Item - 2013.EX33.11
Tracking Status
- City Council adopted this item on July 16, 2013 with amendments.
- This item was considered by Executive Committee on July 3, 2013 and was adopted with amendments. It will be considered by City Council on July 16, 2013.
EX33.11 - Results of the Service and Organizational Review of Toronto Emergency Medical Services and Toronto Fire Services
- Decision Type:
- ACTION
- Status:
- Amended
City Council Decision
City Council on July 16, 17, 18 and 19, 2013, adopted the following:
1. City Council authorize the Chief, Toronto Emergency Medical Services to submit a business case through the 2014 and future years’ budget to add 169 paramedic positions over the next three years from 2014 through to 2016.
2. City Council request the City Manager and the Chief, Toronto Emergency Medical Services to consult with the Province of Ontario, in particular the Ministry of Health and Long Term Care, regarding confirmation of 50/50 provincial cost-shared funding for paramedic positions being covered in the first year of operation.
3. City Council affirm the continuation of the Community Paramedicine Program as part of a strategy to reduce call volume pressures and to provide the most appropriate mobile patient care to vulnerable Toronto communities and residents.
4. City Council request the Chief, Toronto Emergency Medical Services to submit a business case through the 2014 budget process for resources to implement Lean type solutions (Six Sigma and ISO for example) to reduce hospital delays that contribute to paramedic wait times and expand Lean type solutions to both Toronto Emergency Medical Services and Toronto Fire Services to improve operational performance.
5. City Council refer the following recommendations to the Fire Chief and General Manager, Fire Services to commence or continue implementation and report further as required:
a. Adopt an aggressive enforcement policy for Fire Code violations that impact upon the immediate life safety of the occupants of a building;
b. Establish annual Fire Code Compliance inspections of high risk occupancies;
c. Pursue mobile technology solutions to improve the efficiency of inspection and enforcement of Fire Code requirements;
d. Train fire suppression crews on key areas of the Ontario Fire Code and utilize them to augment incident prevention and inspection activities;
e. Establish a Policy requiring building owners to cover the full City cost to inspect premises for non-compliance of orders issued under the Ontario Fire Code; and
f. Implement Business Intelligence reporting software and enhance business analysis capability.
6. City Council request the Fire Chief and General Manager, Fire Services to move forward with the fire accreditation process with target completion by 2015/2016.
7. City Council request the Fire Chief and General Manager, Fire Services to implement a strategy to increase the focus on prevention, public education, and inspection to reduce the incidence of fires and other emergencies and report further through 2013 and future years' Committee process as required.
8. City Council request the Fire Chief and General Manager, Fire Services to continue to implement dynamic staging and predictive modelling to improve the City’s fire deployment and determine the most strategic and service and cost efficient placement of fire resources and apparatus.
9. City Council request the Fire Chief and General Manager, Fire Services to explore an enhanced use of fire pre-emption including leveraging technology through other related traffic congestion management initiatives to improve fire response and report further as required.
10. City Council refer the possible closure of station 424 at 462 Runnymede Road to the Fire Chief and General Manager, Fire Services for further evaluation with the other 2013 budget adjustments and to report back in the Fall of 2013 when reporting out the results of the Fire Underwriters Survey.
11. City Council request the Fire Chief and General Manager, Fire Services to bring forward an updated Fire Master Plan by the end of 2014, incorporating changes resulting from Parts 5 to 9 above and considering the results of a City-wide risk assessment including impacts to the community fire risk profile used to establish insurance ratings.
12. City Council authorize the City Manager, in consultation with the Chief of Toronto Emergency Medical Services and the Fire Chief, Toronto Fire Services to undertake a further evaluation of the benefits, limitations, risks and required investments to consolidate the communications centres and other operational, technological and administrative opportunities and modifications so that Emergency Medical Services and Fire Services report to the same Deputy City Manager, and report back to the Executive Committee in the first quarter of 2014 on the outcomes of the evaluation.
13. City Council authorize the Fire Chief and General Manager, Fire Services to evaluate opportunities for the Toronto Fire Services Communications Centre to provide communications services to other municipalities or organizations to generate additional net revenues.
