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Toronto Paramedic Services

2014 Annual Report

July 2014 graduating class of newly recruited Paramedics and


Emergency Medical Dispatchers

Toronto Paramedic Services Annual Report 2014

from the chief ..........................................................................4


mission, vision, values ...........................................................5
strategic direction ..................................................................6
2014 operating budget ...........................................................8
operations .............................................................................10
communications centre........................................................11

table
of
contents

operational support ..............................................................12


program development and service quality.........................13
performance ..........................................................................14
research and clinical excellence..........................................15
community paramedicine ....................................................17
customer service...................................................................20
health and safety ..................................................................21
news and events...................................................................22
cardiac safe city ....................................................................25
community and public engagement ...................................26
awards and recognition .......................................................27
honours received ..................................................................28
what the public is telling us ................................................29
looking ahead .......................................................................30

Toronto Paramedic Services Annual Report 2014

Our men and women are proud to serve the residents and
visitors of Toronto with kind, compassionate and clinically
excellent care each and every day.
Chief Paul Raftis

from the chief


On behalf of Toronto Paramedic Services, I am pleased to present our 2014 Annual Report. It highlights our many
accomplishments that could not have been possible without the care and dedication of our Paramedics,
Emergency Medical Dispatchers (EMDs), support staff and leadership team.

Chief Paul Raftis

In October 2014, the name, Toronto Paramedic Services, was adopted. This name change was designed to help
the public better understand the role of our staff and to harmonize the name of Torontos service with other
paramedic services across Ontario. In 2014, we continued to focus on clinical excellence by working with our
research partners to ensure that our patients receive excellent care that is based on the latest medical evidence. In
addition, we achieved efficiencies through integration and shared services, expanded our Community Paramedicine
services which provide significant benefit to our most vulnerable residents, reduced ambulance response times, and
balanced the budget.

In this report, you will also find details of our many programs and services, including Community Paramedicine
which continues to be a key component of the Toronto Seniors Strategy. With financial assistance from the Ministry of Health and Long-Term
Care (MOHLTC), we were able to extend the reach of our services, including the House Calls for Medically Complex Patients program as
well as the Independence at Home initiative for vulnerable seniorsa partnership with Toronto Community Housing. The success of the
Community Paramedicine Program is based on the active role played by frontline Paramedics in supporting the needs of medically complex
patients and providing more appropriate alternatives for repeated 911 responses, thereby avoiding unnecessary hospital visits.
Also in 2014, and for the first time, Toronto Paramedic Services began hiring part-time Paramedics. Approximately 100 new part-time staff
started work in 2014 and, along with scheduling and dispatch technology enhancements, have helped to manage the increase in emergency
medical call demand that the City continues to experience.
In September 2014, Toronto Paramedic Services Communications Centre was re-accredited as a Centre of Excellence. This designation
has been accorded to only 139 other dispatch centres worldwide (out of approximately 4,000), and signifies that the centre has achieved an
internationally recognized benchmark of care being delivered to the community.
Finally, Id like to thank all of our staff for their individual contributions to the quality of life for our patients and their loved ones. The
combination of compassionate care along with clinical excellence is the hallmark of a truly patient-focused Paramedic service. I am extremely
proud of every member of our team as they fulfil their roles with dedication and kindness and, I believe, make Toronto a better place to live.
Toronto Paramedic Services is committed to remaining a world leader in prehospital medicine, focused on evidence-based clinical care,
efficiency and fiscally responsible improvements that benefit our patients and their families every day.
Paul Raftis, Chief, Toronto Paramedic Services
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Toronto Paramedic Services Annual Report 2014

mission, vision, values


Mission Statement
Toronto Paramedic Services is an industry leading, public service organization that exists to protect the quality of life in Toronto by providing
superior and compassionate prehospital and out-of-hospital medical care, responding to patients with health emergencies and to the special
needs of vulnerable communities through integrated, mobile, Paramedic-based healthcare.

Vision Statement
Toronto Paramedic Services strives to meet the changing needs of our community for prehospital and out-of-hospital medical care by demonstrating our
fundamental values every day.

Values:
Service

We are compassionate with our callers and patients. We accept the trust and confidence they put
in us especially when they are most vulnerable.

Optimism

We value the opportunity to make a difference in someones life every day.

Integrity

We are ethical in all of our interactions. We remain trustworthy to the public we serve by never
compromising our professionalism or integrity.

Teamwork

We build strong relationships by working well together and independently. We support a


professional workplace that communicates respect for diversity, equitable treatment and contribution.

The September 2014 paramedic graduating class

Leadership

We are an organization of leaders. We nurture, grow and practice leadership skills at every level of our
organization which helps us achieve the Toronto Public Services values of stewardship, service and
commitment.

Excellence

We continuously improve everything we do through personal development, education, evaluation, and


evidence-based research. We achieve excellence by demonstrating the highest degree of expertise as
Emergency Medical Dispatchers, Paramedics, Support and Leadership staff, working together as a team.
Toronto Paramedic Services Annual Report 2014

strategic direction
In keeping with the Citys Strategic Actions for 20132018, Toronto Paramedic Services
strives to fulfill its mission through:
Organizational Efficiency and Effectiveness
Mitigate emergency calls through various clinical pathways
Fully implement Patient Safety Advocate to defer calls
Expand Community Paramedicine, e.g., Community Referrals by EMS (CREMS), Seniors Strategy, Health Links, House Calls, etc.
Improve citizen first response through public education and prevention
Maximize efficiency and effectiveness of required continuing Paramedic education and training
Develop and implement process improvements for frontline operations and in the Communications Centre

Strengthening Organizational Excellence


Be an employer of choice
Support employee engagement and professionalism
Support employee and labour relationships

Clinical Excellence
Renew vision of clinical excellence as a key priority
Fully implement targeted Advanced Life Support model of care
Maintain Communications Centre accreditation as a Centre of Excellence
Obtain Canadian Medical Association accreditation for Paramedic education and training programs
Successfully complete Toronto Paramedic Services Primary Care Paramedic Program, in partnership with
Toronto Employment & Social Services, under Regulation 257/00 of the Ambulance Act of Ontario
2015-2016
Paramedics Diego Macias and Tara Tewari
caring for deafblind patient

