OTTAWA PARAMEDIC SERVICE 2014 ANNUAL REPORT
OTTAWA PARAMEDIC SERVICE ANNUAL REPORT 2014 2465 Don Reid Dr, Ottawa, ON K1H 1E2-613-580-2424
NOTES OF APPRECIATION...In every case your people are polite, professional and respectful of the patient s dignity. They clearly care. I don t know how or where you find these superb individuals but please, keep doing exactly what you re doing! My sincere thanks to your entire team. I would like to thank the Paramedics that responded when my father suffered a recent heart attack. They diagnosed the issue and transported him quickly and safely to the Heart Institute. I recognize that there are a lot of times you attend a call and brush off what you do as just my job. I want them to know that my father is still with us today because of the care they provided. Thank you to all Paramedics for the work they do in our city every day. Be proud. I recently had an acute heart attack in my home. I was not aware of any heart condition, but I felt it was necessary to call 9-1-1. In doing so, the excellent and immediate service provided by the Paramedics in getting me to the Heart Institute, saved my life. The Paramedics are to be commended for the life saving procedures that enabled me to be treated immediately upon arrival at the hospital. Please convey my gratitude and best wishes to those responsible, I will be eternally grateful. We feel great appreciation for our Paramedic Service. It is only when there is a real need for help that we can fully understand what a vital service it is to our city and community. Our family recently experienced this real need for help. We want to relay our thanks to the two Paramedics who came to our rescue and to the Ottawa Paramedic Service, for all the good work you do. I had a recent interaction with one of your Communications Officers and want to commend them for their calmness, ability to connect with the patient, and immediate ability to assess the location by asking a number of questions, since the exact location was unknown by the caller. The Communications Officer helped ease our tension by assuring us that help was on the way.
Letter from the Chair...1 Letter from the Chief...2 Our Service...3 Mission, Vision, Values...4 Our People...5 System Performance...7 Response Volume...7 Response Time Standards...9 Paramedic Response Unit...10 Ministry of Health and Long Term Care Certification...11 Communications Centre System Performance...12 Clinical Excellence...13 Research & Innovation...14 Community Partnerships...16 Significant Events...17 Offload Nurse Program...18 Public Accountability...19 Looking Ahead...19 Appendix...20 Table of Contents
Letter from the Chair As the Chair of the Community and Protective Services Committee, I am pleased to receive the 2014 Ottawa Paramedic Service Annual Report. City Council and the Ottawa Paramedic Service remain dedicated to improving the quality of life of Ottawa s residents. The services noted within this report are indicative of the ongoing commitment to the community. Council is proud of the investments made to ensure the highest standard of care to our residents. This is demonstrated through providing advanced medical care to critically ill patients, providing life saving instructions over the phone, teaching CPR and First Aid to members of our community, training and responding to specialized events with valued emergency service partners, participating in ground breaking research trials or implementing innovative solutions to provide the highest level of medical care to patients in the most timely manner. A testament to these service offerings is when I hear from residents who want to share their positive experiences and commend the Paramedic staff member who saved a loved one s life, reassured a worried parent or provided a calming voice on the other end of a 9-1-1 call. Response volumes continue to rise as a result of population growth and an aging demographic, which further demonstrates the importance of our Paramedic Service. On behalf of the Community and Protective Services Committee, please join me in acknowledging the extremely important work of the Ottawa Paramedic Service and thank them for providing the highest level of immediate medical care to our residents in need. Diane Deans, Chair Community and Protective Services Committee Ottawa Paramedic Service - 2014 Annual Report
