REPORT TO THE CORPORATE SERVICES COMMITTEE

Transcription

1 REPORT TO THE CORPORATE SERVICES COMMITTEE From: Bettyanne Cobean, Clerk-Treasurer Date: April 5, 2007 Subject: Agenda / Executive Summary Call to Order Acknowledgements of any Pecuniary Interests Approval of Minutes o March 8 th and March 15th, 2007 DELEGATIONS: 2:00 P.M. Jill Ackerman, Ministry of Health Base Hospital Restructuring (POSTPONED) 2:15 P.M. Dr. Hazel Lynn Health Unit Budget Presentation ACTION ITEMS ADMINISTRATIVE MATTERS 1. Land Ambulance Update a. EMS Director Position Recognition of Department Head status October 1 st, b. Base Hospital Restructuring (Report attached) c. Non-Emergency Transportation (Reports attached) INFORMATION ITEMS 2. Ministry of Community Safety and Correctional Services The Emergency Management and Civil Protection Act requires the implementation of a mandatory Essential Level emergency management program by all Ontario municipalities. This letter acknowledges that the County of Bruce has completed all the steps that are required for the maintenance of the Essential Level Emergency Management Program required by this legislation in ADJOURNMENT

2 From: Doug Smith, Director of EMS, CEMC Date: April 5, 2007 Subject: Base Hospital Re-Structuring REPORT TO CORPORATE SERVICES COMMITTEE BACKGROUND The Ministry of Health & Long Term Care has been working toward a strategy for modernizing and improving the efficiency and effectiveness of the Base Hospital system in Ontario. On August 10, 2006 I provided an update to Committee on the status of this effort and outlined the next steps the Ministry would be pursuing to optimize the Base Hospital Program resources to enhance services to keep pace with other EMS system changes. The most significant of these steps involves reducing the number of Base Hospitals from the current twenty-one (21) Local Programs to six (6) Regional Base Hospital Programs. On September 25, 2006 we received a Draft copy of a revised Performance Agreement for a Host Hospital from the Ministry. After review of this draft Performance Agreement we continue to have serious legitimate concerns regarding the entire Base Hospital restructuring process and the disposition of current rural Base Hospital Programs. We were invited to provide comments to the attention of Mrs. Jill Ackerman, Senior Field Manager, Southwest Ontario by October 20, We provided our comments and concerns (attached) to Ms. Ackerman and to Mr. Malcolm Bates, Director, Emergency Health Services Branch. Also copied were Minister Smitherman, Carol Mitchell, MPP, Bill Murdoch, MPP, Bob Pringle, Warden, Grey County and Robert Morley, Warden, Huron County. In his reply (attached) dated October 25, 2006 Mr. Bates responded to Warden Oswald, In order to offer the County of Bruce a further opportunity to offer comments and suggestions for improving the efficiency and utility of the Base Hospital Programs in Ontario, I have asked Mrs. Jill Ackerman, Senior Field Manager, Southwest Ontario to meet with you and County Officials. Mrs. Ackerman is here today in response to Mr. Bates request to provide an update on the process and to answer any questions or concerns you may have.

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7 A GUIDE TO CHOOSING APPROPRIATE PATIENT TRANSPORTATION Introduction This guide is intended as a reference for planners, providers and users of medical transportation, particularly those involved in arranging patient transfers. There have been recent amendments to the Ambulance Act which impact on ambulance and non-ambulance use for transporting people in need of medical services. Among other things, the amendments provide a new definition for the term "ambulance" and "ambulance service". They expressly stipulate when an ambulance must be used to transport a patient and implicitly provide for when an alternative vehicle, such as an accessible taxi or a private medical transport service could be considered for patient transfers. While increasing demand for medical transportation and the emergence of a nonambulance transportation sector will influence decisions on vehicle selection, the amendments to the province's Ambulance Act will help in clarifying when an ambulance should be selected as the preferred vehicle to transport persons in need of medical services. The Ministry's position on the use of ambulance resources has not changed. There will be more effective and efficient medical transportation if ambulance resources are directed to patients whose needs necessitate the use of an ambulance and if other forms of patient transportation are used only when it is safe and appropriate to do so. Ambulance Act Amendments 56. (1) The definition of "ambulance" and "ambulance service" in Section 1 of the Ambulance Act are repealed and the following substituted: "ambulance" means a conveyance used or intended to be used for the transportation of persons who,: (a) (b) have suffered a trauma or an acute onset of illness either of which could endanger their life, limb or function, or have been judged by a physician or a health care provider designated by a physician to be in an unstable medical condition and to require while being transported, the care of a physician, nurse, other health care provider, emergency medical attendant or paramedic, and the use of a stretcher; "ambulance service" means a service, including the service of dispatching ambulances, that is held out to the public as available for the conveyance of persons by ambulance.

