Report To: Program Planning Committee
From: Robert Smith, Chief of Paramedic Services
Date: March 19, 2025
Re: 2024 Paramedic Response Time Standards - Issue Report
Purpose
The purpose of this report is to provide the Manitoulin-Sudbury DSB’s Program Planning Committee with background on the Ontario Ambulance Response Time Standards (RTS) and detail the results of our 2024 Response Time Performance Plan. A letter detailing our performance will be submitted to the Ministry of Health (MOH) Emergency Health Services Branch (EHSB) Director as dictated in the Ambulance Act Regulations by the March 31, 2025 deadline.
Background
In 2006 the provincial government established in conjunction with the Association of Municipalities of Ontario (AMO), a Land Ambulance Committee (LAC), to review a number of subjects including ambulance response time standards. Arising from that work on July 31, 2008 the provincial government made changes to the Ambulance Act, Response Time Performance Plans. These changes were to be phased in over three years and were expected to be fully in effect in 2011, however a series of delays caused the new standard to take effect in 2013.
Specifically relating to the standard, each Direct Delivery Agent (DDA) is to send their response time plan to the MOHLTC EHSB Director through their local Field Office no later than October 31 of each year. The report is to detail responses with targets for patients in sudden cardiac arrest, and patients presenting on the “Canadian Triage and Acuity Scale” (CTAS) 1, 2, 3, 4, & 5. Then, by March 31st of each year the DDA will submit the same table completed with the actual results achieved in the year previous.
As in the past, these response times are based upon district not on Paramedic Service. In other words, data is reported for all calls within the Manitoulin-Sudbury DSB area regardless of which Paramedic Service performed the call.
Canadian Triage and Acuity Scale Overview
To understand the RTS design it is essential to understand the Canadian Triage and Acuity Scale (CTAS). CTAS is a nationally adopted method for categorizing grouping patients according to the severity of their condition, and reported as follows:
CTAS 1: Severely ill, requires immediate resuscitation
• Includes the most serious life threatening conditions, or where imminent risk of deterioration exists.
CTAS 2: Patient requires rapid medical intervention
• Includes conditions that are a potential threat to life or limb function, requiring rapid medical intervention or delegated acts.
CTAS 3: Requires urgent care
• Includes conditions that could potentially lead to serious problems requiring emergency intervention.
CTAS 4: Requires less urgent care
• Includes conditions related to patient age, distress or potential for deterioration or complications that would benefit from intervention.
CTAS 5: Requires non-urgent care
• Includes conditions in which investigations or interventions could be delayed or referred to other areas of the health care system.
Additionally, the response Time Standard reporting includes Sudden Cardiac Arrest (SCA) incidents.
2024 Response Time Standard Targets and Actuals
As detailed earlier, Manitoulin-Sudbury DSB is required to report the targeted response time standard to the MOH by October 31st of each year. The 2024 targets were submitted in October of 2023. This report details the target results for 2024, 18 months later.
MOHLTC ADRS Data Set
| Patient Severity | Target Time | Actual Time | Target Response Met | Call Volume |
|---|---|---|---|---|
| SCA | 6 minutes, 30% of time |
6 minutes, 31.9% of time | Yes | 47 |
| CTAS 1 | 8 minutes. 30% of time | 8 minutes, 40.3% of time | Yes | 71 |
| CTAS 2 | 15 minutes, 65% of time | 15 minutes, 66.8% of time | Yes | 1,155 |
| CTAS 3 | 20 minutes, 75% of time | 20 minutes, 76.2% of time | Yes | 2,911 |
| CTAS 4 | 25 minutes, 85% of time | 25 minutes, 87.4% of time | Yes | 1,464 |
| CTAS 5 | 25 minutes, 85% of time | 25 minutes, 87.1% of time | Yes | 171 |
Current Issues/Challenges
The current process for calculating Paramedic Service response time efficiency has been in place for twelve years and is more appropriate than earlier metrics, however there are ongoing challenges specific to Manitoulin-Sudbury DSB Paramedic Services design. These included static deployment modeling, use of on-call deployment and geography.
The ability of a less urban Paramedic Services to achieve the 6 or 8-minute responses to critical incidents is challenging due to the lack of resource density and lengthy travel distances.
Additional challenges include on-call deployment of Paramedic Services resources in some communities. Five of the Paramedic Services Stations operate a mixture of on-site and on-call staffing. During the on-call periods, staff have up to ten minutes to become mobile (reaction time) while those staff on site are required to be mobile within two minutes. This extended reaction time negatively impacts on the total response time.
Sudden Cardiac Arrest (SCA) calls represent less than 1% of the total volume of Paramedic Service Activity, and while these events are of significant risk to the patient, slight changes to response times have a significant impact on the RTS target compliance. Paramedic Services staff are working with municipal Fire Services leadership to expand the Medical Tiered Response capacity to help address response time to the most serious events.
While the Province sets the RTS for SCA and CTAS events, the legislation permits the DSB to set both the response time target and the target percentage success for CTAS 2, 3, 4, & 5 calls. This factor is important when comparing performance to other paramedic services. Altering target times or target percentages can impact on ease of comparison.
Conclusion
The twelve years of data is suggestive of ongoing challenges with ideal target achievement; however, it is evident that our response times for 2024 held steady despite significantly increasing call volumes and longer response times. The use of the nonurgent transfer service (PTS), Community Paramedicine Program and expansion of Medical Tiered response Agreements are all efforts being implemented to help mitigate the impact of increasing call volumes on Paramedic Services ability to achieve success with the RTS program. Staff are requesting that the Board approve the 2024 Response Time Standard Actuals and submit them to the MOHLTC EHSB Director through their local Field Office no later than March 31, 2025.