Maintain leadership in national and international medical research to promote integrated, evidence-based
clinical care
Evaluate and revise, as needed, the current Clinical Supervision model to provide prehospital clinical
evaluation and quality assurance of all certified Paramedics
Successfully complete Ministry of Health and Long-Term Care (MOHLTC) Land Ambulance follow-up Audit

Toronto Paramedic Services Annual Report 2014

Paramedic response unit

Improving Response Time


By 2020, improve response times for life-threatening emergency calls to achieve 8:59 minutes, 90% of the time
Reduce in-hospital offload delays by adding Lean/Six Sigma expertise per the City Managers Service & Organizational Review
Develop and implement comprehensive performance management targets for all program areas

Optimizing Staffing

Evaluate Emergency Medical Dispatcher schedules


Implement new scheduling processes and software2015 to 2016
Continue to implement recommendations of the City Managers Service & Organizational Review

Maximizing Infrastructure Efficiencies


Complete Lean management principles project to re-engineer work flow processes in hospitals
Following the expropriation of existing ambulance stations, construct the first multi-function station to increase effectiveness of the new
operational model
Continue to collaborate in the new tri-service (Paramedic Services, Police 911, Fire) Toronto Radio Infrastructure Project (TRIP)
Participate in the development of the NG (Next Generation) 911 Project

Toronto Paramedic Services Annual Report 2014

2014 operating budget


Community Paramedicine and Emergency Call Mitigation
Emergency Medical Dispatch and Preliminary Care
Emergency Medical Care
City Emergency and Major Event Mass Casualty Care
Total Program Budget

Gross

Net

Includes Provincial Funding


(thousands of dollars)

City Funding Only


(thousands of dollars)

2,593.6

708.9

24,730.9

383.8

153,745.6

70,630.3

6,779.2

610.9

187,849.3

72,333.9

2014 Service Deliverables


On January 30, 2014, the Toronto Paramedic Services Operating Budget was approved to fund:
Emergency Medical Care (Paramedic Care)

24-hour emergency medical response for the City of Toronto from 45 ambulance stations located across the City with a fleet of 156
ambulances and an approved complement of 958 paramedics and 108 emergency medical dispatchers.
Targeted response times to life-threatening emergency calls within 8:59 minutes 90% of the time with response time defined as the
elapsed time from the receipt of the emergency call by the Central Ambulance Communications Centre to the arrival of the paramedic
crew at the scene.
Provision of an estimated 202,469 emergency patient transports in 2014, an estimated increase of 3% over the 2013 projection of
196,572 emergency patient transports.
Provision of an estimated 24,200 hours of continuing medical education to Toronto Paramedic Services staff as mandated by the Ministry
of Health and Long-Term Care and Paramedic Services Base Hospital (medical oversight); upgrade training for 12 Primary Care
Paramedics to the Advanced Care Paramedic level; and provision of International Trauma Life Support training to approximately 1,200
students.
In 2014, Toronto Paramedic Services underwent a complete Ministry of Health and Long Term Care (MOHLTC) audit of its Land
Ambulance Service. The audit is conducted by the MOHLTC every three years to ensure Toronto Paramedic Services continues to meet
all legislated requirements as outlined under the Ambulance Act.

Toronto Paramedic Services Annual Report 2014

2014 Operating Budget Funding Source


$187.849 Million

2014 Operating Budget by Service


$187.849 Million
City Emergency and
Major Event Mass
Casualty Care, $6.8, 4%

Interdivisional
Recoveries, $0.9, 0%

Community Paramedicine
and Emergency Call
Mitigation, $2.6, 1%
Emergency Medical
Dispatch and Preliminary
Care, $24.7, 13%

Emergency Medical Care,


$153.7, 82%

2014 Toronto Paramedic Services vs. Citys Total Taxsupported Net Operating Budget $3,755 Million

Property Tax,
$72.3, 39%

Toronto Paramedic
Services, $72.3, 2%

Provincial Subsidies,
$112.5, 60%
Other Tax-Supported
Operating Budget,
$3,682.8, 98%

Sundry Revenues,
$1.3, 1%

Transfers from Capital


Fund, $0.2, 0%

User Fees &


Donations, $0.7, 0%

Community Paramedicine and Emergency Call Mitigation

Continued use of the Community Paramedicine Program to re-direct specific patient groups to appropriate preventative, out-of-hospital
medical care, thereby minimizing or eliminating their reliance on 911 and the hospital system.
Provision of 1,000 First-Aid/CPR and Public Access Defibrillation training courses to City staff and external clients. Toronto Paramedic
Services maintained and provided oversight to 1,495 Automatic External Defibrillators in 2014.
Continued utilization and investigation of innovative call diversion and mitigation strategies to improve ambulance availability.
Continued work with hospital stakeholders to implement Lean/Six Sigma type solutions to reduce hospital delays that contribute to
paramedic wait times, and to improve operational performance.

Emergency Medical Dispatch and Preliminary Care

Continued development and implementation of improved computer-aided dispatch technology and processes in the Central Ambulance
Communications Centre to facilitate the deployment of ambulances to improve response time performance.
Implementation of new Emergency Medical Dispatch (EMD) shift schedules in the Central Ambulance Communications Centre to better
match EMD staffing with emergency call demand, by shifting more staff to weekends and higher peak demand times during the day.
In 2014, the Central Ambulance Communications Centre underwent a re-accreditation process for the third time as a Centre of
Excellence by the International Academy of Emergency Dispatch. Accreditation establishes the centre as having achieved an
internationally benchmarked, high standard of patient care delivered by EMDs. The centre triages incoming emergency calls with the aid
of the Medical Priority Dispatch System (MPDS).

Toronto Paramedic Services Annual Report 2014

operations
The Operations section is directly responsible for providing evidence-based emergency
medical care and transportation by Paramedics with ambulances and emergency response
vehicles.
Garrie Wright, Deputy Chief, Operations

Achievements
In September 2014, Toronto Paramedic Services successfully completed the Ministry of
Health and Long-Term Care (MOHLTC) Land Ambulance Service Audit. The audit is
conducted by the MOHLTC every three years in accordance with legislation, and examines
over 250 individual items including policies and procedures, vehicles, equipment, as well
as paramedic patient care and documentation. In preparation for the audit, Toronto
Paramedic Services traditional work-flow processes were reviewed and re-designed, with
a new model being implemented in March 2014. This new model resulted in immediate
efficiencies in Superintendents daily work, increased the amount of time with their
assigned staff and improved tracking and reporting of their efforts.

