Report To: Program Planning Committee
From: Paul Myre, Chief of Paramedic Services
Date: April 27, 2022
Re: Response Time Standards - Issue Report
Background
Paramedic Services across Ontario are required by law to establish a performance plan for the following calendar year regarding overall response times to calls for service. As per the Ambulance Act of Ontario, Regulation 257/00, the term “Response Time” is defined as the time a notice is received from a Paramedic Unit by a Central Ambulance Communications Centre (CACC) to the arrival on-scene of the Paramedic Unit.
The plan must provide targets for Paramedic Service response times to 911 calls sequenced by acuity using the Canadian Triage and Acuity Scale (CTAS). This tool prioritizes patients based on their chief complaint on a scale from 1-5, 1 being the highest severity and 5 being the lowest.
The plan must also include Paramedic Services’ target response times to all Sudden Cardiac Arrest (SCA) calls. The Ministry of Health (MOH) establishes the expected response times for all SCA (6 minutes or less) and CTAS 1 (8 minutes or less). The Paramedic Services sets the expected response time targets for all other calls. The legislation further mandates that Paramedic Services not only establish a plan but also must ensure that the plan is continuously maintained, enforced and evaluated.
By no later than October 31 in each year, Paramedic Services must submit a copy of the established plan for the following year including expected targets to the MOH. A complete copy of the previous year’s performance including the percentage of response times to Sudden Cardiac Arrests, CTAS 1,2,3,4 and 5 must be submitted to the MOH by no later than March 31st.
Current State
Since 2017, our service has submitted the following response times and performance expectation as targets by October 31 of each year:
| Patient Type | Plan in Minutes | Plan in Percentage | Performance in Percentage |
| CTAS 1 | 8 mins* | 30% | Due March 31 |
| CTAS 2 | 15 mins | 65% | Due March 31 |
| CTAS 3 | 20 mins | 75% | Due March 31 |
| CTAS 4 | 25 mins | 85% | Due March 31 |
| CTAS 5 | 25 mins | 85% | Due March 31 |
| SCA | 6 mins* | 30% | Due March 31 |
*Plan in minutes established by the Ministry of Health
On March 31,2022, Paramedic Services submitted the following 2021 calendar year Response Time performance in percentage to MOH:
| Patient Type | Plan in Minutes | Plan in Percentage | Performance in Percentage for 2021 |
| CTAS1 | 8 mins* | 30% | 28% |
| CTAS 2 | 15 mins | 65% | 62% |
| CTAS 3 | 20 mins | 75% | 90% |
| CTAS 4 | 25 mins | 85% | 83% |
| CTAS 5 | 25 mins | 85% | 83% |
| SCA | 6 mins* | 30% | 27% |
As evidenced by the 2021 submission, Paramedic Services did not achieve five out of six response time targets set in October of 2020. For each of the missed targets, the MOH requested a comment on why the targets were not met. While 2021 was an anomaly from previous years likely due to the COVID-19 pandemic, staff believe that based on the analysis of individual station performance there are additional contributing factors none of which are mutually exclusive.
1. Call volumes continue to rise. Paramedic Services has seen an 18% increase in emergency call volumes since 2019 which translates into 1125 more calls in 2021 than in 2019. The service is forecasting an increase consistent with this pattern for 2022 as well.
2.The MOH chute time expectation for our on-call stations between 20:00 and 08:00 hours is 10 minutes therefore our set targets for SCA and CTAS 1 are a challenge to meet at onset. Only the Chapleau station met the target for CTAS 1 calls. Foleyet station had 0 CTAS 1 calls registered during 2021.
3. Our vast geography continues to be the largest contributing factor to our response time challenges. Upon performing individual Response Time Standard (RTS) performance for each Paramedic Service Station, it is evident where our response time challenges reside. As previously mentioned, our “on-call” stations will continue to struggle in achieving RTS targets simply by virtue of the 10 minutes chute time during evening hours. Below is a table demonstrating each Paramedic Services station’s RTS performance.
| CTAS 1 | CTAS 2 | CTAS 3 | CTAS 4 | CTAS 5 | |
| Foleyet | N/A | 23% | 58% | 100% | 100% |
| Chapleau | 33% | 59% | 88% | 96% | 100% |
| Gogama | 0% | 53% | 26% | 61% | 0% |
| Massey | 8% | 49% | 76% | 85% | 75% |
| Espanola | 70% | 72% | 85% | 93% | 95% |
| Little Current | 17% | 55% | 69% | 80% | 64% |
| Wiikwemkoong | 45% | 82% | 90% | 96% | 100% |
| Gore Bay | 0% | 61% | 67% | 77% | 88% |
| Mindemoya | 27% | 69% | 73% | 77% | 75% |
| Hagar | 33% | 52% | 73% | 78% | 33% |
| Noelville | 20% | 39% | 61% | 63% | 60% |
| Killarney | 0% | 50% | 83% | 100% | 100% |
4. The data within the individual Paramedic Services station table validate the Sault Ste. Marie Innovation Centre’s recommendation that there are gaps in emergency coverage in the French River area. Both our Noëlville and Hagar response times are reflective of the shear geographical coverage area and the prolonged loss of resources in both communities when transporting patients to Sudbury or Sturgeon Falls.
5. Little Current, Mindemoya and Gore Bay also performed below expectations largely due to increased urgent/emergent interfacility transfers. Despite a continued effort to educate sending facilities that Ornge should be the first point of contact for urgent/emergent transfers to Sudbury for diagnostic imaging, our crews continually are being assigned Priority 3 and 4 transfers out of expediency rather than consideration of systemic impacts. Gore Bay is an on-call station and is subject to the same challenges previously articulated in this report. That being said, Gore Bay is also victim of geographical location and is the primary resource sent to communities to the west including Meldrum Bay which is an approximate one-hour response one way.
Conclusion
While one could very well make a case that the target response times were only “slightly” missed, staff are concerned that several stations did not achieve expected targets. Countermeasures have already been deployed to address gaps on Manitoulin Island such as adding an extra unit in Wiikwemkoong and positioning a Paramedic Response Unit (PRU) in Little Current as a pilot.
The PRU provides emergency coverage for Little Current and Mindemoya when those resources get assigned out of town transfers which staff believe will significantly improve our response time targets for those 2 stations.
For Sudbury East, the recent Medical Tiered Response agreement with the French River Fire Department will certainly mitigate some (but not all) gaps in emergency coverage. The bolt on benefit to this agreement is that the Hagar unit will no longer need to be deployed to Noëlville for emergency coverage when the Noëlville unit is assigned to a call and is transporting patients to either Sudbury or Sturgeon Falls; leaving that important resource to cover it’s assigned area and likely improving response times targets for that station.
At this time, staff are already exploring options to enhance emergency coverage in Sudbury East and have no further recommendations at this time. Staff will monitor response times required but believe a re-assessment will be in order in 2023 to determine if these initial countermeasures prove to be effective at mitigating response time gaps.