Candidate Responses on EMS Issues IN ADVANCE OF 2018 WATERLOO REGIONAL ELECTIONS JAMIE MOFFAT Contents Candidate Listing........................................................................................................ 2 Correspondence:........................................................................................................ 3 Responses from Regional Chair Candidates...............................................................8 Response from Jay Aissa.......................................................................................... 8 Response from Jan d’Ailly........................................................................................ 9 Response from Rob Deutschmann...........................................................................9 Response from Karen Redman.............................................................................. 10 Responses from Cambridge Regional Councillor Candidates....................................11 Response from John Florence................................................................................ 11 Response from Helen Jowett.................................................................................. 11 Response from Karl Kiefer..................................................................................... 11 Response from Jeffrey Shaver...............................................................................12 Responses from Kitchener Regional Councillor Candidates......................................13 Response from Elizabeth Clarke............................................................................13 Response from Tom Galloway................................................................................13 Response From Michael Harris...............................................................................13 Response from Tom Hiller...................................................................................... 14 Response from Jason House.................................................................................. 14 Response from Geoff Lorentz................................................................................14 Response from Ted Martin..................................................................................... 15 Response from Fauzia Mazhar...............................................................................15 Response from Kari Williams................................................................................. 16 Responses from Waterloo Regional Councillor Candidates.......................................17 Response from Jim Erb.......................................................................................... 17 Response from Jane Mitchell.................................................................................. 17 Response from Sean Strickland............................................................................. 18 Response from Beisan Zubi...................................................................................19 Responses from Cambridge Mayoral Candidates......................................................20 Response from Doug Craig.................................................................................... 20 Response from Randy Carter.................................................................................20 Response from Kathryn McGarry...........................................................................20 Response from Colin Tucker...................................................................................21 Response from Ben Tucci....................................................................................... 22 Responses from Kitchener Mayoral Candidates........................................................24 Response from Jiri Marek....................................................................................... 24 Response from Narine Sookram............................................................................ 24 Response from Berry Vrbanovic............................................................................25 Responses from Waterloo Mayoral Candidates.........................................................26 Response from Dave Jaworsky...............................................................................26 Response from Kelly Steiss.................................................................................... 26 Response from Chris Kolednik............................................................................... 27 Responses from Wilmot Mayoral Candidates............................................................28 Response from John Jordan.................................................................................... 28 Response from Les Armstrong............................................................................... 28 Responses from North Dumfries Mayoral Candidates...............................................29 Response from Sue Foxton.................................................................................... 29 Response from Martin Harrison.............................................................................29 Response from Wellesley Mayoral Candidates..........................................................30 Response from Joe Nowak..................................................................................... 30 Response from Bernia Wheaton............................................................................ 30 Candidate Listing Name Email Position Jay Aissa Jan d’Ailly Rob Deutschmann Karen Redman John Florence jay@votejay.ca jan@dailly.ca rob@deutschmannlaw.com Redman4region@gmail.com johnflorencenow@gmail.com Helen Jowett helen@mcdonaldgreen.com Karl Kiefer Karlkiefer52@gmail.com Jeffrey Shaver jeffreyryanshaver@gmail.com Elizabeth Clarke e-clarke@live.ca Tom Galloway Tomjgalloway14@gmail.com Michael Harris michael@votemichaelharris.ca Tom Hiller Tjh.hiller@gmail.com Jason House Jasonhouse2018@gmail.com Geoff Lorentz Geoff.lorentz@rogers.com Ted Martin Tgmartin13@gmail.com Fauzia Mazhar Fauziamazhar65@gmail.com Kari Williams kariwilliamswr@gmail.com Jim Erb Jane Mitchell Sean Strickland Beisan Zubi Doug Craig Randy Carter Kathryn McGarry Colin Tucker Ben Tucci Jiri Marek Narine Sookram info@jimerbwaterloo.ca janemitchell@bell.net sean@seanstrickland.com vote@beisan.ca Buddycraig318@gmail.com Randycarter05@gmail.com Ryn.mcgarry@gmail.com contact@votetucker.com Tucci.ben@gmail.com Regional Chair Regional Chair Regional Chair Regional Chair Councillor – Cambridge Councillor – Cambridge Councillor – Cambridge Councillor – Cambridge Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Kitchener Councillor – Waterloo Councillor – Waterloo Councillor – Waterloo Councillor – Waterloo Mayor – Cambridge Mayor – Cambridge Mayor – Cambridge Mayor – Cambridge Mayor – Cambridge Mayor – Kitchener Mayor – Kitchener Myron Steinman Berry Vrbanovic Dave Jaworsky Kelly Steiss Chris Kolednik John Jordan Les Armstrong Sue Foxton 2mdsteinm@gmail.com Martin Harrison info@martinharrison.ca jirimarek2018@gmail.com electnarinesookram@gmail.co m berryv@outlook.com info@davejaworsky.ca kellyisteiss@outlook.com votechrisk@gmail.com john@johnjordan.ca les.armstrong@wilmot.ca Susan.foxton@outlook.com Mayor – Kitchener Mayor – Kitchener Mayor – Waterloo Mayor – Waterloo Mayor – Waterloo Mayor – Wilmot Mayor – Wilmot Mayor – North Dumfries Mayor – North Dumfries Repli ed Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Joe Nowak Bernia Wheaton Joebarb.nowak@gmail.com Bernia.wheaton@gmail.com Mayor - Wellesley Mayor – Wellesley No Yes Correspondence: Here is a copy of the correspondence that was sent out to all candidates in both regional and mayoral elections: Hi , I'm wondering if you have any considerations about our region's Paramedic Services. In the name of full disclosure - I am married to a paramedic in the region. However, you will see below that the problems I am observing are based on statistics and publicly available information, not anecdotal experience. I am happy to discuss the ins and outs of these numbers - I have spent a fair amount of time studying them now. I am a CPA, as well as have an MBA - statistical and business case analysis, as well as strategic planning, are firmly within my wheelhouse. I am happy to answer any questions as to the importance or meaning of the numbers I present below. And finally - I am sending the same correspondence to all candidates, and will likely provide the responses to the union and professional associations that represent paramedics in the region for voting information purposes. Paramedics and their extended families number in the thousands inside Waterloo region, and that pales in comparison to the greater public's well-being, which is honestly at stake. I'll try to provide you with some food for thought based on the information I have available to me. It speaks to an opportunity for strong leadership to make an impact: 2016 Ontario Municipal Benchmarking Report: http://mbncanada.ca/app/uploads/2017/11/ems_2016.pdf unfortunately this is 2016 data 2017 gets published Nov 1, but there are some important