It is with great pride that I present the Ottawa Paramedic Service 2014 Annual Report to the Community and Protective Services Committee and residents of the City of Ottawa. The members of the Ottawa Paramedic Service are committed to serving the residents and visitors of the City of Ottawa through providing the highest level of immediate medical care. This report highlights the performance of the Service over the previous year and shares the many successful programs and services delivered by our members. They are not only responsible for providing emergency response, triage, treatment and transport for patients during their time of need but also provide community paramedicine programs, first aid and CPR instruction as well as emergency dispatching and 9-1-1 call taking for all of Eastern Ontario. Together, the work of the administrative staff, Communications Officers, Equipment and Supply Technicians and Paramedics results in the provision of progressive paramedic care to the residents and visitors of the City of Ottawa. Notable highlights from 2014 include: The successful community paramedicine pilot partnership with the West Carleton Family Health Centre that assists the elderly population in maintaining their independence and reducing their calls to 9-1-1. Several research programs that aim to improve paramedicine through innovative and evidence based practices such as the Targeted Engagement Diversion Program and the Canadian C-Spine study. Successful re-certification of the Ottawa Central Ambulance Communications Centre. Direct consultation with all staff that sought their input regarding the establishment of the Service s priorities over the next term of Council. As we look to the future, we recognize some of the challenges we face as demand for our service grows. The members of the Ottawa Paramedic Service remain committed to finding innovative ways in providing the highest standard of care to all patients. Letter from the Chief Chief Anthony Di Monte Ottawa Paramedic Service 2
Our Service In 2001, the new City of Ottawa assumed responsibility for the delivery of paramedic services as defined by the Ambulance Act of Ontario. The Province of Ontario funds 50% of land ambulance services and 100% of the cost for the Ottawa Central Ambulance Communications Centre (OCACC). Since 2001, the Service has emerged as a leader, both provincially and nationally, in progressive paramedic service delivery. Through the professionalism and dedication of Equipment Supply Technicians, Communication Officers, Paramedics and administrative staff, a dynamic organizational culture of service excellence has been created. The Ottawa Paramedic Service is dedicated to its community and patients by providing progressive Table 1: Ottawa Paramedic Service Profile: Area Served paramedic care in the nation s capital. The Service strives to be a dynamic leader in delivering and improving paramedicine, continuously seeking new knowledge and applying innovation. As an employer, the Ottawa Paramedic Service champions a safe and supportive work environment based on the core values of trust, integrity and respect. The Ottawa Paramedic Service provides emergency medical coverage to 2,791 square kilometers while the OCACC provides dispatching services to over 10,000 square kilometers of Eastern Ontario. The Service provides a fully integrated advanced life support system delivering state of the art medical services to over one million residents and visitors to the City of Ottawa every day. City of Ottawa Geographic Coverage 2,791 km 2 Base Population 927,118 Daytime Population 997,845 Percentage of Population over age 65 13% Services Provided Advanced Life Support (ALS) Community Paramedicine Program Public Access Defibrillator (PAD) Program Ottawa Paramedic Service - 2014 Annual Report
Mission, Vision, Values Our Quality Service Model serves to focus all members efforts in achieving success and guides all decision making within the organization. It reflects our coordinated goals of meeting patient and community expectations for excellence in outof-hospital patient care, service reliability, public safety, and accountability. There are five drivers within the Quality Service Model: Our People Business Processes and Performance Research and Innovation Partnerships Technology and Information Mission The Ottawa Paramedic Service is dedicated to its community and patients by providing progressive paramedic care in the nation s capital. Vision To be dynamic leaders in delivering and improving paramedicine, continuously seeking new knowledge and applying innovation. Values Safe & Supportive Work Environment Trust - Integrity - Respect This Quality Service Model ensures day-to-day decisions align with the mission, vision and values and provides direction for the future of our service 4
