Item - 2024.AU5.6

The Audit Committee recommends that:

1. City Council request the Chief, Toronto Paramedic Services to:

a. Review its performance plan and its response time targets to see if any updates are needed; and 

b. Improve overall response times to ensure it meets its response time targets and performance plan, particularly for the highest acuity calls.

2. City Council request the Chief, Toronto Paramedic Services to:

a. Monitor and report out on performance by geographic areas to better inform future decision-making; and

b. Reassess the designations of priority post stations, taking into consideration hospital locations, frequent dispatch locations, and areas with greatest needs by level of acuity and the type of hospital care required.

3. City Council request the City Manager, in consultation with the Chief, Toronto Paramedic Services, to request the Ontario government to:

a. Consider establishing a provincial mandated target for wait time to offload a patient to encourage hospitals to better manage offload delays;

b. Invest in a centralized database of integrated healthcare, to facilitate paramedic referrals to alternate healthcare providers and the transport of patients to non-hospital facilities; and

c. Provide the requested staffing increases to address the resource needs in the Central Ambulance Communications Centre.

4. City Council request the Chief, Toronto Paramedic Services, to conduct a detailed staffing analysis that includes call volume, workload demand throughout the day, inactive staff, and response time targets to determine the optimal staffing level for frontline staff.

5. City Council request the Chief, Toronto Paramedic Services, to explore and implement strategies to help manage the daily, weekly, and seasonal peaks in demand that contribute to the low availability of staffed ambulances.

6. City Council request the Chief, Toronto Paramedic Services, to:

a. evaluate the effectiveness of its retention strategies and initiatives and consider additional strategies if needed, to ensure it remains competitive in retaining frontline staff, including call takers and dispatchers, considering burnout and wellness; and

b. consult union representatives and subject matter experts as part of this evaluation.

7. City Council request the Chief, Toronto Paramedic Services, to conduct a cost-benefit / risk analysis of innovative approaches for responding to low acuity calls to free up resources for higher acuity calls.

8. City Council request the Chief, Toronto Paramedic Services, to collaborate with Toronto Police Service and Toronto Community Crisis Service, to:

a. Improve data collection and communication channels to enable paramedics to directly refer calls that would benefit from the attendance of Toronto Community Crisis Service or alternate City agencies; and

b. Develop a more comprehensive plan for call diversion and consider if joint training is necessary to enhance each workforce's understanding of roles, responsibilities, limitations, and awareness of available mental health programs and resources.

9. City Council request the Chief, Toronto Paramedic Services, to improve the analysis of data on frequent 9-1-1 users, to:

a. Identify more patients who can benefit from the community paramedicine programs; and

b. Consider developing targeted public education and awareness campaigns to reduce non-emergency call volume.

10. City Council request the Chief, Toronto Paramedic Services to:

a. Determine the optimal level of ambulances it requires in its fleet to meet its needs and response time targets; and

b. Compare this to its existing fleet to determine the level of surplus and consider selling the vehicles not needed.

The Auditor General, Tara Anderson, and Assistant Auditor General, Ariane Chan, gave a presentation on Toronto Paramedic Services: Rising Response Times Caused by Staffing Challenges and Pressures in the Healthcare System.

The Audit Committee:

1. Requested the Auditor General to report directly to the July 24, 25 and 26, 2024 meeting of City Council with information that identifies the 13 hospitals mentioned in the "Average Wait Time to Offload Patient (in Minutes) by Hospital, 2022-2023'" portion of the report (June 21, 2024) from the Auditor General and presentation to Committee.

As mandated by the Ambulance Act, R.S.O. 1990 (the Act), Toronto Paramedic Services provides paramedic-based healthcare services 24 hours a day, seven days a week, 365 days a year in Toronto. Its services encompass emergency medical dispatch, paramedic care and land ambulance transportation to hospital, and community paramedicine. Toronto Paramedic Services manages its own ambulance communications centre to receive and dispatch calls, including 9-1-1 calls transferred to it by the Toronto Police Service.

On average, Toronto’s ambulance communications centre handles about 910 emergency calls per day. The centre is the busiest of all the 22 ambulance communications centres in the province, receiving approximately 16 per cent of the medical emergency calls in Ontario.

The ongoing shortage of doctors is putting added pressure on paramedic services. The Ontario College of Family Physicians reported that more than 516,000 Torontonians are currently without a family doctor. It further forecasts that nearly one million Torontonians could be without a family doctor by 2026. With the ongoing shortage of doctors, more people rely on paramedic services (and hospital emergency departments) as a safety net to access basic healthcare services they need when other options are unavailable.

This audit assesses whether Toronto Paramedic Services is providing ambulance emergency response services in a timely manner across the City of Toronto, while optimizing the use of its resources. In assessing this objective, our audit aimed to answer the following questions:

- Is Toronto Paramedic Services meeting its legislated and internally approved targets for providing a timely emergency response to persons requesting ambulance service?

- Is Toronto Paramedic Services effectively measuring, monitoring, and reporting on how well it meets its targets and using these results to inform management decisions?

- Are there opportunities for Toronto Paramedic Services to optimize its use of resources, including the use of vehicles and staff, to improve its performance and response time?

Our report highlights opportunities for Toronto Paramedic Services to improve the efficiency and effectiveness of its operations by:

a. Reviewing response time targets, improving overall response times particularly for higher acuity calls, and monitoring response times by geographic area.

b. Requesting further provincial support to address the healthcare system pressures. Determining optimal staffing and ambulance resources and implement strategies to help manage the daily, weekly, and seasonal peaks in demand that contribute to the low availability of staffed ambulances.

c. Implementing strategies to free up resources for higher acuity calls by employing innovative approaches to address low acuity calls, diverting some mental health calls to partners in the future, and understanding the needs of frequent 9-1-1 users better through data analysis.