EASTERN HEALTH BRIEFING NOTE October 23, 2020 Page 1 of 8 Title: Resources required to maintain operational standards in Eastern Health service. Issue: Continuous increases in annual call volumes have left the Metro Ambulance Service dangerously understaffed and unable to meet call volume demands for both emergency and non-emergency responses. Staffing and Statistics: Currently, the in-year call volumes for the Metro Ambulance Service (MAS) is tracking consistent with our average three-point-four percent (3.4%) year over year call volume increase over the previous five years. MAS call volume for 2020/21 FY will record an estimated 27, 589 calls, representing an increase of approximately 3.2% from our 2019/20 call volume of 26,728 calls. In 2015, the Pomax report recommended the addition of ambulance resources in three phases. Their projections at that time, predicted that we would need to add three-24/7 additional ambulances into the system by 2020, representing an additional 26,208 unit-hours per year added to the system. (3 units x 24hrs x 7days x 52 weeks). In 2015, 8,528 unit-hours per year were added to Eastern H Paramedicine and Medical Transport (EH PMT) resource base. This enabled EH PMT to add additional ambulances (24 ambulance hours on weekends, and 140 ambulance hours Monday to Friday) to bring the System Status Plan (SSP) to its current configuration. (Appendix A). With the addition of the above referenced 8,528 unit-hours added in 2015/16, the net additional estimated Pomax-predicted unit-hours required to meet demand by 2020, based on a 2.5 % per year call volume growth rate, would be adjusted to 17,680 additional unit-hours by 2020. The addition of the CAD and its customized reporting ability, has enabled managers of EH PMT Program, to quite easily compare our call demand against our resources and our Unit-Hours￾Utilization (UhU), (Appendix B), which shows the hours a crew is assigned to a call (emergency and non-emergency) per shift. UhU reports on the time when an ambulance is assigned to an October 23, 2020 Page 2 of 8 actual call. It does not reflect the travel time to get to a station or post in the city, nor does it capture the time used to clean or restock the Ambulance post call. UhU is calculated by dividing the number of transports by the number of "unit-hours," with one unit-hour defined as a fully equipped and staffed vehicle in your EMS system. National practice standards of operation indicate that an average UhU should range between 0.35 to 0.45. UhU indices less than 0.35 are indicative of possible overstaffing, while more than 0.45 indicates likely understaffing for the call volume being managed. Studies show that services running crews at or above 0.45 will see an increase in sick use, increased burn out and time loss due to mental health issues and higher than average injury claims. The CAD evidence proves that the UhU for working Paramedics are at or well above 0.45, even when including the additional units up-staffed above our SSP levels, to help meet demand when call volumes and waiting transfers are greater than our staffing levels, for the time of day. CAD evidence also reveals that off load delays in the Metro Hospitals are resulting in the effective loss of one -12 hour ambulance every day of the week (Appendix C) and that if we (Appendix D and E). As it stands, our data shows that we had 2022 occurrences over 12 months, whereby we had no ambulance available to respond. With the addition of the required unit-hours outlined above, along with; the Paramedics providing Palliative Care (PPPC) pilot program, predicted to remove 800 to 1000 911 calls per year and diverting these calls from the Emergency Department, and the addition of a Non- Medical Transport Service, with potential to remove 3000 transfers, it is plausible that operations could fall back into a reasonable demand and workflow, enabling us to meet our response standards at the 90th percentile of our call demands, ensuring a workflow whereby units and call demands are back in alignment, and the UhU would come back within national standards targets of 0.35-0.45. October 23, 2020 Page 3 of 8 Prepared by: Michelle Breen-Director Paramedicine & Medical Transport Eastern Health Approved by: Kenneth Baird- Vice President, Quality, Process Improvement and Clinical Supports e [ ___| $i (B __in _ 1m .. . < —I $ &, — a=s—_ [ise __|__ amore __| [ise __|__ saoane __| [ise __|__ arose __| |___ NMondaytoFrday ___| [ise ~I oes 2000 — |19—| —— woniay to may —] [ise __|__ oasoane _| |___ Wesiands only ___| ee O 5G — aan _ s om [monran __|__ cecostco __| [z § ( ~ ce — s [impead ___ |__ oxcource __| October 23, 2020 Page 5 of 8 Appendix B- Unit Hour Utilization (UhU) CAD Report (September 1, 2019-Aug 31, 2010) Weekdays Total UhU Weekends National Standard for EMS is 0.35-0.45 Time on calls less than 0.35 indicate overstaffing while over 0.45 ranges indicate understaffing of Ambulances for call volume. Studies show that services running crews at or above 0.45 will see an increase in sick use, increased burn out and time loss due to mental health issues and higher than average injury claims. October 23, 2020 Page 6 of 8 Appendix C- Off Load Delays Report (September 1, 2019 August 31, 2020) 3079.7 hours over a year equals 257 twelve hour shifts or a 12 hour ambulance Mon-Friday removed from the system. October 23, 2020 Page 7 of 8 Appendix D- Metro Unit Not Available (Red Alert) September 1, 2019-Aug 31, 2020 Alert Levels Defined: o Level one no ambulance available at least one Emergency (911) call waiting o Level two no ambulance available at least one Routine call waiting o Level three - no ambulance available no calls waiting 551.7 total hrs equates to twenty three- 24 hour days, with no ambulance available The CAD stamps the number of times we have no units available, for how long and what types of calls (911 or transfers) are waiting in our que at that moment. If we are stamped by CAD as being in level- 2, with ten routines in the que and a 911 call comes in, we will be then stamped as being in level 1 by CAD, but it does not recount the 10 routines that already existed and were counted in the level -2 previously. This is why the grand totals above are different from the summary of non-emergency calls waiting at different levels. October 23, 2020 Page 8 of 8 Appendix E- Metro Call Demand September 1, 2019- August 31, 2020 This is based on 90th percentile. When we have all of our 10 units on duty, we Just to meet the number of 911 calls and transfers that come in per hour 90% of the time. Leaving nothing for peak calls that actually came in per hour of day, above the 90 percentile (shown in RED). Where our units line meet or dips below the green, it signifies that Metro had no units available. This graph reflects the number of calls that come in per hour. It does not reflect the calls that were not completed each hour or how many rolled over into the next hour.