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Developed by: Emergency Management Group Inc. 

65 Cedar Pointe Drive, Suite 144Barrie, ON L4N 9R3 

705.719.9007/888.421.0665 

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Haliburton County 

Paramedic Master Plan 


 

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Dear Council, CAO Mike Rutter and Paramedic Chief Tim Waite: 

 

After several months of analysis and review, Emergency Management Group (EMG) has 
completed the Haliburton County Paramedic Service Master. Numerous documents and 
sets of data were examined including Haliburton County reports, Provincial legislation, 
Ministry of Health Emergency Health Service standards and policies, Canadian Census 
statistics, and Paramedic Service records. 

Our EMG consultant team would like to thank County CAO Mr. Mike Rutter and 
Paramedic Chief Tim Waite for being very generous with their time and assisting us along 
the way. Interviewing key individuals, touring various facilities with management staff, and 
interpreting various forms of collected material from a county perspective would not have 
been possible without their assistance. Our team had many specific questions and Chief 
Waite along with his management/administrative team were instrumental in providing the 
answers. Lastly, we would like to thank the Paramedics and Paramedic Union for their 
time in assisting us through interviews and surveys. All this assistance has helped provide 
a full 360-degree view of the Haliburton County Paramedic Service. 

As a result of this process, we have identified key challenges and provided 
recommendations for a path forward. The goal for EMG through this project was to 
provide a ten-year Paramedic Master Plan. It will become apparent to the reader that 
many of the recommendations have been made within the first six years of this plan. This 
is however not a reflection of the Chief, his management team, nor the frontline 
Paramedics. In fact, all members of the Service should be commended for being able to 
manage and serve the public at a high standard while operating such a lean Paramedic 
Service with respect to human resources (management, administration, and frontline). 

The listed recommendations offer a recommended course of action, and many are 
ordered in a fashion to move forward in smaller steps, but the final direction and order lies 
fully within the hands of the County. We encourage continued discussion and review, 




understanding that it is the County and its representatives that have the best perspective 
of the needs and circumstances within their community. 

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One area of great success would appear to be the Community Paramedic Program which, 
by all accounts, has had an immensely positive impact on underserviced community 
members. This program must continue to evolve and progress and should be fully 
supported behind a strong 9-1-1 emergency response system and appropriate 
administrative support as noted within the recommendations. 

While there were a few broad areas to address, the most immediate challenge is the 
diagnostic interfacility transfer volume deriving from the Haliburton Highlands Health 
Services sites located in Haliburton and Minden. This significant transfer volume is 
affecting present deployment daily, at times leaving the community with few or no 
ambulance resources and taking its toll on all Paramedic Service staff from the Chief to 
the frontline Paramedics. 

A theme noted within the recommendations is collaboration. Collaboration is essential in 
providing the best healthcare to the community and needs to be at the forefront moving 
forward. Through collaboration we believe there are solutions to the major challenges 
that will ensure the best needs of the community are cared for. 

There are costs associated with some of the recommendations noted in this report and 
expenses in healthcare can be significant. It must be iterated that investment into the 9-1-
1 emergency response Paramedic Service (frontline, management/supervision, and 
administration), is cost shared at 50% with the Ministry of Health Emergency Health 
Services branch of the provincial government. This funding is retroactively provided upon 
cost approval from the Ministry. The estimated costs noted within the recommendations 
represent the full cost associated with the improvement and the County share should be 
50% of those totals. With these investments, Council has an opportunity to support an 
overworked department by helping them resource adequately to meet the challenges 
found in the Master Report. 

 




In conclusion, it was a pleasure to work with such a skilled team of professionals. We can 
see the pride that this team takes in delivering the best service possible to its community 
members. The dedication of the employees of Haliburton County Paramedic Service is to 
be commended. 

Yours Truly, 

 

EMG Consultants 

 



