Cornwall SD&G Emergency Medical Services

Transcription

1 Cornwall SD&G Emergency Medical Services Preparation of a Comprehensive Deployment Review Summary James Batchelor 12 th May 2014 Final Report Presentation 1

2 Presentation Objectives Benchmarking Modelling Recommendations Summary Final Report Presentation 2

3 Objectives Final Report Presentation 3

4 Overall Study Objective The purpose of this study is to identify options to maximize existing resources for response time performance. Aspects to be evaluated include shift times, deployment posts, staffing and resource configurations. An assessment of the central start methodology is to be included. Final Report Presentation 4

5 Benchmarking Final Report Presentation 5

6 Benchmarking Two similar Services that are close to Cornwall SD&G EMS were approached and their data collected. These data were analyzed in the same way by ORH to guarantee fair comparisons. Key operational factors benchmarked. A selection are shown here. Final Report Presentation 6

7 Service Benchmarking Average Time at Hospital Sample Period Priority Service 1 Service 2 Cornwall Cornwall 1 20:11 13:45 20:23 20: :50 22:06 29:06 32: :18 24:21 44:30 37: :10 23:42 47:51 39:24 Final Report Presentation 7

8 Modelling Results Final Report Presentation 8

9 Modelling Calibration travel time model set up based on road speeds achieved by Cornwall SD&G EMS vehicles as captured by GPS. This travel time model was input into ORH s bespoke simulation model, which replicates the operations of an EMS provider. This model has now been used to test options for change. Final Report Presentation 9

10 Key Standards The new response time framework lists 8- minute response to the highest priority incidents as a key measure. Cornwall SD&G EMS has set a service-wide standard of 68%. Each lower tier municipality has agreed that a 50 th percentile of 12 minutes would be a fair minimum performance for each sub area. The 90 th percentile gives a good backstop position for long responses. Final Report Presentation 10

11 Station Range Cover Priority 4 Incidents Final Report Presentation 11

12 Modelling Job Cycle and Demand Runs were undertaken to examine the effect of changing key operational parameters within the job cycle time and current (2012) demand levels. Those shown here are: Time at scene Time at hospital Chute time Abort rate Altering P1 and P2 transports Final Report Presentation 12

13 Modelling Job Cycle and Demand Summary All runs undertaken to alter job cycle components and demand have shown a modest increase in 8 minute performance with larger gains at the 90 th percentile. The choice of target, 8 minutes rather than the 90 th percentile, will drive the efficiencies required moving forward. Final Report Presentation 13

14 Modelling Deployment plans Runs were undertaken to examine the effect of altering Cornwall SD&G s current deployment plan and adding in alternative response locations. Final Report Presentation 14

15 Deployment Modelling Current Deployment Plan # of Available Ambulances Day Night PRU - Day 1 Cornwall Cornwall Cornwall Monkland Winchester 3 Williamsburg Alexandria 4 Brown House Corner Cornwall 5 C, W, Alex, M, C Morrisburg 6 C, W, Alex, M, C, Avon Avonmore 7 C, W, Alex, M, C, Avon, L - 8 C, W, Alex, M, C, Avon, L, C - 9 C, W, Alex, M, C, Avon, L, C, C - Key Current Performance Code C W Alex M Avon L Cornwall Winchester Alexandria Monkland Avonmore Lancaster Station Municipality 8 Minute 50th 90th Performance Percentile Percentile Akwesasne 8.8% Cornwall 78.2% North Dundas 53.8% North Glengarry 54.4% North Stormont 15.3% South Dundas 33.6% South Glengarry 17.6% South Stormont 10.3% Overall 57.9% Final Report Presentation 15

16 DSA Mobilisation Locations 2012 Final Report Presentation 16

17 Central Start vs Multi Start Under both options if Cornwall SD&G operates such a fluid deployment model as currently there will be very little difference in performance: The crew booking on at Lancaster will immediately be posted elsewhere, for example. At the end of shift, vehicles will not necessarily be back near their home station. If Cornwall SD&G moved to a less dynamic model, with crews booking on and responding from their home stations (tethered), performance difference would be seen. Final Report Presentation 17

18 Tethered Deployments Tethered Day & Night Priority 4-8 Minute Performance Priority 4-50th Percentile Priority 4-90th Percentile Municipality Base New Impact Base New Impact Base New Impact Akwesasne 8.8% 8.4% -0.4% Cornwall 78.2% 65.5% -12.6% North Dundas 53.8% 54.6% 0.7% North Glengarry 54.4% 54.7% 0.3% North Stormont 15.3% 40.8% 25.5% South Dundas 33.6% 33.7% 0.1% South Glengarry 17.6% 46.5% 28.9% South Stormont 10.3% 11.8% 1.5% Overall 57.9% 54.0% -3.8% Final Report Presentation 18

19 Alternative Deployment Plan Posting Plan V2 Additional 24/7 DSA Current Deployment Plan Posting Plan V2 # of Available Ambulances Priority 4-8 Minute Performance Priority 4-50th Percentile Priority 4-90th Percentile Municipality Base New Impact Base New Impact Base New Impact Akwesasne 8.8% 8.6% -0.2% Cornwall 78.2% 79.5% 1.4% North Dundas 53.8% 55.3% 1.5% North Glengarry 54.4% 56.7% 2.2% North Stormont 15.3% 43.5% 28.1% South Dundas 33.6% 34.8% 1.2% South Glengarry 17.6% 31.7% 14.1% South Stormont 10.3% 12.2% 1.9% Overall 57.9% 60.9% 3.1% Day Night PRU - Day # of Available Ambulances Day Night PRU - Day 1 Cornwall Cornwall Cornwall Cornwall Cornwall Cornwall Monkland Winchester 2 Williamsburg Winchester 3 Williamsburg Alexandria 3 Brown House Corner Alexandria 4 Brown House Corner Cornwall 4 Monkland Cornwall 5 C, W, Alex, M, C Morrisburg 5 C, W, Alex, M, C Morrisburg 6 C, W, Alex, M, C, Avon Avonmore 6 C, W, Alex, M, C, Avon Avonmore 7 C, W, Alex, M, C, Avon, L - 7 C, W, Alex, M, C, Avon, L Cornwall 8 C, W, Alex, M, C, Avon, L, C - 8 C, W, Alex, M, C, Avon, L, C - 9 C, W, Alex, M, C, Avon, L, C, C - 9 C, W, Alex, M, C, Avon, L, C, C - 10 C, W, Alex, M, C, Avon, L, C, C, C - Modelling Results Final Report Presentation 19

