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TO: Chair and Members Corporate and Emergency Services Committee FROM: Terri Burton Director, Emergency Services DATE: February 18, 2015 SUBJECT: Land Ambulance Service Delivery Options REPORT NO: CES-4-2015-5 RECOMMENDATION None. For information only. ORIGIN The Province of Ontario, Ministry of Health and Long-Term Care, transferred responsibility for land ambulance delivery to upper-tier municipalities (UTMs) (and service boards where no upper-tier exists), effective January 1, 2001. The District of Muskoka (District) contracted the delivery of ambulance services through a Request for Proposal process in 1999 and again in 2008. The District’s current contract with Medavie EMS Ontario is scheduled to expire December 31, 2015. BACKGROUND The Emergency Health Services Branch (EHSB) of the Ministry of Health and Long-Term Care oversees air and land ambulance services in Ontario, as well as, ambulance communication centres that are responsible for dispatching those services. EHSB manages and regulates land ambulance services provided by upper-tier municipalities and District Social Services Administration Boards by establishing standards for the management, operation and use of ambulance services and ensuring compliance to those standards. The Ambulance Act, R.S.O. 1990, c. A.19, as amended by the Services Improvement Act, 1997, sets out the legislative framework for the funding and delivery of land ambulance services under Municipal jurisdiction. The District provides 24 hours per day, 7 days per week land ambulance service delivery throughout Muskoka and neighbouring communities when requested. The District and its contractor are collectively responsible for: Administration and records management; Page 1 Recruitment, hiring, training and review of staff performance; Scheduling work rosters; Productivity and quality regulations assurance; Liaison with related agencies and levels of government; Fleet and facilities maintenance; Budget preparation; and Policy and procedure development and implementation. All Paramedics are graduates of community college programs and are certified by the Province of Ontario. Paramedics are also certified by the Sunnybrook Centre for Prehospital Medicine. Sunnybrook is the District’s Base Hospital Program which provides a Medical Director to oversee delegated medical acts performed by Medavie’s Paramedics. Paramedics receive a minimum of sixteen (16) hours of Continuing Medical Education (CME) annually. The majority of people requesting ambulance service are seniors. For rural area residents of Muskoka, ambulance service has an increased value as it is a link to emergency health care and an initial point of contact for out of hospital medical care. Muskoka is fortunate to have a group of highly skilled and dedicated Paramedics who have chosen to live and work in Muskoka. Paramedics are a constant feature, remain in the forefront as a service provider, and are ambassadors representing The District Municipality of Muskoka on each call. Paramedic personnel are the most valuable asset to the land ambulance program in Muskoka. ANALYSIS Under the Ambulance Act and Regulations, the District can choose how to deliver land ambulance services. There are various models which are common throughout Ontario, as follows: Direct delivery through a municipal ambulance department; Contracted delivery through a hospital; Contracted delivery through another municipal ambulance department; and Contracted delivery through a private ambulance company. The opportunity to design the land ambulance service delivery is extraordinary for any community, and while there are many possibilities, there are also challenges. The District’s goal is to ensure a delivery system that provides optimal clinical care in a cost effective manner. District staff will analyze the delivery of land ambulance services through each model noted above. The evaluation requires several steps in order to make the best decision for the District and the analysis will be driven by the following key principles: Optimizing patient care and transportation; Quality assurance programs and clinical performance; Cohesive support services and administration; Management and operational experience; Opportunities to introduce new ideas and vision for land ambulance service delivery; Minimizing risk to the District; and Opportunities for cost reduction and economies of scale. Annex ‘A’ illustrates current models of delivery in Ontario. There are thirty-five (35) Upper-Tier Municipalities who are providing direct ambulance service delivery. There are seven (7) District Social Services Administration Boards that provide direct service. Lastly, there are eight (8) municipalities that Page 2 contract the delivery of ambulance services through varying models. There are also five (5) contracted First Nations ambulance services. Staff will prepare a report and recommendations for ambulance service delivery options to Council. FINANCIAL CONSIDERATIONS It should be noted that throughout Ontario, municipalities are responsible for