Land Ambulance Response Time Standard Q&A
How was the current response time standard devised?
A response time standard was established by the ministry based upon consultation with stakeholders and focused on the 1996 ambulance system performance for each individual upper tier municipality and designated delivery agent prior to the assumption of land ambulance responsibilities by these entities.
Is the existing response time standard still relevant?
No. The 1996 standard does not reflect today’s patient demographics, recognize areas of growth or consider medical-based evidence that has become available since 1996 related to improving patient outcome.
Why implement this new response time performance plan framework?
Since 2001, the municipal sector has had the legislated responsibility to ensure proper land ambulance services to its residents. The ministry recognizes that these entities should therefore establish performance targets that are tailored to the needs of their citizens.
Does this change the definition of ambulance “response time”?
Yes. In recognition of the role of dispatch in the overall provision of emergency ambulance response, response time beginning January 1, 2013 will be defined as the elapsed time from the point that a call for emergency ambulance response is received by an ambulance communication service to the arrival of an ambulance or other qualified first responder to the scene. This, for the first time in Ontario, marries the response time of ambulance communication services and ambulance service providers to reflect actual response time as seen from the patient’s perspective. In cases of sudden cardiac arrest, response time will be measured from the call arriving at the dispatch centre to the arrival of a person trained and qualified to provide defibrillation.
How will response time performance plans help to improve rapid ambulance response to life-threatened patients?
Under Regulation, municipalities will be responsible for the development of response time performance plans that specify response targets to CTAS 1 patients, which includes sudden cardiac arrest victims. Municipalities will also have to provide this plan to the ministry and report on the successes achieved in meeting the stated targets identified. Municipalities will also report to the ministry on the percentage of times sudden cardiac arrest patients received medical intervention from a person trained and qualified in automated external defibrillation.
How will the response time performance plans help to improve patient care?
Response time performance plans developed by upper tier municipalities and delivery agents will be patient-outcome focussed; will measure total emergency response time to emergency calls – response time from the patient’s perspective; and will provide the opportunity for upper tier municipalities and delivery agents to identify and target ambulance resources where they are most needed. Municipal planning also provides the opportunity to recognize and adopt medically based evidence related to improving the outcome of patients, and to engage in local innovation to improve on the delivery of pre-hospital medical care.
How is accountability maintained under the proposal?
Regulation 257/00 Part VIII spells out the responsibilities of upper tier municipalities and delivery agents respecting the development and reporting of response time performance plans. Land ambulance operators – whether service is directly provided by a municipality or provided by contracted services – will continue to be required to meet ambulance certification review criteria on response times, which will require every operator to follow the municipally defined response time performance plans. As well, every response time performance plan submitted to the ministry will be reported on the ministry website, along with the actual response times achieved.
What impact will response time performance plans have on ambulance dispatch services?
The regulation places new obligations on communication services respecting the establishment, maintenance, enforcement, evaluation, updating and reporting of response time performance plans. These obligations will focus on dispatch operations. All land ambulance dispatch centres are required to develop and submit annual response time plans that indicate the percentage of times that ambulances will be notified and dispatched for emergency calls within two minutes from receipt of a request for emergency ambulance services.
Will performance planning and reporting impact upon the responsibilities of upper tier municipalities and delivery agents in providing land ambulance services?
Since 2001, the ministry has required that every upper tier municipality and delivery agent bear full responsibility for ensuring the proper provision of land ambulance services to their residents, and to fully fund the provision of such services. To assist, the ministry provides a grant for a portion of these costs. Municipal responsibility includes providing land ambulance services in a manner that it deems as necessary to meet the medical needs of its residents.
Response time performance plan requirements emphasize this responsibility, as municipalities establish and then achieve land ambulance response times that recognize the medical need for prompt response to the most critically ill and injured Ontarians. The requirement for land ambulance operators to meet a response time standard will remain as a part of land ambulance operator certification review will not change under the ministry’s proposal. The proposed change will not negatively impact on the level of ambulance service municipalities will provide, nor on the quality of patient care that will be afforded by paramedics under their employ.
Will the ministry provide reports on the combined dispatch/first responder/ambulance response time plans and achievements?
Yes. This information will be provided in the same place as the municipal/dispatch response time plans and performance results.
What are the key dates associated with this new framework?
July 2008 – Government passes land ambulance response time amendment to Regulation 257/00
October 1, beginning in 2012, and every year thereafter – Upper tier municipalities, delivery agents and ambulance dispatch services begin development of response time plans for the following calendar year.
October 31, beginning in 2012, and every year thereafter – Upper tier municipalities, delivery agents and ambulance dispatch services provide response time plans to the Ministry of Health and Long-Term Care.
January 1, beginning in 2013, and every year thereafter – All upper tier municipalities, delivery agents and dispatch services begin following their respective response time performance plans; ministry posts the municipal and dispatch response time plans on the government web site.
March 1, beginning in 2014, and every year thereafter – Performance reports for each upper tier municipality, delivery agent and dispatch service are posted on government web site.