20 Station Range Cover Including Long Sault Post - Priority 4 Incidents Final Report Presentation 20

21 Alternative Deployment Plan Posting Plan V4 Additional 24/7 DSA & 12hr DSA New Long Sault Post Prioritised before Avonmore and Lancaster Current Deployment Plan # of Available Ambulances Day Night PRU - Day Posting Plan V4 # of Available Ambulances Day Night PRU - Day 1 Cornwall Cornwall Cornwall Cornwall Cornwall Cornwall Monkland Winchester 2 Williamsburg Winchester 3 Williamsburg Alexandria 3 Brown House Corner Alexandria 4 Brown House Corner Cornwall 4 Monkland Cornwall 5 C, W, Alex, M, C Morrisburg 5 C, W, Alex, M, C Morrisburg 6 C, W, Alex, M, C, Avon Avonmore 6 C, W, Alex, M, C, LS Avonmore 7 C, W, Alex, M, C, Avon, L - 7 C, W, Alex, M, C, LS, Avon Cornwall 8 C, W, Alex, M, C, Avon, L, C - 8 C, W, Alex, M, C, LS, Avon, L - 9 C, W, Alex, M, C, Avon, L, C, C - 9 C, W, Alex, M, C, LS, Avon, L, C - 10 C, W, Alex, M, C, LS, Avon, L, C, C - Modelling Results 11 C, W, Alex, M, C, LS, Avon, L, C, C, C - Priority 4-8 Minute Performance Priority 4-50th Percentile Priority 4-90th Percentile Municipality Base New Impact Base New Impact Base New Impact Akwesasne 8.8% 8.8% 0.0% Cornwall 78.2% 80.5% 2.4% North Dundas 53.8% 56.3% 2.5% North Glengarry 54.4% 58.0% 3.6% North Stormont 15.3% 29.8% 14.5% South Dundas 33.6% 36.0% 2.4% South Glengarry 17.6% 32.5% 14.9% South Stormont 10.3% 52.8% 42.5% Overall 57.9% 64.4% 6.6% Final Report Presentation 21

22 Alternative Deployment Plan Posting Plan V6 Two Additional 12hr PRUs in Long Sault and Lancaster Current Deployment Plan Posting Plan V6 # of Available Day Night PRU - Day # of Available Ambulances Ambulances Day Night PRU - Day 1 Cornwall Cornwall Cornwall Cornwall Cornwall Cornwall Monkland Winchester 2 Williamsburg Winchester Long Sault Williamsburg Alexandria 3 Brown House Corner Alexandria Lancaster Brown House Corner Cornwall 4 Monkland Cornwall 5 C, W, Alex, M, C Morrisburg 5 C, W, Alex, M, C Morrisburg 6 C, W, Alex, M, C, Avon Avonmore 6 C, W, Alex, M, C, Avon Avonmore 7 C, W, Alex, M, C, Avon, L - 7 C, W, Alex, M, C, Avon, L - 8 C, W, Alex, M, C, Avon, L, C - 8 C, W, Alex, M, C, Avon, L, C - 9 C, W, Alex, M, C, Avon, L, C, C - 9 C, W, Alex, M, C, Avon, L, C, C - Modelling Results Priority 4-8 Minute Performance Priority 4-50th Percentile Priority 4-90th Percentile Municipality Base New Impact Base New Impact Base New Impact Akwesasne 8.8% 8.7% -0.1% Cornwall 78.2% 79.0% 0.9% North Dundas 53.8% 53.9% 0.0% North Glengarry 54.4% 54.4% 0.0% North Stormont 15.3% 15.5% 0.1% South Dundas 33.6% 33.4% -0.1% South Glengarry 17.6% 46.1% 28.5% South Stormont 10.3% 44.1% 33.8% Overall 57.9% 62.9% 5.1% Final Report Presentation 22

23 Modelling Deployment Plans Summary (1) The key result from the modelling is that to achieve the required standards in each lower tier municipality, more vehicles are required to cover more posts. The key issue facing Cornwall SD&G is not one of job cycle time or business, but one of geographical coverage. Final Report Presentation 23

24 Demand Projections Both plans V4 (ambulance led) and V6 (PRU led) allow for improved response performance past 2015, but additional investment would be required by If the PRU plan is taken forward the additional investment required by 2020 would need to be ambulance based to cope with the increased level of patient transports that are occurring. Final Report Presentation 24

25 Summary The key issue facing Cornwall SD&G is not one of job cycle time or business, but one of geographical coverage. Three alternative plans will meet the majority of required standards, each with different costs and benefits, all require a new station in Long Sault: Add x7 ambulances around $1.5 million recurrent cost all targets met. Add two 12 hours PRUs in Lancaster and Long Sault cost around $500,000 recurrent these PRUs would need to work in the community as well as providing an EMS response role North Stormont does not meet 12 minute standard and 8 Final Report Presentation 25 minute standard is not met.