Each October every ambulance service provider in Ontario must prepare and submit an annual Response Time Performance Plan for the following calendar year to the Emergency Health Services (EHS) Branch of the Ministry of Health and Long Term Care. Beginning in March 2014, service providers are then subsequently required to report annually to the Director of EHS Branch on their performance throughout the previous year with respect to the targets that were set in their Response Time Performance Plan.
The Response Time Performance Plan outlines six specific target times, as well as the associated targeted performance expectation, for emergency responses to notices from the dispatch centre with respect to patients as categorized by paramedics using the Canadian Triage Acuity Scale (CTAS) classifications of SCA, I, II, III, IV & V. For definitions and an explanation of these CTAS classifications, please click here.
The target times for response to those patients categorized as Level SCA (Sudden Cardiac Arrest) and Level I (Resuscitation) have been determined and established by EHS Branch. Service providers are required to set performance targets against these government-established time-targets for those two categories of patients.
For those patients categorized as CTAS II, III, IV and V, each service provider is responsible for establishing both a target response time and a performance target for each category.
Algoma District Paramedic Services’ response times can be influenced greatly by certain circumstances that are not always easy to predict and are often outside of its control.
The size of the area that Algoma District Paramedic Services is responsible for responding to is immense (8 times the size of PEI) and almost one in every five ambulance responses requires our paramedics to travel greater than 20 kms, and in some cases over 100 kms, to access the emergency scene.
Night time On-Call Coverage
Presently our call volume is not sufficient to warrant 24-hour on-site paramedic staffing at 7 of our 8 bases (see Deployment Strategy page). This means that between 7pm and 7am, the paramedics are at home and on-call by pager. During these periods of on-call staffing our paramedics are allowed up to 8 minutes to respond to the ambulance base and start the ambulance response phase.
Our region can be subjected to a harsh winter climate, which can negatively impact the time it can take our paramedics to safely travel to an emergency scene.
As a result of one or more of the factors noted above, as well as others not listed, it can take anywhere from a few minutes to well over 60 minutes for the paramedics to arrive on scene from the time they are notified of the call. There will always be an unquantifiable number of ‘outlier’ responses that will negatively affect measured response times in our district. Given these challenges, proposing to achieve high percentile performance targets for the EHS Branch’s established target response times of 6 minutes for sudden cardiac arrests and 8 minutes for CTAS I patients is not reasonable for a remote service provider such as Algoma District Paramedic Services. For example, given the acceptable 8-minute reaction time during on-call staffing, the EHS Branch’s target response time of 8 minutes for a Level I patient may have already elapsed by the time the paramedics arrive at the ambulance base to commence the ambulance response phase.
2015 Performance Plan
The following chart outlines Algoma District Paramedic Services’ Response Time Performance Plan for 2015.
2015 Algoma District Paramedic Services Response Time Performance Plan*
|Patient Acuity Level||Type of Measured Response||Target Response Time (Crew Notified to Arrived Scene)||Performance Target|
|Sudden Cardiac Arrest||Defibrillator On Scene||6 minutes (established by MOHLTC)||35%|
|CTAS I (Resuscitation)||Paramedics On Scene||8 minutes (established by MOHLTC)||50%|
|CTAS II (Emergent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%|
|CTAS III (Urgent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%|
|CTAS IV (Less Urgent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%|
|CTAS V (Non Urgent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%|
NOTE: It must be noted that legislation requires that a single Response Time Performance Plan must be submitted by each service provider. For that reason, the target response times and performance targets in the plan must apply for the entire district and therefore take into account all of the ‘outlier’ calls discussed above under Response Time Challenges. Response time performance within communities where ambulance bases are located will naturally be superior to these targets.
2014 Performance Report
The following chart outlines Algoma District Paramedic Services’ Response Time Performance Plan for 2014.
2014 Algoma District Paramedic Services Response Time Performance Report
|Patient Acuity Level||Type of Measured Response||Target Response Time (Crew Notified to Arrived Scene)||Performance Target||Actual Performance|
|Sudden Cardiac Arrest||Defibrillator On Scene||6 minutes (established by MOHLTC)||35%||63.0%|
|CTAS I (Resuscitation)||Paramedics On Scene||8 minutes (established by MOHLTC)||35%||67.9%|
|CTAS II (Emergent)||Paramedics On Scene||17 minutes (established by the ADSAB)||50%||80.1%|
|CTAS III (Urgent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%||80.7%|
|CTAS IV (Less Urgent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%||86.5%|
|CTAS V (Non Urgent)||Paramedics On Scene||17 minutes (established by the ADSAB)||75%||83.1%|
Median Emergency Response Time
Many people find the median emergency response time to be a valuable indicator of Algoma District Paramedic Services efficiency.
Median Emergency Response Time: the mid-point or central tendency of the time it takes from the moment that a paramedic crew is notified of an emergency call to the time paramedics arrive on scene for our most critical (CTAS SCA, CTAS I and CTAS II) patients. Half of all responses are lower than the median and half of all responses are higher.
In 2014, Algoma District Paramedic Services’ median emergency response time was 6:16 (min:sec).
The Algoma District Paramedic Services Quality Assurance program is overseen by the Deputy Chief of Algoma District Paramedic Services. The program is responsible for ensuring that the emergency medical patient care and transportation provided by paramedics is carried out at a consistent, standard and acceptable level. By constantly evaluating patient management and documentation, Quality Assurance is able to recognize strengths and weaknesses in the system and respond as necessary.
The Quality Assurance program helps establish a standard of care and identifies needs for training programs and education to ensure proper and professional care is provided at evolving levels. in addition to recognizing where improvement may be needed, the program identifies areas where paramedics are high performing and deserving of acknowledgment and positive feedback.
The Quality Assurance program consists of many different facets, some of which include direct paramedic service observation, documentation review, intermittent skills evaluations and a comprehensive orientation process upon hiring. Although we naturally concentrate on current practice, we evaluate our past and look to the future. We not only monitor our own trends such as response times and patient care but we also look outside and benchmark our practice against others in the field.
The Deputy Chief of Algoma District Paramedic Services is responsible for overseeing investigations and reporting on any internal or external concerns brought forward.
An effective Quality Assurance program provides the public with confidence that their emergency medical service is serving them with an established standard of care.