LEEDS GRENVILLE EMERGENCY MEDICAL SERVICES
Q. Who made the decision to increase the
level and quality of ambulance service in Leeds & Grenville?
A committee was created with political representation from all of the municipalities
within Leeds & Grenville and the separated municipalities of the City of
Brockville, the Town of Prescott, and the Town of Gananoque.
There was an 18 month period of research and consultation, by a number of
working sub-groups, with the stakeholders including private ambulance
operators, municipally operated ambulance services, hospitals, and
representatives from the Ministry of Health and Long Term Care.
presentations were conducted for the Councils of Brockville, Prescott,
Gananoque, and the United Counties of Leeds & Grenville, after which
approval was received from all of the Councils prior to the implementation of
How has the ambulance system been improved since being operated by the
United Counties of Leeds & Grenville?
there was only one (1) station, based in Brockville, that provided 24/7
coverage in Leeds & Grenville. Leeds Grenville EMS now operates six
stations, five (5) of which are 24/7 stations which provides equal access to an
ambulance for all residents of Leeds & Grenville.
level of paramedic training has improved since the downloading of land
ambulance operations. The paramedics now receive forty (40) hours of training
annually (previously only received 24 hours of training). In addition, Leeds
Grenville EMS have 40 paramedics who have been trained or are in the process of
being trained in the advanced paramedic skill of Advanced Airway Management (i.e.
Endotracheal Intubation, which is a procedure by which a tube is inserted
through the mouth down into the trachea (the large airway from the mouth to the
lungs). The purpose is to permit air to go up and down and, most importantly,
to ventilate the lungs, in the event that a patient is not breathing or
requires assistance to breath.)
Grenville EMS, with the participation of the Fires Services in Leeds &
Grenville, has implemented the Fire Medical Assist First Response &
Defibrillation Program. This program provides advanced first aid, C.P.R., and
defibrillation training to firefighters so that they can render medical
assistance until an ambulance arrives. Currently, there are 314 firefighters
from 22 fire stations in Leeds & Grenville that are trained and equipped
for this program.
Why is the cost of the ambulance service different from the original
estimate of the approved model? Why has the cost of the ambulance service
A. 1) The costs estimated in the original model had to be
increased for the following reasons.
salaries in the original model were based upon the 1999 hourly wage rate,
however, this figure was adjusted to reflect previously negotiated wage
increases. In addition, staffing levels were modified by adding 2 full-time and
15 "unscheduled" part-time paramedics in order to maintain the
approved level of service and to provide coverage for vacation, illness and
training needs. Finally, the original model called for two "second
life" ambulances to be used for contingency purposes. However, due to the
age and condition of the fleet, it quickly became apparent that a third
"second life" ambulance (that was already in the fleet) had to be
re-instated to service, in order to ensure adequate resources were available in
the event of mechanical breakdowns.
impact of the above changes resulted in a net.difference, between the original
model and the 2001 actual costs, of approximately $295,000 (or 7.9 % over the
cost of the original model).
order to meet the legislated requirement of meeting the '90,h Percentile Response
Tim& from 1996, as stated in the Ambulance Act, Leeds Grenville EMS needed
to increase the number of on-site, staffed hours at the stations which resulted
in the need to hire more full-time paramedics (33 paramedics in 2000 to 49
paramedics in 2001). By having the paramedics in the stations on a 24 hour
basis, this has effectively eliminated the ten (10) minute time period that was
previously permitted to allow the paramedics to report to their station so that
they could respond to a call in the un-staffed hours.
a result of the increased staffing hours and full-time paramedics, the
associated costs also increased (i.e. wages & benefits, uniforms, training,
etc ... )
the ambulance service was downloaded, Leeds Grenville EMS received the existing
fleet of ambulance vehicles from the Ministry of Health. Some of the ambulance
vehicles were due to be replaced (due to the age of the vehicle and the high
mileage) by the Ministry of Health, Emergency Health Services Dept., prior to
the download. However, as a result of the download, Leeds Grenville EMS was now
responsible for the replacement of these vehicles.
addition to receiving the aging ambulances, Leeds Grenville EMS also received
some medical equipment that needed to be replaced (specifically defibrillators)
because they were at the end of their five year life-cycle and were requiring
constant repair and maintenance.
