Response Time Standards - Issue Report

Report To: Manitoulin-Sudbury District Services Board

From: Paul Myre, Chief of Paramedic Services

Date: February 16, 2023

Re: Response Time Standards

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 calls. The 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 Ministry of Health. 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 31^st.

Current State

As reported to the board in April of 2022, our 2021 submission to the Ministry of Health (Figure 1) demonstrated that Paramedic Services missed all but one of the target Response Time Standards. While the COVID-19 Pandemic certainly played a role in our inability to hit our targets, other factors such as the current regionalized health care model requiring patients to be transported by Paramedic Services to facilities outside of our service area continues to impact our ability a consistent balance in emergency coverage. This combined with our enormous geographical but sparsely populated service area, current resource availability and ever-increasing call volumes will continue to produce unpredictable fluctuations in our response times.

Figure 1

2021 Response Time Performance

Fortunately, the service implemented approved countermeasures in 2022 that were designed to address holes in our response capacity that were within Staff’s realm of control. As described in the April report, a second transporting unit was deployed in Wiikwemkoong along with a PRU in Little Current to mitigate unavoidable gaps in emergency coverage in our high-volume areas. The service also entered into a tiered response agreement with the municipality of French River which permitted Staff to cease the practice of moving the Hagar crew to standby in Noëlville whenever the Noëlville crew was transporting a patient to Sudbury or Sturgeon Falls.

Staff are proud to report our 2022 Response Time Standards targets were achieved with the exception of our 6-minute response to Sudden Cardiac Arrests (SCA) (Figure 2). While this is an important target and one that has an emotional component attached to it, our average response time for SCA was just under 17 minutes. This means our crews either travelled an average of 15 kilometers per SCA call or were possibly “on-call” when the call was received.

Figure 2

2022 Response Time Performance

*Plan in minutes established by the Ministry of Health

Conclusion

Staff will be submitting our 2022 Response Time Standards performance to the Ministry of Health by the March 31, 2023 deadline.  By comparing our 2021 response times performance to our 2022 results, our countermeasures appear to have noticeably addressed some of our measurable gaps in our response capacity.