STAFF REPORT
March 8, 2000
To: Community services Committee
From: Barry H. Gutteridge, Commissioner, Works and Emergency Services
Subject:Toronto Ambulance Response to the Ministry of Health Ten Point Plan
Purpose:
This report will update Council on the progress Toronto Ambulance has made in dealing with the emergency department
overcrowding issue.
Financial Implications and Impact Statement:
None. The Chief Financial Officer and Treasurer has reviewed this report and concurs with the financial impact statement.
Recommendations:
It is recommended that:
(1)Council continue to support Toronto Ambulance in its efforts to deal with ongoing hospital emergency department
overcrowding; and
(2)The appropriate City officials be authorized and directed to take necessary action to give effect thereto.
Background:
On December 20, 1999, Elizabeth Witmer, the Minister of Health and Long Term Care, announced a ten-point plan to help
alleviate overcrowding in hospital emergency departments and to reduce ambulance diversion. Of the $23 million promised
in the plan, $ 3.2 million were given to Toronto Ambulance. This report will update Council on progress to date.
Comments:
One of the major items in the plan was the formation of geography-based emergency service networks. Toronto Ambulance
is an active participant in these networks that have been in place since early January. While most of the focus of these
groups has been on in-hospital issues, a working group from Toronto Ambulance and the emergency departments has
developed a protocol which, when implemented, will commit the hospitals to accept all patients from their region,
regardless of their emergency status.
Critical Care Bypass Override:
In order to ensure that critically ill patients are seen in a hospital as quickly as possible, Toronto Ambulance has initiated a
policy which mandates that certain life-threatening patients be taken to the closest hospital regardless of emergency
department status. All hospitals are aware of this new directive, and are unanimous in their support. Since we implemented
this policy on January 14, we have overridden Critical Care Bypass on four occasions. Ambulance staff and the
Sunnybrook Base Hospital have reviewed each incident, and to date, no inappropriate episodes have been identified.
Hospital Destination Co-ordinator:
The addition of the hospital destination co-ordinator position in our communication centre has resulted in efficiency gains.
This MOH-funded position is in place 24 hours daily, seven days per week. When the hospital system begins to fill up, and
facilities begin to restrict ambulance access, the co-ordinator begins to call all emergency departments to determine their
status and what resources they have available. By knowing where beds are available, ambulances are sent to hospitals that
are able to accommodate them, which has resulted in reduced waiting time for patients. It has also meant that ambulances
are more often able to honour patient requests for specific hospitals. The hospitals have commented that this program
seems to have resulted in a more equitable distribution of patients.
The co-ordinator position has also had effects on road paramedics. The crews now have one number to call from the scene
to determine where they can transport patients. They spend less time phoning around and "bed shopping", and are able to
inform families where there loved ones are going. The quadrant dispatchers are also noticing less stress, since they too have
only one person to ask about hospital availability, instead of calling around themselves.
Dedicated Hospital Clearance Units:
On Wednesday, March 1, Toronto Ambulance added four additional units to its transfer operation. These ambulances are
used to expedite the movement of discharged patients from hospitals to other facilities or their home. It operates from
07:00 to 19:00, Monday through Friday, and on weekends from 10:00 to 22:00 with two units.
Conclusions:
These initiatives, together with a slight reduction in demand have increased the amount of time hospitals are on normal
status from about 47% in December to 58% in January, and 70% in February. However, the problems that led to the crisis
have not been solved, and there will be times in the future when there are few "open" emergency departments.
The target set by the Ministry of Health, and agreed to by the hospitals is less than 9% RDC, and less than 1% CCB.
Toronto Ambulance is committed to working with area hospitals and the Ministry of Health to meet these targets.
Contact:R.L. Kelusky
General Manager
Phone: 397-9240 Fax: 392-2115
R.L. Kelusky
General Manager, Toronto Ambulance Services
B. Gutteridge
Commissioner, Works and Emergency Services
