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Emergency Medical Services (EMS)
Program Summary – April 2011
Local Service Realignment (LSR)
The downloading of the Land Ambulance services, now referred to as Emergency Medical Services (EMS), occured differently than other services. Instead of unilaterally assigning the service to an entity, the Ministry Health and Long Term Care (MOHLTC) requested proposals from Consolidated Municipal Service Managers (CMSM)s or District Social Services Administration Boards (DSSAB)s. If no proposal was forthcoming they accepted proposals from individual municipalities. Through this process Designated Delivery Agents (DDA) were selected.
In the South, the DDA is normally the County or Regional government. In the North, the DDA is normally the District Social Services Administration Board (DSSAB). The three exceptions in the North are the City of Greater Sudbury, the Town of Parry Sound and the City of Thunder Bay. These entities assumed the DDA responsibilities rather than the local DSSAB. There are 49 DDAs in the province.
The Board became the DDA for Land Ambulance Services in March 2000. A Land Ambulance Subcommittee of the Board was established to plan for the assumption of services on January 1, 2001. The Board approved the continuation of the contract with the Sault Area Hospital until it could decide on a process to select the long term service provider. The selection of an ongoing service provider occurred through a competitive Request for Proposals (RFP) in July 2001. The City of Sault Ste. Marie was the successful respondent to the RFP and became the service delivery contractor effective April 1, 2002. Services to the Garden River First Nation (GRFN) became operational December 2009 under an agreement with the MOHLTC.
The EMS Service operates as a division of the Sault Ste. Marie Fire Services. EMSfleet consists of 9 Ambulances and 1 Emergency Support Unit. There are 3 ambulances staffed 24 hours a day 7 days per week. In the Garden River First Nation there is one ambulance staffed 12 hours per day 7 days per week. The fleet includes two (2) administrative vehicles.
Emergency First Response Teams (EFRT)
An EFRT is an organized group of qualified first aiders who respond to medical emergencies within their communities. As an extension of the EMS system, the teams are established and trained by Ministry of Health, EHS Branch, overseen by a Regional Training Coordinator, and re-stocked by the EMS service. The EFRT respond to assess, treat and stabilize an injured patient or ill patient until the ambulance arrives on scene. They do not have the authority to transport a patient. EFRT are functional in PrinceTownship, Searchmont, Goulais River and Batchawana. They are operated by the volunteer fire departments in these communities. There are written agreements with the EFRTs which set out the roles and responsibilities of the parties.
Central Ambulance Communications Centre (CACC)
Ambulance services are integrated component of the provincial health and emergency response system. The MOHLTC funds 100% of the cost of the Central Ambulance Communications Centres (CACC)s. The local CACC is operated by the Sault Area Hospital under a Memorandum of Understanding with the MOHLTC and is staffed by hospital employees.The CACC is independent of the Board and the service contractor (the City of Sault Ste. Marie Fire Services).The local CACC serves the entire Algoma District and employs 14 full time staff and 11 part time staff.
Following the receipt of any emergency medical call the local CACC dispatches the most appropriate, available ambulance. The dispatch decision is made regardless of location or jurisdiction: the most appropriate ambulance is the one dispatched. Dispatched ambulances may cross jurisdictional, municipal, provincial and international boundaries to respond to requests for assistance. CACC ensures speedy and seamless accessibility.
The CACCs follow protocols to ensure that appropriate ambulance resources are dispatched to major incidents. They do this while trying to ensure that local ambulance needs are met. The process of balancing coverage is difficult when major emergency situations or high call volumes occur.
The CACC is also responsible for maintaining the Provincial mapping system. As map upgrades are made available the CACCs distribute these to the DDAs.
The MOHLTC provides the ambulance radio infrastructure and communications network. The equipment is the property of the Province which will also maintains the units. The use of these radios and the associated frequencies by non-provincial entities is prohibited.
The MOHLTC funds a significant portion of EMS services and retains responsibility for the many aspects of the system. They continue to regulate EMS through setting, monitoring and evaluating standards. These standards have been developed to ensure that a consistent quality of EMS services is available across Ontario. The standards include service provider licensing, response times, ambulance call and event documentation, staff qualifications and training. They include patient care standards monitored by the service provider and the Base Hospital. The Ministry also sets the standards for vehicles and equipment.