Paramedics Adam Hobbs and Dara Sheridan


caring for patient

Toronto Paramedic Services continued to phase in its targeted model of care where
Advanced Life Support (ALS) Paramedic crews respond more consistently to ALSappropriate calls based on the Medical Priority Dispatch System (MPDS) triage system.
This change results in more efficient use of resources as medical skills are more closely
matched to patient needs.
In partnership with St. Michaels Hospital, Toronto Paramedic Services completed the
training of its Advanced Care Paramedics (ACPs) to participate in two important clinical
research trials, scheduled to start in early 2015one focusing on the treatment of
traumatic injury to reduce blood loss and the other to minimize the damage caused by
acute stroke.
In the spring of 2014, Toronto Paramedic Services successfully negotiated terms and
conditions of employment for the hiring of part-time Paramedicsthe first such agreement
with Toronto Civic Employees Union Local 416. Approximately 100 new part-time staff
were hired in 2014 and have helped to manage the increase in emergency call demand
while reducing overtime costs.

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Toronto Paramedic Services Annual Report 2014

communications centre
The Central Ambulance Communications Centre (CACC), which is 100% funded by the
Ministry of Health and Long-Term Care (MOHLTC), provides an ambulance dispatch service
that includes 911 call receiving, call triage, ambulance dispatch and real-time system
performance monitoring. The Centre is operated under a Performance Agreement with the
MOHLTC. It includes the design, operation and maintenance of radio, telephone and
computerized communications equipment. The CACC also provides training to its
Emergency Medical Dispatchers (EMDs) and creates and maintains map location data.
Gord McEachen, Deputy Chief, Central Ambulance Communications Centre

Achievements
In November 2014, the CACC was re-accredited for the third time as a Centre of Excellence in
accordance with the standards set out by the International Academies of Emergency Dispatch
(IAED). This designation has been accorded to only 139 other centres worldwide, and ensures that
the highest standard of service is provided to the community. Accreditation establishes the centre as
having achieved an internationally benchmarked, high standard of patient care delivered by EMDs.
In February 2014, a new schedule was implemented for Emergency Medical Dispatchers (EMDs) that
better matches service demand while considering the physiological, personal and health and safety
needs of EMDs. In September, EMDs were surveyed to gain their feedback on the new schedule and
review possible adjustments to be implemented in 2015.
In partnership with the IAED, the CACC designed and implemented an enhanced tool used by EMDs
to screen for emerging infectious diseases during the 911 call-taking process. This vital information is
then relayed to Paramedics, enabling them to safely provide the most appropriate care.
Toronto Paramedic Services successfully negotiated funding with the Ministry of Health and LongTerm Care (MOHLTC) for 17 new EMD positions in the CACC as recommended by the City
Managers Service and Organizational Review and adopted by City Council in July 2013.

Emergency Medical Dispatcher Norm


Rivera answering 911 call

As part of ongoing facilities upgrades in the CACC, ceiling and lighting renovations were completed to
ensure that the physical surroundings support the wellness of staff.

Toronto Paramedic Services Annual Report 2014

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operational support
The Operational Support section plays a critical role in supporting Toronto Paramedic
Services frontline Paramedic and EMD services, by providing functions that include fleet
services, facility maintenance, staff scheduling, materials management, equipment
maintenance services and communication systems engineering.
Frank Hurlehey, Deputy Chief, Operational Support

Achievements
Through the Citys Facilities Transformation Project, Toronto Paramedic Services successfully
transferred budget, staff and responsibility for the operation, maintenance and cleaning of all
divisional facilities to the Citys corporate Facilities Management Division in June 2014, allowing
for more centralized oversight and support of these functions.
Renovations were completed to modernize and integrate the workflow of Toronto Paramedic
Services Fleet and Equipment Services areas. Based on Lean methodologies, the new design
has resulted in a streamlined, timely and efficient process for ambulance repair/servicing,
decontamination, deep cleaning, and inventory and restocking of all medical supplies,
products and equipment that meets provincially legislated standards.
Toronto Paramedic Services continued to achieve efficiencies through ongoing work with other
Divisions (Toronto Fire Services, Toronto Water, and Corporate Fleet Services) on shared
vehicle and repair contracts e.g., repair of Paramedic Services vehicles.
Support staff member Sandra Fearon
servicing stretcher

Design of Toronto Paramedic Services first multi-purpose station began in 2014. The station is
to be situated near the soon-to-be completed Humber River Hospital on Wilson Avenue. Due
to its strategic location, this new facility will be used as part of Paramedic Services active
deployment plan, as well as for its Special Operations Unit and to house pandemic supplies.
Construction is scheduled to begin in mid-2015.
Toronto Paramedic Services continued to work with Toronto Fire Services and Toronto Police
Service in meeting all timelines and benchmarks towards completion of the Toronto Radio
Infrastructure Project (TRIP), shared by the three emergency services. This project will provide
integration and interoperability of radio systems and allow better radio coverage for emergency
responders throughout the city.

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Toronto Paramedic Services Annual Report 2014

program development and service quality


This section supports frontline operations through emergency planning, community-focused healthcare,
ensuring legislative compliance and maintenance of quality standards. It includes evidence-based
education for staff and the public, and provision of accurate information to the public regarding Toronto
Paramedic Services programs.
Cindy Nicholson, Deputy Chief, Program Development and Service Quality

Achievements
Working with the Ministry of Health and Long-Term Care (MOHLTC), Toronto Paramedic Services
received provincial funding for two (2) Community Paramedicine initiativesthe Independence at Home
program and a system upgrade to its Community Agency Notification process. The Community
Paramedicine Program reduces call volume pressures and provides the most appropriate, mobile patient
care to vulnerable Toronto communities and residents. This program was affirmed by City Council in July
2013, per the City Managers Service and Organizational Review.
In partnership with Toronto Employment and Social Services (TESS), Toronto Paramedic Services
commenced a Primary Care Paramedic (PCP) training program for 15 students, aimed at allowing
individuals from diverse communities to become life-saving professionals by mitigating their costs and
helping them become self-reliant. The Toronto PCP Program is recognized by the MOHLTC as equivalent
to a college program.
Toronto Paramedic Services Public Access Defibrillation (PAD) Program continued to save lives by
allowing bystander medical interventions to begin sooner. Through 2014, eighty-four (84) automated
external defibrillators (AEDs) were installed at workplaces and facilities throughout the city of Toronto with
12 lives saved.