Our People Our people are the greatest asset within the Ottawa Paramedic Service. The 598 members work in one of four unique divisions: Operations, Communications, Technical Services and Special Operations. Collectively, front-line Paramedics, Communications Officers and critical behind the scenes support staff provide a wide range of expertise that results in the delivery of exceptional medical care to our community. There are a variety of backgrounds and skill sets that contribute to the successful delivery of paramedicine within the City of Ottawa. diagnosis of the patients they serve. This ensures the residents of Ottawa receive the highest level of care, even in complex medical emergencies, when utilizing the Paramedic Service. Ottawa continues to have one of the highest percentages in Ontario of responses where an Advanced Care Paramedic was present. In 2014, an Advanced Care Paramedic attended 82.8% of all responses. All Ottawa Paramedics are college graduates and are delegated by the College of Physicians and Surgeons to perform medical interventions under the regulated Health Professions Act. As such, they are certified to administer numerous medications and perform an extensive list of controlled medical acts for patients experiencing acute injury or illness. The complement of Paramedics includes approximately 45% being certified as Advanced Care Paramedics (ACP), who are licensed and trained to administer an expanded list of medications, advanced airway management and cardiac interventions, initiate several clinical therapies and have an advanced ability to conduct early identification and Ottawa Paramedic Service - 2014 Annual Report
privy to a behind the scenes experience as they learned the day-in-the-life of an Ottawa Paramedic Service employee. Day of Pink, where staff members showed up for work at Paramedic Headquarters with a bit more colour than usual to show their desire to stop bullying. International Day of Pink is a day where communities across the country, and across the world, unite in celebrating diversity and raising awareness to stop Homophobic, Transphobic & all forms of bullying. The Paramedic Service remains committed to the Diversity Champion Program which aims to: Support current diversity within the Ottawa Paramedic Service; Engage and build relationships with diverse communities in Ottawa, allowing the Paramedic Service to learn how to better meet their unique needs and to educate them on the role of the Paramedic Service within the city; and Improve diversity through recruitment and retention strategies to help ensure that the Ottawa Paramedic Service is diverse and representative of the community it serves. Some of the highlights in 2014 include; Paramedic Awareness Week Camp for First Nations, Métis and Inuit youth who spent a week at Paramedic Headquarters with Paramedics, communications officers and equipment supply technicians. They were The Paramedic Service hosted another successful graduation ceremony for new Paramedic recruits that have replaced retirees or filled positions made vacant. All new recruits successfully complete a rigorous hiring process and Orientation and Mentorship programs before becoming a Paramedic within the City of Ottawa. These new Paramedics were formally recognized for this achievement in front of their family and peers. In acknowledgement of varying expertise and experiences, an extensive staff engagement exercise was conducted to gain insight into the Service s priorities over the next term of Council. The result of this direct consultation was the generation of numerous suggestions in the areas of operational process, financial accountability, client and stakeholder relations and employee engagement. Many of the initiatives have been embedded into the Service s plan for this next term of Council. 6
System Performance PARAMEDIC RESPONSE VOLUME The highest priority for the Ottawa Paramedic Service is to provide the best possible clinical care to the residents and visitors of the City of Ottawa. In order to achieve this, our staff continuously analyze response times, response volumes and patient outcomes in order to maximize the deployment and usage of paramedic resources. The 3 primary measures that determine service demand and associated resource requirements are: Total number of calls: Total number of 9-1-1 calls received at Ottawa Central Ambulance Communications Centre. Total number of clinical incidents: Total number of patients assessed and treated. Total response volume: Total number of Paramedic resources required to respond, which is initially determined by a Communications Officer who obtains and assesses the caller s information and continuously evaluated by Paramedics once they arrive on scene. An example to illustrate the interdependencies amongst these indicators is a single 9-1-1 call for a vehicle collision with multiple patients requiring multiple resources. Table 2: Paramedic Response Volume by Year The greatest indicator of system utilization is the response volume. In 2014, the Paramedic Service response volume was 127 883, representing a 7.2% increase over the previous year. The five year trend demonstrates a 21.3% overall increase. Ottawa Paramedic Service - 2014 Annual Report
