Emergency Health Services

Complaints and Investigations

Any member of the public – including a patient, parent, stakeholder or agency member – can file a complaint. You can file a complaint with the emergency health services provider directly or the Ministry of Health.

Examples of emergency health service providers include:

Ambulance communication centres/services
Land ambulance service operators/paramedic services
Air ambulance and certified air ambulance providers
Base hospital programs

The ministry conducts investigations to determine if there were any contraventions of the Ambulance Act, its regulations or standards. Investigations can take place in response to a complaint. They can also start because of other concerns.

The ministry’s Emergency Health Services Division conducts investigations for matters under the act but does not conduct investigations into matters covered under any other provincial or federal legislation. The division also does not conduct investigations to determine the cause of injury or death, or the actions of other allied agencies (e.g., fire, police, or hospital staff).

Filing a Complaint with the Emergency Health Service Provider
Filing a Complaint with the Ministry

1. Filing a Complaint with the Emergency Health Service Provider

If you know the emergency health service provider, you can file a complaint directly with them. Typically, this includes an air or land ambulance service operator or an ambulance communication service.

Every emergency health service provider is required to have a quality assurance program in place.
Ambulance service operators must submit incident reports to the ministry for each complaint they receive related to their service.

2. Filing a Complaint with the Ministry

The ministry’s Emergency Health Services Division has the authority to investigate complaints through the Ambulance Act. We are committed to investigating complaints about pre-hospital care responsively and reliably through a rigorous complaints management and investigations process.

Complaints can be sent directly to inspections_investigations@ontario.ca.

Information can also be sent to the following address:

Investigation Services
Emergency Health Regulatory and Accountability Branch
North American Centre, 6th floor
5700 Yonge Street
Toronto ON M2M 4K5

In your complaint, please tell us as much as possible, including:

A description of what happened
When and where it happened (including the date and approximate time)
Who was involved

This will make it easier for the ambulance service provider or ministry to investigate your complaint. Also, if you require any accommodations under the Accessibility for Ontarians with Disabilities Act, 2005 (AODA), please let us know in your complaint submission.

Complaints can be submitted anonymously or with contact information included. Contact information helps the ministry follow up on complaints and collect additional information for investigations. Anonymous complaints, however, could limit the ministry’s ability to investigate.

What to Expect After Filing a Complaint with the Ministry

If you have included contact information with your complaint, you can expect the following:

Intake and Processing: Once you have filed a complaint, the ministry will acknowledge receipt and complete the complaint intake process by:
- Contacting you to review the complaint and explain the ministry process.
- This typically takes place within five business days of receiving your complaint.
Investigator Assigned: If your complaint is actionable under the Ambulance Act, an investigator from the Emergency Health Services Division will be assigned to your complaint.
- An investigator is typically assigned to your complaint within one to two business days.
- Typically, within two business days of an investigator being assigned, they will contact you directly by phone or email to introduce themselves and provide their contact information. They can also answer questions about the investigation process.
- If your complaint is about matters outside of the Ambulance Act, we may make recommendations to you on how to redirect your complaint to the appropriate oversight body.
Investigation: An investigation will be conducted in accordance with the ministry’s investigation process, which typically results in an investigation report and may include additional outcomes.
- An investigator is permitted to request personal health information of a patient to investigate a complaint or concern. Personal health information is handled in accordance with privacy legislation, including the Personal Health Information Protection Act and Freedom of Information and Protection of Privacy Act.
- An investigator will always keep the identity of the complainant confidential unless required by a court order (e.g., by subpoena).
Report Back to Complainant: Once an investigation is complete, you will receive a close-out letter, which will include the concerns raised and identify any contraventions of the Ambulance Act, its regulations or standards.
- If you would like to obtain the investigation report, you must request it from the ministry’s Access and Privacy Office to ensure compliance with privacy legislation.
Appeals Process: if you are dissatisfied with the investigation outcome, you may submit a request to appeal to inspections_investigations@ontario.ca. You may also file a complaint with the Ontario Ombudsman.

Investigation Process

To carry out an investigation, investigators gather evidence in several ways, including:

Gathering and reviewing documentation
Taking statements and conducting interviews
Recording observations
Conducting searches
Making material, document, and equipment seizures.

Investigation Timing

The amount of time required to investigate a complaint varies from case to case, based on a variety of factors.

You are welcome to contact your assigned investigator or Investigation Services for status updates at any time.

Please note that the ministry cannot comment beyond the status of the investigation until an investigation is complete.

Investigation Results

Outcomes from an investigation could include:

A remedial approach – The ministry will ensure that remediation occurs to address identified contraventions of the act and will make recommendations to the respective services. The respective services will then provide their confirmed remedial approach and action plan to the ministry to demonstrate their compliance.
A rewrite order – The ministry will require that a paramedic rewrite the Advanced Emergency Medical Care Assistant (AEMCA) exam where there are consistent concerns of incapacity through an established process. The AEMCA is a paramedic qualification requirement to work within Ontario.
A provincial charge – The ministry reserves the ability to lay a provincial charge for offences respecting the Ambulance Act.
No further action (NFA) – The ministry will take no action in instances where the pre-hospital care was performed in accordance with the legislation, its regulations and standards.

Investigation Reports

Investigations include an official report of the findings, which will be made available to any entitled parties involved in the incident.

If the complainant is not the patient, every effort will be made to contact the patient – unless doing so will cause them emotional harm.

The investigation report will outline the evidence collected and reviewed, and it will identify if there were any contraventions.

How to Request Investigation Reports

Because investigation reports contain personal health information of the patients involved, complainants must request the full report from the Ministry of Health’s Access and Privacy Office.

The office will require documentation to determine the information it can release with the report. Documentation could include information relating to the executor of will, substitute decision maker, power of attorney, next of kin, or other requirements.

To request investigation reports, contact the Access and Privacy Office.

Responding to the Ontario Ombudsman

On May 20, 2021, the Ontario Ombudsman made 53 recommendations to revamp the ministry’s oversight of land and air ambulance services.

The ministry is developing and implementing a plan that is responsive to the report, with input from our valued sector partners and providers.

This includes recruiting additional investigation and air ambulance oversight unit staff. It also involves improving protocols and processes, and investing in modern IT systems to ensure the investigative process is more transparent and accountable.

Contact Us

Emergency Health Services – Complaints and Investigations
5700 Yonge Street, 6th Floor
Toronto, Ontario
Canada M2M 4K5
Tel: 1-800-461-6431 (Toll-free in Ontario only)
In Toronto : (416) 327-7900
Fax: 416-327-7911
Email: inspections_investigations@ontario.ca