14. City Council request the City Manager and the Chief, Toronto Emergency Medical Services to consult with the Province of Ontario, in particular the Ministry of Health and Long Term Care, on the level of staff and funding required for the Toronto EMS Communications Centre to meet the 2 minute call receiving and dispatch standard set by the Ministry of Health and Long Term Care.
15. City Council direct that all recommendations related to future reports flow through Executive Committee in 2013 and 2014.
16. City Council request the Chief, Toronto Emergency Medical Services to report on the development of a workplan, for the 2014 budget, which would ensure highrise residents receive the same response time as low rise residents of the City.
Background Information (Committee)
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59627.pdf
Appendix A - Disposition of Pomax Recommendations
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59901.pdf
Appendix B - Pomax Executive Summary
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59902.pdf
Appendix C - Pomax Final Report
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59903.pdf
Communications (Committee)
(July 3, 2013) Submission from Tony Araujo (EX.New.EX33.11.2)
Motions (City Council)
That City Council delete Executive Committee Recommendation 12:
Recommendation to be deleted:
12. City Council authorize the Chief, Toronto Emergency Medical Services and the Fire Chief and General Manager, Fire Services to undertake a further evaluation of the benefits, limitations, risks, and required investments to consolidate the communications centres and report back in 2014 on the outcomes of the evaluation.
and replace it with the following new Recommendation 12:
12. City Council authorize the City Manager, in consultation with the Chief of Toronto Emergency Medical Services and the Fire Chief, to undertake a further evaluation of the benefits, limitations, risks and required investments to consolidate the communications centres and other operational, technological and administrative opportunities and modifications so that Emergency Medical Services and Fire Services report to the same Deputy City Manager, and report back to the Executive Committee in the first quarter of 2014 on the outcomes of the evaluation.
Vote (Amend Item) Jul-19-2013 9:59 AM
| Result: Carried | Majority Required - EX33.11 - Robinson - motion 1 |
|---|---|
| Total members that voted Yes: 35 | Members that voted Yes are Paul Ainslie, Maria Augimeri, Ana Bailão, Shelley Carroll, Gary Crawford, Vincent Crisanti, Janet Davis, Glenn De Baeremaeker, Frank Di Giorgio, Sarah Doucette, Mary Fragedakis, Mark Grimes, Doug Holyday, Norman Kelly, Mike Layton, Chin Lee, Gloria Lindsay Luby, Josh Matlow, Pam McConnell, Mary-Margaret McMahon, Joe Mihevc, Peter Milczyn, Denzil Minnan-Wong, Ron Moeser, Frances Nunziata (Chair), Cesar Palacio, John Parker, James Pasternak, Gord Perks, Jaye Robinson, David Shiner, Karen Stintz, Michael Thompson, Adam Vaughan, Kristyn Wong-Tam |
| Total members that voted No: 0 | Members that voted No are |
| Total members that were Absent: 10 | Members that were absent are Michelle Berardinetti, Raymond Cho, Josh Colle, Mike Del Grande, John Filion, Paula Fletcher, Doug Ford, Rob Ford, Giorgio Mammoliti, Anthony Perruzza |
Vote (Adopt Item as Amended) Jul-19-2013 10:00 AM
| Result: Carried | Majority Required - EX33.11 - Adopt the item as amended |
|---|---|
| Total members that voted Yes: 35 | Members that voted Yes are Paul Ainslie, Maria Augimeri, Ana Bailão, Shelley Carroll, Gary Crawford, Vincent Crisanti, Janet Davis, Glenn De Baeremaeker, Frank Di Giorgio, Sarah Doucette, Mary Fragedakis, Mark Grimes, Doug Holyday, Norman Kelly, Mike Layton, Chin Lee, Gloria Lindsay Luby, Josh Matlow, Pam McConnell, Mary-Margaret McMahon, Joe Mihevc, Peter Milczyn, Denzil Minnan-Wong, Ron Moeser, Frances Nunziata (Chair), Cesar Palacio, John Parker, James Pasternak, Gord Perks, Jaye Robinson, David Shiner, Karen Stintz, Michael Thompson, Adam Vaughan, Kristyn Wong-Tam |
| Total members that voted No: 0 | Members that voted No are |
| Total members that were Absent: 10 | Members that were absent are Michelle Berardinetti, Raymond Cho, Josh Colle, Mike Del Grande, John Filion, Paula Fletcher, Doug Ford, Rob Ford, Giorgio Mammoliti, Anthony Perruzza |
EX33.11 - Results of the Service and Organizational Review of Toronto Emergency Medical Services and Toronto Fire Services
- Decision Type:
- ACTION
- Status:
- Amended
Committee Recommendations
The Executive Committee recommends that:
1. City Council authorize the Chief of Toronto Emergency Medical Services to submit a business case through the 2014 and future years’ budget to add 169 paramedic positions over the next three years from 2014 through to 2016.