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TABLE OF CONTENTS 
Abbreviations ......................................................................................................................................10 
Executive Summary ............................................................................................................................13 
Section 1: Introduction .................................................................................................................17 
1.1 The County of Haliburton .............................................................................................................17 
1.2 Haliburton Demographics .............................................................................................................19 
1.3 History of Paramedic Services in Ontario ...................................................................................27 
1.4 Haliburton County Paramedic Services .......................................................................................28 
Section 2: Current Assessment ....................................................................................................35 
2.1 HCPS Call Volumes .........................................................................................................................35 
2.2 Haliburton County Patient Acuity ................................................................................................56 
2.3 Response Times..............................................................................................................................62 
2.4 Deployment Strategy ....................................................................................................................69 
2.5 Assets ...............................................................................................................................................82 
2.6 Internal Stakeholder Consultation ..............................................................................................89 
2.7 External Stakeholder Consultations ............................................................................................96 
2.8 Additional Pertinent Documents .................................................................................................99 
Section 3: Current Assessment and Future Challenges........................................................... 108 
3.1 Interfacility Transfers ................................................................................................................. 108 
3.2 Critical Medical Emergency Coverage & Ambulance Offload Delays .................................. 114 
3.3 Lean Management Structure .................................................................................................... 118 
3.4 Aging Infrastructure ................................................................................................................... 121 
3.5 Growing and Aging Population ................................................................................................. 127 
3.6 Paramedic Recruitment & Retention ....................................................................................... 134 
Section 4: Recommendations ................................................................................................... 137 
4.1 Immediate Recommendations (Present – 1 year) .................................................................. 139 
4.2 Short Term Achievable Recommendations (1-3 yrs) .............................................................. 151 
4.3 Mid-Term Recommendations (4-6 years)................................................................................. 165 
4.4 Long-Term Recommendations (7 – 10 years) ......................................................................... 171 
Appendix ‘A’: HCPS Survey Questions ................................................................................................. i 
Appendix ‘B’: Haliburton Paramedic Deployment Plan .................................................................... iii 
Appendix ‘C’: Paramedic Station Reviews ....................................................................................... xxx 
Figure #1 – Map of the County of Haliburton ..................................................................................17 
Figure #2 – Occupied Private Dwellings – County of Haliburton vs. Province of Ontario ............18 
Figure #3 – Jobs by Industry within the County of Haliburton .......................................................19 
Figure #4 - 2021 Population - County of Haliburton vs. Province of Ontario ................................21 
Figure #5 – County of Haliburton – Low Income Breakdown – 2016 - 2020 ..................................25 
Figure #6 – Poverty Rate County of Haliburton vs. Province of Ontario .......................................25 
Figure #7 – Organization Chart for the County of Haliburton ........................................................29 
Figure #8 – Ambulance Dispatch Reporting System (ADRS) ...........................................................37 
Figure #9 – ADRS by Priority ..............................................................................................................38 
Figure #10 – ADRS by Priority ............................................................................................................38 
Figure #11 – CTAS – Breakdown by Year ..........................................................................................40 
Figure #12 – CTAS – Call Count .........................................................................................................40 
Figure #13 – Call Volume Breakdown by Year .................................................................................41 
Figure #14 – Percentage Change by Year .........................................................................................42 
Figure #15 – Calls by Age and Year ...................................................................................................43 
Figure #16 – Percentage of Calls by Age and Year ..........................................................................43 
Figure #17 – Haliburton – Age Composition and Call Volume by Age ...........................................44 
Figure #18 – 2021 – 2022 Number of Calls by Time of Day ...........................................................45 
Figure #19 – Hour of Day Breakdown ...............................................................................................46 
Figure #20 – Percentage of Calls vs. Days of the Week ...................................................................47 
Figure #21 – Percentage of Calls vs. Time of the Month .................................................................48 
Figure #22 – 2022 Calls by Paramedic Services in Algonquin Highlands ........................................49 
Figure #23 – 2022 Calls by Paramedic Service and Location ...........................................................50 
Figure #24 – 2022 Calls by Paramedic Services in Highlands East ..................................................50 
Figure #25 – Haliburton County Calls ...............................................................................................51 
Figure #26 - Proposed Carnarvon Station ........................................................................................52 
Figure #27 - Proposed Maple Lake Station .......................................................................................53 
Figure #28 - Proposed Stanhope Station ..........................................................................................54 
Figure #29 - Proposed West Guilford Station ..................................................................................55 
Figure #30 – Top Incidents - Categorized by Acuity .........................................................................57 
Figure #31 – Primary Problems (Noted by Paramedics in EPCR) ....................................................58 
Figure #32 – Dispatch Problems (Noted withing Dispatch ADRS Data) .........................................58 
Figure #33 – CTAS1 - Primary Problems 2017-2021 ........................................................................59 
Figure #34 – CTAS 2 – Primary Problems 2017 - 2021 .....................................................................60 
Figure #35 - CTAS 3 – Primary Problems 2017 - 2021......................................................................60 
Figure #36 - CTAS 4&5 – Primary Problems 2017 - 2021 .................................................................61 
Figure #37 – 2017 and 2022 – CTAS on Contact ..............................................................................62 
Figure #38 – 5 Year Targets based on CTAS .....................................................................................64 
Figure #39 – Ontario Average Response Time for Priority 4 Calls ..................................................65 
Figure #40 – Station #1 - 4-, 6- and 13-minute Drive Time ..............................................................67 
Figure #41 – Station #2 – 4-, 6-and 13-minute Drive Time ..............................................................68 
Figure #42 – Station #3 – 4-, 6-, 13-minute Drive Time ...................................................................69 
Figure #43 – Neighbouring Response Times for Priority 4 Calls .....................................................72 
Figure #44 – 2021 Response Time Standard – SCA and CTAS1 Results .........................................73 
Figure #45 – CPP Patients 2022 ........................................................................................................80 
Figure #46 – Number of Visits per Month (2022) ............................................................................81 
Figure #47 – Minden Paramedic Station Floorplan ..........................................................................86 
Figure #48 – Haliburton Paramedic Station Floorplan ....................................................................87 
Figure #49 – Tory Hill Paramedic Station Floorplan.........................................................................88 
Figure #50 – Community Survey Results ..........................................................................................95 
Figure #51 – Survey Results Q9 .........................................................................................................96 
Figure #52 – Risk Level Matrix ........................................................................................................ 105 
Figure #53 – Dispatch Problem Call Times (2021-2022)............................................................... 109 
Figure #54 – Primary Problem Call Times (2021-2022) ................................................................ 109 
Figure #55 – Average Call Length for Out of County ................................................................... 110 
Figure #56 – County Average Time of Transfer ............................................................................ 111 
Figure #57 –Average Time of Transfer .......................................................................................... 112 
Figure #58 – Responses - Interfacility Transfer vs Calls (2017-2022) .......................................... 112 
Figure #59 – Time - Interfacility Transfers vs Calls ........................................................................ 113 
Figure #60 – Minden Station – Call Cluster (2021) ........................................................................ 123 
Figure #61 – Haliburton Station - Call Cluster ............................................................................... 124 
Figure #62 – Tory Hill Station – Call Cluster .................................................................................. 125 
Figure #63 – Ten Year Forecast - iMedic Calls ............................................................................... 128 
Figure #64 – Population by Age – Haliburton vs. Ontario ............................................................ 129 
Figure #65 – Percentage of Calls by Age ....................................................................................... 130 
Figure #66 – Haliburton Age Breakdown vs Calls by Age ............................................................. 131 