Initially, the Ministry of Health was to fund 50% of the cost to replace
the defibrillators. We have subsequently submitted an application to the
Ministry of Health to receive partial funding for this equipment.
are significant differences between the operational and capital costs of the
service today in comparison to the services that were in operation prior to
2001. In the previous services, the Ministry of Health covered the cost of
providing such items as new vehicles (on an as needed basis), medical
equipment, and drugs. Other items such as insurance, WSIB, benefits,
professional services, rent/utilities/supplies for the stations, vehicle
repairs & fuel, and paramedic uniforms were all partially funded by the
Ministry of Health. However, since the downloading of the ambulance service,
Leeds & Grenville is now responsible to cover the majority of the cost for
the volume of calls has increased by over 2200 calls (23.9%) from the year 2000
to 2001, which has contributed to increased fuel consumption and repairs and
maintenance for the vehicles.
Q. What is the 90th Percentile Response Time" and
how is it different from the "Average Response Time"?
The 90th Percentile Response Time is a legislated requirement that
was established by the Ministry of Health to be used as a benchmark to measure
the efficiency and effectiveness of a land ambulance service, based on the 90th
Percentile Response Time from 1996. The 90th Percentile Response
Time is a calculation to determine the amount of time with which an ambulance
service must respond to an emergency call (i.e. Code 4 calls only), 9
out of 10 times. The calculation is based on a numerical sort of the response
times for all Code 4 calls (life threatening), from the shortest to the longest
response time. The longest 10 percent of the response times are eliminated from
the calculation and the response time for the call at the 90 percent mark will
determine the 90th
Percentile Response Time.
example, an ambulance service has performed 1000 Code 4 calls in a year. The
response times for these 1000 calls are sorted from shortest to longest, with
the longest 100 calls removed from the calculation. Call number 900 was
responded to in 18 minutes and 32 seconds. Therefore, the 90th Percentile Response Time for
this ambulance service would be 18:32 (mm:ss).
1996, the 90th Percentile Response Time for the services within
Leeds & Grenville was 17:45 (mm:ss). In the subsequent years, from 1997 to
2000, the ambulance services in Leeds & Grenville were unable to meet the
time established in 1996. However, in 2001, Leeds Grenville EMS was able to
meet and exceed the 1996 90th Percentile Response Time with a time
of 17:26 (mm:ss).
90th Percentile Response Time differs from the calculation of the
Average Response Time because it uses only Code 4 priority calls (as explained
above), whereas, the Average Response Time is calculated by utilizing all
calls, regardless of the priority. In 1996, the Average Response Time for the
services in Leeds & Grenville was 13:43 (mm:ss) but in 2001, the Average
Response Time for Leeds Grenville EMS had improved to 10:00 (mm:ss).
Q. If the ambulance in my community is busy on another call, what
level of emergency care can I expect to receive?
A. When an ambulance is committed to a call for an extended period
of time and their response area does not have any immediate ambulance coverage,
all available ambulances and resources are re-deployed to provide balanced
coverage. In addition, your local fire department may be requested to respond
with fire department personnel trained in Emergency First Response, including
defibrillation and oxygen administration.
Q. If I need to call an ambulance to come to my home (or
business), will I receive a bill?
A. If someone is transported by ambulance to the hospital from
their home or business, they will receive a bill from the hospital for $45.00.
One third of this amount is sent to the Ministry of Health and two thirds goes
to the hospital where the person received treatment. Leeds Grenville EMS does
not invoice any patients and does not receive any monies from the
hospital for providing pre-hospital care. If a patient is being transferred
from one facility (i.e. hospital, nursing home, etc. ) to another via an
ambulance, there is no charge.
Q. What happens if I have a complaint about the service I received
from Leeds Grenville EMS?
A. If you are not satisfied with the level and/or quality of care
that you or a loved-one has received when using the services of Leeds Grenville
EMS, you should contact our headquarters office immediately (613-341-8937) and
ask to speak to the EMS Divisional Chief of Operations. The Chief of Operations
will document all the details that you are able to provide regarding the
incident and an internal review and/or investigation will be undertaken.