8 (2) Section 1 of the Act is amended by adding the following definitions: "emergency medical attendant" means a person employed by or a volunteer in an ambulance service who meets the qualifications for an emergency medical attendant as set out in the regulations, but does not include a paramedic or a physician, nurse or other health care provider who attends on a call for an ambulance; "paramedic" means a person employed by or a volunteer in an ambulance service who meets the qualifications for an emergency medical attendant as set out in the regulations, and who is authorized to perform one or more controlled medical acts under the authority of a base hospital medical director, but does not include a physician, nurse or other health care provider who attends on a call for an ambulance. (3) Subsection 22 (1 ) of the Act is amended by adding the following clause: (h) prescribing the standard of care to be provided to persons by emergency medical attendants and paramedics. Application and Interpretation The amendments do not prohibit the use of an ambulance at any time. An ambulance may be used to transport persons in need of medical services where no other means of transportation is available, or where ambulance use is judged to be appropriate for some other reason. Clauses (a) and (b) of the amendment to the definition of "ambulance" clarify the situations where an ambulance should be the vehicle of choice. Clause (a) refers essentially to emergencies. As has always been the requirement, only an ambulance may be used to transport a person in an emergency situation. Clause (b) refers to a specific non-emergency situation involving three conditions that, should they all exist at the same time, would make an ambulance the appropriate vehicle for medical transport. This situation is where the person has been judged by a physician or a physician's designate to be: i) in an unstable condition ii) in need of an escort iii) in need of a stretcher Note: i) This guide and the amendments, as noted above, will have greater relevance to users if they are interpreted and applied in conjunction with a review of the other sections of the Ambulance Act. ii) These amendments do not affect coverage under the Health Insurance Act or co-payments under its regulations.

9 Choosing Medical Transportation Choose an ambulance when: 1. It is an emergency situation. 2. The person has been judged by a physician or a health care provider designated by a physician to be: - unstable - in need of a nurse, other primary care provider, emergency medical attendant or paramedic en route - in need of a stretcher 3. An ambulance is the only available means of transportation and/or ambulance use is deemed to be the most appropriate option to transport the patient. Consider an alternative to an ambulance when: a. It is not an emergency situation. b. The three criteria in #2 above are not met. c. The situation in #3 above does not apply. Alternative medical transportation may include accessible taxis, stretcher capable private medical transport services, and transportation services operated by volunteer agencies. Contact for Questions about this Guide If you have any comments or questions about this guide you may contact Mr. Leslie Sands with the Ministry of Health's Emergency Health Programs Section. Mr. Sands can be reached at (416) , by fax at (416) or by mail at: Ministry of Health Emergency Health Services Programs 5700 Yonge Street, 6th Floor North York ON M2M 4K5 A Guide To Choosing Appropriate Patient Transportation ONTAMO., ^ HOSMTAl I/ \y ASSOCIATION Emergency Health Services Branch - March 7, 1997 Update August 25,2005

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11 REPORT TO CORPORATE SERVICES COMMITTEE From: Doug Smith, Director of EMS Date: April 5, 2007 Subject: Non-Emergency Transportation Report BACKGROUND The non-emergent inter-facility patient transfer is nothing new to Bruce County EMS however, it is imperative to ensure that the costs for operating pre hospital care services be maintained at the most reasonable levels. Provincially, the issue of non-emergent inter-facility patient transfers is an ongoing concern that has been under review by Dr. Chris Mazza, Strategic Lead, Provincial Transport Medicine Systems, MOH&LTC. In May 2005, Dr. Mazza met with the Association of Municipal Emergency Medical Services of Ontario (AMEMSO) in Kingston, outlining his thoughts on where the non-emergent transfer system was going. During his discussion at that time, Dr. Mazza indicated that the current EMS system could not continue to provide both emergent and non-emergent transfers within the existing system. At that time he was new to his current position, however, he did indicate that in the urban centres there needed to be an alternative method of transfer system for the non-emergent patients to ensure that they made their appointments in a timely basis. Dr. Mazza was also cognizant of the lack of funding being made available to the existing EMS system to perform transfers. As Dr. Mazza indicated, the Ministry of Health and Long-Term Care recognizes that transportation is a key piece in transforming the health care system, and he is also aware that they are many issues but he is also looking for solutions. In Bruce County we want to improve emergency response times and ensure that our costs do not spiral out of control. To accomplish this we must control the variables that are causing the increasing costs, namely the non-emergent calls that we are performing. We are presently performing transfers as hospitals and physicians deem necessary, not necessarily as per the Emergency Health Services Branch Guide to Choosing Appropriate Patient Transportation (attached), March 7, To resolve our problems within the concepts that were discussed by Dr. Mazza, we have looked to the solutions that have been implemented within Southwestern Ontario, the guide and in conjunction with discussions held with the EHSB Field Office. Middlesex, Lambton & Huron Counties have reduced their transfer volume by taking a very similar approach. Middlesex advised local hospitals, nursing homes and homes for the aged, that they were changing their deployment strategy to reduce transfers. Further, they assisted the London Health Sciences Centre to broker a deal whereby the hospitals and Voyageur Transportation entered into an agreement that ensured non-emergent patients that fell within the matrix were moved in a timely fashion. 1 of 4