takeaways: First, you will see that we are actually comparatively lucky in terms of call volumes - we receive on average 84 unique responses per 1000 population, vs an average (adjusted to remove the highest and lowest data points so that Thunder Bay's number doesn't skew it way up) of 119 - so we could reasonable expect our medics to get up to 40% busier as the population ages - we are lucky in this regard. You will also see that our region has the lowest performance in terms of KPIs across Ontario especially in the key area of # of in-service ambulance hours per 1000 population - 219 vs an adjusted average of 377. Here's a picture - it's not pretty: The final 3 pages of the report show a lot - we have the slowest response times for CTAS1, Sudden Cardiac Arrest, and CTAS2-4 calls. Particularly bad for arriving within 6 minutes for sudden cardiac arrest: All of our time targets are determined by the Region, with the exception of Sudden Cardiac Arrest and CTAS 1. For now, I will put aside the fact that all the time targets have been extended by at least a couple minutes since initially being set in 2007 - due to an inability to achieve them, likely due to a lack of sufficient resources. I want to focus on why the 6 minute mark is so critical: after 6 minutes without oxygen, the brain starts to experience permanent damage. This means that the downstream effects of each call are worse. It is hard to consider the impact this has to families, who are already reeling. The economic drain and personal cost of arriving late to these calls can hardly be overstated. It can literally be the difference between someone's Dad or Mom being able to recover and take care of themselves vs having to be spoon-fed or put into a long term care nursing home, at the cost of thousands of dollars per month. Statistically speaking, you are most likely to end up with permanent brain damage if you enter sudden cardiac arrest in Waterloo region, vs any other place in Ontario. There is nothing to be proud of in that. Our goal in these cases is to arrive within 6 minutes, 50% of the time - not exactly the highest bar, given the consequences. You'd think we would want to aim for a more consistent response time. The graph above illustrates how far behind our peers we are in this regard. It is only a lack of willingness to invest in our Paramedic Service that makes this the case. When we have anywhere from 20 - 50% less in service ambulance hours than any other service, is it any surprise when our response time performance is correspondingly worse as well? ROW 2017 Paramedic Services Performance Measurement Report: This was the most recent performance measurement report I could find online - I have requested the report for the first 6 months of 2018, and will update if/when I receive it: https://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans-Data/Public-Health-and-EmergencyServices/ParamedicServices_PerformanceMeasurement_Q4_2017.pdf ROW Paramedic Services 10 year Master Plan, 2017-2027: Here is a link to the 10 year master plan, for reference: https://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans-Data/Public-Health-and-Emergency-Services/PSV_MasterPlan.pdf Here are the main issues: Call Volume Growth: The 10 yr strategic plan assumed vehicle annualized response volume increases of 4.82%. The 5 year average growth rate as of 2016 was 6.59% - this is a recipe for trouble. When I ran the numbers out 10 years of an average growth rate of 6.35% over 4.82%, I ended up with a shortfall of 16,000 calls, or 8 full time ambulances, equivalent to 33% of 2016 response volumes. 2017 only made matters worse - an increase of 8.6% - almost double what was expected in the 10 year plan. The plan predicted 46.9k calls in 2016, with steady growth up to 59.2k calls in 2021. Reality was 48.6k calls in 2016, up to 52.8k in 2017. If we continue to add 4.2k calls per year, by the time we hit 2021, we are looking at 69.6k of calls in 2021 - over 10,000 more than our plan expects. Are you expecting growth in Waterloo region to slow down? Because, if not, we are looking at being woefully underprepared for the influx of calls. Unit Utilization: Unit utilization is the main determinant of our region's ability to respond to incoming calls. Our stated goal is to maintain a level of 35%. From the Master Plan: “Experience shows that response time and UU are directly related. Paramedic services that operate at high system-wide UU, typically have little or no capacity-in-reserve to address overlapping calls or external impediments (e.g., hospital offload delay), and their response times are relatively lengthy. Conversely, paramedic services which operate at low UU, typically have relatively large reserves of capacity (by design), and their response times are more rapid. Experience also shows that it is undesirable to operate above an annualized system-wide UU upper threshold of 40% for an extended period. In addition to lengthy response time, a diverse impacts potentially include frequent/costly vehicle maintenance, frequent overtime, increased stress and labour concerns. Leading practices would suggest targeting to a lowe UU(potentially 30% to 35%), as this would contribute to: more optimal operations (vehicle use, overtime, labour), fewer response delays and more rapid response times. According to MBNCanada data, the annualized system-wide UU for most peer EMS services ranges between 25% and 40%.” Reading that, you can see how important it is. In 2017, our unit utilization rose from 38.8% up to 39.3%. A quick note - here is slide 10 from the 2016 Performance Measurement Report (https://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans-- Data/Public-Health-and-EmergencyServices/2017ParamedicServices_PerformanceMeasurement_Q4_2016.pdf) The 2017 report does not include this information - seems odd to stop reporting in detail on the key metric that you have identified as determining your success. I am only left to conclude that it doesn't tell a good story. In this slide, you can see that historically, the hours of 2-6 AM have below average unit utilization. If you discount 2am to 6am, the slowest times of day, our average unit utilization rate rises well above 40%. According to the ROW documents, including the master plan and annual performance reports, UU of 40% is a recipe for code red coverage, overtime, and employee burnout. As a secondary indicator, I have asked how much we paid out in missed lunches and overtime, but no one has wanted to provide that information. Expanding the service would increase our region's efficiency and reduce these wasted costs. To make it worse - this is not a statistic whose average matters. It is a statistic whose peak matters. If you average 35%, but for 4 hours of the day you are running at 45%, for those 4 hours people are dying due to your inability to respond effectively. It is hard to overstate the significance of that. Also factoring into this - based on the conservative growth model the 10 year plan uses, to attain a Unit Utilization rate of 35% would require 37 vehicles (in the high growth forecast, whose estimates have also been surpassed by reality, it is 39 vehicles). Per the About Us on the Paramedic Services website (https://www.regionofwaterloo.ca/en/living-here/paramedicservices.aspx), we currently are operating 37 vehicles, including 31 ambulances and 4 emergency response units - who can treat but not transport. One reason we are so far behind planned performance is because the plan is calling for 37 ambulances. Supervisor, Administrative or other vehicles don't count. The other reason is because our actual call volumes have far exceeded our forecast - a full time ambulance can field 2,000 calls per year. Growth of 4k calls per year requires an additional 2 ambulances per year to maintain performance - and we are still in a position of needing to catch up. Response Times: Operationally, our paramedics are doing well - improving performance for stroke patients, return of circulation and achievement of the STEMI protocols. Our paramedics know what they are doing. But we are selling them short by not providing adequate resources. Slide 14 from the 2017 report illustrates it well: Yes, there have been improvements year over year - we are moving in the right direction! But you will see that in most of these areas we are barely achieving our targets, and in arguably the most important - defib response in 6 minutes or less - we are well behind. Only 44% of the time will paramedics arrive on scene within 6:25 seconds. It would be interesting to see what % of calls we actually achieve the 6 minute response time, alas, no one is willing or able to provide me with that information. I can only imagine how frustrating it must be for the paramedics who try their best day in day out to see their best efforts hindered by a lack of resources that every other region in the province seems to understand the need for. I understand that this may be a little deeper into the numbers than you normally go, possibly the first time you've seen them - and I know we are all doing the best that we can, with what we have. But I hope you are seeing the need to give more to our medics so that they can do better for