2014 Annual Report DUFFERIN COUNTY PARAMEDIC SERVICE 325 Blind Line Orangeville, ON L9W 5J8
Table of Contents Human Resources... 2 Vehicles... 2 Stations... 3 Responses... 4 Public Access Defibrillator (PAD) Program... 5 Public Relations... 6 Training... 7 New Programs... 8 Offload Nursing... 8 Community Paramedic Program... 9 STEMI Bypass/ Code STEMI...10 Budget...11 Appendix 1 Response Time Standards...12 1 P a g e
Dufferin County Paramedic Service responds to 911 calls for medical requests on a 24/7 basis. The service operates out of 3 stations, with 8 ambulances, 2 first response units, travels 330 000 km s per year, employs 58 staff members and responds to more than 7,800 emergency calls per year. Human Resources Paramedic Staffing ACP PCP Full time 22 10 Part time 4 17 Total 26 27 Total Staff 53 Support Staff Chief 1 Deputy Chief 1 Superintendent s (Also included in staffing) 4 Quality Assurance 1 Administrative Assistant 1 Total 8 Vehicles 8 Demers Ambulances 2 Emergency Response Vehicles 2 P a g e
Stations Orangeville Headquarters/Administration 325 Blind Line Orangeville, ON L9W 5J8 Shelburne 301 Rintoul Crescent Shelburne, ON L9V 3C5 Grand Valley 66 Main Street North Grand Valley, ON L9W 7N4 3 P a g e
Responses In 2014, Dufferin County Paramedic Service responded to 7,805 emergency calls, with 5,230 calls being dispatched as Code 4 Life Threatening. The average response time for Dufferin County Paramedic Service in 2014 was 8 minutes and 30 seconds. See Appendix 1 Report to Ministry of Health Response Time Standards 2014 Dispatch Priority Dispatch Problem Location of Calls 4 P a g e
Public Access Defibrillator (PAD) Program Dufferin County Paramedic Services manages the PAD program within Dufferin County. Currently there are more than 100 PAD s available in the community. Dufferin County Paramedic Service responded to 59 calls in 2014 were a defibrillator was required. In 41 circumstances, a defibrillator arrived at the patient within 8 minutes (from time of 911 call first defibrillator at patient s side). Percentage of Calls 41/59 =69.49% < 8 min Dufferin County Paramedic Service received funding for 6 new defibrilator s and 4 defibrillators were upgraded. Headwaters Racquet Club Orangeville District High School (3 rd unit added to building) Saint Timothy s Catholic Church Glenbrook Elementary School Tony Rose Memorial Arena ( 2 units upgraded) North Dufferin Community Center (2 nd unit added to facility) Center Dufferin recreation Centre (2 nd unit added to facility) Alder Street Arena ( 2 units upgraded) 5 P a g e
Public Relations Dufferin County Paramedic Service completed over 200 hours of Public Relations within the County of Dufferin at various events. Public school training Food drive Career Pathways Vial of life presentations Mass CPR training Honour Guard Activities Tours for Boy Scouts, Girl Guides, Private Schools and DACL Teddy Bear Clinic Tim Horton s Camp Day Dairy Queen Miracle Treat Day Numerous other Public Service Presentations 6 P a g e
Training Dufferin County Paramedic Service stresses the importance of continuing education with all employees. During the 2014 calendar year, Paramedics completed over 1300 hours of training which included; Sepsis Alert Code STEMI New Equipment Training Field Trauma Triage Training Air Ambulance Utilization Standards training Annual Practice Review Documentation Training Ebola Virus Disease o Response guideline was developed for Dufferin County Paramedic Service o Staff received training for implementation of response guidelines, donning/doffing of PPE Hazardous Drug Awareness Training Superintendent s received health and safety training, due diligence training Two Paramedics completed Community Paramedicine Program through Centennial College 7 P a g e
NUMBER OF PATIENTS TIME FOR OFFLOAD (MM:SS) New Programs Dufferin County Paramedic Service recently introduced two new programs solely funded through alternative sources. The Offload Nursing Program was introduced in November 2014 to help alleviate ambulance delays within the hospital. Also, in November 2014, Dufferin County Paramedic Service received funding to train, develop and implement a Community Paramedic Program for the residents of Dufferin County. Offload Nursing Ambulance offload delay refers to the transfer of patient care from the Paramedic crew to the staff of the emergency department. These delays can have significant impact of the timely delivery of services by the Paramedic Service. Dufferin County Paramedic Service was able to secure funding to provide one nurse 12 hours a day. This nurse is dedicated to accepting patients from Paramedic Crews when the Emergency Department is running at capacity and there is no available resources to allow the crew to transfer care to the accepting hospital. Prior to the implementation of the Offload Nursing Program, the 90 th percentile for Ambulance Offload at Headwaters Health Care Center was 62 minutes and the range of offload was between 25-40 patients per month. Within the first month of the program, the total patients in Offload decreased to 11 despite the highest volume of patients being transported and the 90 th percentile for decreased to 20 minutes. As the program is still in the early stages, the results are preliminary but have demonstrated that the program will be extremely successful. The graph below shows the total patients transported, total patients in Offload delay > 30 minutes and the 90 th percentile for Offload by Dufferin County Paramedic Service to Headwaters Health Care Center in 2014. 