1. Emergency Medical Services Department 2014 Budget Overview

2. Emergency Medical Services 2013 Budget 2013 Actual 2014 Budget Expenditures$34,665,860 $35,082,880 $36,373,980 Recoveries(25,679,350)(26,260,520)(26,854,540) Net Operations$8,986,510$8,822,360$9,519,440 Contributions from Reserves(756,900)(369,930)(958,200) County Responsibility$8,229,610$8,452,430$8,561,240

3. Emergency Medical Services Emergency Medical Services 2013 Performance 2013 net departmental operations $222,820 over budget (County of Essex share) Modified work assignments (for WSIB / pregnancy / injury) Escalating WSIB NEER costs Increased legal costs including costs associated with Interest and Grievance Arbitrations Rising costs of vehicle repairs and maintenance

4. Vehicle repair and maintenance were overspent –Increasing call volumes & increase in kilometres travelled (2.2 million km – 2013) –Aging high mileage fleet Vehicle Fuel costs under budget –Fuel and emissions savings program & deployment strategies Medical supplies & equipment over budget –increased call volumes Wages on budget, benefits over budget –WSIB NEER costs Emergency Medical Services Emergency Medical Services 2013 Performance

5. Three stations opened in 2013 –Essex (shared facility) –LaSalle (shared facility) –Tecumseh (stand alone) Emergency Medical Services Emergency Medical Services 2013 Performance

6. Overall increase in “patient carried” call volume

7. Emergency Medical Services Emergency Medical Services 2013 Performance Increasing urgent / emergent responses

8. Emergency Medical Services Emergency Medical Services 2013 Performance

9. Emergency Medical Services Emergency Medical Services Ontario Municipal Benchmarking Initiative (OMBI) In 2013 EMS Service continued to participate in OMBI with 15 other EMS services in Ontario The Essex / Windsor Area, continues to experience one of the highest rates of EMS response per population in the province at 133 calls per 1,000 population. (OMBI 2012) Below the median cost per in service unit hour

10. Emergency Medical Services 2014 Proposed Budget Priorities: Continuity of service levels Maintain mandatory programs and legislated requirements Address future capital needs Anticipated call volume growth Keep abreast of technology Investing in patient and paramedic safety

11. Emergency Medical Services 2014 Proposed Budget The department continues to foster fiscally responsible quality pre-hospital care through: Mutually supportive relationships: –other emergency services –health care agencies in the community Public education - prevention and awareness Continuous Quality Improvement to ensure the highest standards are achieved Supporting employees by providing them with the tools and methods to accomplish quality care

12. Emergency Medical Services 2014 Proposed Budget - Funding MOHLTC amended funding formula in 2010 Current year funding now based on the 50% of prior year budget adjusted for inflation 2014 estimated provincial funding will be 48%, not 50%

13. Emergency Medical Services 2014 Proposed Budget Cost Shift due to Change in Weighted Assessment: Municipal Share20132014 % Allocation Actual Weighted Assessment Preliminary Weighted Assessment City of Windsor52.911%52.523% Township of Pelee0.304%0.300% Total recovery-service partners53.215%52.823% County of Essex46.785%47.177%

14. Source - ADRS (Dispatch Data) Emergency Medical Services 2014 Proposed Budget

15. Source - ADRS (Dispatch Data) Emergency Medical Services 2014 Proposed Budget Level of AcuityTime (min:sec) 2013 Response Time Plan Target 2013 Actual Percentile (estimated) Sudden Cardiac Arrest 6:0055%54.00% CTAS 18:0075%79.32% CTAS 210:0090%87.37% CTAS 312:0090%87.27% CTAS 414:0090%90.92% CTAS 514:0090%90.33%

16. Emergency Medical Services 2014 Proposed Budget Essex Windsor EMS has one of the highest call volumes per 1,000 population in the Province

17. Emergency Medical Services 2014 Proposed Budget Essex Windsor EMS has one of the highest call volumes per 1,000 population in the Province