the rest of us - it's not for a lack of effort! Another avenue of investment would be switching to mechanized stretchers, as many other services have done - this tends to have a number of positive benefits for service, including less workplace injuries, keeping our well-trained medics on the road longer. Luke would probably have a much better idea of the benefits involved with that - just seems to be the direction that most services are going. I hope this has opened your eyes regarding the state of affairs of Paramedic Services in Waterloo Region - I am very proud of all the many wonderful things our region has to offer! It is just hard to reconcile that pride with our current performance and investment in our public health, via Paramedic Services. I am very interested in your thoughts on the matter, and how the points I raised have made you feel. All the best in the upcoming election, . Jamie Moffat Responses from Regional Chair Candidates Response from Jay Aissa September 21, 2018 Dear Jamie, I want to thank you for your email dated today, September 21, 2018, regarding our Region’s current level of support to our Paramedic Services, your analysis of where things now stand and where future pressures on our Paramedic Services will leave us moving into the future unless measures are taken to address the issue. At the outset, I want to congratulate you for the excellent work you have done and for the detailed research that you have articulated in your presentation. I can assure you that I too have conducted some research in the area that I classify “First Responders” which, of course, includes our Paramedic Services. I can assure you (and thank you at the same time) that your research, analysis and conclusions are much more in-depth than mine. Never the less, you and I have come to similar conclusions, and I would very much like to make a few general comments. I invite you to visit my website at www.votejay.ca and you will see that I have focused my campaign for Regional Chair on three (3) specific issues. Those issues are 1. A new, high-tech teaching hospital for the Region of Waterloo 2. A new Master Transportation Plan for the Region of Waterloo, and 3. Enhanced staffing, equipment and personal professional medical support for our First Responders I believe I am the only candidate for Regional Chair who has publicly stated such a clear and bold set of policy positions from the very beginning of this campaign. Please rest assured that all our First Responders have my support and thanks, and when elected Regional Chair, I am committed to providing that continued support. I share your concerns. I am a business owner, and I employ over 70 people. I have lived in this Region since 1982. Like all residents, I have depended on our First Responders for immediate medical assistance, timely transportation to a medical facility if needed, protection against fire and protection of my person and property against crime. If you will allow me to quote from my public website, “Our First Responders, be they our Police Force, our Ambulance Service, our EMT’s, and anyone else who is involved in law enforcement or disaster control or relief, are the heroic public face of our Region”. I believe that to be true. Without exception, all our First Responders put themselves at physical and mental risk every day, and they do deserve our respect and financial support. By financial support I mean that this Region must put more financial resources into staffing and equipment with the aim of reducing call times and lessening both the physical and mental stress being experienced by our First Responders every day. When elected Regional Chair, I am committed to ensuring our First Responders are properly financed and staffed. I am also committed to ensuring our First Responders are given the equipment they need to do their jobs, and I am committed to ensuring our First Responders are given access to any and all support programs and services they may need to assist and provide care in their time of need. To be clear on this point, I am talking about support for those who suffer PTSD and other physical and mental ailments. Again, thank you for your email. If you have any further questions, please don’t hesitate to contact me. I will be only too happy to respond accordingly, and I’m also more than happy to meet with you and your group during the campaign. Jay Aissa P.S> Jamie, I’d like to post this open letter on my website, but before I do that, I’ll wait to hear from you. This is a matter of public concern, and my response to your letter will become a matter of record. I’m looking forward to hearing from you. Response from Jan d’Ailly I responded to Jan, pointing to the comparatively fewer number of medics and ambulances, as well as suggested looking into the HeadStart technology that has been adopted by Niagara region. Response from Rob Deutschmann Hi Jamie, Thank you for this information. When I was a Regional Councillor from 2010 to 2014 we had access to similar information comparing our performance on a number of metrics with other communities. I had always remarked that we were the lowest funder of emergency medical services then on a per capita basis and I did not agree with that. I sat on a committee that examined our EMS and what we can do to improve. My view then, as it is today, is that we need to invest more and also continue of find efficiencies, especially with respect to offloading. You have identified some other forms of efficiency and that should be noted, but I believe additional investment and the off loading delay are two of the biggest obstacles holding us back from having the type of EMS service that our community should have. I would refer you to my website www.robforchair.ca where I have clearly stated in my policy reflections and in my Policy Statement about safety in our community that we need to invest more. No need to convince me about how we are not doing the best we can. I believe we can do better. I have the conviction to advocate for the increased investment. The most important role of a politician is to ensure safety in our community. That means ensuring that we have adequate EMS and policing services to properly serve our community. At this time we do not. Thank you again for you very informative email. As Regional Chair I would be pleased to follow up with you on this. I think our community benefits when we tap into the knowledge of community advocates such as yourself. Feel free to pass on my comments. Regards. Robert Deutschmann Response from Karen Redman Karen Redman Oct 11, 5:46 PM Thursday Jamie, with apologies for the delay, I assume there is no survey just looking for comments? The Paramedic team do a great job providing service to residents of Waterloo Region. You make us safe. Your service makes us proud. I was in attendance at the Kitchener Fire Fighters memorial this fall and was pleased to see first emergency responders acknowledged. The profession you have chosen is not merely a job, it is a life style for you and your families. When considering the impact of off load delays throughout the system, it is important to acknowledge many factors contribute to this bottle neck. Factors such as repeat callers to 911, lack of staff to process patients at the hospital, people with mental illness, isolation, family breakdown, alcohol and drug addictions. In order to address these contributing factors, there needs to be a multi-pronged approach to providing the necessary supports for Paramedics to do their job and overcome these hurdles. To address the call volume growth, there has been an outreach/education program launched for everyone who calls 911 four times or more during a year. The strategy to provide education and support that may better suit their needs in a more cost effective way rather than clogging up emergency services Offloading patients is identified as another bottleneck. Providing a dedicated health professional to triage patients arriving by ambulance would help alleviate some of the backlog. However, there is a lack of beds in which to move patients who are to be admitted. There are some best practices from which the Region can learn in other Municipalities. Governments measure what they value and change what they measure. This is why the stats on Performance indicators, reports on additional equipment required, personnel compliments and CTAS matter. The growth of calls, the ability to service the townships, combined with the ageing of our population make a compelling case for continuing to invest in our paramedic services and monitor the implementation of long term plan as part of the annual Budget cycle to meet increasing need. Thanks. Responses Candidates from Cambridge Regional Councillor Response from John Florence John Florence 2:34 PM Friday Oct 12, Jamie initially looking at your email several weeks ago...Over the last 2 days I’ve completed a review of the very detailed stats & graphs you sent me re the Current State of “OUR” Regions Paramedic Services Wow we REALLY NEED to roll up our collective sleeves & get MOVING FORWARD on HEALTH & SAFETY ISSUES ...The John Florence Team this election has been emphasizing just that; SO WAS I SHOCKED..I’d say so; but