2014 City of Ottawa Paramedic Response Density Map The map above shows the Ottawa Paramedic Service response volume by ward. Generally speaking the more densely populated a ward is the higher the response volume. 8
System Performance PARAMEDIC RESPONSE TIME STANDARDS Despite the increase in volumes, the Ottawa Paramedic Service was successful in achieving the provincially-legislated and Council approved response time standards in 2014. This is the second year the Ottawa Paramedic Service utilized the new response time reporting framework, therefore providing limited comparison to previous years performance. The current response time reporting framework is defined as the elapsed time from when the first Paramedic Unit is notified to the arrival of a Paramedic Unit on scene. Response times across Ontario are all measured and publicly reported in the same manner by the Ministry of Health and Long Term Care. Table 3 outlines the legislated response time standard targets and results based on a CTAS (Canadian Triage Acuity Scale) score which is the level of care required for a patient (CTAS Score I being of highest priority). The percent rank target represents the percentage of times that a Paramedic crew has arrived on-scene to provide paramedic services to patients within the established target response time. Table 3: Paramedic Response Time Standard Category CTAS I CTAS II Target Time (Minutes) 8 Minutes 10 Minutes Percent Rank Target 75% 75% 2013 Performance 83.6% 85.5% 2014 Performance 79.5% 82.9% CTAS III 15 Minutes 75% 95.4% 93.5% CTAS IV 20 Minutes 75% 98.7% 98.0% CTAS V 25 Minutes 75% 99.6% 99.2% The level of care required by a patient (CTAS) can only be determined once the Paramedics have arrived on scene to conduct a medical assessment and initiate care. The acuity is defined through a CTAS score as noted within the response time standard. The priority of the Paramedic being dispatched is defined by a Code (Code 4 being the highest priority) which is determined by the Communications Officer using a medical algorithm call-taking process. 73% of all responses are dispatched as a Code 4 to ensure that the sickest patients receive treatment in a timely manner. Ottawa Paramedic Service - 2014 Annual Report
PARAMEDIC RESPONSE UNIT The Paramedic Response Unit (PRU) is a vehicle staffed with a single Primary Care Paramedic. The primary function is to provide first response capacity with a single Paramedic arriving rapidly on scene to initiate patient care. A transport unit is simultaneously dispatched to provide back up, if transport is required. This allows the PRU to downgrade or defer the transport unit, thereby allowing the transport crew (Paramedic Unit) to respond to the next emergency call. The PRU provides continual coverage in their assigned area, as they do not transport patients to hospital and are immediately available upon clearing a call. The single Paramedic Rapid Responder initiative utilized by the Ottawa Paramedic Service is an industry best practice for deployment and has been adopted by many other Paramedic Services in Ontario and across Canada. Table 4 displays the total responses and average response time for the Paramedic Response Units. Table 4: PRU Response Volumes and Times Year 2010 2011 2012 2013 2014 Responses 5,863 8,488 10,666 13,051 10,561 Percent Rank (8:00 Target) 94.5% 94.8% 92.8% 91.6% 89.7% In 2014, deployment of PRU s was modified in an effort to maintain resource availability across the city. Previously PRU s were deployed to all Code 4 s. They are now deployed to those calls where they are likely to be the closest responding resource. COMMUNITY DEFIBRILLATOR RESPONSE TIME STANDARDS In cases of sudden cardiac arrest, response time is defined as the elapsed time from when the first Paramedic Unit is notified to the arrival of any person trained and equipped to provide defibrillation. This response time is impacted by whether there is a public access defibrillator on scene, such as a public recreational facility or.table 5: Community Target for Cardiac Arrests Category Target Time (Minutes) the arrival of Ottawa Paramedic, Police, Fire or OC Transpo Security who are equipped with a defibrillator in their vehicles. Table 5 shows the Ottawa Paramedic Service s performance against the legislated response time standard for Sudden Cardiac Arrests. Percent Rank Target 2013 Performance 2014 Performance Sudden Cardiac Arrests 6 Minutes 65% 73.5% 63.0% (Defibrillator) Staff will be conducting a review of the defibrillator program in 2015 and will be reporting on the outcomes. 10