Paramedic Sohail Bastani in classroom

Clinical supervision by our Educational Superintendents was expanded to provide 12-hour coverage,
seven days a week, to support the integration ofnewrecruits, provide in-field oversight Paramedic
students, and to assist management staff with maintaining their Paramedic certification.
Toronto Paramedic Services continued to recruit a diverse workforce in 2014, hiring Paramedics and
Emergency Medical Dispatchers (EMDs) with various cultural backgrounds and fluency in languages that
include Tagalog, Korean, Tamil, Russian, Ukrainian, Romanian, Vietnamese, Portuguese and Polish.
Training was completed to allow Primary Care Paramedics (PCPs) to take patients suffering a specific
type of heart attack (STEMI) directly to heart catheterization labs for immediate surgery to improve patient
survival and outcomesbased on a successful research study that demonstrated the benefit for patients.
Toronto Paramedic Services Annual Report 2014

13

performance
Number of Emergency Transports
In 2014, the number of emergency transports provided by Toronto Paramedic Services was 210,098an increase of more than 6% over
2013 (See Figure 1), and an increase of over 48% since 2005 when emergency transports totalled 141,409. This is attributable to a growing
and aging population. Emergency transport volumes are projected to continue growing by 4 to 5% per year, reaching approximately 230,000
by 2016.

Response Time
(Length of time for Toronto Paramedic Services to arrive at an emergency scene)
Figure 2 below shows Toronto Paramedic Services 90th percentile response time trend for life-threatening calls. Although emergency
transports in 2014 increased by 6.2% over 2013, response times to life-threatening emergency calls have shown a modest improvement
compared to 2013. Toronto Paramedic Services Patient Safety Advocate (PSA) function continues to focus on response time performance
both in real-time and retrospectively to ensure that our patients receive a timely response.
Figure 1

Figure 2

Emergency Transport Volume

Toronto Paramedic Services Response Trend (Life Threatening)

240,000

231,633

230,000

220,603

220,000

210,098

12.9
12.7

12.5

12
11.5

182,538

180,000

11.5

173,301

170,000

160,289

160,000

12.5
12.3

12

12.0

187,819

190,000

12.7

12.4

12.3

197,874

200,000

163,648 164,516

11.0

154,026

11.5
11.3

11.3

10.7

10.5

141,409
14

13

20

20

12
20

11
20

10
20

09
20

08

07

20

06

20

20

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20

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10.0
05

140,000

14

13.1
13.0

210,000

150,000

13.5

Toronto Paramedic Services Annual Report 2014

research and clinical excellence


For almost 20 years Toronto Paramedic Services has continued to focus on clinical
excellence through its participation in numerous research trials to ensure that evidencebased medical care is provided to our patients. These studies have not only validated the
effectiveness of care already provided by Toronto Paramedics, but have also led to industryleading improvements in out-of-hospital care at the local, national and international levels.
Research drives critical changes that improve patient outcomes, and sets standards and
best practices for prehospital providers worldwide.
Some of These Research Trials Have Included:
Administration of certain drugs to halt potentially fatal heart rhythms (1996)published in the New England Journal of Medicine;
Transporting patients suffering from a specific type of heart attack directly to specialized hospitals to administer time-sensitive treatments
(2013)accepted as a poster presentation at the 2014 National Association of EMS Physicians conference; and
Use of rapid body cooling to treat cardiac arrest victims (currently underway).
In addition, all Advanced Care Paramedics (ACPs) received training in 2014 for
two upcoming research trialsone focusing on the treatment of traumatic injury to
reduce blood loss and the other to minimize the damage caused by acute stroke,
both to be carried out by Paramedics in the prehospital setting.
The depth and sophistication of these studies have brought international
recognition to the City of Toronto and its researchers and have resulted in many
new initiatives and innovations being implemented within the prehospital and
Paramedic services system.

Post-Cardiac Arrest Survival


A current initiative involves the SPARC Network (Strategies for Post-Arrest
Resuscitative Care). This network is a collaborative group of hospitals, physicians,
and other medical professionals involved in cardiac care. The groups focus is to
increase the survival rate of post- cardiac arrest patients and includes the
exploration of therapeutic hypothermia, or the extreme cooling of a patient
suffering from cardiac arrest to increase their chance of survival. Toronto
Toronto Paramedic Services Annual Report 2014

From left to right at the Resuscitation in Motion conference: Dr. L.


Morrison, Scientist Rescu, St. Michaels Hospital, Dr. R. Verbeek,
Physician Sunnybrook Centre for Prehospital Care, Paramedic Ken
Mooney, Cardiac Arrest Survivor Andrew Rosbrook, Paramedics
Allister Keene, Joe Barta, Sherry Wilson, Susan Devries, Stephan Ryan.

15

Paramedic Services Paramedics and patients are participating in the largest clinical trial of post-arrest cooled patients in the world. This is
part of a province-wide study under the supervision of Dr. Laurie Morrison and her research team at St. Michaels Hospital.
Another important study in the treatment of cardiac arrest is the tracking of out-of-hospital cardiac arrest (OHCA) survival ratesin other
words, how many cardiac patients not only survive to receive care and treatment in a hospital but also do well enough to return home after
this treatment. The intervention of a bystander in providing immediate cardiopulmonary resuscitation (CPR) and/or assistance from an
automatic external defibrillator (AED) is another important part of survival. Dr. Morrison tracks this data for Toronto Paramedic Services
patients and recently provided some outstanding resultsfrom 2004, when OHCA survival rates were 2% (for all cardiac rhythms) to the first
6 months of 2014, OHCA survival rates grew to 15%. This seven-fold increase in survival is a result of both Paramedic care and of increased
actions of bystanders to assist the patient before Paramedics arrive.

Clinical Research
Toronto Paramedic Services is the largest contributor to the Resuscitation Outcomes Consortium (ROC), and is one of only ten Regional
Clinical Centres across North America comprising this network. The ROCs mission is to conduct clinical research in the areas of CPR and
traumatic injury in the prehospital setting.

