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Paramedic Services Response Time
Paramedic Services Response Time Reporting
Prior to the downloading of land ambulance services in 2000 to the upper tier municipalities (UTM) and Designated Delivery Agents (DDA) the Ministry of Health and Long-Term Care (MOHLTC) there were no legislated response time standards in place. At the time of transition MOHLTC introduced a standard that required the UTM/DDA to maintain the 1996 90th percentile response time to urgent and emergency calls for the entire service area.
The 1996 90th Percentile Response Time benchmark established for the County of Perth was sixteen minutes, eight seconds (00:16:08). Response time for that purpose is defined as the elapsed time from the notification of the ambulance crew by the ambulance dispatcher of a patient requiring emergency care, to the arrival of the ambulance crew at the scene (“Time 2” to “Time 4”). The following graph represents a retrospective review of the 90th% Response Time performance within the County of Perth:
In 2006, AMO and the provincial government established a joint Land Ambulance Committee. The mandate of the committee is to review key elements of the land ambulance service in Ontario including inter-facility transfers, training, funding, and response time standards.
The Response Time Standard Working Group, a sub-group within the committee, concluded that the current land ambulance certification standard regarding response times was in need of change. The Working Group concluded that “new medical evidence and measurement practices are now available to form new and local response time plans”.
The provincial government approved a new Regulation (Reg. 267/08, Part VIII) outlining the reporting requirements of the new response time plans.
The new ambulance response time reporting standard measures ambulance response time based on the severity of the calls as found by the paramedic using the Canadian Triage Acuity Scale (CTAS). CTAS (Canadian Triage Acuity Scale) is an international medical triage standard utilized by hospitals, ambulance communication services and paramedics to identify how urgently a patient requires medical care.
The new ambulance response time reporting standard divides ambulance calls into 6 categories as listed below.
Sudden Cardiac Arrest: person has no pulse and is not breathing
CTAS I: severely ill, requires resuscitation (ie. Choking, major trauma)
CTAS II: requires emergent care and rapid medical intervention (ie. head injury)
CTAS III: requires urgent care (ie. Mild asthma)
CTAS IV: requires less urgent care (ie. Ear ache)
CTAS V: requires non-urgent care (ie. Sore throat)
For Sudden Cardiac Arrest (SCA) patients the Provincial response time standard for getting a defibrillator to the call is 6 minutes from the time the ambulance crew is notified. The municipality will be allowed to use the time that any defibrillator, including fire department and public access defibrillators, was used to assist a victim of sudden cardiac arrest. The municipality must set the percentage of time that a defibrillator will reach an SCA patient in 6 minutes.
For CTAS level 1 patients the Provincial response time standard, from the time the paramedic crew is notified until the time they arrive the scene, is 8 minutes. The municipality must set the percentage of time that an ambulance will reach a CTAS 1patient in 8 minutes.
For CTAS level 2 through CTAS level 5 categories, the municipality will establish both the target ambulance response times and the percentage targets.
The 2013 ambulance response time performance plans that are submitted by each municipality will be made available publically. The public availability of these plans and the subsequent public availability of the actual performance, as measured by March 31st of the following year, are intended to ensure transparency and accountability on the part of the municipality.
Response time to the patient is the key element of each of the Ambulance Act updates. It is each municipality’s responsibility to set the response time guidelines appropriate for their municipality and to establish what resources and programs they will put into place to help meet the response times within their financial means.
In an attempt to establish response time plan targets that are realistic and appropriate, a retrospective review was performed applying the mandated targets of the new response time plan to the response time performance over the past several years. Staff considered past performance to establish future targets. Ambulance call volume and response time data from 2009, 2010 and 2011 was utilized to project what the County of Perth’s 2013 performance would be; assuming the demand and available resources for ambulance service is similar to the same period.
- The 2013 target for meeting the Ministry of Health and Long-Term Care response time of six (6) minutes for Sudden Cardiac Arrest patients is 51%. This means that the County of Perth targets a defibrillator arriving at the scene of a cardiac arrest within the six (6) minute response time 51% of the time.
- The 2013 target for meeting the Ministry of Health and Long-Term Care response time standard of eight (8) minutes for CTAS level 1 patients is 70%. This means that the County of Perth targets paramedics arriving at the scene of critically ill or injured patients within the eight (8) minute response time 70% of the time.
- The proposed response time targets for CTAS level 2 through CTAS level 4 patients is established at sixteen (16) minutes 75% of the time.
- The proposed response time targets for CTAS level 5 patients is established at sixteen (30) minutes 75% of the time.
The proposed Response Time Standards have been set based on the best available response information and evidence based medical practices currently experienced by Perth County EMS. These targets are considered to be achievable given current system pressures and deployment strategies accounted for in the current budget. This plan builds on the current performance of Perth County EMS with the ability to further enhance performance through Public Access Defibrillation Programs and other deployment initiatives.
Perth County EMS will continue in its commitment to the delivery of fiscally responsible pre-hospital care while continuing to implement process improvements to ensure the highest quality pre-hospital care possible.
“The response time performance plan has been created in accordance with Part VIII of O. Reg. 257/00 of the Ambulance Act. In publishing these response times, Perth County does not guarantee, warrant or otherwise promise that EMS service will be provided within the expected response times as conditions and circumstances will vary from time to time. Nothing herein shall constitute an expectation that service will be delivered within the expected response time and Perth County is not legally responsible or liable for any inability to meet the expected response times.”