surprised..Not really. CHANGE is NEEDED at all levels of Municipal Govt & Obviously in “OUR” Paramedic Services..This City & this Region needs to BETTER PRIORITIZE its Spending of Tax Payers ..hard earned money. Jamie I don’t believe You or Your DEDICATED Workers need to review another Political Hopefulls Survey Submission .. What you’re really looking for & the Region Requires: is COMMITMENT to MOVE FORWARD on New & Adequate Equipment, more Personnel,& Existing Staff Professionally Compensated. etc YOU GUYS are the PROFESSIONALS & IF your Team helps to SELECT John Florence as 1 of your 2 choices. To Represent Cambridge at the Region Then We. Will meet ...Prioritize YOUR GOALS & work Together Over the next 4 years to MAKE IT HAPPEN with the WIN WIN result of a More Secure & Healthier Waterloo Region . Yours Sincerely John Florence & ps Jamie Please Feel FREE to Attach this email in full to the package You are providing your membership ..Thanks again for your dedicated & sacrificial services you provide “OUR” Region. Response from Helen Jowett Dear Mr Moffat, Thank you for taking the time to connect re your concerns. Im sure you can appreciate that as representatives of our the entire community, it is important for us to balance the needs and wants of many. As an HR professional I am also aware that interference with contract negotiation can be problematic. I will continue to consider your commentary as Paramedic service information is presented to council. Thank you Helen Jowett, CHRL, MBA Regional Councillor, Cambridge Response from Karl Kiefer Karl Kiefer 9:29 AM Wednesday Oct 10, Hello Jamie! Thank you for your very detailed and informative email. Sorry for my slow reply as it has been a” little “ busy lately. Having said that, I will certainly be open to review and look for opportunities to improve and strengthen our Paramedic Services in the Region. It is good to have and follow a ten year master plan but there needs to be flexibility to “fine tune” or make adjustments where and when required. I will be asking staff and my elected colleagues to address the concerns and suggestions that you have shared. I like you and many others, am proud of our Paramedic Services in our Region and I have I will always work for improvement and sustainability. Regards, Karl Sent from my iPhone Karl Kiefer Regional Councillor - Cambridge Response from Jeffrey Shaver Jeffrey Shaver 3:28 PM Sunday Sept 23, Sorry for delay. I have to admit that not to much thought has gone into this area but I am aware that persons are constantly working overtime leading to fatigue and now you have pointed out the information about us missing the critical 6 min mark. I am a supporter of additional mental health services that might help reduce some mental health related callouts. I would support additional ambulance services to help get that average down. Responses from Kitchener Regional Councillor Candidates Response from Elizabeth Clarke Hi, Jamie Thanks for your email. I recall we've spoken in the past. I believe we're making progress, but know we're still not meeting our Paramedic Master Plan targets in terms of response times or unit utilization rates, and we do need to do much better. We've added two ambulances in 2018, and we added three in 2017, but our aging population, persisting offload delays, and problems with the provincial dispatch system (which ranks too many calls as life threatening) continue to create real challenges for our Paramedic Services. As you know, we've recently added a new Community Paramedic Program to divert some unnecessary calls, and are continuing to lobby the Provincial government for dispatch system changes. Our new Maple Grove station, opening in 2019, will give us bases in the north and the south, which should improve our average response rates. But I know that if we are to meet our PMP targets, continuing monitoring and investment by Council will be needed. Thanks again for your email. Elizabeth Clarke Response from Tom Galloway Tom Galloway 11:38 AM Monday Sept 24, Jamie, thanks for your detailed message. There is no doubt more resources are necessary and the EMS Master Plan is our guiding document in that regard. Most every year additional resources have been added and that is likely to continue. Council takes most of its direction from the Chief and the Medical Officer of Health. They are the professionals Council relies on. I am sure if we veer far from the Master Plan, I believe we will hear from them. As you know, Council continues to invest in Capital infrastructure for EMS with the $20 million new HQ state of the art facility. Thanks again Response From Michael Harris Michael Harris 12:15 PM Friday Oct 12, Jamie It was a pleasure chatting with you in greater detail about your collection of data as it pertains to the state of affairs for our Paramedic Services here in the Region. As a former MPP, I constantly elevated the issue of Ambulance response times in our region especially in the townships. One of my projects was to push the Gov't for the region to take over the dispatching from the Province just like Niagara, Toronto, Ottawa and Muskoka. The incident at the Regional Airport was the catalyst for the working group chair by retired police chief Gravill that the province would not participate in. In addition the govt at the time would not disclose the report that evaluated the Niagara pilot project and showed how using new predictive technology and regionally operated under one roof with other emergency services would enhance response times. see link to one of the stories here https://www.thespec.com/news-story/2604490-province-not-keen-on-unified-911dispatch/ Clearly the numbers you have put together warrant a better explanation and a deeper dive when it comes to the master ems plan. If elected you have my commitment to ask the important questions and be a strong advocate and continually push for better response times. Regards, Michael Harris Response from Tom Hiller Tom Hiller 6:27 PM Thursday Oct 11, Hello Jamie, Thank you for following up with this, it was a pleasure to be able to talk with you directly. I recognized a distressing situation immediately upon review of your initial email but let those thoughts simmer instead of immediately replying. I apologize. You've done good work with this, and though 2017 data has not been available, you are right that it is unlikely to show a remarkable turn for the better. Obviously I would like to also review input by Regional staff and hospital administrators but it is clear that resource funding has much more than lagged increasing demand for paramedic services. Addressing this has to be placed as a top priority for the incoming council. The 2017 data, available in early November I am certain will only confirm this urgency. The metrics indicate that we are seriously vulnerable to increased mortality and morbidity if we do not act. Further, the stresses place upon staff with such high unit utilization rates at peak times threatens workforce health which alone carries a huge cost liability. Increasing funding / resources to regain a semblance of control over these critical services would seem to be a moral imperative. It would be among my uppermost priorities and I would act on it at the first opportunity. Yours truly, Tom tomhiller4waterlooregion.weebly.com TJ (Tom) Hiller Response from Jason House Jason House 21, 10:52 AM Friday Sept My son is in Grade 12 and is pushing forward to becoming a Paramedic. To say I support the Paramedic Services goes without question. The current council thinks it's funny to build an LRT route straight in front of a major hospital. That's the intellect we in this city are dealing with here. Paramedics are in a lot of ways more important than the hospital itself. They stabilize and secure patients long before ever reaching a hospital. Their front line experience is invaluable compared to hospital funding. I've seen first hand how our hospitals operate. My son had an emergency appendectomy. Not one nurse would wheel my son down to the surgery room. They all stood around and instructed the Janitor lady to do it. She'd only been on the job for 2 weeks and had no idea where the surgery room was. So I told the nurses off and pushed my son's bed and IV trolley myself until I found the Surgery room myself. Everyone there acts like it's someone else's job, a lot of entitlement going on. Paramedics I've seen in action though, they are the actionable services and that I admire and give respect to. I'm all for getting things done and done right. Less talk more action would best describe me. So yes I would wholeheartedly support greater funding for Paramedics and the Police for that matter. That's a separate issue altogether. Response from Geoff Lorentz Geoff Lorentz 3:06 PM Thursday Oct 11, Sorry Jamie, this is a busy time at my other job. You and I have been down this road before. I can commit to say that if re-elected I will ask that we take another look at Paramedic Services. There are a lot of factors that are at play, we are still waiting for the Province to sign the legislation to allow paramedics to triage patients and reroute to emergency care clinics etc. Instead of hospitals. We are also starting