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LEEDS GRENVILLE EMERGENCY MEDICAL SERVICES

Frequently Asked Questions

 

Q.     Who made the decision to increase the level and quality of ambulance service in Leeds & Grenville?

 

A.    1) 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.

 

        2) 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.

 

        3) Individual 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 the system.

 

Q.      How has the ambulance system been improved since being operated by the United Counties of Leeds & Grenville?

 

A.     Previously, 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.

 

        The 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.)

 

        Leeds 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.

 

Q.     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 increased?

 

A.     1) The costs estimated in the original model had to be increased for the following reasons.

        The 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.

 

        The 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).

 

2)    In 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.

 

3)    As a result of the increased staffing hours and full-time paramedics, the associated costs also increased (i.e. wages & benefits, uniforms, training, etc ... )

 

4)    When 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.

 

5)    In 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.

 

6)    There 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 these items.

 

7)    Finally, 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"?

 

A.    1) 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.

 

        For 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).

 

        In 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).

 

2)    The 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.

 

 


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