2. City Council request the City Manager and the Chief of Toronto Emergency Medical Services to consult with the Province of Ontario, in particular the Ministry of Health and Long Term Care, regarding confirmation of 50/50 provincial cost-shared funding for paramedic positions being covered in the first year of operation.
3. City Council affirm the continuation of the Community Paramedicine Program as part of a strategy to reduce call volume pressures and to provide the most appropriate mobile patient care to vulnerable Toronto communities and residents.
4. City Council request the Chief of Toronto Emergency Medical Services to submit a business case through the 2014 budget process for resources to implement Lean type solutions (Six Sigma and ISO for example) to reduce hospital delays that contribute to paramedic wait times and expand Lean type solutions to both Toronto Emergency Medical Services and Toronto Fire Services to improve operational performance.
5. City Council refer the following recommendations to the Fire Chief to commence or continue implementation and report further as required:
a. Adopt an aggressive enforcement policy for Fire Code violations that impact upon the immediate life safety of the occupants of a building;
b. Establish annual Fire Code Compliance inspections of high risk occupancies;
c. Pursue mobile technology solutions to improve the efficiency of inspection and enforcement of Fire Code requirements;
d. Train fire suppression crews on key areas of the Ontario Fire Code and utilize them to augment incident prevention and inspection activities;
e. Establish a Policy requiring building owners to cover the full City cost to inspect premises for non-compliance of orders issued under the Ontario Fire Code; and
f. Implement Business Intelligence reporting software and enhance business analysis capability.
6. City Council request the Fire Chief to move forward with the fire accreditation process with target completion by 2015/2016.
7. City Council request the Fire Chief to implement a strategy to increase the focus on prevention, public education, and inspection to reduce the incidence of fires and other emergencies and report further through 2013 and future years' Committee process as required.
8. City Council request the Fire Chief to continue to implement dynamic staging and predictive modelling to improve the City’s fire deployment and determine the most strategic and service and cost efficient placement of fire resources and apparatus.
9. City Council request the Fire Chief to explore an enhanced use of fire pre-emption including leveraging technology through other related traffic congestion management initiatives to improve fire response and report further as required.
10. City Council refer the possible closure of station 424 at 462 Runnymede Road to the Fire Chief for further evaluation with the other 2013 budget adjustments and to report back in the fall of 2013 when reporting out the results of the Fire Underwriters Survey.
11. City Council request the Fire Chief to bring forward an updated Fire Master Plan by the end of 2014, incorporating changes resulting from recommendations 5, 6, 7, 8 and 9 of the report (June 18, 2013) from the City Manager and the Deputy City Managers, and considering the results of a City-wide risk assessment including impacts to the community fire risk profile used to establish insurance ratings.
12. City Council authorize the Chief of Toronto Emergency Medical Services and the Fire Chief to undertake a further evaluation of the benefits, limitations, risks, and required investments to consolidate the communications centres and report back in 2014 on the outcomes of the evaluation.
13. City Council authorize the Fire Chief to evaluate opportunities for the Toronto Fire Services Communications Centre to provide communications services to other municipalities or organizations to generate additional net revenues; and
14. City Council request the City Manager and the Chief of Toronto Emergency Medical Services to consult with the Province of Ontario, in particular the Ministry of Health and Long Term Care, on the level of staff and funding required for the Toronto EMS Communications Centre to meet the 2 minute call receiving and dispatch standard set by the Ministry of Health and Long Term Care.
15. City Council direct that all recommendations related to future reports flow through Executive Committee in 2013 and 2014.
16. City Council request the Chief, Emergency Medical Services to report on the development of a workplan, for the 2014 budget, which would ensure highrise residents receive the same response time as low rise residents of the City.