Advanced Treatments for Heart Attack, Stroke, Trauma and Post-Cardiac Arrest
Toronto Paramedic Services has continued to expand its STEMI (a type of heart attack),
stroke, trauma, and post-cardiac arrest patient care programs to reduce prehospital
mortality. These programs continue to demonstrate improved survival outcomes and
make critical differences in the quality of life of our patients.

Figure 3

STEMI Transports
800

The STEMI program allows Advanced Care Paramedics (ACPs) to take patients
suffering a specific type of heart attack (known as STEMI) directly to heart
catheterization labs for immediate surgery to improve patient survival and outcomes
based on a successful research study that demonstrated the benefit for patients.
Training was completed in 2014 to allow Primary Care Paramedics to do the same.

600

400

Figure 3 shows that that the number of STEMI patients that have been transported
by Paramedics for definitive in-hospital care has increased three-fold since 2008.
This has been as a result of advancements in research in which Toronto Paramedic
Services has played a pivotal role.

Community
Hospital

200

0
20

16

08

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20

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1
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1
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A published research paper on severe traumatic injury in the Annals of Surgery in


2010 ranked Toronto Paramedic Services first out of nine North American
paramedic services studied, with the highest survival-to-discharge rate for treatment
of traumatic injuries.
Toronto Paramedic Services Annual Report 2014

community paramedicine
Toronto Paramedic Services Community Paramedicine Program was created in the fall of
1999. The program is a series of community-centred initiatives which focus on health
promotion and injury prevention. Among paramedic services, Toronto is at the forefront with
a number of innovative initiatives.
The Community Paramedicine Program exists to help connect the most vulnerable
population of patients to the most appropriate entry into the healthcare system. It
uses a variety of programs and approaches matched to each patients particular
needs, while alleviating unnecessary emergency responses and emergency room
visits.
With the success of our Community Paramedicine Program, we have seen a 50%
reduction in the number of residents who call Paramedic Services two or more times
in a six-month period. This success is the result of frontline Paramedics taking an
active role in supporting our vulnerable patients and providing the resources to assist
those who need it most.
In January 2014, the Ministry of Health & Long-Term Care (MOHLTC) announced
funding to support the development of Community Paramedicine programs across
Ontario. This support was significant affirmation that paramedics have been making
substantial inroads for vulnerable Ontarians. As a pioneer of Community Paramedicine
in Canada, Toronto Paramedic Services received funding for two pilot initiatives: the
Community Agency Notification (CAN) program and the Independence at Home
program.

From left to right: Superintendent Darcy Brebner, Community


Paramedics Michelle Grant, Mark Yandt, Siobhan Carlin, and
Deputy Chief Cindy Nicholson

Community Agency Notification (CAN)


The CAN program ensures patients stay connected with community support agencies, such as during medical emergencies when
Paramedics are usually involved in the response and care of such patients.
The CAN program bridges the communication gap between the community agency and the client by notifying community agencies in real
time when their clients have been in contact with Toronto Paramedics. This type of notification allows community agencies to better respond
to their clients changing needs resulting from declining health, injury, or environmental changes. A CAN notification maintains seamless
transition of care, which may result in fewer emergency room (ER) visits, shorter hospital stays, more effective continuum of service delivery,
Toronto Paramedic Services Annual Report 2014

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and improved quality of life for the patient and their loved ones. By the end of 2014, almost 1,700 clients had been registered with the
programa twofold increase since 2013.
The MOHLTC funding received in 2014 will allow Toronto Paramedic Services to upgrade the current CAN electronic platform. The resulting
enhanced technology solution will greatly enhance the capacity and functionality of CAN, allowing more vulnerable people to stay safely
connected to their support mechanisms.

Community Referrals by EMS (CREMS)

Figure 4

Number of CREMS Referrals


4,000

3,550
3,250
2,798

3,000

2,000

1,000

3,000

1,735

969

1,201

1,076

1,234

589

t
Ta
r

ge

t
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ge

t
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15

Ta
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ge

14
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08

Since 2006, the CREMS program has provided a mechanism for frontline
Paramedics who respond to 911 emergency calls to make specific healthcare
referrals based on a determination that a patient is in need of additional care or
support services. Referrals are made to the appropriate Community Care Access
Centre (CCAC) to arrange for further assessment, and to determine the types of
available service that are best suited to each patients needs, thereby reducing
future trips to the emergency department.
The 2013 launch of an electronic CREMS referral process through the
Paramedics electronic patient care reporting (ePCR) system has led to an over
60% increase in referrals in 2014 (See Figure 4). The CREMS ePCR process has
also been broadened to provide referrals to additional specific provincial programs
such as Healthcare Connect for Primary Care, and the Ontario Telemedicine
Network for Telehomecare Monitoring for unmanaged congestive heart failure
(CHF) and chronic obstructive pulmonary disease (COPD) patients.

Health Links
With the advent of the provincial Health Links strategy in November 2012, Toronto Paramedic Services continues to contribute to multiple
Health Links programs in partnership with Local Health Integration Networks (LHINs).
Health Links are teams of primary care physicians, long-term care home staff, community agencies and paramedic providers, who work
collaboratively to meet the needs of complex-care patients and their families through targeted care. This is accomplished by creating formal
care plans, ensuring that the care plan is understood and followed, and by providing any necessary support to families and their healthcare
providers. Accurate information exchange is essential within these Health Links programs, and Toronto Paramedic Services plays a key role in
that information gathering and exchange.

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Toronto Paramedic Services Annual Report 2014

Independence at Home (IAH)


This 12-month pilot initiative, funded by the MOHLTC, will involve two Community Paramedics following up regularly with seniors living in
specific Toronto Community Housing sites who have a history of multiple calls for Paramedic service. The goal of the IAH program is to ensure
that seniors at higher risk of healthcare issues have appropriate supports in place to manage their medical and social conditions, ultimately
reducing their reliance on 911 and the hospital system.

