The Budget Committee on February 17, 1998, recommended to the Strategic Policies and Priorities Committee, and Council:

The Budget Committee on February 17, 1998 had before it a letter of transmittal (February 11, 1998) from the Emergency and Protective Services Committee advising that the Committee on February 10, 1998 recommended to the Budget Committee, and Council, the adoption of the report dated January 27, 1998, from the Commissioner, Toronto Ambulance.

Councillor Ron Moeser, Scarborough Highland Creek, appeared before the Budget Committee in connection with this matter.

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(Transmittal letter dated February 11, 1998, addressed to

the Budget Committee from

the Emergency and Protective Services Committee)

The Emergency and Protective Services Committee on February 10, 1998, recommended to the Budget Committee, and Council, the adoption of the report dated January 27, 1998, from the Commissioner, Toronto Ambulance, wherein it is recommended that:

The Emergency and Protective Services Committee had before it a report (January 27, 1998) from the Commissioner, Toronto Ambulance, regarding the acquisition of replacement ambulances.

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(Report dated January 27, 1998, addressed to the

Emergency and Protective Services Committee from the

Commissioner of the Toronto Ambulance)

The purpose of this report is to seek the approval of Toronto Council to proceed with the purchase of twenty-four (24) new ambulance vehicles in 1998, through a bulk order with the Ministry of Health. These vehicles are necessary to ensure the continued service and mechanical integrity of the ambulance vehicle fleet.

The funding source for this purchase will be the Department=s 1998 Operating Budget, in the amount of $1.948 million. The Department faces difficulty with the timing of the purchase since it is our understanding that the budget approval process is not scheduled to be completed until April 15, 1998. The funds the Department has allocated for this purchase represent a portion of an increase it is requesting over its 1997 approved operating budget.

It is recommended that:

Toronto Ambulance deploys an emergency fleet consisting of 130 ambulances, of various ages and usage. Because of the extremely high volumes of emergency medical calls in Toronto, the ambulances undergo extensive travel, and a great deal of wear and tear. As such, the Ministry of Health requires that there be regular, standardized maintenance and service programs carried out to so as ensure the ambulances= safe and reliable operation.

In addition, the Department, at the direction of the Ministry, maintains a replacement cycle which allows for the scheduled replacement of aging vehicles. AAge@ is determined by years, or by kilometrage (or in some cases by state of repair). When an ambulance reaches either sixty months or 180,000 kilometres, whichever comes first, it is deemed necessary to be replaced. It should be noted that this replacement cycle is longer than the cycle which existed up until 1993, when it was forty-eight months, or 120,000 kilometres. The replacement cycle was increased in that year, in the face of increasing budgetary constraints, and in an attempt to reduce operating costs.

To not replace the ambulances will lead to situations where there will be increasing numbers of vehicle breakdowns, which will likely result in incidents where there are delays in the delivery of emergency pre-hospital care. This could result in unnecessary patient suffering and, in some cases, unnecessary mortality. In addition, non-replacement of ambulances will result in higher maintenance and repair costs, to the point where operating ambulances will be cost-inefficient

Over the last several years, Toronto Ambulance has been replacing its ambulance vehicles at the rate of approximately 24 - 30 per year. Prior to 1992, the cost associated with their purchase came out of its annual operating budgets. However, since 1992 all of the Department=s ambulances had been supplied directly by the Ministry of Health. The cost of the vehicles had been borne entirely by the Ministry, and was not captured as part of either the Ministry=s or Metro=s portion of (roughly equal) funding of Toronto=s ambulance service. This translated into millions of dollars in budgetary savings over that period of time.

The provincial downloading of ambulance services to municipalities has resulted in a funding problem which had not been anticipated. The Ministry of Health has announced that it is no longer going to supply ambulances to Toronto every year. This is a downloading cost over which the Department has no control (a similar downloading pressure is that of approximately $500 thousand per year worth of equipment and supplies that the Ministry had also provided at no cost to Toronto since 1992).

However, the Ministry has approached us asking that we participate with them in a joint bulk purchase of ambulances for 1998. As such, the cost for 24 replacement ambulances will be $1.948 million in 1998, which will be lower than the price we will have to pay should we purchase the vehicles ourselves. Based on the service necessity of replacing the vehicles, as well as the purchase savings which will be realized by the city, we have agreed, - subject to Council approval, - to participate with the Ministry. The price, though, is contingent on receiving delivery of the ambulances by March 31, 1998, with payment to the supplier to follow within 10 days thereafter. If delivery is not accepted by March 31, 1998, the cost of purchasing the ambulances will go up by two percent per month, for every month of delay.

The Department=s original 1998 Operating Budget submission was prepared in July, 1997, for the Metropolitan Toronto government. It was premised on maintaining a >zero= percent increase over the 1997 budget amount. In response to downloading and other financial pressures, though, it has been forced to seek an increase in it=s 1998 Operating Budget request. Part of the increase is necessary to permit the purchase of the 24 replacement ambulances.

Council is not expected to confer final approval of the City=s operating budgets until April 15, 1998. This will fall after the date the Department will be able to purchase replacement vehicles at its presently estimated price. Therefore, based on the savings which will be available, the Department seeks the approval of Council for this item in advance of the regularly scheduled 1998 budget approval process.

Toronto Ambulance must replace 24 of its existing ambulances in 1998. This is part of a normal annual cycle of replacement of ambulance vehicles, and is necessary to ensure that there is no compromise to the levels of emergency care and medical transportation which is currently being provided to the citizens of Toronto.

The Department has not purchased any of its own ambulances since 1992. The ambulances supplied at no cost by the Ministry of Health since that time have proved of assistance to the financial circumstances of both the Department and Toronto.

The Department faces two difficulties related to replacing ambulances. First, provincial downloading of ambulance services to municipalities has placed the Department in a position where it must request a budget increase in 1998 in order to purchase ambulances which were supplied at no cost by the province in previous years. This is a cost above and beyond the department=s regular operating expenses, and is something over which it has had no control.

Second, to optimize the purchase price of replacing 24 ambulances this year, the Department must have approval to spend $1.9 million prior to March 31,1998. However, this date is in advance of the presently scheduled budget approval process time frames. Failure to secure approval by this date will result in an increase to the purchase price, which will also exceed the Department=s originally requested budget increase amount for this item.

Ron Kelusky, Director, EMS Operations, 397-9240, Fax: 392-2115.