12 Lambton County also took the initiative to alter their deployment strategy. They then advised their local hospitals, nursing homes and homes for the aged that they would no longer be able to perform non emergent transfers beyond that allowed within their deployment strategy. This allowed the local hospitals to enter into an agreement with Voyageur Transportation. In Huron County, they met with local hospital representatives and these meetings initially resulted in limited success. In discussions with the Emergency Health Services Branch s Field Office in Hamilton it was advised that they change their deployment strategy to meet the needs of the County and limit the number of vehicles available for nonemergent transfers. In all instances, this has allowed local EMS providers to reduce their emergency response times and have better control over their increasing costs due to non-emergent transfers. The Southwest Field Office also indicated that the Central Ambulance Communication Centre (CACC) directs the movement of all ambulances and dependant on the deployment strategy will assign calls to the local ambulance service based on the parameters within the deployment strategy. Given that the CACC is governed by the parameters of the deployment strategy, this document must dictate the type of coverage that a County requires. If it is ensured that the minimum number of vehicles required to meet emergency coverage for a reduced response time is maintained, any extra vehicles could then be used to transport non-emergent patients. ANALYSIS Most smaller urban and rural communities throughout Ontario continue to provide nonemergency transfer services, however, many have begun to question their continued role in this service and have tightened up their Emergency Coverage Policies to maintain balanced emergency coverage by limiting the number of vehicles available for nonemergency transportation. To effectively make a change in strategy, the deployment strategy needs to be changed to reflect the necessity of keeping a minimum number of ambulances readily available. This change in deployment would reduce unanticipated costs by maintaining minimum coverage and effectively reducing response times. This would reduce the number of non-emergent calls being completed by the service and a minimum ambulance count would be maintained to meet emergent needs. A concern that would arise from this action would be that the health care sector would make all non-emergent calls into emergent calls. Therefore, any change in deployment policy must be communicated to all local Hospitals and their Medical Advisory Boards as well as the various Long Term Care Facilities to ensure that they do not take this action. It would also be prudent to advise the local health sector of any alternative transfer services that may be available in the area. If County Council approved, it would be anticipated that this strategy could be rolled out fairly quickly in order to ensure that costs are controlled. 2 of 4

13 Non Emergent Patient Transport Regional Steering Committee The Non Emergent Patient Transport Regional Steering Committee has been meeting for over 2 years with the focus of reviewing the current system for non- emergency transfers in both Grey and Bruce Counties. The committee is also mandated to provide recommendations to each respective organization s political committee or CAO on ways to find improvements and efficiencies the current system, which will be beneficial to all stakeholders. Committee membership includes EMS services from Grey and Bruce County, hospital representatives from Grey Bruce Health Services (GBHS), South Bruce Grey Health Centre and Hanover Hospital. The committee has looked at call volumes, patient destination trends, call booking procedures, decision making guidelines and has held presentation sessions with non ambulance transportation services capable of servicing the Grey/Bruce area. Discussions held at the most recent meeting in October 2006 led to a decision of the committee to recommend a pilot project to each organization regarding utilizing a non ambulance transfer service to transport patients from GBHS to health care facilities outside of the Grey/Bruce area and more specifically into the London, Kitchener/Waterloo, Toronto and other facilities where transportation times are in excess of four hours. The committee heard that the long distance transfers produce the heaviest burden on the EMS services in Grey and Bruce Counties. Non-Emergency transfers of this type often result in emergency vehicles being out of the counties for up to eight hours at a time. There are instances when three or four of these transfers are completed in a single day, which severely limits our ability to meet legislated response times. The implementation of the pilot project would help to identify if there are improvements gained in meeting response times if the current ambulance resources being used for out of town transfers were available within. The pilot project was to have lasted approximately 3-6 months and all costs associated the project to be borne by GBHS. Once completed, the project would have been evaluated from both the EMS perspective and the hospital perspective and the decision to continue would have been made at that time. Both Counties endorsed the study in December 2006, however, the senior administrators of the hospital networks in Grey and Bruce Counties did not endorse the pilot project and instead have advertised for a data analyst to assess patient transportation volumes and trends and report back to the CEO s when the findings are complete. BUDGET & STAFFING IMPACTS A change in the current deployment strategy should result in a slight saving based on reduced travel, overtime costs as well as wear and tear on vehicles. Any additional costs for non-emergent transfer would be the responsibility of the health sector requesting the service. Staffing levels will not be affected as current staffing levels are designed and in place to meet basic balanced emergency coverage requirements. 3 of 4