Ottawa Central Ambulance Communications Centre MINISTRY OF HEALTH AND LONG TERM CARE CERTIFICATION The Ottawa Central Ambulance Communications Centre (OCACC) provides 9-1-1 call taking and triaging and dispatches all Paramedic resources for the City of Ottawa, the United Counties of Prescott and Russell as well as the United Counties of Stormont, Dundas and Glengary. This equals a geographical area of over 10,000 km2. The Ottawa Paramedic Service manages these dispatching services under contract for the Ministry of Health and Long Term Care. As such, OCACC must successfully meet the Communication Service Review criteria and the legislated requirements to operate a Communication Service in the Province of Ontario. The purpose of the Communication Service Review is to ensure OCACC operates in a manner consistent with the Performance Agreement, Performance Standards, Manual of Practice and in compliance with legislation. The legislated Service Review occurs every third year. 2014 marked a Service Review year where OCACC hosted the Ministry of Health and Long Term Care over 2 days. Throughout this on-site Ottawa Paramedic Service - 2014 Annual Report inspection, OCACC provided evidence in the form of live observation, supporting materials and interviews that demonstrated compliance with 23 elements. These elements are categorized by service delivery, quality assurance and administration. The Ministry of Health and Long Term Care found that OCACC successfully met the Communication Service Review criteria and specifically commended their work in the following areas: Preparation for the Ambulance Service Review Comprehensive Quality Assurance Program Training Operations Policy and Procedures Liaison and Communication
OTTAWA CENTRAL AMBULANCE COMMUNICATIONS CENTRE SYSTEM PERFORMANCE In 2014, the OCACC answered 121,964 calls for the City of Ottawa, the United Counties of Prescott and Russell as well as the United Counties of Stormont, Dundas and Glengary. As a result, they performed critical dispatching functions based on a response volume of 158,708 Paramedic resources for emergency call assignments across all municipalities. The Ministry of Health and Long Term Care has also created response time standards (call processing times) for all ambulance communications centres in Ontario. This new standard applies to sudden cardiac arrest and CTAS 1 patients only, as they are the most critically ill, and is measured as the time difference between when the call is received at the communications centre and when a Paramedic Unit has been notified of an emergency call. Staff must report annually on the percentage of time this performance is achieved within 120 seconds. Table 6 shows the call processing times for CTAS I and Sudden Cardiac Arrest patients. Table 6: Ottawa Central Communications Centre Call Processing Times Category Target Time (seconds) 2014 Percent Rank Target 2014 Performance CTAS I 120 Seconds 75% 86.8% Sudden Cardiac Arrest 120 Seconds 75% 89.1% 12
Clinical Excellence The Ottawa Paramedic Service remains committed to promoting and supporting improved clinical care, safety and quality. When a member of the public requires immediate medical care, an entire team of dedicated, highly qualified people come together in the name of providing excellence in clinical care delivery: the Paramedics, Communications Officers and Equipment Supply Technicians, trainers, quality assurance staff and critical support staff. The Paramedic Service is also active on a number of provincial and national working groups related to performance measures including the Ontario Municipal Benchmarking Initiative (OMBI) Emergency Medical Service Expert Panel and the Paramedic Chiefs of Canada Performance Measures Working Group. This data is utilized to set best practice standards and assists in evaluating the quality and form of care being delivered on a daily basis. All data collected during the course of a Paramedic s duties is protected under the Personal Health Information Protection Act and is never shared outside the circle of care. Table 7 outlines the Top 10 call types based on the Paramedic s assessment of the patient once on scene: Table 7: Top 10 Call Types in 2014 Call Type # Calls In 2014 Musculoskeletal Trauma 18,317 General Illness / Weakness 13,065 Chest Pain / Discomfort / Cardiovascular 6,251 Stroke / Confusion / Neurological 4,816 Behavioral / Psychiatric Disorder 4,681 Difficulty Breathing / Respiratory 4,279 Treatment - Diagnostic Returns 3,974 Alcohol Intoxication / Drug Overdose 3,304 Abdominal Pain / Problems 2,249 Diabetic Emergency 1,028 Ottawa Paramedic Service - 2014 Annual Report
