Peel Regional Paramedic Service Capital Planning Services Project

1
Peel Regional Paramedic Service Capital Planning
Services Project

• EPSC Meeting
• July, 2006

2
Project Purpose

• Create a system plan that addresses current and
  future needs for paramedic services in Peel with
  a corresponding capital plan

3
System Plan Objectives

• Improve compliance to response time targets while
  keeping up with increasing demand
• Leverage existing resources where appropriate
• Address related issues that impact system
  performance
• Take workforce perspectives and concerns into
  account

4
Detailed Analyses ofEMS Responses

• Call volumes and locations
• Time of day
• Day of week
• Growth projections

5
Current EMS DemandTime of Day Day of Week
M
T
Th
F
S
S
W
6
Peel PopulationGrowth Projection
7
PRPS Call Demand Projection
8
Approach

• Start with blank piece of paper
• Consider
• Cost efficiency
• Utilization of existing resources
• Where it makes sense to do so
• Field staff working conditions
• Based on dialogue with field staff

9
Options for Ambulance System Configuration

• Fire Dept. Model
• Ambulance Station Model
• Fluid Deployment Model
• Hybrid Model

10
Options for Ambulance System Configuration

• Fire Dept. Model
• Ambulance Station Model
• Fluid Deployment Model
• Hybrid Model

11
Fire Department Model

• Full integration / assimilation of ambulance
  service into FD
• Deploy from current or projected fire station
  locations
• Staffing with traditional fire dept. shift
  schedules

12
Hybrid Model

• Selective use of components from the other
  options
• Match vehicle placement, number of vehicles,
  staff schedules to demand patterns
• Geographic and time
• Deploy from a combination of fire stations,
  police stations, stand-by stations, and street
  corner posts

13
Cost Differences

• Estimated costs for the hybrid and fire models,
  respectively
• Key drivers Personnel, vehicles, buildings
• 20 year projection - 2007 through 2026
• Call volume growth assumptions
• In 2006 dollars
• lt12 minute response time target

14
Sources of Cost Differences

• Fire Department models are intended to protect
  buildings, occupants and contents
• Logistical approach for stationary targets
• Ambulance services are intended to deliver
  healthcare to people
• Logistical approach for moving targets
• Fire department logistical model not designed to
  fulfill ambulance mission

15
Cost Differences
16
Recommendations
17
RecommendationHybrid Model

• Using Fire, Ambulance and Police Stations Street
  Posts only as needed

18
RecommendationsOperational Efficiency

• Optimize placement of ambulances
• Place ambulances based predictable patterns of
  where needed
• Recognize geographic coverage issues
• High priority for unit placements in Caledon
• Balance geographic coverage and system response
  times
• Optimize scheduling
• Put ambulances/crews in field based on
  predictable patterns of demand

19
RecommendationsOperational Efficiency

• Appropriate Response Time Targets
• All Emergency Response Mode Calls
• PRPS ACP Units lt12 min.
• Selected High Acuity Emergency Response Mode
  Calls
• 10
• FD EMR First Response Units lt6 min.
• PRPS ACP Units lt12 min.

20
RecommendationsOperational Efficiency

• Utilize FD and PRPS units to stop the clock on
  system response time performance calculations
• Reporting / accountability for performance of
  each FD and PRPS on response agency on response
  time compliance
• Minimum 90 compliance
• Public reporting process
• Work towards higher compliance levels over time
  using QI techniques
• Missing target on as many as 10 of cases is not
  acceptable
• Meeting target 100 of time is financially
  impractical

21
Incremental ImprovementsWhen Adding Vehicles

• 1200 target
• 34 vehicles for 90 coverage
• 60 vehicles still does not get 100

22
RecommendationsOperational Efficiency

• Reduce Waste of Resources from Hospital Off-Load
  Delays
• Provincial report and recommendations do not
  provide short term relief strategies
• Huge financial and operational burden
• With off-load times gt30 minutes
• Loss of 292,000 per month in wall time
• Equates to 3.5 million per year
• Implement hospital paramedic off-load program
• Staff one medic at each of 3 hospitals
• 2006 implementation cost - 442,000
• If these 3 medics care for just 12 patients per
  day that equates to an addition of 15 to 20 unit
  hours per day or a potential long term net saving
  of 400,000 to 600,000 future annual savings

23
RecommendationsOperational Efficiency

• Optimize PRPS utilization of Ministry of Healths
  Central Ambulance Communications Centre
• Modify / Update call triage process to safely and
  reliably differentiate emergency (RLS) vs.
  immediate response mode
• Reduce risk of unwarranted RLS responses
• Managing deployment using CACC staff
• Simplified unit location plan that does not
  include unit movements when unit availability
  changes

24
Number of Vehicles
25
Hybrid Model Deployment0100 800

• 1200 target
• 21 vehicles for 93 coverage

26
Hybrid Model Deployment0800 1900

• 1200 target
• 34 vehicles for 93 coverage

27
Hybrid Model Deployment1900 100

• 1200 target
• 30 vehicles for 93 coverage

28
Demand Coverage

• Number of vehicles needed is dependent on time of
  day
• Prioritization of placements in Caledon area for
  geographic rather than demand coverage
  purposes

29
Deployment Plan Example
30
Facility Locations (35)

• 8 police stations
• 3 existing EMS stations
• 24 fire stations

31
Existing Facility Locations (35)
32
Facility Modifications

• Hybrid Model
• 24 of 35 existing facility modifications
• 16 FD
• 8 PD
• Double bay configuration
• Admin. Support facility

• Fire Model
• 33 fire station modifications
• Double bay configuration
• Admin. and support facility growth to accommodate

33
Double Bay Design

• Modify existing structures with shared wall,
  HVAC, etc. with fire or police structure
• 1 active unit
• Spare unit storage
• Later, 2 active units

34
Financial Implications

• Assumptions
• Land Acquisition Cost 0
• Where land provided and where adequate room
  available
• Following figures are net present value (in
  2006 dollars)

35
Financial Implications

• Estimated total construction cost over 5 years
• Facility modifications
• Hybrid Model (24)
• 8.4 million
• Fire Model (33)
• 12.7 million

36
Timetable

• Hospital Paramedic Off-Load Program
• ASAP
• Facility Construction
• Over the next 5 years
• Use fire and police facilities as stations /
  posts in the meantime

37
Conclusion

• Hybrid Model Recommendation
• Lower construction costs
• Lower operating costs
• Allows EMS and FD work forces to co-locate while
  reducing operational cost

38
Next Steps

• Incorporate feedback from this meeting
• August 3, 2006
• Final presentation to Council
• Final written report

39
Contact Information

• Mic Gunderson
• mic.gunderson_at_healthanalytics.org
• 863-838-3295
• Todd Hatley
• todd.hatley_at_healthanalytics.org
• 919-656-5700