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Program Description: Emergency Medical Services - Land Ambulance

Land Ambulance Land ambulance services are a vital part of emergency health care in Ontario.  The delivery of land ambulance services is the responsibility of municipalities as one part of a much larger realignment of services between the province and municipalities.  Land ambulance costs are shared between municipalities and the province of a 50:50 basis in accordance with a funding template. In 2000/2001, the Ministry of Health and Long-Term Care is providing over $400 million for land and air emergency health services in Ontario.

Legislated Framework The Ambulance Act, as amended by the Services Improvement Act, 1997, and the Tax Credit and Revenue Protection At, 1998, sets out the legislative framework for the funding and delivery of land ambulance services under municipal jurisdiction. On January 1, 1998, each upper tier municipality (regional and county governments or their municipal equivalent) became responsible for funding all costs associated with the provision of land ambulance service within its area.  The legislation required the transfer of the service from the Province to a designated municipality or delivery agent by January 1, 2000. On March 23, 1999, the government announced its intention to extend the deadline for municipalities to assume responsibility for land ambulance to January 1, 2001.  The government also announced that the province would share the approved cost of land ambulance with municipalities on a 50/50 ratio beginning January 1, 1999.

Regulations Regulations impact on program and policy decision dealing with the assumption of responsibility for land ambulance by municipalities.  These include the interaction with existing operators, ambulance coverage and workload requirements, the role of the ministry, ambulance service roles and responsibilities in relation to other health care and emergency services clients and stakeholders. O. Reg. 501/97, dealing with licensing service operators, qualifications of persons employed in ambulance and communication services, standard of care and operational requirements, has been extended until December 31, 1999. O. Reg. 129/99, deals with the apportionment of costs between delivery agents and the sharing of costs between counties and separated municipalities.

Co-payment Co-payment fees for land ambulance service will continue to be set and regulated by the province through legislation.  Co-payment fee is a fee shared by hospitals and the province to cover some of their respective costs.

Vehicles and Equipment Ownership of existing ambulance vehicles and equipment will be transferred to municipalities of delivery agents when they assume full responsibility.  As of January 1, 1999 the Ministry is sharing fifty percent of cost of replacing ambulance vehicles and equipment.

Implementation: Options and Requirements The Ambulance Act provides for three options for the provision of land ambulance services.  Upper-tier municipalities and designated delivery agents may: enter into an agreement with one or more existing land ambulance operators if they meet licensing requirements; provide the service directly; or conduct a Request for Proposals to select the best quality, best price provider of service.

Administration and Process The Ministry of Health and Long-Term Care will continue to ensure through legislation and regulations that minimum standards are maintained for all aspects of land ambulance service and that service providers meet required service quality and delivery requirements.  Subsequent to December 31, 2000, all upper tier municipalities and delivery agents will have to deliver service directly or enter into an agreement with an operator who can be licensed by the Ministry.

Changing Roles and Responsibilities The following reflects Strategic Planning, Service System Management and Service Delivery Responsibilities of the Province and municipalities for ambulance service.

Land Ambulance Implementation Steering Committee In February 1999 the Association of Municipalities of Ontario (AMO) and the Ministry of Health and Long-Term Care (MOHLTC) established a joint committee, the Land Ambulance Implementation Steering Committee (LAISC) to work collaboratively on land ambulance transition issues. Through LAISC, subcommittees have been established to address ambulance dispatch, finance, standards and purchasing and other issues. LAISC has been involved in the following accomplishments: Providing input on a framework for approved costs and a funding template Purchasing arrangements through MOHLTC,s ambulance supply store (Judson St. Store) and government pharmacy Establishing and maintaining a joint web site

Status of Land Ambulance Transfers to Municipalities Municipalities and province worked together to ensure that there was a smooth transition that provide a high-quality, responsible and seamless land ambulance service throughout Ontario. Prior to 2001, 19 of the Upper Tier Municipalities (UTMs) / Designated Delivery Agents (DDAs) had assumed responsibility for ensuring the proper provision of land ambulance services in their communities.  The remaining 30 UTMs/DDAs assumed responsibility for land ambulance services by January 1, 2001.

Funding Template The Land Ambulance Implementation Steering Committee (LAISC), under the leadership of Brad Clark, Parliamentary Assistant to the Minister, and Roger Anderson, Chair of Durham Region, provided input on a framework for approved costs and a funding template. The government approved a funding template based on the model developed by the provincial/municipal working group.  The template defines the costs the province will share on a 50:50 basis with municipalities.  The government is providing an estimated $30 million in additional cost-sharing assistance.  [Please refer to Appendix A: Current Submission for Land Ambulance approved cost funding.]

Standards A subcommittee of the Land Ambulance Implementation Steering Committee (LAISC) has been formed to review standards. Next steps are to work with municipalities in reviewing standards governing land ambulance services including Operator Certification, Patient Care and Transportation, Documentation, Communicable Disease and Response Time.  The government has committed to fund 50 per cent of all approved standards.

Redirect Consideration and Critical Care Bypass (RDC/CCB) The Ministry has established a new working group to review redirect consideration and critical care bypass, including its impact on ambulance services.  The work of this group is being finalized.

Paramedic Training Defibrillation / Symptom Relief Program Ontario has spent approximately $9 million on a defibrillation program, training and equipping over 4,500 paramedics to administer drugs known to relieve distressing symptoms to patients. Ontario Pre-Hospital Advanced Life Support (OPALS) Study: Ontario leads the world in paramedic research.  The OPALS study evaluates the health benefits to patients of advanced care paramedic services.  The study demonstrates what paramedic skills - such as defibrillation and advanced airway management - will help victims of cardiac arrest. The Ministry began funding the OPALS study in 1995 with a total allocation of $15.5 million.  A total of 379 advanced paramedics have been trained in communities involved in the study. The OPALS study continues to receive worldwide support for its scientific design and focus on important paramedic related research questions.

The District of Nipissing Social Services Administration Board contracted with: The North Bay General Hospital The Mattawa General Hospital The town of Temagami The West Nipissing General Hospital The approved Ministry template indicates a cost of approximately $4.1 million in 2001 for the service in the District of Nipissing.

DISTRICT OF NIPISSING - CALL VOLUME FOR YEAR 2000 MATTAWA 568 NORTH BAY 12,000 TEMAGAMI 295 WEST NIPISSING 1,593 TOTAL CALLS FOR YEAR 2000: 14,456   COST PER CALL 283.00