a program called paramedicine, where we are encouraging chronic 911 callers to try doing things differently as well as the new facility is under construction which will give us more capacity and options for additional vehicles. I value and understand the difficulties of the job and will work with Council and staff during budget meetings if I am still there to see if there is anyway to accelerate the findings in the master plan. I have meet privately with the local executive in the past and would be happy to do that in the future. Just for a bit of History, when I first was on Regional Council in the 90’s. Regional Council has to make a decision to bring our Ambulance service into the Region as employees or to continue with a private contractor. I fought to have the service as Regional employees and was able to convince the council of the day to do just that. We have come along way since then. Thanks for your interest and concern. Cheers, Geoff Lorentz geoff.lorentz@rogers.com www.geofflorentz.ca Response from Ted Martin Hi Jamie, I want to thank you for sending this very detailed analysis. I am big on data-based decisionmaking and continuous improvement, so the facts and figures you have provided will definitely help me drill down more than the surface-level comments I have on my website (on www.tedmartin.ca under Change, I have a little blurb on Paramedic Response). Your statement about the economic drain and personal cost of arriving late to these calls is particularly eye-opening: It can literally be the difference between someone's Dad or Mom being able to recover and take care of themselves versus having to be spoon-fed or put into a long term care nursing home, at the cost of thousands of dollars per month. (If you are okay with it, I wouldn't mind adding a sentence like that to my website to help drive the importance of this issue home for others.) I find it unacceptable that a person is most likely to end up with permanent brain damage after a sudden cardiac arrest in Waterloo region than any other place in Ontario. (I modified a sentence on my website to capture this.) And I expect that your analysis that unit utilization is the main determinant of our region's inability to respond to incoming calls is absolutely correct. I do believe that paramedic response times is a key issue facing our region and is, perhaps, the most important area where increased funding is needed, and likely a lot of it. I think we need -- and your data supports the need -- more paramedics, more vehicles and probably a building to house them. I realize my response just scratches the surface, but I trust you can see that I do appreciate your facts and figures, and agree with your conclusions. Perhaps we could arrange to get together to talk about this some more. Sincerely, Ted. Response from Fauzia Mazhar Fauzia Mazhar 5:18 PM Tuesday Oct 9, Hello Jamie: Thank you for your informative email. My apologies for the delay in responding to you. I had marked your email for reading later when it arrived but as you can imagine my email is handled with more than one person at this time so it got unmarked at some point. Last week's reports on off-load delays reminded me of your email. I found it in my inbox this morning and just finished reading it. It is unfortunate that our region is falling behind in one of the most important areas. Current wait times are unacceptable. I like the idea of mechanized stretchers. Investments in paramedic services is definitely very important. Thank you for bring this matter to my attention. Sincerely, Fauzia Mazhar Response from Kari Williams Kari Williams 12:52 PM Wednesday Oct 10, Hello, Thank you so much for all of the information. I was aware of some of it, but it definitely is eye-opening and I appreciate all the research you have shown. I know there is a need for improved service in the region. With a growing and ageing population, as well as an opioid crisis, there will be a growing need for improved and expanded EMS services. I understand that this is only one piece of the puzzle as well. I'm quite alarmed at the response times for cardiac arrest. It also bothers me that during large events and the Ezra street party, we run out of vehicles. I know we can do better and anticipate the times where they are at capacity to prevent being in the red. I want to be on council because I can work to provide innovative solutions issues such as this. Improving the housing situation, harm reduction, understanding our changing environment and its impacts, and fully reviewing statistics to anticipate future needs will work together to reduce pressure on the system and hopefully improve response times. I took statistics in both my undergraduate and graduate programs and I think it is so important to have these numbers to provide concrete examples of issues and how we can find solutions. I will be interested to see the updated numbers as well. If elected to council I will work to improve and expand services and reduce strain on our EMS workers. I will try to correct the areas that are limiting them from providing the excellent service they are capable of giving. Thank you for contacting me and giving me the opportunity to share my ideas. Please let me know if you have any follow up questions from my answer. Responses from Waterloo Regional Councillor Candidates Response from Jim Erb Jim Erb Oct 13, 12:17 AM Saturday My response will be more general in nature rather than responding to specifics raised in your email. My comments come from my volunteer work a number of years ago as a member of Citizens for Better Government (CFBG) and subsequent reading and community involvement. CFBG spent two years reviewing and recommending how our municipal government in Waterloo Region could be more responsive the residents it serves. Emergency services were one of the key areas we reviewed. There are no question front-line workers are feeling overworked and underfunded. The Paramedic Services Master Plan prepared for the Region in 2016 highlighted that EMS demand is increasing because of an aging population. The report concludes that additional resources are required to reverse the declining level of service front line workers are able to provide. More staff, vehicles and additional technology are all required to take the pressure off our current system. One of the solutions I see to addressing the current concerns is to consider a big picture response. Would there be value in working with the Provincial Government, the Region of Waterloo and the Waterloo Wellington Local Health Integration Network to eliminate the bottlenecks in hospital emergency rooms? Currently ambulances get backed up waiting for emergency room staff to accept patients. Sometimes there are four or five ambulances and their attendants waiting for hours thereby unable to respond to other calls. Is one of the solutions to the concerns raised in your email to provide additional long-term care beds and support staff, thereby freeing up to 40% of hospital beds currently occupied by patients who would otherwise be discharged to long-term care facilities? In turn, this would free up beds in emergency departments and permit paramedics to deliver their patient in a timely manner, and then be able to respond to the next call. I think we also need to consider consolidating the Region’s four dispatch centres into one with more modern communication equipment which would increase response times and ambulance efficiency by pinpoint direction to the required location and utilizing the closest ambulance unit(s). From personal experiences, my family and I are very grateful to our front-line paramedics who work tirelessly as part of our health care system. Regardless of funding levels or ideal equipment, they respond to care for people with professionalism, dedication to their calling as health care professionals, often in circumstances that not ideal or routine, and on many occasions, they save lives. They are to be commended for their dedication. Response from Jane Mitchell Jane Mitchell 5:08 PM Friday Sept 21, I was on the EMS master plan planning committee. Some of the recommendations such as the second EMS operations building near the landfill are already underway. I know we need more Paramedics and ambulances if only due to growth. An interesting idea floated by Mayor Sue Foxton is to reduce calls by regular check ups by a paramedic in high call areas like senior’s apartments. This has worked well in Hamilton. Unfortunately, due to serious illness of my daughter and grandson this summer, I have had close contact with ambulances and paramedics. You all have my highest regard in your life saving work. I also know how backed up emergency can be, even though code reds have been reduced. Sincerely Jane Mitchell Response from Sean Strickland Sean Strickland Sept 20, 9:02 AM Thursday Hi Jamie, I have always been progressive in terms of finding more funding for EMS service. I have participated in 3 master plans and each plan has increased the investment in EMS services significantly. Thanks for the email. Sincerely, Sean Sean Strickland Sept 20, 10:22 AM Thursday The last report I saw indicated that our response times were decreasing. Happy to meet with