Paramedic Services Station Location Project -Issue Report

Report To: Program Planning Committee

From: Paul Myre, Chief of Paramedic Services

Date: February 24, 2022

Re: Paramedic Services Station Location Project - Issue Report

Background

As some of our Paramedic Stations are approaching end-of-life and will soon require significant renovations or perhaps even replacement, staff have commenced an in-depth analysis process for capital planning purposes. For the first step, the Sault Ste Marie Innovation Centre was engaged to perform a heat mapping of 911 calls throughout the entire Manitoulin-Sudbury district collating data from the 2017, 2018, 2019 and 2020 years.  This heat mapping exercise of all urgent and emergent Paramedic Services calls over this four (4) year period provided a focused analysis on current station locations which was reported to the board at the September 2021 meeting. Staff at that time sought approval from the board to continue this analysis and explore optimal station locations based on our 911 call volumes. This issue report explores recommendations that come solely from a data analysis perspective and have not undergone a strategic or tactical scrutiny from staff.

Current State

As reported in September 2021, Paramedic Services currently occupy twelve (12) Paramedic Stations across our district. A Building Condition Analysis (BCA) conducted by Housing Services Corporation (HSC) Business Solutions in September of 2020 provided the board with some future capital assumptions and explored a sound fiscal approach to ensure a prudent use of public dollars when addressing critical components. 

A close assessment of our current asset location and exploration of system optimization opportunities are a vital component for downstream planning purposes. Staff reported, at the time, that this study would be an important initial step in understanding whether all of our stations are in fact in optimal locations and would be a point of reference, as stations attain their end-of-life expectancy, to inform capital decision making. Staff are delighted to provide the board with attached report from the Sault Ste Marie Innovation Centre outlining the results of phase II of our in-depth analysis into our Paramedic Services call volumes evaluated using our current station locations. As noted in the report, the Innovation Centre dissected the data to produce recommendations that would address two important questions; 

1. Are our current Paramedic Services stations in the right location based on     our call volumes? and 

2. Based on this data, where would stations optimally be located if, by using this data set, they could be positioned in locations that would provide the overall best emergency coverage? 

The analysis utilizes “driving distance in minutes” to every urgent and emergent 911 call from each of the 12 Paramedic Services stations as one data point using a 30-minute driving distance (driving at posted speed limits) to provide a geographical context. The report also explores overall responses to emergency calls based on the Canadian Triage and Acuity Scale (CTAS) and the legislated Response Time Standards (RTS). The CTAS is a tool to help define a patient’s need for care. CTAS scores are provided to each patient by Paramedics to assign a level of acuity based on the presenting complaint and the type and severity of their presenting signs and symptoms. Patients are triaged using CTAS to ensure that they are medically managed based on their need for care so that the sickest get prioritized for immediate care. CTAS has 5 severity levels, 1 being the most severe and 5 being essentially non-urgent. For example, a heart attack would be classified as a CTAS 1 or the highest priority (life or death) call while a bruised finger would be classified as a CTAS 5. As per the Ambulance Act, Designated Delivery Agents (DDA) are responsible for the development of land ambulance response time targets and performance, which are submitted to the ministry on an annual basis. Below was the Manitoulin-Sudbury DSB RTS submission for 2020:

2020 Response Time Standart (Regulation 257/00 Part VIII)

The Response Time Standards referred to in the Innovation Centre’s report is from 2019 as that was the only plan published by the Ministry of Health at the time the report was commissioned.

An example on recommendation comparison found in the report can be referenced below.  In it, the graph on the left speaks to the current state of our station locations and overall emergency coverage. The graph on the right shows the 12 most optimal locations in the Manitoulin-Sudbury area for stations that would maximize emergency coverage while also considering a call’s CTAS type and target times associated with them.

Data driven recommendation comparison:

Current 12 Stations' Coverage

Most Optimal Station Location

Percent Coverage if 12 Most Optimal Locations had Stations vs Current Locations, CTAS Times Considered, 2017-2020

                                                                         Most Optimal Location Coverage         Current Locations' Coverage

All Calls Rostered from MSDSB stations                 #                   %                                     #                   %          

Total Calls Covered                                                19,840              90.2%                         19,701               89.5%

Not Covered                                                             2,161                9.8%                           2,300                10.5%

Total Calls                                                             22, 001                                                22,001

Conclusion

Staff are seeking approval to take this information back to our teams and apply an operational/tactical and strategic perspective and report back with the final recommendations.