COUNTY OF SIMCOE
To:
COMMITTEE OF THE WHOLE
Section:
Human Services – Paramedic Services
Item Number:
CCW 15-347
Meeting Date:
October 13, 2015
Subject:
Paramedic Services Ten (10) Year Planning Outlook
Recommendation:
THAT Item CCW 15-347 regarding the County of Simcoe Paramedic Services Ten (10) Year
Comprehensive Deployment Review report be received;
AND THAT staff update the Paramedic Strategic Facility Plan in consideration of the optimized 23 site
recommendation as outlined in Schedule 2 to Item CCW 15-347.
Executive Summary:
This Item introduces the Ten (10) Year Comprehensive Deployment Review by ORH Consultancy
(ORH). The review was intended to evaluate our projected demand, identify efficiencies and provide a
modelling tool to facilitate staff analysis. This effort was undertaken as part of a comprehensive
strategic planning initiative aimed at ensuring resources are optimized and investments are well
planned to ensure responsible operational and fiscal management.
It is estimated that County of Simcoe Paramedic Services (CSPS) will experience an 81% increase in
call demand by the end of 2024. With the use of facility locations identified by ORH and related
operational efficiencies, it is projected that an increase in staffing of 38% will be needed to meet the
81% increase in demand. The development and hand over of a predictive modelling tool will allow staff
to simulate various operational scenarios and evaluate impacts.
The significant increase in demand requires us to consider the development of strategies to curb
projected demand and related impacts on County and local municipal as well as health care system
resources and costs. Should such strategies / programs demonstrate reduction in health care costs,
reinvestment strategies could achieve greater efficiencies across the entire system.
Background/Analysis/Options:
Further to Council approval, in 2014 County staff conducted a Request for Proposal (RFP) to engage a
consultancy group to achieve the following objectives:
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Committee of the Whole CCW 15-347
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1. Establish a ten (10) year operational master plan encompassing:
a. Optimized deployment based on expected demand, geography demographics and
patterns;
b. Operational staffing requirements;
c. Facility planning based on the identified needs.
2. Provide a predictive modelling tool to be retained and used by staff. This tool will allow staff to
predict the impacts of changes and emerging trends to more accurately plan resource needs.
ORH Consultancy was retained in this regard. ORH Established 1986, has conducted over 500 studies
in the UK, Canada, Australia and Middle East and over 250 EMS related assignments. They have
expertise in analysis of demand, resource utilization and simulation modelling to improve cost
effectiveness.
County staff compiled and provided ORH with paramedic call data, vehicle travel data as well as
planning, demographic and population information. Sources included CSPS patient care data and
operational information, Ministry of Health and Long Term Care (MOHLTC) ambulance dispatch data,
Amendment 1 to the Growth Plan for the Greater Golden Horseshoe (commonly referred to as Growth
Plan Amendment 1 “GPA1”), County of Simcoe Official Plan 2013 (as approved by the Ontario
Municipal Board), and County of Simcoe Land Budget background supply data and information
provided by Hemson Consulting, the County’s growth management consultants.
All local municipalities were advised of the effort and asked to provide any specific information from
their respective areas related to growth, planned communities or roads networks or any other
information which may be helpful for the review.
Demand Predicted to Rise
Utilizing standardized statistical methods (Holt Winters) as well as population based trending reveals
different demand growth scenarios. It is believed by ORH that the population based trending is more
accurate. You will note that the forecasted demand rate shows an overall estimated increase in
demand of 81.4% with 35.7% increase from 2014 - 2019 (approximately seven percent (7%) per year)
and another 45.7% from 2019 – 2024 (approximately nine percent (9%) annually).
There are three (3) contributing factors behind the 81% increase in demand:
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The increasing overall population levels account for approximately 31%;
Changes in the age/gender profile (more elderly) accounts for about 13%;
Increasing demand rates across the age/gender group’s account for 37% (people are tending
to utilize paramedic services more often over time).
In their report, ORH goes further to develop demand projections by local municipality attached as
Schedule 1.
Station Locations Impact Efficiencies
Paramedic staff have previously outlined a facility plan aimed at placing stations of sufficient capacity in
locations close to call demand. ORH has reviewed the projected call demand and locations and have
developed a 23 site optimized facility location recommendation to realize efficiencies and project
resource needs to demand. The placement of stations closer to the projected call demand will
result in more calls being reached within eight (8) minutes and increased efficiency.
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Maintaining current facility locations will result in the need for 46.5% in staffing increases by 2024 and
some local municipalities will experience poorer response times. However, if stations are relocated, the
efficiencies generated reduces the increase in staffing to 38% and improves response times. This
represents a savings of 20 staff over the 10 year period. Given the significant improvements resulting
from the proposed station movements, staff recommend that the facility plan be updated in
consideration of the 2024 optimized solution provided by ORH as outlined in Schedule 2.
Predictive Modelling Tool
ORH has developed and utilizes a predictive model designed specifically for Paramedic operations.
ORH undertook comprehensive data analysis to ensure accurate modelling inputs and validated it
against the current service profile. This tool will allow staff to measure the impacts of changes such as
call volume, hospital time, population growth, etc. and confirm associated requirements.