Table #1: Ontario Census Data – Permanent Residents Occupancy ..............................................20 
Table #2: Dwelling Types – County of Haliburton vs Province of Ontario .....................................22 
Table #3: County of Haliburton Unemployment Rate .....................................................................24 
Table #4: Annual Income – County of Haliburton vs. Province of Ontario .....................................24 
Table #5: Top Incidents – 2020-2022 ................................................................................................56 
Table #6: Emergency Coverage Reinstatement (C-MEC & Response Delays) ...............................71 
Table #7: Deployment Numbers by Location ...................................................................................71 
Table #8: Staffing Levels by Location ...............................................................................................74 
Table #9: Replacement Schedule ......................................................................................................84 
Table #10: Haliburton Highlands Hospital - CT Transfers ............................................................. 114 
Table #11: Number of Simultaneous Calls in Minutes (2020 – 2022) .......................................... 116 
Table #12: Ambulance Offload Delays (2017-2021) ..................................................................... 117 
ABBREVIATIONS 

ALS 

Advanced Life Support 

ACP 

Advance Care Paramedic 

ADRS 

Ambulance Dispatch Reporting System 

AMPDS 

Advanced Medical Priority Dispatching System 

AOD 

Ambulance Offload Delay 

CACC 

Central Ambulance Communications Centre 

CCP 

Critical Care Paramedic 

CEPCP 

Central East Prehospital Program 

CMEC 

Critical Minimum Emergency Coverage 

CSWB 

Community Safety and Wellbeing 

CT 

Computerized Tomography 

CTAS 

Canadian Triage Acuity Scale 

DPCI 

Dispatch Priority Card Index 

EHS 

Emergency Health Services 

EMCA 

Emergency Medical Care Attendant 

EMS 

Emergency Medical Services 

EOWC 

Eastern Ontario Wardens Caucus 

EPCR 

Electronic Patient Care Reports 

HHHS 

Haliburton Highlands Health Services 

MMAH 

Ministry of Municipal Affairs and Housing 

MOH 

Ministry of Health 




MOHLTC 

Ministry of Health and Long-Term Care 

MRI 

Magnetic Resonance Imaging 

PCP 

Primary Care Paramedic 

PRU 

Paramedic Response Unit 

SCA 

Sudden Cardiac Arrest 

SIRCH 

Supportive Initiative for Residents in the County of Haliburton 

WSIB 

Worker Safety Insurance Board 




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EXECUTIVE SUMMARY 

The Transforming Environment within Emergency Services 

The role of a paramedic today has extended from emergency response and transportation, to 
include a wide range of community-based health and public services that are enhancing access 
to care and services by connecting patients to primary and community care. 

With the ever-evolving delivery of paramedic services, and with the increasing population and 
diversification within the County of Haliburton, the Haliburton County Paramedic Services are 
responding to an increase in incidents and more complex calls than ever before. Planning 
requires an emphasis on organized and connected care that puts patients first, while being 
efficient to alleviate and ease costs. 

Purpose 

The anticipated population growth, unique demographic trends and the evolution of the 
County has unquestionably put stresses and challenges on the current paramedic services. The 
Paramedic Master Plan has been developed to ensure that the Haliburton County Paramedic 
Service is able to meet the demands and sustain the current service levels with the 
development and multiplicity of Haliburton County. With the future projections and 
anticipations, the development of the Master Plan included detailed analysis of the potential 
response time performance, considering factors such as roadway networks, town development, 
travel time as well as community resources. 

The objective of the Master Plan is to identify the future staffing, fleet, and station resources 
thar are required to respond to 9-1-1 demands and the needs of the County’s growing and 
aging population, equitably and consistently. The Master Plan also identifies opportunities and 
prospective opportunities to mitigate costs. 

The Master Plan will also be used to help guide workforce development, staff retention and the 
well-being needs of the paramedics. 

Resource Needs 

This Master Plan identified the needs and has proposed 20 recommendations based on the 
comprehensive analysis located in this report. The following recommendations are based on 
data collection and researching the challenges facing the Haliburton County Paramedic Services 
today. These recommendations present the best scenarios to aid and assist the County in 
moving forward and are not the only available solutions. They are attempts to make the 


greatest impact in the most effective and efficient manner based upon industry standards. 
While they are presented in a numerical order, items may be skipped and the path may be 
altered depending on continued risk tolerance, desire to change and willingness to consider 
financial challenges. 

