Item - 2025.EX24.6

The Executive Committee recommends that:

1. Subject to confirmation of Provincial funding, City Council authorize the addition of 112 staff complement to the Toronto Paramedic Services’ 2025 Operating Budget as an in-year adjustment, comprising 102 frontline Paramedic Full Time Employees, five supervision staff and five support staff resources (i.e., fleet, administrative, payroll, scheduling, training, planning and professional standards) to help mitigate frontline staff workload as a result of increased emergency call demand pressures.

2. Subject to confirmation of Provincial funding, City Council request the Chief, Toronto Paramedic Services to bring forward business cases through the 2026 and future budget processes seeking additional resources as outlined in Appendix A to the report (June 3, 2025) from the Chief, Toronto Paramedic Services, to respond to the projected three (3) percent average annual increase in emergency call demand.

3.  City Council reiterate its request to the Ontario Government to consider establishing a provincial mandated target for wait times to offload a patient to encourage hospitals to better manage paramedic offload delays.

The Executive Committee recommends that:

1. Subject to confirmation of Provincial funding, City Council authorize the addition of 112 staff complement to the Toronto Paramedic Services’ 2025 Operating Budget as an in-year adjustment, comprising 102 frontline Paramedic Full Time Employees, five supervision staff and five support staff resources (i.e., fleet, administrative, payroll, scheduling, training, planning and professional standards) to help mitigate frontline staff workload as a result of increased emergency call demand pressures.

2. Subject to confirmation of Provincial funding, City Council request the Chief, Toronto Paramedic Services to bring forward business cases through the 2026 and future budget processes seeking additional resources as outlined in Appendix A to the report (June 3, 2025) from the Chief, Toronto Paramedic Services, to respond to the projected three (3) percent average annual increase in emergency call demand.

3.  City Council reiterate its request to the Ontario Government to consider establishing a provincial mandated target for wait times to offload a patient to encourage hospitals to better manage paramedic offload delays.

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

This report responds to City Council’s direction for the Chief, Toronto Paramedic Services to develop a Multi-Year Staffing Plan by June 2025 following the completion of a detailed staffing analysis, for consideration through the annual budget processes to add staff resources over the next five years to respond to:

- Hospital/health care system pressures;

- Rising emergency call demand; and

- Increasing response times to critical patients.

Toronto Paramedic Services continues to experience increasing emergency call demand of 2 percent to 5 percent annually, along with ongoing healthcare system pressures, including persistent challenges from in-hospital paramedic wait times, which have increased by 11 percent since 2019. These combined pressures are leading to increased service demands, and significant strain on ambulance availability and frontline staff. Factors driving these pressures include: an aging and growing population, the drug toxicity crisis and a lack of access to primary care, particularly for vulnerable individuals. In response to these growing pressures, the Multi-Year Staffing Plan provides a proactive and data-driven approach to strengthening frontline paramedic resources and addressing urgent service challenges to help protect public safety.

Toronto Paramedic Services conducted a detailed analysis to determine frontline paramedic resource needs, factoring in hospital/healthcare system pressures and rising emergency call demand. The analysis indicates that Toronto Paramedic Services anticipates an increase in emergency call demand of 11 percent by the end of 2028, combined with ongoing healthcare system pressures from in-hospital paramedic wait times. In 2024, healthcare system pressures and increasing call demand led to a 300 percent increase in the duration of low ambulance availability across the city compared to pre-pandemic levels.

This Multi-Year Staffing Plan includes the addition of 331 frontline positions from 2025 to 2028 to address growing service demands, to improve ambulance availability and to increase emergency coverage for the community. This is in addition to the new frontline positions approved through the 2025 budget process to address immediate operational needs and lasting pressures incurred from the pandemic. A four-year staffing plan was developed versus a longer-term plan due to significant forecasting challenges and uncertainties past 2028. Beyond a four-year horizon, the accuracy of projections diminishes considerably, increasing the risk of misalignment between staffing levels and operational needs.

In addition to operational improvements, this plan is designed to support the long-term resilience of Toronto’s paramedic workforce. Immediate and long-term investments in additional staffing aim to reduce workload and the reliance on overtime, mitigate staff burnout, and improve retention and morale. Toronto Civic Employees Union, Local 416 was consulted in the development of this Multi-Year Staffing Plan.

Impacts and Outcomes

The staffing investment outlined in this Multi-Year Staffing Plan is anticipated to have a positive impact on service delivery, organizational capacity, and staff well-being. It is anticipated that full implementation of this Multi-Year Staffing Plan and achievement of a 65 percent resource utilization (which measures how much time emergency vehicles are busy on calls compared to their total work hours) will result in an increase of ambulance availability by up to 20 percent by the end of 2028; this enhancement is essential as availability is a primary driver affecting emergency response time. By addressing staffing challenges, the investment will support improved ambulance availability and service delivery. Enhanced staffing levels will also help to reduce reliance on overtime and help balance workload amongst frontline staff. Foregoing these investments will not address increasing service demand, thereby negatively impacting service delivery and placing staff well-being at risk. Toronto Paramedic Services will measure and report the impacts of the staffing investments through annual budget processes.