18. Emergency Medical Services 2014 Proposed Budget System pressures such as offload delays, call volumes continue to increase Deployment strategies established to address system pressures and meet performance targets Therefore the 2014 budget: Maintains all service and deployment levels while addressing future capital needs Addresses inflationary increases to operational costs

19. Emergency Medical Services Challenging Issues for 2014 Emergency Medical Services Challenging Issues for 2014 Outside Influences with no EMS control: Increasing EMS service demand Lack of Physicians, Lack of Specialists Lack of Hospital Beds Lack of Long Term Care Beds Impacts the daily operation and adds cost to the EMS system

20. Emergency Medical Services Challenging Issues for 2014 Challenging Issues for 2014 Offload Delays at Windsor Hospital Emergency Departments

21. Emergency Medical Services Challenging Issues for 2014 Offload Delays at Windsor Hospital Emergency Departments: MOHLTC funding continues for the Dedicated Nurse in the ER Offload delay times decreased substantially in 2013 (approximately 35% reduction) Despite reduction, Offload Delay continues to be a persistent and significant burden on EMS Offload Nurse Program and funding continues as a temporary program renewed annually

22. Off Load Delays 2009 to 2013 20092010201120122013 Total OLD 4,2516,9029,3028,357 6,902 Total Hours 2,6535,3899,2818,875 5,389 OLD/Day 11.618.925.524.3 18.9 AVG Length (Min) 37.546.959.956.5 46.9 Lost EMS Time Cost $1,331,317$808,350

23. Emergency Medical Services Challenging Issues for 2014 Emergency Medical Services Challenging Issues for 2014 Aging Population The Essex / Windsor area demographics indicate a higher ratio of population that is in their senior years Persons over 65 yrs account for > 50% of EMS response EMS call volumes will continue to increase

24. Emergency Medical Services Challenging Issues for 2014 Emergency Medical Services Challenging Issues for 2014 Aging Population Senior Care Strategies increasing in-home services –Increased demand for EMS services –Increasing pressure to provide “non-traditional paramedic services”

25. Emergency Medical Services Challenging Issues for 2014 Emergency Medical Services Challenging Issues for 2014 Long Distance Transfers Lack of specialists in the Essex / Windsor area  patients transported to London and Detroit for treatment  average 5 patients per week Each time a patient is transported, vehicles are out of Essex / Windsor area:  London 5.5 hours (minimum)  Detroit 1.2 hours (minimum)

26. Emergency Medical Services Challenging Issues in 2014 Emergency Medical Services Challenging Issues in 2014 Technology Paramedic Safety/Injury Prevention Power lift cots Bariatric patient transport vehicle and devices Information and Technology Evolving technology related to computer systems, equipment & patient records increasing the cost of providing additional support

27. Emergency Medical Services Challenging Issues in 2014 Emergency Medical Services Challenging Issues in 2014 Fleet and Stations Purchase/Replacement of Dougall Ave Facility Implementation of asset management plan to address future capital needs and increasing fleet costs

28. Emergency Medical Services Challenging Issues in 2014 Emergency Medical Services Challenging Issues in 2014 Legislated Response Time Plan Response time targets based on patient acuity Evidence based The EWEMS team has established a Response Time Plan that is operationally cost effective while meeting the needs of the community at large Proposed 2014 budget based on maintaining service levels to meet those targets

29. Emergency Medical Services Challenging Issues in 2014 Emergency Medical Services Challenging Issues in 2014 Legislated Response Time Plan Level of AcuityTime (min:sec) 2013 Response Time Plan Target 2013 Actual Percentile (estimated) 2014 Response Time Plan Target Sudden Cardiac Arrest 6:0055%54.00%55% CTAS 18:0075%79.32%75% CTAS 210:0090%87.37%90% CTAS 312:0090%87.27%90% CTAS 414:0090%90.92%90% CTAS 514:0090%90.33%90%