House Calls for Medically Complex Patients


In May 2014, a joint proposal between Toronto Paramedic Services and the Toronto Central LHINs
House Calls program was awarded funding by the Toronto Central LHIN through the Ontario
Medical Association. The goal of the funding is to incorporate Community Paramedic home visits
in the House Calls program. House Calls is an interdisciplinary mobile team providing frail and
vulnerable homebound seniors with medical assessments and care at home rather than in
hospital.
This pilot initiative aims to demonstrate that integrating the work of Toronto Paramedic Services
with the House Calls program can reduce 911 calls, emergency department visits and
hospitalizations, as well as reduce the number of re-admissions that occur within a 30-day period
for the targeted population of frail, homebound elders. This population has been identified as the
highest-need patient group within our healthcare system. This is a new and innovative approach
not only for paramedic services, but for healthcare in general. A Community Paramedic will operate
as an extension of the House Calls team, providing advanced diagnostic skills and testing in
addition to a developing expanded scope of care for housebound patients.

Community Paramedic caring for patient

Our Commitment Is to:


Increase CREMS referrals by 10% annually to ensure that vulnerable patients are identified and
put into contact with the appropriate Community Care Access Centre or provincial programs.
Increase the number of home visits to the most vulnerable patients by Community Paramedics.
Continue participation in the various Provincial Community Paramedicine working groups, and
continue collaboration with other Community Paramedicine Programs across Ontario and
abroad to establish and validate best practices.
Continue participation in the Health Links program within the city of Toronto, and continue
involvement with the larger, multi-service LHINs surrounding the city.
Work with the MOHLTC to continue support of the Community Paramedicine program and
existing Community Paramedic staffing in conjunction with an expanded scope of clinical
practice.
Toronto Paramedic Services Annual Report 2014

19

customer service
Toronto Paramedic Services Top Requested
Languages for 911, Translated Using
Language Line in 2014
Figure 5

Italian
8%
Russian
9%

Spanish
6%

Tamil
6%
Portuguese
5%
Korean
4%
Hungarian
4%

Mandarin
14%

Vietnamese
4%
Farsi
3%
Arabic
3%
Cantonese
15%

Other Languages
19%

Language Line
In keeping with our commitment to provide excellent customer care to Torontos
diverse community, Toronto Paramedic Services employs an advanced service
within our Communications Centre known as Language Line. This service
allows 911 callers to access life-saving Paramedic care in any one of over 200
different languages. In 2014, our Emergency Medical Dispatchers (EMDs)
utilized this service almost 2,700 times to gather critical information to provide
the most appropriate care to those in need. Figure 5 depicts the top 20
languages for which Language Line was used in 2014.

Compliments and Complaints


Toronto Paramedic Services also recognizes the importance of responding to
customer concerns. In 2014, 270 complaints were received, representing less
than 1% of the over 370,000 emergency responses provided by Paramedics. In
addition, notwithstanding the increase in call volume, the overall number of
complaints received by Toronto Paramedic Services in 2014 decreased for the
second year in a row by approximately 11%, compared to 2013. Meanwhile,
those who contacted us to express their gratitude and to compliment our staff
increased by more than 15%.
Where a member of the public has concerns about our service, our goal is to
ensure that complainants are contacted by our Professional Standards staff
within two (2) business days, 90 percent of the timea goal we surpassed in
2014 at a rate of 94%.

Customer Satisfaction Survey


Toronto Paramedic Services Customer Service Improvement Team (CSIT) takes a leadership role in monitoring customer service activities
within the division and making recommendations for further improvement. As an example, the CSIT led the development of a customer
service survey to allow patients, their friends and families, and the public to provide feedback on our service in a way that is simple, accessible
and relevant. The survey is available online at https://www.surveymonkey.com/r/TEMS_CustomerSurvey and will soon be available in 10
different languages in addition to English.
20

Toronto Paramedic Services Annual Report 2014

health and safety


Toronto Paramedic Services is committed to employing best practices to ensure the safety of
paramedics, patients, and healthcare colleagues at all times.
Dr. Sheela Basrur Health And Safety Award
In 2014, Toronto Paramedic Services was presented with the Dr. Sheela Basrur Health and
Safety Award for a 29% reduction in lost time injuries in 2013, a 47% reduction in lost time
injuries from 2009-2013, and for health and safety program improvements through joint
management and labour efforts.
In 2008, the Citys Occupational Health and Safety Co-ordinating Committee (OHSCC)
established the annual Dr. Sheela Basrur Occupational Health and Safety Award to honour
and recognize the late Dr. Basrurs outstanding contributions to the City of Torontos
occupational health and safety program. The Dr. Sheela Basrur Occupational Health &
Safety Award is presented annually to a City division that has achieved significant injury
reduction in the previous calendar year through proactive health and safety program
improvements resulting from joint management and labour efforts.

Infectious Disease Preparedness


In addition, Toronto Paramedic Services responded to the threat of Ebola Virus Disease by
working with and following the guidance of the Ministry of Health and Long-Term Care,
Toronto Public Health and Public Health Ontario to ensure appropriate processes and
systems were in place in the event that Toronto received any suspected cases of the
disease. This allowed Toronto Paramedic Services to renew our focus on preparedness for
other infectious diseases as well. These preparedness measures included enhanced
personal protective equipment for Paramedics and comprehensive training for Paramedics
that might encounter suspected Ebola cases.
Toronto Paramedic Services also implemented an enhanced 911 screening process for
use by Emergency Medical Dispatchers (EMDs), which has since been sanctioned by the
International Association of Emergency Dispatchers, and was recently advocated by the
United States Centers for Disease Control and Prevention.

Toronto Paramedic Services Annual Report 2014

Paramedic Tom Bruce donning


personal protective equipment

21

news and events


Toronto Paramedic Services Brand
On October 1, 2014, the former Toronto Emergency Medical Services was renamed, Toronto Paramedic Services. The new name more
closely represents the spectrum of services provided to Torontonians and helps the public better understand the work of one of the worlds
leading prehospital care systems. It also harmonizes the name of Torontos service with other paramedic services across Ontario.
While the name is new, this does not affect how the public accesses Torontos 911 system. Residents and
visitors should continue to call 911 for ambulance services as they do now.

TORONTO

PARAMEDIC
S ERV IC E S

One of the most important steps undertaken in determining the new name was to gather input from all staff
through an online survey. Approximately 500 responses were received, which were instrumental in the
decision-making process. In addition, staff from Operations and the Communications Centre were
surveyed regarding the design of their new uniform styles that will bear the new name.
The new brand will be introduced over the next few years in order to remain within our approved operating
budget. New uniforms will be introduced gradually, starting with the 2015 annual issue and as current
inventory is exhausted. Vehicle markings will be changed as replacement vehicles arrive, and other items
will be changed through attrition and end-of-life replacement.
Toronto Paramedic Services electronic media have also changed, including our website,
www.torontoparamedicservices.ca, and social media pages (see Follow Us Online below).
While our name has changed, we remain a world leader in prehospital care. With the dedication and hard
work of our men and women, Toronto Paramedic Services is committed to continued excellence in
providing evidence-based patient care.

