieved within 120 seconds. Table 6 shows the call processing times The Ministry of Health and Long Term Care has also for CTAS I and Sudden Cardiac Arrest patients. created response time standards (call processing

Table 6: Ottawa Central Communications Centre Call Processing Times Category Target Time 2014 Percent Rank 2014 (seconds) Target Performance CTAS I 120 Seconds 75% 86.8% Sudden Cardiac 120 Seconds 75% 89.1% Arrest

12 Clinical Excellence

The Ottawa Paramedic Service remains Table 7 outlines the “Top 10” call types based on committed to promoting and supporting improved the Paramedic’s assessment of the patient once clinical care, safety and quality. When a member on scene: of the public requires immediate medical care, an entire team of dedicated, highly qualified people Table 7: Top 10 Call Types in 2014 come together in the name of providing excellence Call Type # Calls In 2014 in clinical care delivery: the Paramedics, Musculoskeletal 18,317 Communications Officers and Equipment Supply Trauma Technicians, trainers, quality assurance staff and General Illness / critical support staff. 13,065 Weakness Chest Pain / Discomfort / The Paramedic Service is also active on a 6,251 number of provincial and national working groups Cardiovascular Stroke / Confusion / related to performance measures including the 4,816 Ontario Municipal Benchmarking Initiative (OMBI) Neurological Emergency Medical Service Expert Panel and Behavioral / Psychiatric 4,681 the Paramedic Chiefs of Canada Performance Disorder Measures Working Group. This data is utilized Difficulty Breathing / 4,279 to set best practice standards and assists in Respiratory evaluating the quality and form of care being Treatment - Diagnostic 3,974 delivered on a daily basis. Returns Alcohol Intoxication / All data collected during the course of a 3,304 Drug Overdose Paramedic’s duties is protected under the Abdominal Pain / Personal Health Information Protection Act 2,249 and is never shared outside the circle of care. Problems Diabetic 1,028 Emergency

Ottawa Paramedic Service - 2014 Annual Report Research & Innovation

In an effort to provide residents and visitors with the respirations: 2 chest compressions. Outcomes of highest standard of care, the Ottawa Paramedic this study will drive CPR guidelines in the future. Service remains innovative by participating in several research trials and ensuring that TECHNICAL EQUIPMENT evidence based practices are applied. Research partnerships are chosen by the Ottawa Paramedic SERVICE TRIAL (TEST) TEAM Service Research Committee, comprised of This specialized group of Paramedics is tasked front line staff and members of management. A with the testing and the trial of new equipment, thorough review of each proposal is conducted and technologies and innovative approaches prior to appropriate research projects are chosen based them being integrated into regular operations. The on their relevance and benefit to the community. TEST Team ensures that these items have been thoroughly evaluated and have demonstrated RESUSCITATION OUTCOMES added value to the patient, the staff or the Service. In 2014, the TEST Team evaluated the benefits of CONSORTIUM (ROC) an AutoPulse non-invasive cardiac support pump. ROC is an international consortium performing This pump would take the place of existing manual research related to cardiac arrests and has chest compressions for victims of Sudden Cardiac created the single largest repository of cardiac Arrest and assist by freeing up Paramedic staff for arrest data with contributions from cities such as other required medical interventions. Dallas, Pittsburgh, Seattle, San Diego, Atlanta, Toronto and Ottawa. Out-of-hospital cardiac arrest is common, life-threatening and debilitating. As such, the Ottawa Paramedic Service is actively participating in the current Continuous Chest Compressions Study which aims to compare survival to hospital discharge after continuous chest compressions versus the standard recommended cardiopulmonary resuscitation standard of 30

14 Research & Innovation

CANADIAN C-SPINE STUDY (OHRI) involving the Ottawa Central Ambulance Each year, 1.3 million patients who may have injured Communications Centre. Victims of Sudden their neck (c-spine) are transported to Canadian Cardiac Arrest are almost four times more likely emergency departments. Less than 1% of all to survive when receiving CPR from a bystander. these patients actually have a neck bone fracture However, the Communications Officer on the or ligament injury. Even less (0.5%) have a spinal other end of a 9-1-1 call is required to quickly cord injury or nerve damage. These injuries usually and accurately identify a patient that is about to occur at the time of initial trauma and not during have a cardiac arrest and provide instructions for transport to the emergency department. Currently, immediate CPR over the phone. The overall goal Ontario Paramedics transport all trauma victims of this study is to develop, implement, and evaluate (with or without an injury) by ambulance using a the effectiveness of an educational program backboard, collar, and head immobilizers. Trauma designed to improve the cardiac arrest diagnostic victims can stay immobilized for hours. Importantly, accuracy of emergency medical dispatchers and long immobilization is often unnecessary, causes appropriate delivery of dispatch-assisted CPR patient discomfort, contributes to emergency instructions to 9-1-1 callers reporting a cardiac department crowding, and is very costly. arrest victim.