1.16.1 Immediate Recommendations (present-1 year) 

These recommendations will have the most impactful outcome on the immediate future of 
Haliburton County Paramedic Service (HCPS). They are noted as immediate recommendations 
either because they can be implemented relatively easily or because they are so crucial to the 
continued operation of the Service. 

1. Create an interfacility transfer working group (In progress at time of release of this 
Master Plan). 
2. Re-evaluate/update HCPS deployment plan to support recommendations 
3. Development of key performance indicators (KPIs) 
4. Become more involved with the county community safety & wellbeing plan. (In 
progress at time of release of this Master Plan) 
5. Expand the current annual report. 
6. Explore synergies on future capital expenditures. 


1.16.2 Short Term Achievable Recommendations (1-3 years) 

The following short-term recommendations can be achievable with a focused direction and 
support. 

1. Assist in the development of a business case for local diagnostic imaging. (Underway 
at time of release of report). 
2. Hire an administration assistant. 
3. Hire two full time front-line supervisors/superintendents. 
4. Acting supervisor/superintendent program. 
5. Consider no longer certifying senior management. 
6. Add another ambulance to deployment. 
7. Evaluate and plan for the future of the community paramedic program. 
8. Perform detailed facility needs analysis.



1.16.3 Mid Term Recommendations (4-7 years) 

In considering a ten-year plan there is great merit in reconciling progress on a yearly basis. 
However, around the fifth year it is a beneficial to review whether any or all the 
recommendations are still valid. Much can change in five years as proven with the most recent 
pandemic. 

1. Hire a third superintendent. 
2. Add power load to all new ambulance purchases. 
3. New headquarters in Haliburton. 
4. Assess the need for a dedicated resource in Algonquin Highlands. 
5. Assess progress on the master plan and re-evaluate where necessary 


1.16.4 Long Term Recommendations (8-10 years) 

Long term recommendation in excess of 7 years are either the very difficult and comprehensive 
recommendations or they are requiring review at a later date. To predict that far in in advance 
in todays changing world of municipal services and healthcare can be very difficult, however, 
there must be a vision to the future that can guide services in the right direction. 

1. Hire a fourth Superintendent 


 


Introduction

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SECTION 1: INTRODUCTION 

1.1 The County of Haliburton 

The County of Haliburton was formed in 1983 and is an upper tier level of government made up 
of four lower tier municipalities. These municipalities are the Township of Algonquin Highlands, 
the Municipality of Dysart et al, Municipality of Highlands East, and the Township of Minden 
Hills. The County seat is in the town of Minden. 

Figure #1 – Map of the County of Haliburton 

 

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As an upper tier level of government, Haliburton County is responsible for their county 
planning, county roads, bridges, traffic signals and controls, emergency management, 
paramedic services, library, tourism, as well as tax policy. Additionally, the County has a robust 


Information Technology department and GIS section, as well as being involved in Health 
Profession Recruitment with a physician recruiter. 

Being known as part of “Cottage Country”, at just over 4,000 square km, the County of 
Haliburton is home to a large seasonal population as well as many lakes and recreational areas. 
Intrinsically, Haliburton County's economy is dominated by tourism and businesses associated 
with such. The permanent population, according to 2021 census data is 20,571, however, the 
population during the summer months can swell to approximately 45,0001, this number is 
recognized to be low as it is based on 2017 data and does not reflect the increases that were a 
result of the pandemic. According to Statistics Canada, there are currently 21 072 private 
dwellings within the County which is a greater amount than permanent residents. In Haliburton, 
53.9% of the current dwellings are not regularly occupied. In comparison, ,provincewe province-wide,only 
7.39% of Ontario dwellings are not occupied consistently. This highly conveys the seasonal 
nature of the County. 

1 Co-designing The Active City, “Haliburton Village, Haliburton County”, Participatory Planning, accessed October 
2022, https://participatoryplanning.ca/projects/haliburton-village-haliburton-
county#:~:text=The%20county%20has%20a%20year-
round%20population%20of%20just,increases%20the%20population%20to%20approximately%2045%2C000%20in%20summer. 

Figure #2 – Occupied Private Dwellings – County of Haliburton vs. Province 
of Ontario 

 

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An immediate review of Haliburton County’s employment statistics reveals as expected. 
Employment predominantly focuses on the demands of this seasonal population, including 
construction and retail. 

Figure #3 – Jobs by Industry within the County of Haliburton 

 

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1.2 Haliburton Demographics 

Upon review, the demographic profile of Haliburton can be summarized as one of extremes. For 
this report, data has been taken from the most recent Canadian Census (2021) through 
Statistics Canada2. In many cases, the data from Haliburton County is conflicting with the 
averages across the province. While extreme, this information can paint a concise picture of the 
present circumstances and should be able to provide a strong objective to move forward. 

2 Statistics Canada, Profile Table, Statistics Canada, Accessed October 2023, https://www12.statcan.gc.ca/census-
recensement/2021/dp-
pd/prof/details/page.cfm?Lang=E&SearchText=Haliburton&DGUIDlist=2021A00033546&GENDERlist=1,2,3&STATISTIClist=1&HEADERlist=0 

1.2.1 Population 

Over the last five years, the County of Haliburton has experienced a greater than normal 
population increase according to Statistics Canada. According to the latest census data, 
Haliburton County experienced the fourth largest population rate increase in Canada, and the 


highest within Ontario. While Canada saw a 5.2% increase and Ontario had a 5.8% increase in 
population, Haliburton County added 2,509 residents for 13.9% increase. 