14 RECOMMENDATION That we advise Grey Bruce Health Services, South Bruce Grey Health Centre the Hanover Hospital and other affected stakeholders that effective July 1, 2007 the County of Bruce is implementing the following changes to it s Emergency Coverage Policy: The number of ambulances allowed outside the Grey-Bruce coverage area on nonemergency transfers be restricted to one (1) provided there are no other ambulances outside of Grey-Bruce and the minimum number of ambulances required for balanced emergency coverage is maintained. Bruce County will maintain six (6) ambulances between the hours of Monday-Sunday, five (5) ambulances between the hours of Sunday-Thursday and six (6) ambulances Friday-Saturday for balanced emergency coverage. When an ambulance is outside the Grey-Bruce coverage area on a non-emergency transfer the crew will wait no longer than one (1) hour for a patient returning. Ambulances will wait no longer than thirty (30) minutes in Grey County for a patient returning. Providing standby is in place it is acceptable for ambulances completing transfers within Bruce County to remain at the station closest to the destination to wait for a patient returning. While waiting these ambulances can be reassigned to local calls. Low priority calls can be completed when at minimum compliment provided the pickup/destination are within five (5) minutes of each other.. 4 of 4

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16 Corporate Services Committee Finance and Property Division March 8, 2007 Council Chambers Warden Twolan moved into the Chair of the Committee of the Whole and called the meeting to order. Bettyanne Cobean, Clerk-Treasurer joined Warden Twolan as the presenting Department Head. Mr. Doug Smith, Director of EMS was also in attendance. Wayne Jamieson, Chief Administrative Officer and all Committee members were present. Recording Secretary: Bettyanne Cobean ACTION ITEMS ADMINISTRATIVE MATTERS 1. Vehicle Replacement Mr. Smith addressed Committee and explained that in the Ambulance Budget presentation, he had submitted that the County follow the vehicle replacement schedule and purchase two new ambulances at a cost of $210,000. The two ambulances due for replacement are both model year One is a Ford F-E350, unit #1288 with 324,823 km and the other is also a Ford F-E350, unit #1291 with 300,520 km. The County s Preferred Vendor, Demers Ambulances of Quebec has model year Type III, F-E450 Ford, 158 inch Wheel Base with dual main cots. The cost of these vehicles are approximately $99,200 plus $5,952 GST for a total of $105,152 each. The same 2007 model year vehicle with similar ambulance upgrade options will cost $104,650 plus $6,279 GST for a total cost of $110,929. $105,000 is budgeted for each new replacement vehicle as reflected in the Vehicle Replacement Schedule. Mr. Smith requested Committee s consideration for pre-budget approval to purchase two 2006 ambulance from the County s preferred vendor Demers Ambulance of Quebec at a cost of $99,200 plus GST to replace units #1288 and Moved by Mr. Oswald Seconded by Mr. Bagnato That we provide pre-budget approval to authorize staff to proceed with the purchase of two 2006 model year Type III, F-E450 Ford, 158 inch Wheel Base from Demers Ambulances of Quebec at a purchase price of $99,2000 plus GST per unit. Carried. 2. ADJOURNMENT Department Head Department Councillor