The Ottawa Hospital Research Institute (OHRI) CHARACTERISTICS, developed the Canadian C-Spine Rule for alert MANAGEMENT, OUTCOMES AND and stable trauma patients. This decision rule helps Paramedics, emergency department SHORT-TERM ADVERSE EVENTS physicians and triage nurses safely and selectively OF HYPOGYCEMIC PATIENTS remove immobilization, without x-rays or negative In Ontario, Paramedics are required to transport all outcomes. Ottawa Paramedics have been testing patients to hospital. This study looks at the medical the rule in the out-of-hospital environment. Our outcomes of patients treated for hypoglycemia by Paramedics have evaluated over 3,000 patients Paramedics and the possibility of treat and release so far and have accurately identified all injuries. options.

We are currently working with OHRI on a second study to assist with the implementation of the Canadian C-Spine Rule by Paramedics to help reduce patient discomfort, Paramedic intervention times, emergency department crowding, and healthcare costs. The second study is called: A Pragmatic Strategy Empowering Paramedics to Assess Low-Risk Trauma Patients with the Canadian C-Spine Rule and Selectively Transport them Without Immobilization.

AGONAL RESPIRATION STUDY, PHASE 2 This is a continuation of a clinical research project with the Heart and Stroke Foundation of Ontario and the Ottawa Hospital Research Institute

Ottawa Paramedic Service - 2014 Annual Report Community Partnerships

The Ottawa Paramedic Service partners with many The program was initiated through Ministry of organizations including health care providers, Health and Long Term Care funding that was made various government bodies, vendors, schools and available for the development of community-led private businesses to ensure high standards in community paramedicine initiatives. The program patient care and seamless service delivery. aim is to reduce the impact of high needs patients on health services, while improving patient’s quality TARGETED ENGAGEMENT of life. The mobility of a community paramedicine service makes it particularly useful to patients in DIVERSION Rural Northwest with respect to being able to stay The Ottawa Paramedic Service has partnered well at home. with inner-City Health, the Shepherds of Good Hope, Ottawa Hospital and Ottawa Police to HEART SAFE CITY identify homeless individuals who frequently use The Ottawa Paramedic Service continues to be the 9-1-1 service due to intoxication and provide a leader with the Heart Safe City initiative. specialized care outside of a hospital setting. The A partnership between the Paramedic pilot program has provided alternate care options Service, Heart & Stroke Foundation, Advanced to 80 individuals at their request. Coronary Treatment (ACT) Foundation, Maharaja’s Ball as well as private businesses has COMMUNITY PARAMEDICINE seen the placement of over 900 automatic external defibrillators (AEDs) in public buildings, PARTNERSHIP police, fire, and OC Transpo vehicles since The Ottawa Paramedic Service identified a 2001. Since its inception, the Public Access Community Paramedic for the purpose of this Defibrillator program has directly contributed to community paramedicine pilot program with bystanders saving 85 lives, 5 of which the West Carleton Family Health Team. The occurred in 2014. In an effort to strengthen the Community Paramedic is part of a collaborative “chain of survival,” the Community Medicine team team and is responsible for conducting proactive taught 730 First Aid, CPR and AED courses to a home visits to high needs patients. total of 13 224 individuals throughout the year. The Service will be reviewing the Capital Plan for the AEDs that are end of life. 16 Significant Events Off-Load Nurse Program

DESIGNATED EBOLA search of Parliament Hill and responded to several PARAMEDIC SERVICE calls within the established ‘hot zone’ as the event unfolded and public safety remained a concern. The Ministry of Health and Long Term Care This event further demonstrates the critical appointed Ottawa as a designated Ebola dependencies amongst the various responding Paramedic Service. As a result, specialized agencies and all levels of government and personal protective equipment was purchased further validates the importance of collaborative and specialized infection control training was preparation and response in the Nation’s Capital. conducted with select staff members. A lease-back agreement with Fleet Services has allowed the designation and specialized retrofit of a Ford E450 vehicle to transport suspect patients. Previous investments in the decontamination/disinfection vehicle bay at Paramedic Headquarters continue to demonstrate its value as a means of protecting staff who have been involved in a suspected Ebola case.

