Item - 2019.EC5.3

The Economic and Community Development Committee recommends that:

1.  City Council authorize the Chief and General Manager, Toronto Paramedic Services (TPS), to submit a business case to the Ministry of Health and Long-Term Care to consider reinstating the requested 2019/20 land ambulance base funding of $109.442 million for Toronto.

2.  City Council authorize, subject to the confirmation of provincial funding noted in Recommendation 1 above, the addition of 28 frontline Paramedic Full Time Equivalents (FTEs) in 2019 as an in-year adjustment to the Division's 2019 Operating Budget to help mitigate frontline staff workload as a result of increased emergency call demand pressures.

3.  City Council request the Chief and General Manager, Toronto Paramedic Services to bring forward a business case through the 2020 and future budget processes to add the necessary frontline Paramedic staffing and supervision, Support Staff resources (i.e., fleet, administrative, payroll, scheduling, training, planning and professional standards), and additional uniforms, equipment and vehicles over the next five years, as outlined at Appendix A to the report (May 14, 2019) from the Acting Chief, Toronto Paramedic Services, to respond to the projected 4 percent average, annual increase in emergency call demand.

4.  City Council authorize the Chief and General Manager, Toronto Paramedic Services to submit a business case to the Ministry of Health and Long-Term Care as outlined in Recommendation 3 above, and authorize the Chief and General Manager, Toronto Paramedic Services to submit a business case to the Ministry of Health and Long-Term Care to add required frontline Emergency Medical Dispatcher staffing and supervision over the next five years to the Toronto Paramedic Services Communications Centre to respond to the projected 4 percent average, annual increase in emergency call demand.

The Acting Chief, Toronto Paramedic Services gave a presentation on Multi-Year Staffing and Systems Plan Report.

This report responds to three City Council directions from the 2019 budget process. These include that the Chief and General Manager, Toronto Paramedic Services (TPS):

-  "Engage in consultation with authorized representatives of Toronto Civic Employees Union CUPE Local 416 and to report to the Economic and Community Development Committee in the second quarter of 2019 on a multi-year hiring and systems plan for Paramedic Services, to identify any additional system resources that may be required at that time and to include a strategy on how to immediately implement and fully fund paramedics and associated equipment and vehicles costs to fill identified deficiencies."

-  "Report back in advance of the 2020 Budget Process on activities taken to date to keep pace with the increasing call demand in Paramedic Services and to provide future strategies that include financial, operational and staffing implications as well as targeted outcomes to help mitigate call volume and demand"; and

-  "Report back in 2019, prior to the 2020 budget process, on a multi-year hiring and systems plan to address the approximate four percent growth in emergency call demand."
 

In accordance with Council's direction, Toronto Paramedic Services, through formal meetings, consulted with and incorporated feedback from authorized representatives of Toronto Civic Employees' Union, CUPE Local 416 in the preparation of this report. TPS also consulted with the City's People, Equity and Human Rights (PEHR) division on the report.

TPS is responsible for all aspects of land ambulance service for the City of Toronto and also operates a Communications Centre (dispatch centre) for the City through a formal Performance Agreement with the Ministry of Health and Long Term Care. Provincial funding of 50 percent is provided by the Province for land ambulance operations and 100 percent for the Communications Centre. TPS is governed by the Ontario Ambulance Act.

The report outlines TPS' emergency call demand pressures and drivers, efforts to address the increased demand and to support staff, the system impacts of the increased demand on TPS' overall operations, and the ongoing pressures that will continue to impact TPS in the coming years. The report also provides a detailed staffing and associated budget plan (Appendix A) for the next five years to help TPS address the increasing service demand now and into the future.

TPS' emergency call demand has continued to increase by an average of 4 percent each year. In 2018, TPS experienced a 5.4 percent increase in emergency call demand over 2017 which is 1.4 percent higher than expected. The main drivers of this demand include an aging and growing population, increased patient acuity with a greater need to transport patients to specialized facilities, and increases in vulnerable and marginalized populations.

As emergency call demand increases, it also impacts the number of ambulances that are available to respond to other calls, particularly at peak hours of the day. This availability is further exacerbated by “time-on-task”, meaning the total length of time required to service an emergency call. Since 2011, time-on-task has increased by 37 percent for all calls serviced by TPS.

Ambulance availability is also being impacted by the steady increase in lost time due to work-related (WSIB) injury/illness amongst frontline staff. In 2018, this increase was 33 percent over 2017, with total lost hours 55 percent higher than in 2017. Most of this increase is related to presumptive legislation enacted in April 2016, which presumes that a diagnosis of post-traumatic stress disorder (PTSD) in first responders (paramedics, dispatchers, management staff) is work-related. Costs associated with WSIB claims are anticipated to continue increasing.

TPS has implemented multiple initiatives to help address the annual increase in emergency call demand and to support employees in the face of the increased demand. These include improved staff scheduling, use of part-time staff, community paramedicine initiatives, a multifunction station model, enhanced dispatch technology, and improved staff engagement. TPS has also implemented a Psychological Health and Wellness Program, designed to provide staff with comprehensive supports and to help those absent from the workplace (e.g., due to stress-related illness) to return to work sooner. Details are found at Appendix B in this report.

The impacts of increasing emergency call demand are also felt by the TPS Communications Centre’s Emergency Medical Dispatchers (EMDs). In 2018, TPS responded to 330,358 individual emergency incidents with EMDs handling related incoming telephone calls exceeding 420,000. EMDs must also coordinate the dispatch of all such requests and monitor all responding Paramedic resources appropriately. Currently, the number of Paramedic crews exceed the capacity of an individual EMD to manage and additional EMDs are, therefore, required to ensure safe dispatch decisions. This report includes a recommendation that City Council authorize the TPS Chief to submit a business case to the Ministry of Health and Long-Term Care to add required frontline Emergency Medical Dispatcher staffing and supervision over the next five years to the TPS Communications Centre to respond to the projected 4 perecent average, annual increase in emergency call demand.

Other, additional pressures are expected to continue having an impact on TPS' staffing and system resources as well. These include response time performance, a continued growing and aging population, an increasing number of calls per capita, overtime costs and operational support issues. The report discusses these factors in greater detail.