Public Information and Media


Each year, Toronto Paramedic Services launches a spring and a fall public information campaign. The spring campaign launch coincided with
Paramedic Services Week in May and the annual Citizenship Ceremony sponsored by Toronto Paramedic Services. Over 100 new Canadians
and residents of Toronto were present. In addition to receiving their citizenship, the campaign was launched, and the attendees took a tour of
the Communications Centre. The campaign focussed on educating the public that they can call 911 in over 200 languages. Toronto
Paramedic Services Emergency Medical Dispatchers answer about 2,700 calls annually using a translator.

22

Toronto Paramedic Services Annual Report 2014

polski

italiano
magyar
"#

espaol !# !"#$

Hrvatski

DO YOU ?
SPRAIN YOUR ANKLE?
VISIT YOUR DOCTORS OFFICE

!"$%

911inAnyLanguage.ca

Have an Emergency

HIT BY A CAR?
CALL 911 FOR A TORONTO PARAMEDIC

ting vit

Kiswahili

Approximately 30% of Toronto


Paramedic Services calls would
be considered not immediately
life-threatening. However, the
public is often not aware that
many alternatives to calling 911
exist, including Telehealth, walkin clinics and family doctors.
Many members of the public
believe their only healthcare
option when facing medical
issues, is to call 911 or to go to
the emergency room.

franais

portugus

While the spring campaign


focussed on promoting
awareness of 911 availability in
different languages, the fall
campaign (launched on
November 3, 2014), focussed on
building public awareness of
alternative healthcare options
that may not require Paramedic
assistance. The campaign was
created to enhance public
understanding of the role that
paramedics play in the
healthcare continuum and thus,
to help channel more nonemergency medical calls to
other, appropriate healthcare
resources in the community. The
campaign was designed to
promote greater awareness of
the options, particularly during flu
season.

CHEST PAIN?
CALL 911 FOR A TORONTO PARAMEDIC

GETTING THE FLU?


CALL TELEHEALTH ONTARIO 1-866-797-0000

Having shortness of breath?


Chest pains? Afraid your
childs arm is broken after a
fall? Sudden vision problems,
dizziness or numbness?
Then DONT WAIT, CALL 911.
A highly trained
TORONTO PARAMEDIC
can treat your symptoms
and determine the appropriate
course of action.

911. Make the right call.


Visit TorontoParamedicServices.ca

Toronto Paramedic Services Annual Report 2014

23

Make the right call ads in Portuguese, Hungarian, and Chinese

Toronto Paramedic Services campaign took a positive question and answer approach to educating the community on the availability of alternative
healthcare options. However, the campaign also reminds the public that 911 should always be called for immediate life-threatening medical emergencies
like stroke, cardiac arrest, respiratory concerns, or significant trauma from an accident.
The campaign slogan was 911. Make the Right Call. It was targeted to primarily reach high users of Paramedic service and was delivered in
10 languages in addition to English. The targeted media included: TV, radio, print, transit, on-line media and doctors office television. Posters
were also placed in hospital emergency room waiting areas, through TorontoParamedic Services social media channels and radio, web digital
and electronic billboards, as well as through the Citys street furniture program.
Public information dissemination has also included messaging regarding prevention and treatment of extreme heat and cold-related medical
conditions.

Follow Us Online
Our new website and social media pages reflect the changes in our new name and can be
accessed via the Internet from any location, using a personal computer or portable device:
torontoparamedicservices.ca/
twitter.com/torontomedics
facebook.com/torontomedics
youtube.com/user/torontomedics

Toronto Paramedic Services website on a mobile device

24

Toronto Paramedic Services Annual Report 2014

cardiac safe city


In 1999, City Council approved the implementation of Toronto Paramedic Services Public
Access Defibrillation (PAD) program, and directed that the City partner with other
organizations and private clients to support further growth of the program as well as to help
Toronto become Cardiac Safe.
Since 2004, Toronto Paramedic Services has established successful partnerships with the Heart and Stroke Foundation of Ontario (HSFO),
Heart and Stroke National Office, the Mikey Network, and with provincial and federal governments. Together, they have generously funded
approximately half of the almost 1,500 automatic external defibrillators (AEDs) located across the city. Toronto Paramedic Services Cardiac
Safe City program continues to oversee all of these devices, of which approximately 40% are located in City-operated facilities such as
community centres, ice rinks, swimming pools, municipal buildings, and all TTC and in Toronto Police facilities.
Access to Toronto Paramedic Services training programs for first aid, CPR and AEDs was enhanced with the launch of an on-line registration
and payment system in 2014. Safe City delivers approximately 950 training courses per year and allowing residents to register for courses online allows for better customer service, and for more efficient coordination, tracking and administration of courses.

Cardiac Safe City providing CPR lessons to the public at City Hall

Toronto Paramedic Services Annual Report 2014

25

community and public engagement


Toronto Paramedic Services employees are very generous. In 2014, our
employees contributed over $105,000 to the annual City of Torontos
United Way campaign. In addition, they volunteer their own time for
various initiatives including:
Downsview and Scarborough Medical Venturer programa division of Scouts Canada that focuses on
the medical/first-aid/first responder aspects of Scouting. The Scouts are trained to be available to support
Toronto Paramedic Services in providing first-aid to Canadian National Exhibition attendees every August.
Raising over $10,000 for breast cancer awareness.
Raising over $5,000 for the ALS Canada Ice Bucket Challenge.
Raising over $3,000 for mens health during the annual Movember event.
Donating over $5,000 in toys to the Salvation Armys annual Toy Mountain campaign.
Driving the floats in Torontos Annual Santa Claus Parade.
Chief Paul Raftis taking the ALS ice
bucket challenge courtesy of
Toronto Paramedic Association
President Geoff MacBride

Community Paramedic Debbie


Wicks with another member
of Mitzvah Knitters

26

Collecting food for the Daily Bread Food Bank from donations at the St. Patricks Day parade.
Over 50 presentations given by volunteer Toronto Paramedic staff every year to various community and
church groups.