Research & Innovation In an effort to provide residents and visitors with the highest standard of care, the Ottawa Paramedic Service remains innovative by participating in several research trials and ensuring that evidence based practices are applied. Research partnerships are chosen by the Ottawa Paramedic Service Research Committee, comprised of front line staff and members of management. A thorough review of each proposal is conducted and appropriate research projects are chosen based on their relevance and benefit to the community. RESUSCITATION OUTCOMES CONSORTIUM (ROC) ROC is an international consortium performing research related to cardiac arrests and has created the single largest repository of cardiac arrest data with contributions from cities such as Dallas, Pittsburgh, Seattle, San Diego, Atlanta, Toronto and Ottawa. Out-of-hospital cardiac arrest is common, life-threatening and debilitating. As such, the Ottawa Paramedic Service is actively participating in the current Continuous Chest Compressions Study which aims to compare survival to hospital discharge after continuous chest compressions versus the standard recommended cardiopulmonary resuscitation standard of 30 respirations: 2 chest compressions. Outcomes of this study will drive CPR guidelines in the future. TECHNICAL EQUIPMENT SERVICE TRIAL (TEST) TEAM This specialized group of Paramedics is tasked with the testing and the trial of new equipment, technologies and innovative approaches prior to them being integrated into regular operations. The TEST Team ensures that these items have been thoroughly evaluated and have demonstrated added value to the patient, the staff or the Service. In 2014, the TEST Team evaluated the benefits of an AutoPulse non-invasive cardiac support pump. This pump would take the place of existing manual chest compressions for victims of Sudden Cardiac Arrest and assist by freeing up Paramedic staff for other required medical interventions. 14
Research & Innovation CANADIAN C-SPINE STUDY Each year, 1.3 million patients who may have injured their neck (c-spine) are transported to Canadian emergency departments. Less than 1% of all these patients actually have a neck bone fracture or ligament injury. Even less (0.5%) have a spinal cord injury or nerve damage. These injuries usually occur at the time of initial trauma and not during transport to the emergency department. Currently, Ontario Paramedics transport all trauma victims (with or without an injury) by ambulance using a backboard, collar, and head immobilizers. Trauma victims can stay immobilized for hours. Importantly, long immobilization is often unnecessary, causes patient discomfort, contributes to emergency department crowding, and is very costly. The Ottawa Hospital Research Institute (OHRI) developed the Canadian C-Spine Rule for alert and stable trauma patients. This decision rule helps Paramedics, emergency department physicians and triage nurses safely and selectively remove immobilization, without x-rays or negative outcomes. Ottawa Paramedics have been testing the rule in the out-of-hospital environment. Our Paramedics have evaluated over 3,000 patients so far and have accurately identified all injuries. (OHRI) involving the Ottawa Central Ambulance Communications Centre. Victims of Sudden Cardiac Arrest are almost four times more likely to survive when receiving CPR from a bystander. However, the Communications Officer on the other end of a 9-1-1 call is required to quickly and accurately identify a patient that is about to have a cardiac arrest and provide instructions for immediate CPR over the phone. The overall goal of this study is to develop, implement, and evaluate the effectiveness of an educational program designed to improve the cardiac arrest diagnostic accuracy of emergency medical dispatchers and appropriate delivery of dispatch-assisted CPR instructions to 9-1-1 callers reporting a cardiac arrest victim. CHARACTERISTICS, MANAGEMENT, OUTCOMES AND SHORT-TERM ADVERSE EVENTS OF HYPOGYCEMIC PATIENTS In Ontario, Paramedics are required to transport all patients to hospital. This study looks at the medical outcomes of patients treated for hypoglycemia by Paramedics and the possibility of treat and release options. We are currently working with OHRI on a second study to assist with the implementation of the Canadian C-Spine Rule by Paramedics to help reduce patient discomfort, Paramedic intervention times, emergency department crowding, and healthcare costs. The second study is called: A Pragmatic Strategy Empowering Paramedics to Assess Low-Risk Trauma Patients with the Canadian C-Spine Rule and Selectively Transport them Without Immobilization. AGONAL RESPIRATION STUDY, PHASE 2 This is a continuation of a clinical research project with the Heart and Stroke Foundation of Ontario and the Ottawa Hospital Research Institute Ottawa Paramedic Service - 2014 Annual Report