OCTOBER 22ND SHOOTING The Ottawa Paramedic Service responded within minutes to the October 22nd shootings at the National War Memorial and Parliament Hill to initiate immediate medical care of 3 patients. The Paramedic Tactical Team, who receives specific training for events such as these, were embedded within the Ottawa Police and Royal Canadian Mounted Police Tactical Teams to conduct a

Ottawa Paramedic Service - 2014 Annual Report Off-Load Nurse Program

The Operations Division continues to oversee the provincially funded Off-Load Nurse Pilot Program, a partnership between the Ontario Ministry of Health and Long Term Care, the local emergency departments and the Paramedic Service. This initiative allows Paramedics to transfer the care of a patient to the designated off-load nurse within the hospital’s Emergency Department in an effort to expedite the return of paramedic resources to the community and increase availability to respond to other medical emergencies. In 2014, the Province committed $1.5 million for the 2013/14 fiscal year to continue the pilot project. Table 8 outlines the Paramedic time saved through the dedicated Off- Load Nurse Pilot Program.

Table 8: Time Saving From Dedicated Off-Load Nurse Pilot Program Year Time Gained by OLN Time Spent Waiting in Excess (Hours) of 30 Minutes (in Hours) 2010 11159 45869 2011 15202 40370 2012 17244 38753 2013 19619 29577 2014 24423 27445

18 Public Accountability Appendix

The Ottawa Paramedic Service remains LOOKING AHEAD committed to establishing an accountable, open Response volumes have increased by 21.3% over and transparent relationship with the public. the previous 5 years. Meeting legislated response The Service is trusted to provide an established time standards will become more challenging as level of care prescribed by legislation and has an this trend is expected to continue. accountability framework that ensures adherence to this level of care. The Ottawa Paramedic Service remains committed to monitoring indicators such as response volume, The Professional Standards Section of the response times, unit availability during peak Paramedic Service is tasked with investigating periods, reliance on surrounding municipalities’ all complaints that are received from the public. Paramedic Services and evaluating innovative In 2014, there were 70 complaints received from solutions in the interest of providing the highest the public regarding the Paramedic Service. Each quality of medical care to all patients in a timely complaint is investigated thoroughly by reviewing manner. incident reports and conducting interviews with members of the public and staff. The written A review of the deployment plan, the current response of all investigations is provided back community paramedicine partnership with West to the complainant. In 2014, 21 of the 70 Carleton Family Health Team, diversion programs public complaints were deemed to be founded, such as the continued involvement with the meaning the Paramedic Service did not meet the Targeted Engagement Diversion Program and expectations of the public and corrective action the on-going Off-Load Nurse Pilot Program are was taken. examples of programs that have been successful in off-setting the existing response volume The Paramedic Service also received 189 pressures. compliments in 2014 regarding patient satisfaction with the level of care provided or notes of The Paramedic Service will continue to review its appreciation for participating in various community operations to develop and refine strategies in an events. All compliments are relayed to the staff effort to mitigate increasing call volumes and will member and published in a weekly newsletter. report back if required.

Ottawa Paramedic Service - 2014 Annual Report Appendix

KEY TERMS CACC: Central Ambulance Communications CTAS 5 - Conditions that may be acute but non- Centre - dispatch and call taking centre for urgent, as well as conditions which may be part Paramedic 911 calls. of a chronic problem, with or without evidence of deterioration/ Code 1: A non-urgent call which may be delayed without being physically detrimental to the Percentile: A percentile is the value of a variable patient. below which a certain percent of observations fall. Code 2: Any call which must be done at a specific time due to the limited availability of Percentile Rank: The percentile rank of a score special treatment or diagnostic/receiving facilities. is the percentage of scores in its frequency distribution which are lower than it. Code 3: Any call which may be answered with moderate delay. All patients classified in this priority group are stable or under professional care and are not in immediate danger.

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

Code 8: Stand-by Call. Vehicle or ambulance crew utilization to provide emergency coverage or for anticipation of a call.

CTAS - Canadian Triage and Acuity Scale

CTAS 1 - Threats to life or limb requiring immediate aggressive interventions.

CTAS 2 - Potential threats to life, limb or function requiring rapid medical intervention or controlled acts.

CTAS 3 - Conditions that could potentially progress to a serious problem requiring emergency interventions.

CTAS 4 - Conditions that relate to patient age/distress or potential for deterioration or complications which could benefit from intervention or reassurance within one hour.

20 OTTAWA PARAMEDIC SERVICE 2465 Don Reid Drive Ottawa ON K1H 1E2 (613) 580-2424 www.ottawaparamedicservice.ca @ottawaparamedic