June 15, 1998
TO:Emergency and Protective Services
FROM:Ron Kelusky,
Acting General Manager, Toronto Ambulance
SUBJECT: Critical Care Transport Program
Purpose:
To seek Toronto Council's approval to enter into contracts with various hospitals for the provision of Critical Care
Transport Unit (CCTU) services. This report describes a formalized partnership between Toronto Ambulance and
Sunnybrook Health Science Centre for the purposes of providing critical care transport services between hospital
intensive care units and emergency departments, and major tertiary level health centres such as St. Michael's, Toronto
General and Sunnybrook.
Funding Sources, Financial Implications and Impact Statement:
This program is predicated on being revenue neutral to revenue positive, with full cost recovery for all operating and
overhead expenses. Fees will be paid by the participating hospitals, and not by any of the patients utilizing the service.
Any revenue over expenses will be applied to enhancing the City's social safety net via public ambulance service.
Recommendations:
"It is recommended that:
(1)Toronto Council endorse Toronto Ambulance's Critical Care Transport Unit program; and
(2)Toronto Council endorse Toronto Ambulance's pursuit of revenue opportunities which subsidize social safety net
public ambulance service and reduce reliance on municipal taxes, in particular where such opportunities arise from
provincial hospital restructuring initiatives; and
(3)Toronto Council authorize Toronto Ambulance to enter into CCTU cost-recovery or cost-recovery plus contracts
with various hospitals: and
(4)The appropriate City officials be authorized and directed to take the necessary action to give effect thereto."
Background:
Many hospital patients with critical injuries or illnesses require emergency ambulance transportation between their
current hospital setting and a more sophisticated centre such as Toronto General Hospital, St. Michael's or Sunnybrook
Health Science Centre. Due to the severity of their conditions, traditionally a physician, a nurse and sometimes a
respiratory therapist have had to accompany the patient during the ambulance trip between facilities. In addition, special
medical equipment such as transport ventilators, intravenous medication pumps, and special patient monitors have been
needed and have had to be taken from the hospital's use into the ambulance.
Recently, staff reductions at the sending hospitals have made it increasingly impractical and extremely expensive for
them to staff and equip these critical care transfers. As a result, a number of these facilities have approached Toronto
Ambulance to determine if we are in a position to assume these duties on a full cost recovery basis.
Upon consideration, it has become evident that such a program would not only improve service delivery within the
community, but could also be structured to be revenue neutral, if not actually generating net revenue. Toronto
Ambulance has therefore established a provisional partnership with Sunnybrook Health Science Centre to plan the
process of upgrading certain paramedics to the skill level required to service these emergency transports. In addition,
Sunnybrook has agreed that, under the auspices of such a program, it will provide ongoing medical control, risk
management and quality assurance.
Comments and/or Discussion and/or Justification:
The demand for critical care transport services does not warrant a dedicated full-time ambulance crew. Accordingly, the
Departments planning provides for four City ambulances to be staffed and equipped to be capable of such work, but to
operate as regular paramedic ambulances at all times other than when needed for critical care assignments. The fees
recovered from the sending hospitals will cover any staff hours required by the critical care calls.
The program provides some attractive cost-free spin-off benefits since, at most times, the critical care equipped units
will service regular emergency calls in the community,. For example, where patients from regular ambulance calls could
benefit from any of the new skills acquired by the critical care teams (such as advanced ventilation procedures), these
services will be provided to these patients at no new cost to the taxpayer.
Our partnership with Sunnybrook Health Science Centre enhances a pre-existing relationship which stretches back more
than 15 years, in their capacity as Base Hospital to our paramedic programs. A close association with the critical care
physicians at this university teaching hospital provides us with medical delegation (responsibility for advanced care),
risk management, training programs and assistance in program marketing.
This program was developed in some part due to the urging of members of our paramedic staff. An internal training
opportunity call has elicited more volunteers than the program will be able to admit, based on its receiving approval. The
necessary discussions with CUPE Local 416 and Corporate Services will be undertaken to explore the most appropriate
method of compensation for the hours of duty engaged in critical care transports. This compensation approach parallels
successful agreements with CUPE on similar special projects.
This unique program provides the further benefit of supporting staff morale and professional pride by offering
opportunities for new challenges for some of our more experienced paramedic staff.
Conclusions
The Critical Care Transport Program will provide a number of benefits to the community, to the staff of Toronto
Ambulance and to the hospital services available in the city. Since the costs of the service will be fully covered by the
hospitals themselves (from existing transportation budgets), the project will enhance service to the community at no cost
to the municipal tax base.
With this in mind, the Department encourages Council to support these and future related initiatives.
Contact Name:
Ron Kelusky
Phone: 397-9241Fax: 392-2115
Ron KeluskyBarry Gutteridge
Acting General ManagerCommissioner
Toronto AmbulanceWorks and Emergency Services
