Paramedic Services Response Time Target Compliance 2025 Actuals - Issue Report

Report To:                             Manitoulin-Sudbury District Services Board

From:                                        Robert Smith, Chief of Paramedic Services

Date:                                         February 19, 2026

Re:                                              Paramedic Services Response Time Target Compliance 2025 Actuals - Issue Report

Strategic Plan Goal:       2. Transform How We Work
Objective:                              2.1 Leverage data and analytics to inform decisions, support advocacy and improve service design

Strategic Plan Goal:       1. Expand Service Integration
Objective:                              1.3 Improve access to services in underserved areas by addressing co-location gaps and integrating points across districts

Purpose
The purpose of this report is to provide the DSB Program Planning Committee with background on the Ontario Ambulance Response Time Standards (RTS) and detail the results of our 2025 Response Time Performance Plan. A letter detailing our performance must be submitted to the Ministry of Health (MOH) Emergency Health Services Branch (EHSB) Director as dictated in the Ambulance Act Regulations by the March 31st deadline.

Background
In 2006 the provincial government established the Land Ambulance Committee (LAC), to review subjects including ambulance Response Time Standards. Subsequently, the Ambulance Act was amended to require annual Response Time Performance Plan submissions, a process fully implemented in 2013.

Since then, each Upper Tier Municipality (UTM) or Direct Delivery Agent (DDA) has been responsible for submitting the plan for the next year to the Ministry of Health no later than October 31 of each year. The report sets out response targets for patients in sudden cardiac arrest, and patients presenting on the “Canadian Triage and Acuity Scale” (CTAS) 1, 2, 3, 4, & 5. Additionally, by March 31st of each year a response target compliance report must be reviewed and submitted for the previous calendar year.

Response Plan design must be based upon call location, not based upon what Paramedic Service managed the incident. In short, RTS data is captures all calls within the Manitoulin-Sudbury DSB area regardless of which Paramedic Service responded.

CTAS Overview
As stated, the RTS planning and compliance targets event severity using 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 is defined 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.

2025 Response Time Standard Targets
As detailed earlier, Manitoulin-Sudbury DSB is required to submit targeted response times to the MOH by October 31st of each year. The 2025 targets were submitted in October of 2024. The table below details the 2025 target times and compliance.

MOH ADRS Data Set

The RTS table above captures that Target Compliance was met on all but the CTAS 5 patients. A detailed review of the CTAS 5 events found that several of these calls were nonurgent interfacility transfers, where Manitoulin-Sudbury DSB’s PTS program could not accommodate the call. Use of Paramedic Services for these types of calls is often delayed ensuring emergency coverage across the districts can be maintained. If CTAS 5 interfacility calls were excluded, Target Compliance would have been 87.1%.

Current Issues/Challenges
The current process for calculating Paramedic Service response time efficiency has been in place for thirteen years and has proven to be more appropriate than earlier metrics, where a 90th percentile of the 1996 data had to be maintained for emergency responses; however, the RTS system has its own challenges. These stem from the current Dispatch Priority Card Index (DCPI) model. The DCPI system historically overprioritizes, resulting in the assignment of limited resources to calls where the actual patient acuity did not require the response immediately. The result is resource degradation. In May of 2026, the Ministry of Health (MOH) has scheduled Manitoulin-Sudbury DSB Paramedic Services to migrate over to the Medical Priority Dispatch System (MPDS) dispatching model. The MOH reports that MPDS provides a far more accurate correlation of response priority to actual patient acuity. This new dispatching model should help to reduce resource degradation for overprioritized call assignments.

The 2025 RTS target data reveals that target compliance was achieved for all acuity sets except for CTAS 5 calls. These calls are defined as nonurgent by the MOH that do not pose immediate risk. The increasing Paramedic Services call volume (14,000 total assignments in 2025), specifically for higher acuity, does require that assignment to low priority calls be held as a triaging measure. As such, the ability to achieve target success for CTAS 5 call is more impractical over time.

The Manitoulin-Sudbury DSB Paramedic Services static deployment model provides emergency 9-1-1 coverage to the communities but is one without significant service depth. With the exception of Little Current, where a single paramedic PRU is staffed during the day time, and Wiikwemkoong, with a second response ambulance during the daytime, Manitoulin-Sudbury DSB has one ambulance on-site in each of the 12 stations during the daytime while only 7 stations operate with an on-site ambulance after 8:00 PM. Stations in Gore bay, Killarney, Gogama, Foleyet and Chapleau move to an on-call model from 8:00 PM to 8:00 AM. On-call responses have 10 minutes to respond (chute time) while on-site staff are required to be mobile within 120 seconds. This fact makes RTS target times of 6 minutes or 8 minutes for the most serious incidents unlikely.

Geography presents one of the most significant challenges to Manitoulin-Sudbury DSB Paramedic Services. The districts encompass 45,000 square KM and include vast areas of remote land. Paramedic Services stations were built to closely match population density, but over that last number of years, population growth with expansion away from these locations has taken place. There has been net migration into recreational areas where residents can enjoy environmental opportunities. Unfortunately, these areas are not immediately adjacent to station locations. The resulting impacts include longer response times.

Age is a driver of health care consumption. The median age of residents in Manitoulin and Sudbury districts is more than 11 years greater than the provincial median age and access to Paramedic Services increases with an older population leading to greater consumption compared to population across the province.

Conclusion
The thirteen years of response data collection identifies ongoing challenges with target achievement; however, it is also evident that our 2025 target response times for the most acute patient conditions were met, despite significantly increasing call volumes. The use of the nonurgent transfer service (PTS), expansion of the Community Paramedicine Program, Medical Tiered Response Agreement redesign and the introduction of MPDS as the dispatching tool are all efforts being implemented to help mitigate system pressures negatively impacting on Paramedic Services ability to achieve success for patients and communities. In October, staff proposed RTS Plan for 2026 that maintained the 2025 targets.