Community Partnerships The Ottawa Paramedic Service partners with many organizations including health care providers, various government bodies, vendors, schools and private businesses to ensure high standards in patient care and seamless service delivery. TARGETED ENGAGEMENT DIVERSION The Ottawa Paramedic Service has partnered with inner-city Health, the Shepherds of Good Hope, Ottawa Hospital and Ottawa Police to identify homeless individuals who frequently use the 9-1-1 service due to intoxication and provide specialized care outside of a hospital setting. The pilot program has provided alternate care options to 80 individuals at their request. COMMUNITY PARAMEDICINE PARTNERSHIP The Ottawa Paramedic Service identified a Community Paramedic for the purpose of this community paramedicine pilot program with the West Carleton Family Health Team. The Community Paramedic is part of a collaborative team and is responsible for conducting proactive home visits to high needs patients. The program was initiated through Ministry of Health and Long Term Care funding that was made available for the development of community-led community paramedicine initiatives. The program aim is to reduce the impact of high needs patients on health services, while improving patient s quality of life. The mobility of a community paramedicine service makes it particularly useful to patients in Rural Northwest with respect to being able to stay well at home. HEART SAFE CITY The Ottawa Paramedic Service continues to be a leader with the Heart Safe City initiative. A partnership between the Paramedic Service, Heart & Stroke Foundation, Advanced Coronary Treatment (ACT) Foundation, Maharaja s Ball as well as private businesses has seen the placement of over 900 automatic external defibrillators (AEDs) in public buildings, police, fire, and OC Transpo vehicles since 2001. Since its inception, the Public Access Defibrillator program has directly contributed to bystanders saving 85 lives, 5 of which occurred in 2014. In an effort to strengthen the chain of survival, the Community Medicine team taught 730 First Aid, CPR and AED courses to a total of 13 224 individuals throughout the year. The Service will be reviewing the Capital Plan for the AEDs that are end of life. 16
Significant Events DESIGNATED EBOLA PARAMEDIC SERVICE The Ministry of Health and Long Term Care appointed Ottawa as a designated Ebola Paramedic Service. As a result, specialized personal protective equipment was purchased and specialized infection control training was conducted with select staff members. A lease-back agreement with Fleet Services has allowed the designation and specialized retrofit of a Ford E450 vehicle to transport suspect patients. Previous investments in the decontamination/disinfection vehicle bay at Paramedic Headquarters continue to demonstrate its value as a means of protecting staff who have been involved in a suspected Ebola case. search of Parliament Hill and responded to several calls within the established hot zone as the event unfolded and public safety remained a concern. This event further demonstrates the critical dependencies amongst the various responding agencies and all levels of government and further validates the importance of collaborative preparation and response in the Nation s Capital. OCTOBER 22ND SHOOTING The Ottawa Paramedic Service responded within minutes to the October 22nd shootings at the National War Memorial and Parliament Hill to initiate immediate medical care of 3 patients. The Paramedic Tactical Team, who receives specific training for events such as these, were embedded within the Ottawa Police and Royal Canadian Mounted Police Tactical Teams to conduct a Ottawa Paramedic Service - 2014 Annual Report
