Report To: Program Planning Committee
From: Robert Smith, Chief of Paramedic Services
Date: October 21, 2020
Re: 2021 Deployment Plan Pilot – Issue Report
Manitoulin-Sudbury DSB is legislatively responsible for the delivery of paramedic services to the citizens of Manitoulin and Sudbury Districts. Since service assumption in 2004 staff have brought forward a series of plans for service enhancements in a manner that has been both prudent and fiscally responsible. Without exception, the Board of Directors have been engaged and supportive.
In 2017, as part of budget deliberations, the Manitoulin-Sudbury DSB approved the implementation of the Strategic Deployment Plan for Paramedic Services permitting service enhancements for 24/7 onsite coverage in Massey and French River, and 12/7 onsite coverage in Killarney, Foleyet and Gogama. The design was supported despite the nebulous state surrounding the Northeast LHIN non-urgent pilot program, a program now in its eighth year. The Paramedic Service deployment model has remained unchanged since that time.
The 2020 budget approval was based upon known 2018 Ministry funding, given that 2019 funding had not been received prior to final 2020 budget approval. 2020 Ministry funding was announced in late spring of 2020 and this funding included an unbudgeted $289,000 in provincial ongoing funding.
Given that Paramedic Services received the above stated operational monies, staff have determined that implementation of a deployment pilot model where the resources deployed in Gore Bay and Chapleau could be increased to include 24/7 onsite coverage for a period of 16 weeks, each year, during seasonal periods of higher call volumes. This increased staffing would leverage part time Paramedics. Additionally, Paramedic Services would pilot increase staffing for the LaCloche and Manitoulin Island areas by way of an extra transporting ambulance from 9:00am to 9:00pm for the seasonally busier period between mid-May to mid-September. The upstaff resource would operate for 18 weeks.
The proposed pilot deployment being brought forward to the Board is specifically designed to manage increasing workload during specific periods of time, a plan that addresses both response capacity across a number of communities, but also mitigates challenges associated with health and safety concerns related to hours free from work/rest periods.
The workload intended to be addressed has been broken out to three specific areas. These challenges are expressed below as follows.
The Gore Bay Paramedic Station operates with on-site deployment from 8am to 8pm each day, and then in an on-call deployment from 8pm to 8am. The data for the most current year suggests that there is an increase in workload during the summer months. More than 33% of the days in these months involve a call out of Paramedics during the hours of 8pm to 8am. This action results in extended reaction time of up to 10 minutes versus 2 minutes for on-site coverage, reduced rest time, and premium payment for call out of a minimum of 4 hours at time and one half per Paramedic, per call out.
The Chapleau Paramedic Station operates with on-site deployment from 8am to 8pm each day, and then in an on-call deployment from 8pm to 8am. The data for the most current year suggests that there is an increase in workload during the summer months. More than 50% of the days in these months involve a call out of Paramedics during the hours of 8pm to 8am. This action results in extended reaction time of up to 10 minutes versus 2 minutes for on-site coverage, reduced rest time, and premium payment for call out of a minimum of 4 hours at time and one half per Paramedic, per call out.
The service areas captured within the LaCloche, and Manitoulin Island communities have been the benefactors of several efforts to reduce resource degradation caused by regionalized health system design that focused on tertiary care outside of these communities. Efforts to ensure accurate patient assignment has resulted in significant shedding of non-urgent long-distance transfers from Paramedic Services. Despite success in maintaining Paramedics in their deployed communities, staff have continued to see increasing volumes of urgent and emergent activities, bypass protocols that result in transport from the scene directly to Health Sciences North and higher acuity events. There is a demonstrative seasonal correlation showing an 18% average monthly increase in monthly volumes during the summer months. Additionally, the data demonstrates a 33% average hourly increase in volume between the hours of 9am and 9pm. This increase has resulted in challenges for response capacity.
Additionally, and intended to help inform the Board of Directors, Paramedic Services has work diligently to manage issues such as shift extension overtime. In 2018 the service implemented staggered start times that were intended to assist in containing incidents where staff were assigned responses late in their shifts. This plan was brought into play as a mitigation strategy, understanding that emergency call volumes were increasing. In 2020, from mid-May to mid-September, the overall service shift extension events had increased by 5.1% over 2019. The subset of LaCloche and Manitoulin Island had actually increased by 38.5%. In can be concluded that the deployment modeling had successfully resulted in a 26.1% reduction in shift overruns across all other areas.
This pilot would see the movement of both Chapleau and Gore Bay Paramedic Services stations to 24/7 deployment for 16 weeks each year, from mid-May to early September. Additionally, the pilot would allow for upstaffing of a single transport ambulance out of the Little Current Paramedic Services Station from 9am to 9pm each day to mitigate resource loss due to challenges explained within this issue report. Due to the seasonal nature of this plan, Paramedic Services would utilize part time personnel for coverage.
Should the DSB approve the proposed pilot, implementation would occur on May 16, 2021 and would be managed within an approved 2021 budget envelope. The total increase to staffing would be 8,232. This would be broken out as follows:
Chapleau for (16 weeks):
| days | staff | hours/day | weekly hours | Total hours |
|---|---|---|---|---|
| 7 | 2 | 12 | 168 | 2688 |
Gore Bay (16 weeks):
| days | staff | hours/day | weekly hours | Total hours |
|---|---|---|---|---|
| 7 | 2 | 12 | 168 | 2688 |
LaCloche/Manitoulin Upstaff (18 weeks):
| days | staff | hours/day | weekly hours | Total hours |
|---|---|---|---|---|
| 7 | 2 | 12 | 168 | 2856 |
The rollup impact of this plan, and all other increases in the 2021 Paramedic Services budget would be presented to the Finance Committee as part of their 2021 budget deliberation for their consideration.
Staff believe that the pilot enhancements being proposed are fiscally prudent and consistent with the historical practice of introducing incremental increases that are demonstratively beneficial to our communities. These changes will address increasing need for service capacity, while also addressing staff health and safety related to the hours of work within communities not recently augmented.
The proposed amended deployment model would be managed as a pilot for 2021, with no change to the permanent fulltime staffing profile. This plan would allow staff the chance to assess efficacy of the changes, specifically related to patient outcomes, response degradation, and health and safety impact on Paramedics. The pilot would be analyzed with a full report delivered to the Board in time for the 2022 budget deliberations.
Staff are asking that the Program Planning Committee recommend approval of this Deployment Plan Pilot in principle to the Board and that the Board direct the Finance Committee to consider the Deployment Plan Pilot during the 2021 budget deliberation.