GUELPH – Data showing Guelph-Wellington Paramedic Service (GWPS) response time targets were seldom met in Wellington County over the past four years, while targets in the city were rarely missed, has some county councillors calling for change.
A report showing GWPS was unable to fully meet the targets and compliance rates as set by Guelph City Council for 2022 was presented at the Sept. 13 social services committee meeting by GWPS general manager/Chief Stephen Dewar.
“Causes included pressures from increased call volumes and the impact of hospital offload delays,” the report stated.
Response time targets are based on the Canadian Triage Acuity Scale (CTAS), a system used by hospitals and other services across Canada.
The five levels of CTAS include:
- CTAS 1: requires resuscitation (i.e. cardiac arrest);
- CTAS 2: requires emergent care (i.e. major trauma);
- CTAS 3: requires urgent care (i.e. mild shortness of breath);
- CTAS 4: requires less urgent care (i.e. minor trauma); and
- CTAS 5: requires non-urgent care (i.e. sore throat).
The report indicates GWPS fell short of meeting all but one of the response category targets set for 2022.
Across the entire coverage area, CWPS met its target only in the latter category, CTAS 5, surpassing the target of 90 per cent response within 20 minutes by achieving a 93% score.
The report also provided data showing the response time target attainment over a four-year period, from 2019 to 2022, for the entire region and also broken down to City of Guelph, Wellington County and its seven lower tier municipalities.
That data showed that, region-wide, the service missed targets in two of the five categories each year between 2019 and 2022, while missing four of five in 2022.
However, within the City of Guelph only a single target category was missed during the entire four-year period (CTAS 4 in 2022), while the targets were met only once during that time throughout Wellington County (CTAS 5 in 2021).
Targets were attained in various categories nine times in Centre Wellington from 2019 to 2022, while no more than three response targets were achieved in any other municipality during that period.
In Erin and Mapleton, no target response levels were attained during that time.
The report points out targets are set and designed for the overall area and include results in urban areas “where faster response times are possible” as well as rural areas “where geography creates challenges to responses.”
At the Sept. 28 county council meeting, councillor Mathew Bulmer expressed concern about the disparity.
“If we look at the four years that were covered by the report and the five categories that were covered, that gives us 20 data points to look at over the last four years and there’s only once out of those 20 data points for the city where the service failed to meet the targets within the City of Guelph,” said Bulmer.
“But it was exactly the opposite outside in the county, where only once in the last four years was it able to meet those targets.
“I think that’s unfortunate. We understand the rural area of service. But when we see a 95% success rate within the city and 5% outside the city, I’m not sure that’s exactly the level of service that we were looking for for our residents, or our residents were expecting.”
Bulmer said he is glad to see the breakdown by municipality included in a report.
“I think it’s important to keep getting this information from the city, especially since we’re going to ask in a joint meeting with the city council to make significant investments in the ambulance infrastructure across the county to help improve those figures,” Bulmer added.
“How do we ensure that we keep getting the data that was provided for the September meeting?”
Social services chair councillor Dave Anderson said the committee would continue asking for the breakdown.
“I’d be happy to support a letter to the City of Guelph expressing our gratitude for those numbers and our ongoing requests for those numbers so that we can make better decisions with better information,” said Warden Andy Lennox.
“Some of these response times aren’t going to be able to be resolved quickly, but we have plans in place,” said Anderson, noting a plan to relocate ambulances stations around the county to improve response times “is still out there.”
Councillor Jeff Duncan pointed out the ambulance location study was done “a while ago” and would have to be updated.
“Do we know what’s happening with this report? These ambulance stations will not get constructed until we know where they’re going,” he pointed out.
“These are ongoing discussions with the city right now,” said treasurer Ken DeHart.
“They have indicated that they want to be the ones that do the study, because they’re the service manager and we’ve expressed the need for urgency for this study to be updated.”
DeHart explained the original study was done in 2016 and a “branch-off study” was done by the county, using the same data from the original study, in 2018.
“So we would like it updated before we start pursuing new properties to improve some of the response times,” said DeHart.
DeHart said the city is considering a “truncated study,” which would focus on three of the top priority sites,” while looking to stick to the regular schedule of every 10 years for a full study, “which would put it at 2026 or ’27.
“We have pushed back on that and I should have some updates when we present the budget.”
“We’re willing to upgrade those facilities and now we’re in a holding pattern due to the City of Guelph,” said councillor James Seeley.
“That’s not acceptable and as a service provider, they need to do a better job.”
“The problem we’re having today has nothing to do with facilities, it has to do with backup,” said councillor Earl Campbell, adding a solution to lengthy ambulance offload delays is needed to improve response times.
“It was reported at this meeting that we’ve seen offloads improve but we’ve also seen offloads where an entire 12-hour shift by two paramedics was served at the hospital,” said Campbell.
He also noted part of the response time issue is due to ambulances having to move further from their base location to provide wider coverage when ambulances are stuck at Guelph hospitals.
“So whether we put them in a barn or shed, or put a tarp over top of their vehicle while they’re parked, if they’re not stationed in the communities that they’re assigned to, because of the backfill … we’re never going to achieve it,” said Campbell.
“We can build them a damn Taj Mahal, but if we don’t park the ambulance where we say we’re going to park it, your response times are always going to suffer.”
The GWPS report notes efforts to improve response times to emergency calls are ongoing.
“The Community Paramedicine Program is also in place to offer non-emergency services to high-risk individuals in the community, effectively reducing the occurrence of emergencies and ensuring appropriate care is given to avoid hospitalizations,” the report states.
“There is evidence that this program is achieving its objectives and lessening the burden on the hospital system.”
The report also notes provincial legislation changes have allowed paramedics to transport certain patients to alternate destinations instead of the emergency department.
“This minor shift has resulted in a small but significant decrease in the number of patients presenting to the hospital, leading to better patient flow and fewer offload delays,” the report states.
Despite the continuing pressures, the report explains, City of Guelph council has accepted GWPS’ recommendation to set the targets for 2024 at the same levels as in 2022 and 2023.
