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Why This Audit Matters

Toronto Paramedic Services (the Division) provides 24/7 medical emergency pre-hospital care and ambulance transportation. Timely ambulance emergency response is critical, particularly for people with medical issues requiring urgent attention at the hospital. Every second matters for ambulance emergency response, particularly when it is a matter of life or death.

What We Found

1. Response Times Increasing as Availability of Staffed Ambulances Decreases

  • Ambulance response times targets were met about 80% of the time in 2023 but overall response time, which includes dispatch response times, increased.
  • More calls did not meet the legislated targets for response times in 2023 than 2019, for patients with life-threatening and highest acuity conditions.
  • The Division met its own targets for ambulance response times for lower acuity patients more than 80 per cent of the time in 2023, however highest acuity patients would benefit more from faster response times.
  • Low availability of staffed ambulances has become more frequent and lasting a longer period of time.
  • Response times varied by geographic area and are not monitored; response time was slower for high priority calls outside of the Toronto downtown area.

2. Why is this Happening – Healthcare System Pressures, Need for Further Provincial  Support, and Staffing Challenges

  • In-hospital time continues to account for the majority of paramedics’ service time, with paramedics experiencing more instances of waiting longer than 30 minutes to offload patients.
  • Staffing challenges can be an issue at peak times of demand when more staffing is needed, such as on the weekends, weeknights after 9 p.m., and during the summer and fall months.
  • The Division has not conducted a comprehensive analysis to determine its optimal staffing level to address staffing challenges, response time targets, and daily, weekly, and seasonal demand surges.

3. Opportunities for Improvement Going Forward

Toronto Paramedic Services should explore:

  • Strategies to free up resources for higher acuity calls and better address low acuity calls.
  • Diverting some mental health calls in the future through its ongoing collaboration with Toronto Community Crisis Service.
  • Enhancing frequent 9-1-1 user analysis to identify patients for community paramedicine programs and developing targeted public education to reduce call volume; and
  • Determining the optimal level of ambulances required.

By The Numbers

  • The average response times for life-threatening and highest acuity patients increased 6% and 14%, respectively, from 2019 to 2023
  • The number of times with zero staffed ambulances available increased from 29 episodes in 2019 to over 1,200 episodes in 2023
  • On average in 2023, almost 2.5 hours in total every day had 5 or less staffed ambulances available
  • Call volume has increased by 6% from 2019 to 2023
  • Voluntary full shift overtime increased 169% from 2019 to 2023; end-of-shift overtime accounts for 38% of all overtime hours from 2019 to 2023

This figure shows a donut pie chart showing a percentage breakdown of the Average Paramedic Service Times. The chart contains three components. The first component “Respond and Transport” is 21%. The second component “Time on Scene” is 19%. The third component “In Hospital Time” is 60%.

In 2023, 60% of paramedics’ time was spent in hospitals; 42% of cases took longer than 30 minutes to offload patients to hospitals.

How Recommendations Will Benefit the City

Implementing the 10 recommendations in this report will assist Toronto Paramedic Services in identifying improvement areas, determining the appropriate level of resources, explore ways to better manage call demand, and ultimately help improve staffed ambulance availability and response times.