350 Offload Report 1:55:12 300 250 200 150 100 50 0 316 25 297 278 278 279 0:45:00 0:39:21 1:42:00 1:37:00 35 34 29 32 287 1:04:00 298 0:39:00 307 0:52:00 25 22 26 279 1:09:00 286 1:23:00267 40 35 1:03:00 320 1:40:48 1:26:24 1:12:00 0:57:36 0:49:00 0:43:12 0:28:48 0:20:00 0:14:24 16 11 0:00:00 Total Patients Transported Total Patients in offload delay (>30min) Offload Time 90th Percentile MONTH 8 P a g e
Community Paramedic Program Community Paramedicine is recognized internationally as a best practice to help manage increased demands for paramedic services. The Community Paramedic project has the potential to reduce emergency calls, emergency department visits and hospitalizations, demand for long-term care beds and will ultimately increase patient satisfaction. Ensuring seniors and other high-risk patients can access the right care, at the right time, in the right place, supports Ontario s Action Plan for Health Care. Partnering with the Dufferin Area Family Health Team, Headwaters Health Care Centre, Central West LHIN, and community care partners, Dufferin Community Paramedics will assist high risk clients living with complex medical issues such as diabetes, chronic obstructive pulmonary disease, congestive heart failure and co-morbidities. Such patients are often frequent Paramedic Service and Emergency Department users, and this new project will allow paramedics to provide in-home visits to do check-ins, assessments, perform blood and urine tests and administer medications in consultation with the patient's physician. Two Advanced Care Paramedics completed training through Centennial College for Community Paramedicine which included didactic, practical and clinical components. 9 P a g e
STEMI Bypass/ Code STEMI The STEMI Bypass program was introduced to Dufferin County in 2008 and involves the transport of patients who are experiencing ST segment elevation Myocardial Infarction (Heart Attack). When the paramedics respond to a patient presenting with symptoms of a MI, they will perform an ECG. Upon identification of a STEMI on the ECG, the paramedics will initiate transport to Southlake Regional Hospital. Many studies have been completed on best care for patients presenting with STEMI and current guidelines dictate that the patient be transported immediately to a Cardiac Center capable of performing Primary Percutaneous Coronary Intervention (Primary PCI). The goal is for the patient to have this procedure within 90 minutes of initial patient contact (time that first health care provider make first contact with patient.) Over the past seven (7) years, Dufferin County Paramedic Service has been able to identify many patients and successfully transport them to Southlake Regional Hospital for this life saving procedure. In 2014, eleven (11) patients were transported from their home to Southlake Regional Hospital. Code STEMI is a new program that involves the coordinated efforts of Headwaters Health Care Center, Southlake Regional Hospital and Dufferin County Paramedic Service. In June of this past year, HHCC introduced a new program that involved the immediate transport of patients who presented to the Emergency Department with a STEMI. Once identification of a STEMI has taken place, the ED will contact ambulance dispatch and request a paramedic crew respond to the hospital for a patient to be transported to Southlake Regional Hospital. The goals of this program are to have the patient transported to a Cardiac Center within 30 minutes, door-in/door-out (time from first patient contact in ED to time patient leaves hospital with paramedics.) Again, the goal is for the patient to have this procedure completed within 90 minutes of initial patient contact. In just over six (6) months, Dufferin County Paramedic Service transported fourteen (14) patients from Headwaters Health Care Center to Southlake Regional Hospital for this life saving procedure. 10 P a g e
Budget The approved budget for 2014 was $5,960,680.00. A more detailed report on the budget for 2014 will be available in the annual financial audited report. 11 P a g e