While a population increase typically signals growth within a community, the recent increase in 
Haliburton appears to be disingenuous. A great number of this growth has been due to 
seasonal residents making Haliburton their primary residence. This population growth does not 
always equate to new tax growth, as seasonal residents who are now permanent residents do 
not add more revenue to the tax base within the County. This does, however, indicate the need 
for more emergency services as the higher the population the greater the need for community 
supports. The trend of relocating from more urban areas has been exasperated by the recent 
pandemic and the growing acceptance and ability for workers to work from home. According to 
Canadian Census data the percentage of those working from home in Haliburton doubled from 
10.5% to 21% from 2016 to 2021, and it is anticipated that this will increase even further with 
improved technology and internet connectivity within the County. 

With the benefit of recent Census data, reviewing data from Statistics Canada regarding the 
percentage of dwellings occupied by usual residents provides a good comparison to other areas 
of the province. At 46% Haliburton County has, by far, the least number of usual residents per 
dwelling. As noted above, 54% of the dwellings in Haliburton are utilized by seasonal residents. 

Table #1: Ontario Census Data – Permanent Residents Occupancy 

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A breakdown of the age in population is another significant factor when considering current 
statistics. An analysis of the community age groups is based upon the most recent Statistics 
Canada data. The current statistics reveal a much more aged population in Haliburton than the 
entire province. As seen below, it is evident that the older adult population of Haliburton is 
nearly double that of the entire province; with 35.72% of the population being 65 or older as 
opposed to Ontario with 18.1% of the population being over 65. An older population typically 
indicates increased use of healthcare and services, lower income (due to pension earnings), and 
a smaller workforce. When combined with a lack of housing, balanced growth becomes hard to 
obtain. 

Figure #4 - 2021 Population - County of Haliburton vs. Province of Ontario 

 

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1.2.2 Housing Stock 

Housing in Haliburton is a genuine issue. While Haliburton experienced a 13.9% increase in 
population since 2016, there has been a 0.2% decrease in dwellings over the same period. This 
can be attributed to seasonal residents transitioning their primary residence to Haliburton. 

There is also a lack of affordable housing that not only creates problems with staffing within all 
levels in the County but can also contribute to homelessness. Through the consultation process, 
a lack of available housing has been noted as a real barrier to recruiting and retaining staff. 

Upon review, there is a substantial difference between the types or styles of dwellings offered 
between Haliburton and the rest of Ontario. In Haliburton, over 93% of dwellings are single 
detached homes whereas that number is 53.6% for Ontario. The prevalence of single detached 
homes in Haliburton does not typically indicate a vibrant rental market which would be essential 
for new workers starting out in a community. Row housing, apartments in a duplex as well as 
semi-detached housing account for less than 1% each of the dwelling composition within 


Haliburton. Currently, five story or higher apartments are essentially non-existent, as opposed 
to the Province, which makes up for nearly 18% of housing. 

Table #2: Dwelling Types – County of Haliburton vs Province of Ontario 

 

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The Ministry of Municipal Affairs and Housing (MMAH) under the Housing Services Act, 2011 
(HSA) requires all Service Managers to develop a ten-year Housing and Homelessness Plan. In 
Haliburton County, by provincial mandate, this responsibility falls to the City of Kawartha Lakes. 

The City of Kawartha Lakes drafted the most recent Housing and Homelessness Plan in 2019. 
Lack of housing stock was noted as an issue in this report. It was noted that from 2010 to 2018 
market rent prices rose by nearly 20% while vacancy rates fell drastically to just under 2%.3 

3 Building Stronger Communities, The City of Kawartha Lakes and the County of Haliburton Housing and 
Homelessness Plan (2020-2029), accessed October 2022, https://www.kawarthalakes.ca/en/living-
here/resources/Housing-Rental-Listings/KL-Housing-and-Homelessness-Plan-2019-Accessible.pdf 

Affordable housing is still tougher to obtain for low-income residents. Those waiting for 
community housing face a wait time of up to ten years for availability to affordable housing. The 
County Council adopted a model from the Housing and Homelessness Plan that would aim to 
significantly increase housing in the County over the next ten years with a goal of an additional 


750 rental units. However, there are many factors involved in achieving this goal including 
funding and willingness of private contractors to build units. 

Finally, a review of the composition of households in Haliburton shows that most households 
are of two or less people (77.8%) as compared with the Province of Ontario (59.2%). This 
further suggests that a substantial part of the population consists of older adults without 
dependants living at home. 

1.2.3 Poverty 

According to the Ontario Living Wage Network, the living wage required to live in Haliburton is 
$19.42 an hour4, which reflects the 2018 living conditions. This data indicates that Haliburton 
ranks the fourth highest living wage in Ontario; the calculation was made just behind Toronto, 
Halton, and Peel. According to Supportive Initiative for Residents in the County of Haliburton 
(SIRCH) Community Services contributing factors to poverty are “seasonal and low-paying 
employment and lack of public transportation are exacerbated by difficulty in finding affordable 
housing options, high food prices and lack of affordable childcare”5. 