Origin
Summary
This report responds to Council's request for the City Manager to conduct a service and organizational review of Toronto EMS and Toronto Fire Services. The purpose of the review was to identify and recommend opportunities that maintain the quality of these core municipal services while achieving potential efficiencies.
The review included an assessment of operational improvements, a demand and resource analysis, and an evaluation of service delivery model options including organizational consolidation. A third party consulting firm, Pomax Ltd., in partnership with Berkshire Advisors, MGT of America and Stantec were retained through a competitive process to undertake this assignment.
The consultants put forward 20 recommendations for the City Manager and Deputy City Managers' consideration related to organization, resources and apparatus, prevention and education, fire inspection and enforcement, and the communications centres. This report communicates the results of the review including the recommended disposition of each. The City Manager and Deputy City Managers recommend implementation of 14 recommendations, further due diligence be undertaken on 4 recommendations and no further action be taken on 2 recommendations.
The Pomax recommendations and the report recommended disposition are summarized in Appendix A. The Pomax Executive Summary is attached as Appendix B and their full report is attached as Appendix C. A summary of their recommendations organized by main topic are described below.
Organization
The consultants recommend that Toronto EMS and Toronto Fire Services continue as separate organizations and concluded that a consolidated model will not yield the expected financial, operational or service benefits for Toronto given the maturity of the City’s fire and paramedic services. A firefighter-paramedic service delivery model for Toronto was also considered and not recommended given the significant start up and capital investments required with little evidence of improvement in clinical outcomes for patients.
Toronto EMS Resources and Apparatus
The consultants confirm that call demand for emergency medical response has increased by 28% over the last ten years driven by a growing and aging Toronto population. They estimate a continued increase in call demand of 2 % to 4 % annually and identify that the City requires an additional 169 paramedics over the next three years to meet current and future demand for emergency medical response for a total increase of 220 paramedic positions including positions approved through the 2013 budget process. This report requests authority to submit these investment requests through the 2014 and future years' budget process.
Based on early information, the consultants found that community paramedicine programs are expected to slow the growth of event volume for emergency medical response and transport of patients that have not had the benefit of preventative care. The consultants confirm that the Toronto EMS Community Paramedicine Program provides good value at a relatively low cost to the City and recommends its continuation.
Toronto Fire Services Resources and Apparatus
The review identifies improvements in the deployment of fire resources and apparatus through the use of dynamic staging and predictive modelling. Section 3D of this report provides further information related to dynamic staging and predictive modelling. A predictive modelling project for Toronto Fire Services was approved in the 2013 Capital Budget and a procurement process is underway to purchase this technology. This report requests that the Fire Chief continue to implement dynamic staging and predictive modelling to determine the most strategic and efficient deployment of fire resources and apparatus.
The consultants suggest that the City use fire traffic pre-emption more effectively to improve fire response times. Traffic control pre-emption gives emergency response vehicles a green light at specific signalized intersections and has shown to improve fire response times and reduce the risk of collision involving response vehicles, particularly in congested areas. This report requests the Fire Chief to explore expanding the use of traffic pre-emption in Toronto including leveraging technology investments through related City Transportation Division congestion management initiatives including the Traffic Congestion Management Action Plan and consideration of Intelligent Transportation Systems.
The consultants confirm that demand for fire response (actual fires and false alarms) has remained flat or declined over the last ten years and that the number of actual fires has also declined even though the population has increased. The consultants identify that there are options available to reconfigure fire resources and apparatus to achieve efficiencies while continuing to provide similar response coverage and outline the possibility of reducing vehicles and stations. Reconfiguring fire resources and apparatus should be carefully considered through a detailed risk assessment including changes to the community risk profile used to establish insurance rates.
The City Manager and the Deputy City Managers agree that there are opportunities to rationalize and realign the distribution of fire resources and apparatus to achieve efficiencies over the longer term particularly as improvements to fire deployment come on line and enhancements to public education and prevention programs are implemented.
The City Manager and the Deputy City Managers also agree that reconfiguring fire resources and apparatus requires further evaluation including a detailed risk assessment and consideration of implications to Toronto’s insurance ratings and impacts on service levels. This report recommends that the Fire Chief undertake further evaluation to reconfigure fire resources and apparatus and bring forward changes through an updated Ten-Year Fire Master Plan in 2014 considering the results of the Fire Underwriters Survey and the outcomes of a City-wide risk assessment.