The Compelling Case for Change
The potential for an 81% increase in demand by 2024 is significant. This pace of growth represents a
heavy burden on our community and is not sustainable. The need to pursue greater efficiency and call
mitigation options is high.
Ambulance Dispatch – The County of Simcoe along with GTA partners (Peel, York, Durham and Halton
Regions) have partnered on the development of a report identifying the need for enhanced technology
and processes in the MOHLTC operated dispatch centres. It was identified in this report that the current
method of prioritizing calls is inaccurate and artificially adding pressure to the emergency services by
generating too many emergency calls that are not high acuity emergencies. Following this, MOHLTC
consultant, Dr. Michael Feldman released a paper which quantified that the currently used MOHLTC
call triage process over-prioritizes calls almost twice as much as a well-known and widely used
alternative call prioritizing process. The issue of dispatch modernization has long been the subject of
Association of Municipalities of Ontario (AMO) delegations with MOHLTC staff. The Ontario Association
of Paramedic Chiefs (OAPC) has recently participated with the MOHLTC on a committee formed to
look at dispatch changes. The report from this committee has been completed and is planned to be
presented to the Minister of Health at a later date. Though the report is at this point confidential, it is
believed that changes to the call prioritization process is an area of focus.
Call Mitigation – There is currently a high level of development of new strategies to manage patients’
health care in their communities through proactive approaches with the goal to reduce hospital
admissions and 9-1-1 Emergency Medical calls.
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Figure 1 – Drivers of Demand Growth
THE DRIVERS OF 81% GROWTH IN
DEMAND
Populaiton
Increase, 31%
Trends in Use,
37%
Aging
Population,
13%
The largest of the three (3) drivers of the demand increase is the “Trends in Use”. This driver speaks to
the fact that once the factors of population size and growth are accounted for, people are generally
using Paramedic Services more often than they did historically. It is this area that must be explored to
better understand the causes of this trend which may be related to lack of access to care or lack of
knowledge of care options. The community paramedicine programming and relationships represent an
approach being used across Ontario as well as in many other areas of the world to identify and begin to
impact this driver of demand.
Below is a sample of some of the efforts in place within the County of Simcoe, in discussion or under
development:
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Community Paramedicine – community partnership approach to reduce emergency health care
system use
CHAP – EMS - Partnering with social services to provide health awareness to reduce
emergency health care system use
Expanding Paramedicine In the Community (EPIC) Study – paramedics managing chronic care
patients in the community
Health System Review – Health Links initiatives
Second Curve Initiative – (NSM LHIN) local health care planning
Call Data Analysis – review calls by category and location to identify trends
OMEGA Protocol – Redirecting low acuity patients calling 911 to alternative care options
Alternative Pathways – paramedics using the Ontario Telemedicine Network (OTN) to facilitate
treatment and avoid transport
Police Services – Community Hub Model
Nurse Led Outreach Teams (NLOTS) – Acute Care Emergency Nurses (Registered Nurses
and Nurse Practitioners) providing outreach to seniors in Long Term Care
Staff will pursue opportunities to better understand our demand and continue to partner with other
agencies to provide the right care at the right place at the right time in order to reduce call demand and
transportation to hospital. A detailed report updating the status of the County of Simcoe’s current
community paramedicine initiatives will be provided in the near future.
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In 2014, Paramedic Services (PS) experienced a substantial increase in call demand (9%) which
resulted in the requirement to add significant resources. These additional resources have made early
improvements to end of shift overtime hours and maintained performance. In the first half of 2015, the
rate of demand growth has decreased over 2014 however continues to rise at a rate of 5% in the first
six (6) months of the year. Proposed resources to address the continued rise in call volume will be
included in the draft 2016 Budget submission.
Financial and Resource Implications:
The financial impact of future station changes and resource requirements will be outlined and brought
forward for Council approval as each change is considered.
Relationship to Corporate Strategies:
Growth Related Service Delivery: Create and strengthen partnerships with key stakeholders to support
communities through the delivery of sustainable services.
Specifically, the Health and Emergency Services Paramedics Initiative:
 Enhance ambulance dispatch program to increase efficiencies, respond to increased demands
and improve in overall effectiveness through upgraded technology, processes and governance.
 Increase the efficacy of the regional Medical Aid Tiered Response program to meet increased
demands associated with continued growth to the area
A Culture of Workplace and Operational Excellence: Create and maintain a healthy work environment
that:
 Supports personal and professional growth
 Promotes effective, open and inclusive communications
 Provides services to residents in a fiscally sustainable and responsible manner
Strategic Priority #1: Continue to advance a workplace culture that promotes efficiencies and
effectiveness in fiscal management and service delivery
Reference Documents:
There are no reference documents for this item.
Attachments:
Schedule 1 – ORH Demand Projections
CCW 15-347 Schedule 1.pdf
Schedule 2 – Optimizing Station Locations - 23 Recommended Sites
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CCW 15-347 Schedule 2.pdf
Prepared By: Andrew Robert, Director and Chief, Paramedic Services
Approvals:
Date
Jane Sinclair, General Manager, Health & Emergency Services
Trevor Wilcox, General Manager, Corporate Performance
Mark Aitken, Chief Administrative Officer
October 3, 2015
October 6, 2015
October 6, 2015