4 Ontario Living Wage Network, accessed October 2022, https://www.ontariolivingwage.ca/rates 

5 SIRCH Community Services, About Haliburton County, accessed October 2022, https://www.sirch.on.ca/about-
us/resources/#:~:text=Haliburton%20County%20has%20a%20child%20poverty%20rate%20of,work%20and%20to%
20the%20high%20numbers%20of%20pensioners. 

6 Statistics Canada, Income in Canada-2020, accessed October 2022, https://www150.statcan.gc.ca/n1/pub/11-627-
m/11-627-m2022040-eng.htm 

7 Statistics Canada, Census Program Data Viewer, accessed October 2022, https://www12.statcan.gc.ca/census-
recensement/2021/dp-pd/dv-vd/cpdv-vdpr/index-eng.cfm 

The median household net income in Canada went up 9.8% from 66,500 in 2015 to $73,000 in 
20206. In Ontario, the median household net income was $79,500 in 2020, while in Haliburton 
County, it was up from $56,800 to $66,0007. 

The unemployment rate in Haliburton has steadily been increasing on a macro level over the 
course of the last five census reports, however, most recently, the rate is lower than the 
provincial average of 12.2%. 


Table #3: County of Haliburton Unemployment Rate 

 

2001 

2006 

2011 

2016 

2021 

Unemployment 
Rate 

5.2% 

7.5% 

9.3% 

9.6% 

11.1% 



A detailed look into different income brackets of Haliburton, as opposed to Ontario, reveals a 
far greater percentage of low-income earners in Haliburton than in the province. The graphic 
below details that while Ontario has a higher percentage of earners below $10,000, Haliburton 
has a greater percentage of low-income earners than the province. Low income earners are 
defined as earners making between $10,000-$59,999. Therefore, Ontario then has a greater 
percentage of earners from $60,000 up. In total, 74% of Haliburton earners make less than 
$60,000 a year while in Ontario that number is 68%. Again, these numbers can be attributed to 
a mix of an older population collecting retirement earnings and low paying jobs within the 
County. 

Table #4: Annual Income – County of Haliburton vs. Province of Ontario 

 

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Other datasets relating to income and poverty are available from Statistics Canada which has 
been gathered through census data. 

There is low-income indicator data available for the last two census periods. To be considered a 
low-income household, a specific criterion must be met, which is generated through a complex 
mathematical formula. The median single person household net income for 2021 was $26,503. 
The median household net income for a family of four for 2021 was $53,005. The percentage of 
low-income households has lowered from 2016 to 2021 from 17.15% to 12.86%. 


Figure #5 – County of Haliburton – Low Income Breakdown – 2016 - 2020 

 

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In 2021, the census contained the poverty rate data. Poverty rates indicate the percentage of 
people under the determined poverty line for the specified period. These rates were based on 
2020 data. As the chart below indicates, poverty rates in Haliburton for 2020 at 6.9% were 
better than the Ontario rate of 8.3%. 

Figure #6 – Poverty Rate County of Haliburton vs. Province of Ontario 

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It must be restated that this data represents a snapshot in time and can be highly fluid 
depending on a variety of factors through time. For example, should a major employer close 
their facility, income and numbers would be highly affected. 

1.2.4 Homelessness 

A mix of limited housing and inadequate paying jobs can lead to homelessness. The Canadian 
Observatory on Homelessness defines homelessness as describing, 

“…the situation of an individual or family without stable, permanent, appropriate 
housing, or the immediate prospect, means and ability of acquiring it. It is the result of 
systemic or societal barriers, a lack of affordable and appropriate housing, the 
individual/household’s financial, mental, cognitive, behavioural, or physical challenges, 
and/or racism and discrimination”. 

They further go on to describe four classifications of homelessness. 

1. Unsheltered – entirely homeless and living on the streets or in places not intended for 
human habitation. 
2. Emergency Sheltered – including those staying in overnight shelters for people who are 
homeless, as well as shelters for those impacted by family violence. 
3. Provisionally Accommodated – referring to those whose accommodation is temporary or 
lacks security of tenure. 
4. At Risk of Homelessness – referring to people who are not homeless, but whose current 
economic and/or housing situation is precarious or does not meet public health and 
safety standards8. 


8 20,000 Homes, Registry Week Final Report. Accessed October 2022, https://www.kawarthalakes.ca/en/living-
here/resources/Poverty-Reduction-/20000-Homes-Registry-Week-Final-Report--Accessible-Version.pdf 

Homelessness is to difficult track as there is normally a lack of a fixed address from which to 
coordinate services. In Haliburton, as well as other communities, an initiative called 
Homelessness Registry Week assists in tracking homeless citizens. At key intervals, homeless 
citizens are encouraged to complete a survey and will, in turn, get their names placed on the 
‘by-name list’. This list allows the community to support the homeless and aids in assisting with 
placements. The list is focused on the vulnerability of those who are homeless. There is a lack of 
available data to suggest the recent level of homelessness in Haliburton. However, as noted 
above, the mix of inaccessible housing and level of poverty within the County would suggest 


that homelessness is present and must continue to be addressed through a coordinated multi-
jurisdictional approach. 