Appendix 1 Response Time Standards Mr. Richard Jackson Director Emergency Health Services Branch 5700 Yonge Street, 6th Floor Toronto, Ontario M2M 4K5 RE: RESPONSE TIME STANDARD NOTIFICATION - Response 2014 Dear Mr. Jackson, Pursuant to the Ambulance Act Reg 257, Part VIII: (2) No later than October 1 in each year after 2011, every upper-tier municipality and every delivery agent responsible under the Act for ensuring the proper provision of land ambulance services shall establish, for land ambulance service operators selected by the upper-tier municipality or delivery agent in accordance with the Act, a performance plan for the next calendar year respecting response times. O. Reg. 267/08, s. 1 (2); O. Reg. 368/10, s. 1 (1).(3) An uppertier municipality or delivery agent to which subsection (2) applies shall ensure that the plan established under that subsection sets response time targets for responses to notices respecting patients categorized as Canadian Triage Acuity Scale ( CTAS ) 1, 2, 3, 4 and 5, and that such targets are set for each land ambulance service operator selected by the upper-tier municipality or delivery agent in accordance with the Act. O. Reg. 267/08, s. 1 (2). (4) An upper-tier municipality or delivery agent to which subsection (2) applies shall ensure that throughout the year the plan established under that subsection is continuously maintained, enforced and evaluated and, where necessary, updated, whether in whole or in part. O. Reg. 267/08, s. 1 (2). (5) An upper-tier municipality or delivery agent to which subsection (2) applies shall provide the Director with a copy of the plan established under that subsection no later than October 31 in each year, and a copy of any plan updated, whether in whole or in part, under subsection (4) no later than one month after the plan has been updated. O. Reg. 267/08, s. 1 (2). (7) Without limiting the generality of subsection (6), no later than March 31 in each year after 2013, an upper-tier municipality or delivery agent to which subsection (2) applies shall report to the Director on the following matters for the preceding calendar year: 1. The percentage of times that a person equipped to provide any type of defibrillation has arrived on-scene to provide defibrillation to sudden cardiac arrest patients within six minutes of the time notice is received. 2. The percentage of times that an ambulance crew has arrived on-scene to provide ambulance services to sudden cardiac arrest patients or other patients categorized as CTAS 1 within eight minutes of the time notice is received respecting such services. 3. The percentage of times that an ambulance crew has arrived on-scene to provide ambulance services to patients categorized as CTAS 2, 3, 4 and 5 within the response time targets set by the upper-tier municipality or delivery agent under its plan established under subsection (2). O. Reg. 267/08, s. 1 (2). (8) Without limiting the generality of subsection (6), an upper-tier municipality or delivery agent to which subsection (2) applies shall report to the Director on the performance of each land ambulance service operator selected by the upper-tier municipality or delivery agent in accordance with the Act in respect of the targets set for that operator under subsection (3). O. Reg. 267/08, s. 1 (2). 12 P a g e
24. (1) In this section, response time means the time measured from the time a request is received to the time a notice is given respecting that request. O. Reg. 267/08, s. 1 Please find below and attached the Response Time Performance Plan, as approved by resolution of Council of the County of Dufferin. Below each of the targets please find the actual responses for our community for the calendar year of 2014, from January 1 to December 31. Dufferin County Paramedic Service Performance Targets and Results for the year 2014 CTAS 1 The community response time target to Sudden Cardiac Arrest calls should be 6 minutes or less 35% of the time. CTAS 1 The land ambulance response time target should be 8 minutes or less 60% of the time. CTAS 2 The land ambulance response time target should be 15 minutes or less 90% of the time. CTAS 3 The land ambulance response time target should be 30 minutes or less 90% of the time. CTAS 4 The land ambulance response time target should be 30 minutes or less 90% of the time. CTAS 5 The land ambulance response time target should be 30 minutes or less 90% of the time. CTAS Target Actual SCA 6 min 35% 40.74% 1 8 min 60% 67.65% 2 15 min 90% 91.47% 3 30 min 90% 99.53% 4 30 min 90% 98.99% 5 30 min 90% 100% Please see attached the ADRS backup data reports that supports this submission. I trust this meets our legislative requirements. Should you require any further information or clarification please to not hesitate to contact me directly. Thank you Tom Reid, Chief Dufferin County Paramedic Service 13 P a g e