Off-Load Nurse Program The Operations Division continues to oversee the provincially funded Off-Load Nurse Pilot Program, a partnership between the Ontario Ministry of Health and Long Term Care, the local emergency departments and the Paramedic Service. This initiative allows Paramedics to transfer the care of a patient to the designated off-load nurse within the hospital s Emergency Department in an effort to expedite the return of paramedic resources to the community and increase availability to respond to other medical emergencies. In 2014, the Province committed $1.5 million for the 2013/14 fiscal year to continue the pilot project. Table 8 outlines the Paramedic time saved through the dedicated Off- Load Nurse Pilot Program. Table 8: Time Saving From Dedicated Off-Load Nurse Pilot Program Year Time Gained by OLN (Hours) Time Spent Waiting in Excess of 30 Minutes (in Hours) 2010 11159 45869 2011 15202 40370 2012 17244 38753 2013 19619 29577 2014 24423 27445 18
Public Accountability The Ottawa Paramedic Service remains committed to establishing an accountable, open and transparent relationship with the public. The Service is trusted to provide an established level of care prescribed by legislation and has an accountability framework that ensures adherence to this level of care. The Professional Standards Section of the Paramedic Service is tasked with investigating all complaints that are received from the public. In 2014, there were 70 complaints received from the public regarding the Paramedic Service. Each complaint is investigated thoroughly by reviewing incident reports and conducting interviews with members of the public and staff. The written response of all investigations is provided back to the complainant. In 2014, 21 of the 70 public complaints were deemed to be founded, meaning the Paramedic Service did not meet the expectations of the public and corrective action was taken. The Paramedic Service also received 189 compliments in 2014 regarding patient satisfaction with the level of care provided or notes of appreciation for participating in various community events. All compliments are relayed to the staff member and published in a weekly newsletter. LOOKING AHEAD Response volumes have increased by 21.3% over the previous 5 years. Meeting legislated response time standards will become more challenging as this trend is expected to continue. The Ottawa Paramedic Service remains committed to monitoring indicators such as response volume, response times, unit availability during peak periods, reliance on surrounding municipalities Paramedic Services and evaluating innovative solutions in the interest of providing the highest quality of medical care to all patients in a timely manner. A review of the deployment plan, the current community paramedicine partnership with West Carleton Family Health Team, diversion programs such as the continued involvement with the Targeted Engagement Diversion Program and the on-going Off-Load Nurse Pilot Program are examples of programs that have been successful in off-setting the existing response volume pressures. The Paramedic Service will continue to review its operations to develop and refine strategies in an effort to mitigate increasing call volumes and will report back if required. Ottawa Paramedic Service - 2014 Annual Report
Appendix KEY TERMS CACC: Central Ambulance Communications Centre - dispatch and call taking centre for Paramedic 911 calls. Code 1: A non-urgent call which may be delayed without being physically detrimental to the patient. Code 2: Any call which must be done at a specific time due to the limited availability of special treatment or diagnostic/receiving facilities. Code 3: Any call which may be answered with moderate delay. All patients classified in this priority group are stable or under professional care and are not in immediate danger. CTAS 5 - Conditions that may be acute but nonurgent, as well as conditions which may be part of a chronic problem, with or without evidence of deterioration/ Percentile: A percentile is the value of a variable below which a certain percent of observations fall. Percentile Rank: The percentile rank of a score is the percentage of scores in its frequency distribution which are lower than it. Code 4: This call refers to situations of a life or limb threatening nature and time is critical. Code 8: Stand-by Call. Vehicle or ambulance crew utilization to provide emergency coverage or for anticipation of a call. CTAS - Canadian Triage and Acuity Scale CTAS 1 - Threats to life or limb requiring immediate aggressive interventions. CTAS 2 - Potential threats to life, limb or function requiring rapid medical intervention or controlled acts. CTAS 3 - Conditions that could potentially progress to a serious problem requiring emergency interventions. CTAS 4 - Conditions that relate to patient age/distress or potential for deterioration or complications which could benefit from intervention or reassurance within one hour. 20
OTTAWA PARAMEDIC SERVICE 2465 Don Reid Drive Ottawa ON K1H 1E2 (613) 580-2424 www.ottawaparamedicservice.ca @ottawaparamedic