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