April 26, 1999

To:Emergency and Protective Services Committee

From:Commissioner, Works and Emergency Services

Subject:"Cardiac Safe City" Program

Purpose:

The purpose of this report is to seek Council approval to enter into an agreement with Medtronic Physio-Control for the supply of Automatic Defibrillators and campaign support for the Public Access Defibrillation "Cardiac Safe City" program for the City of Toronto.

Funding Implications:

Under the proposed agreement there are no direct funding implications for the City of Toronto.

Recommendations:

It is recommended that:

(1)Medtronic Physio-Control be approved as the preferred supplier for automatic external defibrillators (AED) to be purchased by the City of Toronto for the "Cardiac Safe City" program;

(2)the initial agreement to remain in effect until December 31, 1999 with the option of extension for a further two one-year periods;

(3)the pilot program involving the placement of automatic external defibrillators (AED) at City Hall is expanded to include Metro Hall and the North York Civic Centre;

(4)approval be granted for the Steering Committee, established by Toronto Ambulance for overseeing the "Cardiac Safe City" program, to explore alternative sources of funding and financial support for the acquisition of automatic external defibrillators for city-owned and operated buildings; and

(5)that appropriate City officials be authorized and directed to take the necessary action to give effect thereto.

Background:

It is widely recognized that survival from out-of-hospital cardiac arrest is largely determined by the rapid delivery of defibrillation - an electrical shock that restarts the heart in a rhythm, which can pump blood. This program is intended as a demonstration project to "lead-by-example" for employers across the city.

Toronto Ambulance and its medical advisors firmly believe that anywhere CPR is provided in the workplace, so also should be easy to use automated defibrillators. There is ample evidence that CPR alone is ineffective in saving these patients. The demonstration project should also be considered as an opportunity to consider ensuring that defibrillation and CPR together are immediately available to protect employees and citizens alike at all City of Toronto corporate workplaces by gradual implementation over the next ten (10) years.

At its meeting held on November 25, 26, and 27, 1998, City Council approved Clause No. 3 contained in Report No. 13 of the Emergency and Protective Services Committee, headed "Public Access Defibrillation (PAD)". The recommendations of the report were as follows"

(1)the City of Toronto endorse the concept of Toronto becoming a "Cardiac Safe City", actively encouraging public involvement in the provision of Cardiopulmonary Resuscitation (CPR) and wherever possible the use of Public Access Defibrillators (PAD);

(2)Toronto Ambulance, in partnership with Sunnybrook Women's College Health Sciences Centre, assume the lead role in promoting and co-ordinating the "Cardiac Safe City" program, inclusive of promoting greater public participation in learning CPR and the introduction of Public Access Defibrillation;

(3)that the Commissioner of Works and Emergency Services be authorized to approach the Ministry of Health, the manufacturers of the defibrillators, and any other potential private sector partner and to report back to the Emergency and Protective Services Committee with a proposed communications plan to encourage the implementation of defibrillation programs in private sector locations throughout the City of Toronto;

(4)the Commissioner of Works and Emergency Services, in consultation with the Commissioner of Corporate Services, to report back to the Emergency and Protective Services Committee:

(a)within six (6) months with recommendations on how to expand the Public Access Defibrillation program to all appropriate City of Toronto owned buildings; and

(b)with a strategy to provide Cardiopulmonary Resuscitation (CPR) training to all City of Toronto employees to promote a "Cardiac Safe" work environment throughout the City of Toronto facilities for employees and the public.

(5)the Commissioner of Urban Planning and Development Services report to the Emergency and Protective Services Committee regarding the options to make Public Access Defibrillation programs mandatory in appropriate private and public sector locations similar to provisions for such life safety equipment as smoke alarms, fire alarms and carbon monoxide detectors.

In response to the above recommendations Toronto Ambulance has undertaken a number of initiatives including:

• a city-wide survey to determine the number of employees who have been trained in Cardiopulmonary Resuscitation (CPR);
• completion of a "request for proposal" inviting proposals from manufacturers and distributors of automatic external defibrillators on supplying automatic defibrillators and campaign support for the Public Access Defibrillation program; and
• an agreement with the Toronto Board of Education for the provision of CPR training within secondary schools.

