STAFF REPORT
December 29, 1999
To: Community Services Committee
From: Barry H. Gutteridge, Commissioner, Works and Emergency Services
Subject: Critcal Care Transport Program Update
Purpose:
To update Council of the activity and status of the previously approved Critical Care Transport Program.
Financial Implications and Impact Statement:
There is no direct financial impact as a result of this report.
Recommendations:
It is recommended that:
This report be received for information;
1. Toronto Council endorse continuation of the existing adult Critical Care program;
2. Toronto Council endorse Toronto Ambulance's pursuit of expansion of the scope of the program to include critically ill
babies, children and women with high-risk pregnancies, subject to the normal budget approval process; and
3. The appropriate City officials be authorized and directed to take necessary action to give effect thereto.
Background:
In June, 1998, Council approved the creation of the Toronto Ambulance Critical Care Transport Program to provide highly
specialized medical care to critically ill and injured patients being transported between hospitals. The program was initially
proposed as a "fee-for-service", charged back to the user hospitals, but was so successful that it attracted Ministry of Health
approval and funding as part of the regular joint funding model for municipal ambulance service.
These specially trained paramedic crews replace the normal complement of physicians, nurses and technicians who
formerly would have accompanied such patients during inter-facility transports. The broad range of high-end medical skills
provided on board the CCTP ambulances ensures the highest possible level of care for gravely ill members of our
community.
During the next year, Toronto Ambulance and its partner, Sunnybrook and Women's College Health Science Centre,
propose to expand this service to care for children and infants down to the age of 29 days, and following that, to high-risk
obstetrics patients, such as those with impending multiple births or potentially premature delivery. These expansions will
place this program in a national leadership position, and will fill a major gap in service in the community today.
As a joint venture, medical direction and delegation is the responsibility of Sunnybrook and Woman's College Base
Hospital Program, while actual operations and staffing is the responsibility of Toronto Ambulance. A joint Critical Care
utilisation committee advises Toronto Ambulance on most aspects of the program.
The Critical Care program now handles three to four cases a day, and during 1999 provided care to more than 700 patients.
The program typically serves the following range of patient problems:
Stroke: 26% Trauma: 17%
Cardiac: 22% Respiratory: 9%
Other Medical: 20% Surgical: 6%
This range is changing continuously as the sending hospitals become more familiar with the program's breadth of skills and
on-board capabilities. Shortly, these units will undertake primary responsibility for all emergency patient inter-facility
transports in the City of Toronto.
The program primarily services hospitals in the City of Toronto with 73 % of the pickup locations at Toronto hospitals. Of
the remainder, 20% of the pickup locations are in GTA, adjacent to the City and in most cases the patient is transported to a
Toronto location.
All patients transported by the CCTU require some level of medical care that in the past would have, required hospital staff
to attend in the ambulance. The Hospital staff that would be required ranges from at least one nurse and one doctor to a
team of healthcare professionals pulled from an active patient care unit. Critical care patients require one or more of the
following complex procedures or monitoring techniques during transport.
Pulmonary artery (Swan Ganz) or arterial pressure monitoring.
Cardiac pacing.
Chest drainage
Advanced airway management including intubation, ventilation and sedation.
A wide range of drug infusions on IV pumps.
Blood products administration.
These procedures are well beyond all other paramedic skills and would normally require hospital medical staff and
equipment to accompany the patient.
In addition to critical care duties the critical care paramedic units work as part of normal emergency operations responding
to 911 calls and delivering advance life support care. Staffing allows for a maximum of 4 units on days and a maximum of
2 units on nights. Current staffing consists of 24 full time critical care paramedics. Twelve staff currently run out of
Toronto Ambulance station number 29 at 887 Pharmacy Ave. and 10 staff run out of Toronto Ambulance station number
30 at 2015 Lawrence Ave. west. As the third class of eight complete their training, staffing will be equalised at twelve per
station. Call volume will determine the need for any future staffing increases.
The training program consists of a total of 13 days in class and lab, nine shifts in a hospital intensive care unit, coronary
care unit, and in an emergency department. The paramedics also complete an in field internship. Class three is projected to
be fully certified in February 2000.
To maintain certification, each year each critical care paramedic is required to attend four hoursof rounds per month for ten
months, five consecutive clinical days in Sunnybrook hospital plus12 hours of regular paramedic CME.
The first class of critical care paramedics finished clinical training and began transporting complicated critical care patients
late in December 1998.
Comments:
Further training is required to enable Critical Care Paramedics to manage high risk Obstetrics and the many infant and
paediatric patients that require transport to specialised centres every day. With the initial adult phase of training being
completed for all CCTU staff by February 2000, further training could begin by fall 2000. This will ensure that the program
completely meets the needs of the citizens of the City of Toronto and surrounding area. With the expansion in service and
demand, specialized vehicles and dedicated service is under consideration.
Conclusions:
The Critical care transport program has been very successful in the initial phase of implementation. All of the paramedics
have contributed a great deal to the development and maintenance of the program in this very important start up phase. The
success of the Critical Care program is due to in part to the very active involvement of the paramedics from equipment
maintenance to mentoring peers. Feedback from the hospital staff on the collective paramedic performance has been very
encouraging and complimentary to the paramedics.
Contact:
Ronald L. Kelusky, General Manager
Phone: 397-9240
Fax: 392-2115
Ronald L. Kelusky
General Manager, Toronto Ambulance Services
Barry H. Gutteridge
Commissioner, Works and Emergency Services
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