17 Corporate Services Committee Finance and Property Division March 15, 2007 Council Chambers Warden Twolan moved into the Chair of the Committee of the Whole and called the meeting to order. Bettyanne Cobean, Clerk-Treasurer joined Warden Twolan as the presenting Department Head. Mr. Doug Smith, EMS Director was in attendance for the Land Ambulance Update. Wayne Jamieson, Chief Administrative Officer and all Committee members were present. Recording Secretary: Darlene Batte, Administrative Assistant Pecuniary Interests: None Declared. ACTION ITEMS ADMINISTRATIVE MATTERS 1. Minutes Moved by Mr. Kraemer Seconded by Mr. Oswald That the minutes of the February 13 th and 15 th, 2007 meetings be adopted as circulated. Carried. 2. Land Ambulance Update a. Township of Scugog The Township of Scugog has passed a resolution petitioning the Minister of Community safety and Correctional Services; Emergency Management Ontario and the Federal Government to revise the funding formula and application process for the Joint Emergency Preparedness Program to increase grants available for emergency preparedness purposes and reduce funding limitations. Mr. Smith commented that the funding application process is sound. He supports the Township of Scugog s resolution and noted that more funding needs to be made available by the Federal Government and Emergency Management Ontario to increase grants and reduce limitations through the JEPP process especially now that all municipalities in Ontario are required to meet and maintain at a minimum an Essential Level of Emergency Management as mandated by the Emergency Management and Civil Protection Act. Moved by Mr. Kraemer Seconded by Mr. McIver That we recommend support of this resolution. Carried.

18 b. Sauble Beach Ambulance Station Mayor Gilbert requested the EMS Director and Clerk-Treasurer to attend a meeting with the Town of South Bruce Peninsula relating to the construction of an ambulance station in Sauble Beach. It was noted that the County of Huron had previously requested Bruce County s consideration to share in the construction of an ambulance station to be located in the Lucknow area to service both Bruce and Huron Counties. Mrs. Cobean explained that the EMS Director at that time had conducted an analysis of the County s EMS Services to identify any under-serviced areas or gaps in the coverage areas. This reported concluded that the numbers collected did not support an ambulance station in either the Lucknow area or Sauble Beach. Mr. Smith is prepared to present that report to the Town of South Bruce Peninsula. 3. Pre-Budget Approval Request Mrs. Cobean explained that the Clerk-Treasury 2007 budget includes one staff change recommending that the six-month contract position which expires March 31 st, 2007 be transferred to a full-time data entry position. Moved by Mr. Smith Seconded by Mr. Bagnato That we provide pre-budget approval to transfer the contract position to full-time effective March 26, Carried. 4. Budget Mrs. Cobean explained that as a result of budget discussions on March 8 th, 2007, she has reviewed the Reserve Accounts and provided a recommendation to Committee to consider utilizing certain Reserves to offset the 2007 budget expenditures. It was noted that the CAO is supportive of the Clerk-Treasurer s recommendation s to utilize these reserves and other minor amendments which will reduce the tax rate to an increase of 5%. It was noted that the Federal Budget is to be presented on March 19 th and the Provincial Budget is to presented March 22 nd. Committee has agreed to meet for a special budget meeting Thursday, March 29 th to discuss the implications of these budget announcements on the County s 2007 budget and finalize a budget to be presented at the April 5 th Session of County Council. 5. Electronic Signatures Mrs. Cobean reported that the County has always utilized electronic signatures for cheques with CIBC. CIBC is updating all of their records and require a resolution from the Corporation acknowledging this agreement respecting facsimile signatures. A copy of the required resolution was circulated for Committee s information. Moved by Mr. Kraemer Seconded by Mr. Bagnato That we endorse the following resolution: That the Corporation create and issue to Canadian Imperial Bank of Commerce an agreement respecting facsimile signatures on the Bank s Form 330 relating to the issuance of instruments under facsimile signatures of authorized officers of the

19 Corporation; And further that the President or a Vice-President together with the Treasurer or Secretary or any one of such officers together with a Director are hereby authorized for and on behalf of the Corporation to execute under its corporate seal, if one exists, and deliver the Agreement to the Bank with such alterations, additions, amendments and deletions as may be approved by such persons executing the same, whose signatures shall be conclusive evidence of such approval; and Any one of the persons designated in paragraph 2 is hereby authorized for and in the name of the Corporation to execute and deliver under the corporate seal or otherwise all such other documents and to do all such other acts and things as may be necessary or desirable to give effect to this Resolution or as may be reasonably required by the Bank. Carried. ACTION ITEMS POLICY MATTERS 6. Communications Referred: a. Grey-Bruce Humane Society The Grey-Bruce Humane Society has submitted a request for financial assistance. Moved by Mr. Smith Seconded by Mr. McIver That we recommend this request be noted and filed. Carried. 7. ADJOURNMENT Department Head Department Councillor