Essex County approves funding two Paramedic Patient Navigator positions

Essex County Council approved the continuation of staff for the Essex Windsor EMS (EWEMS) team for two fulltime District Chiefs in the Ambulance Communications Centre, also known as the Paramedic Patient Navigator (PPN) positions, and to fund the County portion of these Paramedic Patient Navigator positions through levy dollars starting in 2025.

This will help, and has helped, to mitigate offload delays at local hospitals.

EWEMS Chief Justin Lammers explained District Chiefs have been utilized in the Ambulance Communications Centre since the fall of 2022, when the Ministry of Health approved placing a District Chief into the Central Ambulance Communications Centre (CACC) to assist with the flow of ambulances across the entire region amongst other operational responsibilities.

The Report to County Council notes this PPN position was immediately a success, as realized by not only the Essex Windsor EMS leadership team, but also the hospital partners. It was initially staffed 10-hours per day, five- days per week, but increased to 12-hours per day, seven-days per week in November of 2023.

“This is a unique position that not many other Communications Centres in the province have,” Lammers said. “This is one of our own, on the floor of a Ministry-run operation, making real-time decisions to avoid unnecessarily piling-up of ambulances at local emergency departments where possible.”

Though the primary responsibility of the PPN is to balance transport volumes across the region, it also includes working with the dispatch supervisor to provide deployment plan or service policy support on meal break management, Code 3 delay management, rostering/staffing, end-of-shift support, ambulances out of service, general deployment/crew guidance, paramedics service health and safety, and mass casualty incidents the Report to County Council highlights.

Lammers added EWEMS’s regular District Chiefs are on the frontline, performing their operational duties, which can be incredibly demanding at times. That can make it difficult to complete administrative tasks required of them.

“They are facilitating off-load delays in the emergency departments, they are responding to equipment-related concerns, supporting the paramedics with equipment and supplies, attending critical events, and following up with our crews after difficult calls, orchestrating per support debriefs,” Lammers said.

The PPN, however, sees the entire operation and can make tweaks and adjustments along the way to avoid a crisis.

“They not only keep the flow going, but keep us compliant with Legislative requirements,” he said.

“We started the PPN position when our service was facing very difficult times, ambulance availability was the lowest it had ever been. We called a Declaration of Emergency [in 2022], due to the lack of availability in our region,” Lammers recalled.

On January 19, 2024, Essex Windsor EMS received notification that the Designated Offload Nurse Program (DONP) funding through the Ministry, initially applied to offset the wages of the PPN position for the 2022/23 fiscal year, was not approved due to misalignment with the terms of the memorandum of agreement.

Subsequently, Essex Windsor EMS held discussions with the Assistant Deputy Minister Susan Picarello and her team to explore alternative options, the Report to Council noted.

“However, we received a response on March 11, 2024 and it was determined that the DONP funding cannot be allocated to the PPN position, resulting in the County being required to reimburse the amount utilized for that role in the 2022/23 fiscal year, totalling $202,083.”

While the Ministry of Health had previously granted approval for Essex Windsor EMS to place a supervisor in the Ambulance Communications Center, there was never a formal agreement stipulating that the funding would fall under DONP, the report notes. As of the 2023/24 fiscal year, Essex Windsor EMS is authorized to utilize the traditional 50/50 funding outlined in the Land Ambulance Service Agreement.

He said they worked with the Ministry to reduce the impact, but it was not possible.

With conversations continuing with Ministry partners, Lammers added EWEMS received approval from the Ministry of Health to place a District Chief in the Communications Centre, but there was never a formal agreement on how the position would be funded.

Financial implications for the years 2022/2023 and 2023/2024, he added, is $268,521, of which $134,260 is the County share, funded by safe restart. The City will be responsible to fund its share.

He strongly recommended the positions be kept in place. In doing so, it would cost the County $137,34 in 2024, funded by safe restart, and $113,164 in 2025, funded through the levy.

Essex Mayor Sherry Bondy thanked Lammers for troubleshooting and making gains in mitigating Code Red – when two or less ambulances are available – and Code Black – when no ambulances are available – instances in his short-time as Chief. This is making her confident, when the County goes to the Province, if Code Reds and Blacks continue, everything is being done from within the regional wheelhouse to ensure everything that can be done is being done on the County’s end.

Lammers noted that in January of this year, EWEMS experienced 174-minutes of Code Black, with none taking place in February, and only three-minutes in March.

“We are trending in the right direction,” he said, noting it is too early to say the region is out-of-the-woods on this matter just yet.

In answering LaSalle Deputy Mayor Mike Akpata’s question on what message could be presented to the Minister on what could be done to support the team on issues such as this, Lammers noted a report will come to County Council in May that will speak to integration with dispatch and engaging conversations to improve dispatch operations, allowing EWEMS staff to direct personnel on the ground to the most effective use of their time.

Later in the meeting, Director of Financial Services/Treasurer, Melissa Ryan provided information, comparing the cost of a staffed ambulance during an offload delay and the cost of a dedicated Offload Nurse in monitoring patients.

This was in response to a County Council question asked at the March 6 meeting that requested a cost/benefit analysis.

She explained the wages, benefits, and expenses for two paramedics assigned to an ambulance equated to around $143, additionally the operating cost of the ambulance itself – considering all costs – was around $30/hour.

Therefore, the comprehensive costs of an idle ambulance awaiting offload delays is around $173 per hour.

The cost per nurse, inclusive of benefits, is $85.20 per hour, according to a report that sourced information from the hospital. This solely represents the wage cost of a nurse, excluding any additional operating expenses.

Tecumseh Mayor Gary McNamara noted this information emphasizes the Chief’s report as to how important it is to get those dollars from the province.

“Once we get them to the hospital, the patient, it should be a turnover and the responsibility of the hospital to make sure that our patients are transferred properly,” he said.

Sylene Argent, Local Journalism Initiative Reporter, Essex Free Press