Paramedics Rachel Janer and Adrian


Gibbons sporting pink epaulettes to
raise money for breast cancer awareness

Collecting donations to the Daily Bread


Food Bank at the St. Patricks Day
Parade

Paramedics sporting moustaches for


Movember

Toronto Paramedic Services Annual Report 2014

awards and recognition


In 2014, our staff continued to demonstrate their
excellence and dedication. We continue to take
pride in recognizing our Paramedics, Emergency
Medical Dispatchers, and Support Staff for the
outstanding work they do every day in ensuring the
community receives the best prehospital care
available.
The following awards were presented in 2014:
Paramedic of the Year
Chris Barclay

John Dean Chiefs


Award

Emergency Medical
Dispatcher of the Year

Support Staff of the


Year

Norm Rivera

Jacqueline Tomas

Pioneer of the Year

Valour Award

Bruce South

Brenda Brydges
Victor Pak
Richard Vella
Jessica Houghton
Ted Harrod
Dave Naftolin

Ian Beduya
Rachel Janer

In addition, members of the public and allied agency representatives were


honoured for their exceptional deeds in assisting our team with providing
emergency care to those in need.

Toronto Paramedic Services Annual Report 2014

Top-left to
bottom-right:
Chris Barclay, Norm Rivera,
Ian Beduya, Rachel Janer,
Bruce South, Brenda Brydges,
Victor Pak, Richard Vella,
Jessica Houghton, Dave Naftolin

27

honours received
Torontos Got IT Award
For the second year in a row, Toronto Paramedic Services staff were amongst those to
receive the Torontos Got IT Awards of Excellence. Ian Beduya, Multimedia Programmer,
received the Innovation Award for his instrumental work in designing Toronto Paramedic
Services various online tools for supporting frontline staff, including an Education Portal,
Scheduling Portal, station bidding system, lieu time request system and the first-ever
interactive self-scheduling system for part-time Toronto Paramedic Services employees.
Ians continuous commitment to service, quality and excellence has been recognized by
his peers, superiors and by customers.

Ian Beduya receiving the Torontos Got IT award


from Sherry Fahim, Director Portfolio Management,
I&T Division

70thAnniversary of D-Day
On November 12, Toronto Paramedic Services was very
proud to welcome a number of Canadian Second World
War veterans to a special ceremonyrecognizingthe
Toronto Paramedic Services Veterans Support Team (VST)
at our headquarters. In June 2014, 11 members of Toronto
Paramedic Services volunteered their time to assist
veterans during events in France, marking the 70th
anniversary of D-Day and the Battle of Normandy.
Members of the Toronto Paramedic Services support team who assisted
veterans during the 70th Anniversary of D-Day and the Battle of Normandy
with then Veterans Affairs Canada Minister Julian Fantino

28

Toronto Paramedic Services Annual Report 2014

what the public is telling us


These are just a few of the comments received by Toronto
Paramedic Services on the great work of our staff.
Thank you for your quick response, the incredible job you did for
keeping me and my family calm and for being overall wonderful.
Thank you!

Thank you! Thank you! Thank you! The medics were outstanding
amazing and sweet. They kept everyone calm. Dont know what the
City would do without medics like them.

The paramedics were very professional, kind and were an


amazing group.

The medics were magnificent, exceptional, professional and


exquisite. You were the best help she could have asked for. You
were the cream of the crop. You represent training and your job to
the ultimate. It doesnt get better than the two of you. You both are
angels on earth.

They were capable, efficient and helpful without ever becoming


pushy, impatient or intrusive. Their resourcefulness and positive
attitude were welcome sources of strength in what could have
been a very distressing situation.
The medics were wonderful, very kind, very efficient and were
just marvellous.

To the three person crewyou guys are Rock Stars to me. I can
never say thank you enough!
I have to say, I am so proud to be living in a City that has such well
trained and caring EMS staff.

My husband suffered a cardiac block at home. If it werent for


the quick, but calm, expert care and thoughtfulness of your team,
he would not be alive. We are so grateful and appreciative to
everyone from Emergency Services that helped that day.

You both were superb, helpful, very good and knew your stuff
well!

Thank you!! If not for the quick response and care I would not be
writing this today.

I feel that no matter what Im able to say to you in person, it wont


be enough. How do you express, in words, how grateful we are that
you helped to change the entire course of our lives? ...You saved
our entire world.

To those two young beautiful guarding angels, I say thank you.

Toronto Paramedic Services Annual Report 2014

29

looking ahead
2015 brings with it new challenges and opportunities for Toronto Paramedic Services in how
it continues to deliver Paramedic care to the community, including:
Commencement of two research trials involving frontline Advanced Care Paramedics (ACPs)one focussing on the treatment of
excessive blood loss due to traumatic injury, the other to treat acute stroke in the prehospital setting.
Implementation of a new protocol to allow Primary Care Paramedics (PCPs) to take STEMI patients (those suffering a specific type of
heart attack) directly to heart catheterization labs for immediate surgery to improve patient survival and outcomesbased on a
successful research study that demonstrated the benefit for patients.
Continue to develop and implement improved computer-aided dispatch technology and processes in the Central Ambulance
Communications Centre to enhance access to emergent medical care.
Active engagement by Toronto Paramedic Services in several multi-jurisdictional and multi-governmental working groups as part of the
planning for the Pan Am/Parapan Am Games.
Over 1,500 public access defibrillators projected to be in place in 2015 through Toronto Paramedic Services Safe City program.
Construction of the first multi-function ambulance station to improve our operating model and better address the needs of Paramedics
and the community.
Participation in research examining the impact of the CREMS program on hospital services i.e., ER visits, length of stay, 30 day readmissions, etc.
Training of ACPs and Critical Care Paramedics (CCPs) to continue providing evidence-based medical care to the community.
Proposed addition of 56 new Paramedics to our existing staff complement, as recommended by the City Managers Service &
Organizational Review.

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Toronto Paramedic Services Annual Report 2014

Toronto Paramedic Services Honour Guard


Toronto Paramedic Services Annual Report 2014

31

Limited copies printed by City of Toronto Printing and Distribution


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Toronto Paramedic Services Annual Report 2014