you and Executive to discuss further. Regards, Sean Sean Strickland 22, 2:00 PM Saturday Sept Thanks for all the intel Jamie. I will review in due course (Lots going on right now). Really appreciate your concern and commitment to EMS services in Waterloo Region. Do you have a copy of our EMS Master plan? Regards, Sean Sean Strickland 1:11 PM Friday Oct 12, Hi Jamie, I have reviewed our spending to date on EMS and you will see from the chart that we have increased resources significantly over the past 4 years; spending has increased by $10 million, full time equivalency has increased by approximately 50 people. We have added ambulances, added people and improved service. In the next 4 years our current plans include additional FTE's, ambulances and dollars. I also believe based on the recent numbers that more resources than what our plan currently indicates will be requested. Off load delays continue to be a major problem that needs to be addressed in addition to educating people on when it is appropriate to call an ambulance. Thanks for your interest in the region of waterloo and paramedic services. Sincerely, Sean PS I understand you have requested responses from several regional councillors and I have forwarded them this information as well. Response from Beisan Zubi Beisan Zubi 4:35 PM Tuesday Oct 9, Jamie, Thank you so much for flagging this again for me. It slipped by my attention the first time, but I'm glad this was brought back up because I had no idea about the depth of this problem, but I want Regional Council to look at your issues. I'd love to sit down and meet with the union to get a deeper understanding, but from what I've understood so far, it seems that we need to address this ASAP. Investing in mechanized stretchers seems like a good starting point and also looking at getting more paramedics on the streets (though I assume that's much easier said than done) is clearly needed. I'm very much in favour of targeting health care investments just like these. Honestly, the stats you pointed out make me feel scared. While I'm in good health I've been meeting with a lot of older residents, and knowing how a minute or two is life and death for them makes our current times unacceptable. I know we can do better, and I want us to. I hope this is a good starting point for a conversation and thanks again for following back up with me! Responses from Cambridge Mayoral Candidates Response from Doug Craig Doug Craig 5:58 PM Thursday Oct 11, Jamie, Your concerns were brought up at the Regional table. I let them know that I was unhappy because it was evident to me that we need more paramedics and vehicles. I am still not happy with response times. I'm sorry I couldn't get back to you any earlier because of the bulk of challenges that the campaign is unfolding every day and with my efforts in trying to run City Hall. Mayor Craig Response from Randy Carter Response from Kathryn McGarry Kathryn McGarry Friday Oct 12, 12:52 PM Hi Jamie, Thank you for the opportunity to provide comments on our Paramedic Services in Waterloo Region. I have much relevant experience with our Paramedics. As a nurse for over 35 years, I have worked in Critical Care (ER, ICU, Pediatric ICU, NICU) for most of these years. I have worked as a visiting nurse and as a Care Coordinator for CCAC, now the LHIN. I am on an extended unpaid Leave of Absence for the LHIN. With this life time of experience, I have a unique view of the Paramedic services as a candidate in the upcoming Municipal election. I am running for Mayor of Cambridge. The Mayor, as you are aware, has a seat at the Regional Council table. I believe I will have a lot to contribute in any discussion and decision making process regarding the Paramedic services in Waterloo Region. During the past 4 years, I was the MPP for Cambridge, serving as the Parliamentary Assistant to the Minister of Transportation, then was appointed to Cabinet in June 2016 as the Minister of Natural Resources and Forestry. During this time, I was responsible for the Aviation, Firefighting and Emergency Services for the Province of Ontario. My experience in this role, will assist me, if elected, in having a strong voice for our Paramedics at the Regional Council table. I was promoted to Minister of Transportation and viewed road safety as my top priority as Minister and helped pass the Legislation regarding distracted driving, drug impaired driving and cycling safety. I read the ROW Paramedic Service Performance Measurement Report and other studies. Like many, I have real concerns, particularly for the response time for CTAS1 patients. Early intervention improves patient outcomes. As a Care Coordinator who assessed patients for home services, I have first-hand knowledge of the severe impact of patients with brain injuries from lack of oxygen, to their families and health care system. A CTAS1 response time of over 6 minutes is unacceptable and we need to ensure that measures are put in place as soon as possible, to improve the response time. Our Paramedics are doing what they can but need more support and investment. The mechanized stretchers that some Paramedic Services are using would reduce workplace injuries, and ensure a better work environment. The population growth in Region of Waterloo has outpaced the growth of our Paramedic numbers. I would support investing in additional paramedics and investments in equipment that would assist in achieving response times. The public is becoming more aware of the response times in Waterloo Region and I have had several residents contact me about their concerns. As a Member of the Waterloo Region Crime Prevention Council for 7 years prior to my election in 2014, I worked closely with others to ensure that Naloxone became widely available to our community and First Responders. I was also part of the Council’s committee studying the reduction of barriers to calling 911 during an overdose situation. The Good Samaritan Act that was passed by the Federal Govt recently was partly informed by this work. A model of prevention I would work to implement for our youth is the successful Iceland Model the WR Crime Prevention Council is promoting. The global opioid crisis is overwhelming our communities and our Emergency responders, our hospitals and social services. Our communities face staggering issues, due to the growing and escalating increase of the number of mental health care patients. Nurses, doctors, fire, police, and paramedics have all felt the pressure due to this unaddressed issue. Our aging population and the increase in opioid addicts being among the primary causes of this mental health and addictions crisis. As a province, our healthcare system is stretched to the brink. Our communities face more homelessness and crime as a result of the mental health crisis. The taxpayers’ budgets are maxed, ER wait-times are high. I believe there is a better way to provide Mental Health care in Cambridge. Windsor has a model of delivering this care in a dedicated Urgent Care Clinic for Mental Health, in association with the hospital. There are clear benefits and cost savings to our health care system and our First Responders with this delivery model:         Free up ER beds for true emergencies Increase the number of residents per shift first responders can see Reduce First Responder Cost to Municipality Reduce burnout of hospital staff Decrease wait times Reduce overall healthcare spending Provide onsite Mental Health short term stay beds Provide onsite mental health support programs through existing organizations community As Mayor, I would work with the hospital, LHIN, community service providers, EMS, other levels of Government to explore this model of providing Mental Health services, work to invest in our Paramedic Services in Waterloo Region to improve response times and the quality of work life for our Paramedics and First Responders. Thank you for the work you have done in bringing awareness to this critical issue. Best Kathryn McGarry Response from Colin Tucker Colin Tucker 9:12 AM Good morning Jamie, Friday Oct 12, So what I would like to see and help happen is : Hire more paramedics so as to ease up on the overtime they are currently working. This would make for better safety as paramedics will be really tired from working long hours. They would definitely be more focused if they had more rest and worked regular hours. When they work those hours of overtime they are paid time and a half or even double time. It just makes sense to have them work regular hours. The overtime hours could pay for the extra paramedics needed. This would increase time with their families as well. We need more EMS vehicles as well to cover more areas more efficiently. I would also strategically place EMS vehicles at certain fire halls as to decrease response times. I hope this helps Jamie. If you have to you can reword things a little better . Have a great day, Colin Response from Ben Tucci Ben Tucci 10:48 AM Friday Oct 12, Dear Jamie, I have reviewed the material you have provided Waterloo Paramedic Services website information, thank you. and the Region Of I must say I am taken aback by what the numbers reveal. As you can tell from my finance section of my platform