The Fire Underwriters Survey (FUS) is currently underway and the possible closure of station 424 and additional reductions proposed through the 2013 budget process will be considered in their analysis. The Fire Chief anticipates reporting out the results of the FUS in the fall of 2013 in preparation for the 2014 budget.
Fire Inspection and Enforcement
The review identifies that investment in inspection and enforcement in other jurisdictions has shown to reduce false fire alarms, property loss and loss of life and injury to both private citizens and firefighters over time. They suggest that the City adopt a more aggressive enforcement strategy to reduce building code infractions particularly in areas posing the greatest risk to people and property and put forward a number of specific operational improvements. Many of the improvements the consultants put forward are already being implemented including the establishment of a Fire Investigation Team in 2013. This report refers the fire inspection and enforcement improvements to the Fire Chief to commence or continue implementation and report further as required.
Fire Prevention and Education
The consultants found that there is better value for money when emergency services focus on preventing emergencies and mitigating the City’s risk to fire and other emergencies. They highlight that prevention and education programs assist in taking pressure off the emergency response system and may reduce emergency response demand over time.
The consultants emphasize that when reconfiguring fire resources and apparatus to achieve efficiencies, changes should be planned in conjunction with enhanced prevention, education and inspection services to reduce the incidence of fires occurring in the first place. They suggest enhancements in prevention and education which may reduce demand for emergency fire response over the longer term particularly when considering reductions to fire resources and apparatus.
Enhancements to the City’s fire prevention and education programs were approved through the 2013 Operating Budget and are currently being implemented. The City’s fire education and activities are also currently being evaluated through the Fire Underwriters Survey. This report refers the fire prevention related recommendations to the Fire Chief for further evaluation and to report back as required.
Update the City's Fire Master Plan
Many of the Pomax recommendations related to fire resources and apparatus, inspection and enforcement and prevention and education highlight the need to update the Fire Master Plan. The City’s Fire Master Plan was last reviewed and updated in 2007.
An updated Fire Master Plan for Toronto will integrate the current and planned improvements across all fire programs and services and be aligned with the updated Official Plan to ensure that fire requirements resulting from growth are considered. This report requests the Fire Chief to bring forward an updated Fire Master Plan by the end of 2014 incorporating changes resulting from the adoption of recommendations 5 through 9 of this report (related to fire response, prevention and education and inspection and enforcement) and considering the results of a City-wide risk assessment including impacts to the community fire risk profile used to establish insurance ratings.
Toronto Fire Services is also moving forward with accreditation through the Centre for Public Safety Excellence. The Accreditation Program, administered by the Commission of Fire Accreditation International (CFAI), enables emergency response providers to use an accreditation process to set goals, develop strategic action plans and continuously evaluate and improve services provided to the public. The accreditation process involves examining performance across 10 categories, 44 criteria and 253 key performance indicators (KPIs). The results of the accreditation process will also inform the development of an updated Fire Master Plan including ensuring that it is based on leading industry practices. This report recommends that the Fire Chief move forward with the fire accreditation process with a target completion of 2015/2016.
Communications Centres
The consultants did not recommend that the City pursue a consolidated communications centre and identified the cost of cross training, required technology investments, collective agreement issues and variations in funding models as key barriers to integration. The City Manager and Deputy City Managers do not agree that these barriers are insurmountable and recommend additional due diligence be undertaken to explore this further for future consolidation opportunities.
Background Information
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59627.pdf
Appendix A - Disposition of Pomax Recommendations
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59901.pdf
Appendix B - Pomax Executive Summary
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59902.pdf
Appendix C - Pomax Final Report
https://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59903.pdf
Communications
(July 3, 2013) Submission from Tony Araujo (EX.New.EX33.11.2)
Speakers
Geoff MacBride, President, Paramedics Association of Toronto
Robert Boyd, Member, Toronto Paramedic Association
Councillor Adam Vaughan
Motions
City Council direct that all recommendations related to future reports flow through Executive Committee in 2013 and 2014.
City Council request the Chief, Emergency Medical Services to report on the development of a workplan, for the 2014 budget, which would ensure highrise residents receive the same response time as low rise residents of the City.