MOHLTC manages the Certification process which is required for licensing of providers. They direct and fund the CACC dispatch service and base hospital programs. They continue to have an Inspection, Certification and Regulatory Compliance group to ensure quality, consistency and to investigate complaints.
The MOHLTC has designated Base Hospital Programs across Ontario which monitors the quality and appropriateness of advanced patient care provided by paramedics. The Base Hospital for this jurisdiction is the Northeastern Ontario Prehospital Care Program (NEOPCP) based in Sudbury with a district office in the Sault. Any concerns related to that pre-hospital care are noted and dealt with directly with the paramedics; the service provider is informed of any performance issues. The Base Hospital may suggest additional training for individuals or crews.
Certification Review Process
The Certification Review program is a peer orientated, quality based process that assesses the success of each DDA in meeting the requirements of the Ambulance Act, Regulations and standards. The process utilizes a team of experienced ambulance workers and managers to assess service performance and to make recommendations for improvement. This Certification program is focused on ensuring that the quality of patient care and public safety is maintained. The review does not evaluate the financial or operational management of ambulance services except where there is a direct link to the provision of patient care (e.g. purchase of supplies / maintenance of patient care equipment.
During a Certification review the Review Team will evaluate a number of areas including; level and type of ambulance service provided, qualifications of patient care providers, maintenance of paramedic competencies, measures taken to ensure provision of proper patient care, vehicles and equipment are maintained in accordance with standards, measures are taken to protect patients and the public, patient care and public safety policies and procedures are in place and documentation and security of patient care information meets MOHLTC standards.
Upon completion of the Certification Review site visit, the Team Leader for the visit will provide a brief verbal overview of the findings of the Review visit. This meeting will provide an opportunity for the service operator to be informed of any areas of patient care or public safety deficiency that require prompt attention. The meeting will also serve to give the operator an early indication of their success in meeting the requirements of the Review.The final written review includes specific recommendations and upon their completion the renewal of the license to operate a service.
First Nations Communities
Many of the DDAs have a First Nations community located within or adjacent to its boundaries. The province funds and ensures the provision of land ambulance services to First Nations communities. It may do this directly or in partnership with the DDA.
Due to population or the workload on the First Nations community, an ambulance service may be established to serve those First Nations residents. For First Nations communities that are not large enough to support having their own ambulance service, the province will work with the Band Council in each area to arrange for purchase of land ambulance service from a nearby DDA. This has occurred locally with the Garden River First Nations in 2009.
Non-urgent Patient Transfers
Hospitals, long-term care facilities and home care programs require ambulance services to provide urgent and other medically-essential transport for patients. The Ambulance Act defines the criteria for the use of ambulance vehicles. Generally, persons who have suffered any form of trauma or illness which could "endanger their life, limb, or function" or who have been deemed to be in an unstable medical condition requiring the attendance of some form of health care worker and the use of a stretcher, are eligible to be transported within an ambulance vehicle.
Subject to availability, the EMS services can be called upon to perform transfers of patients who do not meet the above criteria. Such trips are commonly made between health care facilities to permit patients to access testing, or to return patients to their homes or other residence. Owing to the limited numbers of ambulances, many trips of the above types are made by private patient transfer services.
The local EMS service attempts to complete non-urgent transfer but always ensures two ambulances remain available for emergencies. Each EMS service is part of the health care and emergency services system of the province and inter-facility transfers for medically-necessary services remain an essential part of that system.
The patient transfers may involve the conveyance of a passenger to a destination outside of the boundaries of the DDA where the call originated. This type of occurrence depletes the fleet available for emergency responses in the originating DDA and increases the potential for cross-border trip costs.
Private sector firms are part of the local solution and provide for the transfer of a portion of the non-urgent demand. These for profit services are not regulated by the Province and they bill their clients directly for service. The vehicles utilized by these private firms are not required to comply with the regulations respecting ambulances, nor are their staff required to be licensed. Fees may vary from service to service depending on the length of the trip. Amendments to the Highway Traffic Act permitted Ontario municipalities to regulate these private services but did not mandate that responsibility.
EMS Public Education
The Sault Ste. Marie Fire Services - EMS division has an active Public Education Committee. They are currently responsible for the "My Medications" a senior’s drug registration program. Staff is available to make presentations to schools and service organizations. They are also actively involved in the local Risk Watch, Preventing Alcohol Related Trauma in Youth and the Slip, Trip and Fall Committees.