on my website at electbentucci.com, I am a numbers guy. I don’t act on emotion nor do I lead using knee jerk reactions to situations facing us. My preliminary conclusion subject to being elected and asking for an immediate fulsome report at Regional Council, is that the service is under equipped and/or equipped inadequately and perhaps under staffed. All of which may also mean under-funded. I arrive at this early conclusion by considering the following in the 2016 MBNCanada Performance Measurement Report; Dispatch time in Waterloo Region = 4.11. This appears to be 28% slower than the next slowest response time of 3.21 in Durham region. The 28% likely means the difference between life or death, serious permanent damage vs. full recovery in heart attacks or strokes etc. all of which we should not accept. Our tax rates suggest we/paramedics ought to be provided with much better support systems. In service Hours = 219 Waterloo Region ranks last amongst all other Regions for in service hours Response Time Performance standard (within 8 minutes) = 71.7% Waterloo Region ranks last amongst all other Regions in the amount of times the ambulance crew arrive on scene for cardiac arrest or other CTAS 1 categorized events within 8 minutes from the time notice is received (71.7%). Response Time Performance standard (within 6 minutes) = 39.9% Waterloo Region ranks last amongst all other Regions in the amount of times the ambulance crew arrive on scene for cardiac arrest or other CTAS 1 categorized events within 6 minutes from the time notice is received (39.9%). Summary We can and must do better. Improvement does not necessarily mean an increase to funding because it appears we are already spending the money on overtime and double overtime on existing resources. Improvement will need to include a review of the equipment we are using vs. today’s state of art equipment that would help deliver better service with less strain and injury to our existing first responders. That equates to less injury/sick time. Similar to my recommendations for the City of Cambridge, I will lobby Regional Council for a complete review of how we do business on all matters with the following 3 goals in mind. 1. Better and more timely service. 2. Safer communities. 3. More affordable communities. Thank you! Ben Tucci, Mayoral Candidate, Cambridge Responses from Kitchener Mayoral Candidates Response from Jiri Marek Response from Narine Sookram Narine Sookram Oct 11, 10:29 PM Thursday Hello Jamie, Many thanks for including me in this email, much appreciated. Here is what I think: Indeed, based on the stats, I think this is something we must put on top of the radar. It was an eye opener for me for sure. I am more knowledgeable now than I was prior to reading all the stats. Though I knew our paramedics do a good job because I had to use the service in the past for a family member, I didn’t realize how lucky we are to have each one of our paramedics. At this point, I feel that finding ways to prove our paramedic system is crucial, particularly because of the rapid growth in our region. Whether that be sharing of education because I believe learning from each other is a great way to improve quality of care. Investing in innovation is key as well I think, because collaborating in innovation can strongly amplify the impact on emergency care in my opinion. And personally, for me, if elected, I’ll have an open discussion and draw ideas from the paramedic themselves to look for possible solutions to make things better. The one thing we know for sure based on the stats is that there is room for improvement with our paramedic system and this is something I wouldn’t want to be overlooked. Sincerely, Response from Myron Steinman Myron Steinman Thursday Oct 11, 10:48 PM Hi Jamie Moffat, I believe you are concerned about the slow response times for Paramedic Services compared to other Cities. Some questions: 1 Do you recommend increasing the number of Paramedics in the Waterloo Region? 2. Is it possible the nature of the roads may be a reason for the slower responses in Waterloo Region.? For example, many cities streets are arranged in a grid while this is not the situation Kitchener-Waterloo, making travel more indirect and thus slower response time than other cities that are arranged in a grid pattern. 3. Would you recommend the Paramedics and Fire Departments become a Regional level of Responsibility? Grand River Transit is Regional responsibility for example. This may enable a more geographical and coordinated response? 4. I am concerned about the connection between Grand River Hospital Kitchener Site and St. Mary's Hospital on Strange Street. The back-up of Go Trains on the railroad on Strange Street is a major concern. 5. I am also concerned about light rail and car traffic on areas of King Street. If the Ion is slowed down/ backed up, and there is a car stalled on the street beside Ion, where will emergency vehicles travel and pass/ get through? One solution to this may to make some streets beside Ion tracks for emergency vehicles and bicycles/ scooters only. In any case, I am calling for traffic studies to be done on both City and Regional Roads. If Ion is to succeed without loss of life, traffic patterns in the City may need to change. These traffic studies cannot only be done in a piecemeal fashion by developers. Sincerely Myron Steinman Candidate Mayor of Kitchener. Mayors are also voting members of Regional Council Jamie for reaching out to me. Thank you in advance for acknowledging you received this email. I hope my comments are helpful with your concerns. Your expertise may be useful to the City in making future decisions. Response from Berry Vrbanovic Berry Vrbanovic Oct 13, 5:34 AM Saturday Hi Jamie, First of all, thank you for sharing with us your very detailed information and analysis of the state of EMS based on local, provincial and national information you have gathered. It is certainly helpful for governance leaders such as myself to have these additional perspectives as we contemplate ensuing that our EMS service, one of our three valued first responder services provided by local and regional government, continue to meet the needs of our residents in a positive manner. Second, let me begin by saying thank you to your spouse and her colleagues, as well as your and their families, for your commitments to public service and helping ensure we are a safety community for all. As you no doubt know, I have been a strong supporter, in my years as both a councillor and now as Mayor, of all our first responders, and plan to continue to do so. All of them do a phenomenal job of serving our community during some of the most challenging times in people's lives and my thanks goes out to them not only for the difficult jobs they all do each and every day but also for the sacrifices that are made by their families as a result of having to provide 24/7/365 coverage for the community. As you likely already know, over the last four years, the region has made improvements in terms of budget, vehicles and staffing, and our plan for the next four years, contemplates the next Council to continue to do so. The kind of information you have provided will no doubt make us question to see if in fact we are doing enough, and work done by EMS Administration is also shedding some light in this regard as well, I understand. The information around in-service hours, and unit utilization are important stats to me as they do speak to one of our main challenges, and that is about off-load delays at the hospitals. Those delays are having a significant impact on our ability to provide services in timely manner, and we need to ensure the hospitals do more to take some responsibility for this. Council has recently instructed EMS administration to do more work in this regard. One of the obvious areas of concern in all of this is the 6 minute sudden cardiac arrest statistic. This is obviously an important measure, that I believe we need to see improvements on. Some of it is dealt with through tiered-response with our police and fire partners, but clearly there is more that we need to do on in terms of EMS resourcing. This is an area I will be watching for in the future, and advocating for investments of additional dollars to see some improvements. As you've noted, response times have improved between 2016 and 2017, suggesting we are on the right track. However, it is too early to tell if that upward trajectory is permanent or a recent statistic only. As a growing community, and an aging one - we need to ensure that the resources for our emergency personnel continue to improve to meet those challenges. In that regard, I am certainly supportive of making sure this area gets the needed attention, and the needed dollars to see further improvements of the system, going forward. Finally, I note the issue around investments in new technology which will improve the patient experience as well as employee workplace safety. I am always supportive of these kinds of investments, where reasonable, as they can play an important role in helping us achieve our overall objectives as a service. In closing, thanks again for your work on this and the opportunity to share some of my