the cost of land ambulance services. The total budgeted expenditures for the District’s ambulance services, including contributions to reserves, was $10.4 million in 2014. However, the Province of Ontario provides an annual grant intended to offset 50% of eligible costs associated with land ambulance service provisions. As a result, the District’s budgeted net levy in 2014 was $5.275 million. COMMUNICATION The Ministry of Health and Long-Term Care will be kept apprised of Muskoka’s findings, transitions or changes. STRATEGIC PRIORITIES The review of land ambulance service delivery options supports the following strategies as identified in the District of Muskoka’s Strategic Priorities: 2.5 Continually investigate means of controlling or reducing expenditures through alternative methods of service delivery. Build strategic alliances or enter into shared services agreements with other agencies, the private sector and the Area Municipalities that result in reduced or avoided costs. Pursue co-operative purchasing initiatives with the Area Municipalities and others in order to reduce expenditures. 8.3 Deliver high quality land ambulance services through a contracted service provider. Continue with the medical first responder services provided through agreement with the Area Fire Departments. 8.7 Facilitate initiatives aimed at improving health care service delivery to all areas of Muskoka. Respectfully Submitted, Terri Burton, RN, DipEd, CMM III EXEC, MBA Julie Stevens, CPA, CMA Director, Emergency Services Commissioner of Corporate and Emergency Services Page 3 Annex ‘A’ DIRECT MUNICIPAL AMBULANCE OPERATOR Designated Delivery Agent EMS Service Delivery Model No. Brant County County of Brant Ambulance Services Direct delivery 1 Bruce County Bruce County EMS Direct delivery 2 Durham Region Durham EMS Direct delivery 3 Essex County Essex-Windsor EMS Direct delivery 4 Frontenac County Frontenac Paramedic Services Direct delivery 5 Grey County Grey County EMS Direct delivery 6 Guelph/Wellington County Guelph Wellington Emergency Services Direct delivery 7 Haldimand County Haldimand EMS Direct delivery 8 Haliburton County Haliburton EMS Direct delivery 9 Halton Region Halton Region EMS Services Direct delivery 10 City of Hamilton Hamilton Paramedic Services Direct delivery 11 Hastings County Hastings Quinte Paramedic Services Direct delivery 12 Huron County Huron County Emergency Services Direct delivery 13 Kawartha Lakes Kawartha Lakes Paramedic Service Direct delivery 14 Lambton County Lambton Emergency Medical Services Direct delivery 15 Lanark County Lanark County Paramedic Services Direct delivery 16 Leeds & Grenville Leeds Grenville Paramedic Service Direct delivery 17 Lennox & Addington Lennox Addington EMS Direct delivery 18 Niagara Niagara Emergency Medical Services Direct delivery 19 Norfolk County Norfolk County EMS Direct delivery 20 Northumberland County Northumberland Paramedics Direct delivery 21 City of Ottawa Ottawa Paramedic Service Direct delivery 22 Oxford County Oxford County EMS Direct delivery 23 Peel Region Peel Regional Paramedic Services Direct delivery 24 Perth County Perth County Ambulance Service Direct delivery 25 Peterborough County Peterborough County/City Paramedics Direct delivery 26 Prescott & Russell Prescott Russell Paramedic Service Direct delivery 27 Renfrew County Renfrew County EMS Direct delivery 28 Simcoe County Simcoe County Paramedic Services Direct delivery 29 Stormont/Cornwall Cornwall SD&G Emergency Medical Direct delivery 30 Services Waterloo Region of Waterloo Paramedic Services Direct delivery 32 York Region York Region EMS Direct delivery 33 Sudbury Sudbury Emergency Medical Services Direct delivery 34 Thunder Bay Superior North Emergency Medical Direct delivery 35 Services Page 4 DISTRICT SOCIAL SERVICES ADIMINSTRATION BOARD (DSSAB) Designated Delivery Agent EMS Service Delivery Model No. Algoma District Paramedic Services DSSAB 1 Algoma Cochrane Cochrane EMS DSSAB 2 Notre-Dame Hospital Kapuskasing - Sensenbrenner Hospital Kenora Northwest Emergency Medical Services DSSAB 3 Manitoulin Sudbury Manitoulin Sudbury EMS DSSAB 4 Rainy River Rainy River District EMS DSSAB 5 Sault Ste Marie Sault Ste Marie Emergency Medical DSSAB 6 Services Tamiskaming Tamiskaming EMS DSSAB 7 CONTRACT SERVICE PROVIDER Designated Delivery Agent EMS Service Delivery Model No. Chatham/Kent Chatham/Kent EMS Medavie EMS 1 Dufferin County Dufferin EMS Contractor 2 Elgin County Elgin EMS Medavie EMS 3 Middlesex Middlesex London EMS Governance Model 4 Prince Edward County Hastings Quinte EMS Contract 5 District of Muskoka Muskoka EMS Medavie EMS 6 Nipissing North Bay & District Ambulance Service North Bay General 7 Hospital Mattawa General Hospital Temagami Parry Sound Parry Sound 8 Hospital FIRST NATIONS SERVICE DELIVERY Designated Delivery Agent EMS Service Christian Island Beausoleil First Nation EMS James Bay (Moose Factory) Weeneebayko Area Health Authority Ohsweken Naotkamegwanning First Nation Rama Rama First Nations EMS Southwold Oneida of the Thames EMS Page 5 .
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