At present staff are working with both Department and Division Heads regarding the completion of the survey to determine the number of employees currently trained in cardiopulmonary resuscitation. All departments, agencies, boards and commissions have been surveyed and Toronto Ambulance staff are currently in the process of compiling the results. It is expected that the final number will be determined within the next few weeks. On completion of the survey and following consultation with the Senior Management Team, a strategy for CPR training will be developed and reported to City Council with recommendations and cost implications.

Request for Proposal:

In cooperation with City Purchasing, Toronto Ambulance issued a request for proposal (No. 9155-99-01490) inviting proposals from manufacturers and/or distributors of automatic external defibrillators on supplying automatic defibrillators and campaign support for the Public Access Defibrillation program. The proponents were requested to submit proposals based on the interest of the City of Toronto in becoming a "Cardiac Safe City". Further, the intent of the RFP was to seek the support of firm(s) who were engaged in the manufacturing and/or sales of defibrillation products and who were interested in becoming corporate sponsors for the "Cardiac Safe City" program and who donate up to ten (10) automatic external defibrillators (AED) for the pilot program.

In addition, proponents were requested to provide a detailed pricing structure of automatic defibrillators for future purchases by the city, a program of re-investment into the "Cardiac Safe City" program through product sales, marketing support related to the implementation of the program and research opportunities.

Two (2) proposals were received, Laerdal Medical Canada Limited and Medtronic Physio-Control Corporation. City Purchasing and Toronto Ambulance reviewed both bids in detail and it is recommended that Medtronic Physio-Control Corporation be awarded the tender.

Medtronic Physio-Control Corporation proposed a collaborative partnership with Toronto Ambulance and the City of Toronto to build a Cardiac Safe City". Through this agreement Metronic Physio-Control will offer up to $40,000.00 toward a public relations campaign to raise public awareness and promote early recognition of chest pain, CPR education, and public access defibrillation. In addition, the agreement also provides for a discount for the purchase of defibrillators by the City and based on the achievement of sales milestones by the firm re-investment back into the program would occur. The sales milestones are based on both private and public sector sales and up to 5% of the sales revenues would be returned to the program and targeted to continued public relations and the CPR campaign.

Medtronic Physio-Control has also committed to expanding research opportunities in cardiac care and will partner with Toronto Ambulance and Sunnybrook Women's College Health Sciences Centre in the development of an "out-of-hospital" cardiac study involving the capture of critical information involving cardiac related emergencies.

Pilot Project:

The initial proposal had called for the placement of three (3) defibrillators at City Hall, Nathan Phillip's Square and based on funding availability the inclusion of Metro Hall and the former municipal Civic Centres at a later date. Under the proposed agreement with Medtronic the City now has available ten (10) automatic external defibrillators at no cost. It is recommended that the pilot program is expanded to include City Hall, Metro Hall and the North York Civic Centre. As funding becomes available, the former City of York, Scarborough, Etobicoke and Borough of East York Civic Centres would be include in the pilot project.

The launch of the pilot project is scheduled for the third week of may, to coincide with Emergency Medical Services (EMS) week in Canada.

Conclusion:

The "Cardiac Safe City" program as initially adopted by City Council in November of 1998 is progressing well. The completion of the request for proposal has provided the required start-up capital as well as defibrillators for the program and at no cost to the city. In addition, the recommendation to approve Medtronic Physio-Control as the successful bidder will ensure long-term sustain ability for the program. The future expansion of public access defibrillation and citizen CPR will be supported through a co-ordinated campaign funded through this agreement. Additional program information regarding the "Cardiac Safe City" program will be reported at a later date.

Contact:

Ronald L. Kelusky

General Manager, Toronto Ambulance

Phone: 397-9240

Fax: 392-2115

Ronald L. KeluskyBarry H. Guteridge

General ManagerCommissioner

Toronto AmbulanceWorks and Emergency Services