own reflections. I would also like to share this with staff, and with your permission, I will do so. I can remove any identifiers is you prefer. I just believe it would be helpful for regional EMF mgm't to review your great work and provide any analysis from them as well. Responses from Waterloo Mayoral Candidates Response from Dave Jaworsky Dave Jaworsky 12, 10:58 AM Friday Oct Hello Jamie As background, I have 25 years of business experience---growing effective teams---and my degree is in Mathematics, so the statistical analysis is appreciated. When the Chief presents his reports to Council, I do dig through them, and as your summary says, Call Volume Growth and Unit Utilization immediately jump out as key performance indicators. Indicators that are not reacting well to the Master Plan, despite our continued investment. I attended the ceremony at Knox Presbyterian early this year to welcome the 30 new paramedics to the team. In addition to your analysis citing Response Times, I would add Off-load Times to the mix. We heard at council last week that we will lose one ‘ambulance-year’ of service, just due to waiting. That is a huge opportunity. Having control of dispatch would prove useful as well, as might better tools (mechanized stretchers), so I would look for experts to advise. There are many ‘people oriented’ demands at the Region: Homelessness; multi-year wait for housing; mental health and police call volume; opioid crisis with dozens of deaths annually, and paramedic service. As a team leader, I always think of the people. When the staff literally can’t get a lunch break, we must search for solutions. Our population is growing, and demographically aging, so we know where that statistic is going. Thanks for the summary report. Dave Jaworsky Response from Kelly Steiss Kelly Steiss 10:16 PM Tuesday Oct 9, Hi Jamie, First of all, my sincere apologies for such a delayed response. I appreciate your patience and the reminder email so that I didn't lose an opportunity to comment and provide some feedback on a service that means so much to me and so much to our Region. Secondly, thank-you so very much for such detailed information, context and links to additional information. It is the first time that I am seeing this kind of information so it gave me a very good understanding of what is the current state and the future needs - although I feel that my learning has only scratched the surface. I look forward to learning more and have an even better understanding of how we can support our paramedics. There was a lot to take in. What stood out for me was:  our growth is not slowing down. I do promote our intensification as a City and a Region so we need to make sure that our services grow accordingly  missed lunches and overtime. For me, this happens because people are committed to their jobs and to the service that they provide. However it is important that we recognize that this does happen and the frequency so that we can identify the impact. There is a real impact that cannot be overlooked.  the hard work and efforts are hindered by the lack of resources. We need to give our paramedics the resources they need so that they can do the work that our community expects. I have personally benefited from the services of our paramedics. From what you have provided, it feels that we are at a critical point in making decisions for the paramedic service ensuring that they have the resources needed to do their job. The Mayor is a member of Regional Council and as such has the responsibility to make sure that our City has the adequate resources and services. I look forward to meeting and learning more about our paramedics. Thanks again, Kelly Steiss Response from Chris Kolednik Chris Kolednik 21, 2:24 PM Friday Sept Hi Jamie, How are you this afternoon, Is there a number I can reach you at? This is a very important topic to me, as roughly two weeks ago an ambulance had to come to my parents home, as my mother's blood pressure had reach up to 207 and it was critical the paramedics came as fast as they did to stabilize what was happening. She was eventually rushed to St Mary's hospital. Between calling 911 and the fire department showing up and then EMS it was roughly 8 minutes. We do have an aging population, and I can speak for my parents who are nearing their 70's, that the issue you have brought up is of critical importance not only to me but to the people of this Region as well, I would like to meet with you if have the time and are willing to meet, Chris Responses from Wilmot Mayoral Candidates Response from John Jordan John Jordan 4:37 PM Friday, Sept 21, Hey Jamie. Thanks for this and WOW. I’ve gone over this and as I’m a numbers guy this would be good if we were talking batting averages..., I’m all in when it comes to public safety and first responders. It may be prudent if we got together for a bit to discuss. It’s a little more than going back and forth with email. Let me know some availability and we’ll go from there. Thanks Response from Les Armstrong Les Armstrong Oct 9, 9:25 PM Tuesday Hi Jamie. This is a very tough subject and I do not want you to think it is one that is not taken seriously. By myself or the rest of Regional Council. Having said that, you obviously know that Council has been wrestling with this problem as long as I have been there ( eight years) and before. Knowing that our growth has been very high over the past few years. It has slowed some, but has taxed all services. Some more than others. The police and medical especially. Since the addition of the RERU's, I have been advocating for more. I know it is not a perfect fix. But as a township resident I feel they are an improvement. This doesn't mean we should not try to increase the number of ambulances. The new program of trying to cut back on the frequent calls by people who can be visited in their home rather than calling for an ambulance because they don't have a doctor. This too is not a fix but a help, we hope. A similar program in another municipality had a significant drop in these calls. This coming year will be a wait and see how the new Provincial government proceeds with it's budget. They were elected on cutting spending and improving services. We will be watching to see how they pull that off. Living in the Township, response time is a concern. I do understand the problem and know it's concern by emergency responders. Having been a police officer, I know the desire to do your job to the best of your ability. My hope is that we can achieve the goal of a full complement of units as soon as possible. I think the desire is there but the exact time line the unknown. As I have said it is going be a year of patience, as all services are being taxed. Medical, police and social. It is going to be a tough budget. I hope this helps you. Les. Responses from North Dumfries Mayoral Candidates Response from Sue Foxton Susan Foxton 10:55 PM Tuesday Oct 9, I am interested in knowing more about the mechanical stretcher and how it impacts time. I am concerned about the statistics and how we need to do things differently. We have to do better, buying more ambulances to have them sit in hospitals is not a solution. I suggested we hire staff to offload patients too at the hospitals but I was informed the unions would not go for it. We also need to deal with the frequent callers differently to free up more staff and ambulances. The rural units seem to be affective, do we make them full ambulances but again will they just sit at the hospitals unable to offload patients. Are we talking about a new hospital, larger hospital to meet the needs of our community’s? The discussion is just beginning. Sent from my iPad Response from Martin Harrison Martin Harrison 12, 7:54 AM Friday Oct Hello Jamie; I would like to let you know that I fully support the paramedic services of Waterloo Region. Paramedic services are vital to the community I pledge to provide support both to the service and to the paramedics themselves. Thank you, Martin Harrison Candidate for Mayor North Dumfries Township Response from Wellesley Mayoral Candidates Response from Joe Nowak Response from Bernia Wheaton Bernia Wheaton Thursday Oct 11, 1:32 PM Thank you for your detailed email. I have focused on the data pertaining to township servicing. We are fortunate to have the station on Nafziger in Wilmot township and we have cultivated relationships with Perth County EMS to serve us from the Milverton direction, but this is one of many ways we are under serviced, even though we send millions of dollars each year to the region in tax dollars to pay for services like EMS. As I'm sure you know, there isn't one ambulance station in Wellesley township. North Dumfries has one, Woolwich has one, and Wilmot has one. Fortunately, we have the lowest call volume of all of the townships. The wait time for EMS response is a concern and is one of many reasons why I believe that Wellesley needs a stronger voice at regional council. We need a presence there that can cultivate relationship and articulate the need in our community. I hope you agree that has been lacking. Again, I thank you for taking the time to ask this important question. Bernia Wheaton 226-228-8283 www.bernia4mayor.ca