1.3 History of Paramedic Services in Ontario 

Paramedic services in Ontario can be considered the youngest branch of emergency services. 
Fire and police services have a rich history throughout Ontario, as well as Canada. Modern 
paramedic services in Ontario started in the 1960’s when the Director of the Emergency Health 
Services Division (EHS) of the Ontario Hospital Services Commission was tasked with developing 
“a balanced and integrated system of ambulance services”9. The Director sought to achieve this 
first through the standardized “Fundamentals of Casualty Care” training course at “Camp 
Borden” (Canadian Forces Base Borden), an armed forces base near Barrie, Ontario. This four-
week course would eventually evolve into a mature community college program in the 1970’s. 
Provincial certification would soon follow with the Emergency Medical Care Attendant (EMCA) 
provincial certification exam. Much standardization and training continued through the 1980’s 
but it wasn’t until 1995 that advanced skills came into being with the implementation across the 
province of the Defibrillation and Symptom Relief Program. Up until that point, ambulance 
attendants could only provide advanced first aid, oxygen and transportation for the ill and 
injured, with the exception of some advanced programs in certain study locations. With 
defibrillation, ambulance attendants were now able to provide the immediate life saving act of 
defibrillating patient’s heart during cardiac arrest. The symptom relief program gave ambulance 
attendants the ability to provide medication for some of the more serious life-threatening 
illnesses. They were able to address breathing issues with Ventolin, allergic reactions with 
epinephrine, and chest pain with nitroglycerin and ASA. This brought some form of advanced 
life support (ALS) to every citizen of Ontario10. 

9 Ontario Association of Paramedic Chiefs, History of EMS in Ontario, accessed October 2022, 
https://www.oapc.ca/history/ 

10 Ontario Paramedic Association, History of paramedics in Ontario, July 27, 2015, www.ontarioparamedic.ca/before-
9-1-1/history-of-paramedics-in-ontario 

Until 2000, responsibility for ambulance services in Ontario fell completely within the 
responsibility of the Ministry of Health (MOH) through the EHS branch. The MOH was 
accountable and in control of funding, training, legislating, and dispatching ambulances until 
the government reconfigured numerous services under what was called Local Services 
Realignment. This reform of the provincial/municipal relationship altered responsibility for 
many services including land ambulance, thus making it part of the financial obligation of the 
upper tier municipalities. The transfer of responsibility for land ambulance was performed 
under an arrangement whereby, the province would maintain control of legislation, dispatching 


and provide 50% provincial funding to the municipalities for the costs associated with the 
provision of services. 

Throughout the early 2000’s, there have been many advancements within ambulance services 
with one notable development being the introduction of the term ‘paramedic’. This title was 
meant to denote the true evolution of the provision of care. Throughout the province, there are 
currently three levels of paramedic care being delivered dependant on the needs of the 
municipality. These three levels are: 

• Primary Care Paramedic 
• Advanced Care Paramedic 
• Critical Care Paramedic 


Most recently, there has been a fourth category known as Community Paramedic. This concept 
moves paramedics from acute care providers to continuing and chronic care providers. This 
new concept is in support of an effort to prevent emergency calls and reduce hospital visits. 

1.4 Haliburton County Paramedic Services 

Haliburton County Paramedic Services (HCPS) operates out of three stations located in Minden, 
Haliburton, and Tory Hill responding to over 9,600 service calls in 2022. 

1.4.1 Administrative Structure 

Haliburton County Paramedic Services is one of six county departments – Corporate Services, 
Planning, Public Works, Economic Development & Tourism, IT and EMS. The administration is 
standard for a paramedic service in Ontario with one noticeable exclusion: the lack of front-line 
supervision. The chief of paramedic services is head of the Department and reports to the chief 
administrative officer (CAO). As the lead of the Department, the chief has overall responsibility 
for the effective performance with four primary key areas of responsibility: 

• Financial Administration 
• Personnel Administration 
• Operational Management 
• Community & Public Relations 


The chief has an executive assistant that functions as an administrator for the department as 
well as performing some functions for the county. Reporting to the chief are two deputy chiefs 
who have split the traditional roles into an operations role as well as a quality assurance and 
education position. The key responsibilities for the deputy chief of operations involves facilities, 
fleet, equipment, health & safety, and scheduling. The primary responsibilities of the deputy 


chief of quality assurance & education include training, staff performance, policy review and 
creation, investigations, and research. The two positions work in tandem along with the chief on 
any matter that requires varied involvement. The commander of clinical programs is a newer 
position within the service which oversees the operations and reporting of the Community 
Paramedic Program. 

Each paramedic station has a paramedic duty officer who oversees some administrative 
function in addition to their role as part of the ambulance crew. They audit electronic patient 
care reports (EPCRs), maintain and order required stock for base, review shift envelopes to 
identify and reconcile expense receipts as well as any issues identified by crews. 

Figure #7 – Organization Chart for the County of Haliburton 

 


1.4.2 Paramedics 

The modern-day paramedic is a highly trained caregiver who has exceptional assessment and 
technical skills to treat emergency patients for both medical and traumatic presentations. As 
mentioned above, there are three distinct levels of paramedic care within the province of 
Ontario: 

• Primary Care 
• Advanced Care 
• Critical Care 


Primary Care Paramedic (PCP) 

A Primary Care Paramedic (PCP) requires a two-year program at a community college which 
provides approximately 500 hours of road experience with a paramedic crew. After successfully 
graduating from the paramedic program, there is a comprehensive provincial exam where a 
passing mark of over 70% must be achieved to practice as a paramedic in Ontario. 

