The Association of Ontario Municipalities (AMO) is concerned about changes to the Ambulance Act and the Fire Protection and Prevention Act, which are set to be tabled at Queen's Park in the fall.
One change aims to reduce unnecessary emergency room visits by having paramedics take patients with minor injuries to family doctors and community clinics. The law currently requires patients to be taken to hospital only.
Another change could see firefighters with paramedic training be able to respond to minor injury calls, provide medical care on fire trucks, and provide symptom relief in some higher-priority calls.
Pilot projects set to begin next spring
The province is looking for two municipalities to participate in pilot projects funded by the Ministry of Health and Long-Term Care, which are expected to begin in March 2018.
At least one Ottawa city councillor doesn't want the city to take part.
"Ottawa is not the right community to try this in.... I haven't seen any evidence that it leads us in a direction that we want to go," said Coun. Mark Taylor, who is also chair of AMO's health task force.
He's concerned Ottawa could be forced to subscribe to the new model, along with other communities, after the pilot projects are completed.
"We also live in a world where provincial arbitrators have a nasty habit of picking up things in one municipality and dropping them down in another," he said.
The president of AMO said she wants to ensure that doesn't happen.
"They keep telling us that it's voluntary, it's voluntary.... So, our demand of them is if this is to truly be voluntary, that we would require that interest arbitrators be prohibited, in law, from replicating it to unwilling participants," said Lynn Dollin.
Ministry to look at possible scenarios this fall
Legislation is expected to be tabled at Queen's Park this fall to change the two acts, and the Ministry of Health and Long-Term Care will consider what kind of calls would be appropriate for transporting patients to family doctors and clinics instead of emergency rooms.
"[The] ministry plans to undertake an operational risk assessment in the fall of potential scenarios, based on feedback from stakeholders to date and experiences of models currently used in other jurisdictions," press secretary Laura Gallant wrote in a statement to CBC News.
Some of those scenarios could include mental health calls, which are on the rise.
A hospital emergency room is not necessarily the best place for those patients, Taylor said.
Province could save, municipalities spend
There is a question of who ends up footing the bill for some costs. While the province may save some money from fewer emergency room visits, other costs could be off-loaded onto municipalities.
The Ministry of Health and Long-Term Care projects the cost of ambulance systems will increase by $300 million to $1.9 billion over five years, between 2015 and 2020.
Land ambulance costs are shared 50-50 with the province, but municipalities cover 100 per cent of the cost of firefighting, Dollin said.
Potential costs could include increased training for paramedics and firefighters to increased legal liability, she said. If patients are dropped off at a hospital, the hospital — and ultimately the province — are liable, but if the person is taken to another facility instead, a city could bear the brunt of that liability.
There are other ways the province could save money, according to AMO, including better call triaging and changing regulations around non-urgent patient transfers.
These types of transfers are especially problematic in northern Ontario, where ambulances are taken out of service to transfer non-urgent patients from one area to another, Dollin said. In southern Ontario, the province often contracts companies to move those patients.
"It's AMO's position that fixing those two things, the benefits would far outweigh those that could be brought about by fire-medics," she said.