Once hired by a paramedic service, further testing and annual recertification from the service 
medical director of a base hospital must carried out. Once the medical director is satisfied with 
their skills and knowledge, they will certify the paramedic in delegated acts under their medical 
license. 

The skills and knowledge that a PCP possesses at this point include: 

• Emergency patient care 
• CPR 
• Supraglottic airway 
• Manual defibrillation 
• Basic life support (BLS) trauma care 
• Blood glucose testing 
• Hypoglycemia management 
• SpO2 monitoring 
• IV initiation/monitoring 
• Pelvic binding 
• CPAP (Continuous Positive Airway 
Pressure) 
• ETT & Trach suctioning 
• Emergency Trach reinsertion 
• Opioid toxicity management 
• Emergency childbirth, including: 
o Delivery 
o Breech Delivery 
o Shoulder dystocia 
management 
o Nuchal cord management 
o 3rd stage management 
(Umbilical Cord 
management/Brandt 
maneuver, post-partum 
hemorrhage management, 
including Oxytocin 
administration) 



• Neonatal Resuscitation 



• COVID assessment/management/ 
vaccination 
• Non-narcotic analgesia (narcotic 
administration as a skill is imminently 
pending) 
• Termination of Resuscitation 
(medical/traumatic) 
• ROSC Management 
• Lead two ECG interpretation. 
• 12 lead ECG application / interpretation 
and STEMI diagnosis 
• STEMI & stroke bypass 
• Field trauma notification for medivac 
(trauma bypass) 
• Taser probe removal 
• Emergency-disconnect for home dialysis


Additionally, under the medical director’s license, a PCP can deliver the following medication 
upon correct diagnosis:

• Acetaminophen (Tylenol) 
• Acetylsalicylic Acid (ASA) 
• Dimenhydrinate (Gravol) 
• Diphenhydramine (Benadryl) 
• Epinephrine 
• Glucagon 
• Ibuprofen (Advil) 
• Ketorolac (Toradol) 
• Naloxone (Narcan) 
• Nitroglycerine Spray 
• Salbutamol (Ventolin) 
• Dextrose 50% 
• Dexamethasone 
• Oxytocin 
• Ondansetron 
• Glycopyrrolate (Palliative) 
• Haloperidol (Palliative) 


 

Advance Care Paramedic (ACP) 

To become an Advanced Care Paramedic (ACP) there is an additional year of community college 
education required over and above the PCP program. This again would include a period of 
practical experience. In addition to the PCP skill set, ACPs are qualified to perform and/or use: 

• Advanced airway management 
equipment 
• Orotracheal and nasotracheal 
intubation equipment 
• Lighted stylet intubation equipment 
• Orogastric and nasogastric tubes 
• Mechanical ventilation 
• Laryngoscopy and removal of 
foreign body obstruction using 
Magill forceps. 
• Initiate an Intravenous Line 
(autonomous IV start) 
• Initiate intraosseous and external 
jugular sites. 



• Initiate fluid bolus (Gravity and 
Pressure Infuser) 
• Pharmaceutical therapy 
• Needle thoracostomy 
• Chest tube monitoring 
• Synchronized cardioversion and 
external transcutaneous cardiac 
pacing. 
• Treatment of cardiac emergencies 
according to Heart & Stroke 
Foundation Advanced Cardiac Life 
Support (ACLS) guidelines 


In addition to the above list ACPs are certified to give these extra medications: 

• Adenosine 
• Atropine 
• Calcium Gluconate 
• Dextrose 
• Diazepam 
• Dopamine 
• Lidocaine 
• Midazolam 
• Morphine 
• Sodium Bicarbonate


Critical Care Paramedic (CCP) 

The highest level a trained paramedic in Ontario can receive is the Critical Care Paramedic (CCP). 
A CCP requires the additional specialized training (over and above the ACP) completed by the 
base hospital associated with service suppling CCP care. Currently CCPs are only located within 
the Toronto Paramedic Service and within the Ontario Air Ambulance Services (ORNGE). In 
addition to the skills that an ACP performs, the CCP practice includes: 

• Transvenous pacing. 
• Management of Pulmonary Artery 
lines 
• Arterial line monitoring 
• Central venous pressure (CVP) 
monitoring 
• An extensive pharmacology scope. 
• Administration of blood and blood 
products 
• Umbilical venous catheter line 
insertion 
• Foley catheter insertion 
• Nasogastric tube insertion 
• Computerized tomography (CT) -
head scan interpretation 
• Chest X-ray interpretation 
• Multiple difficult airway maneuvers 
• Mechanical ventilation, multiple 
modes 
• Chest tube management 
• Sengstaken-Blakemore tube 
management 
• Lab value analysis 
• Blood gas analysis 
• Various medications with physician 
orders 


 


1.4.3 Primary Care Paramedic – IV (PCP Plus) 

Every one of the paramedic levels have the ability for a medical director to permit advancement 
of skills for all three levels. Haliburton County Paramedic Service (HCPS) employs PCP care that 
has evolved to contain a hybrid paramedic level between PCP and ACP care that is referred to as 
PCP Plus. The major advanced skill associated with this hybrid level is intravenous (IV) initiation. 
The establishment of an IV line greatly expands treatment options for many medical conditions. 
This hybrid position can provide treatment for cardiac angina/myocardial infarction with the 
delivery of Nitroglycerin for patients who have never taken it before. This IV initiation also 
allows for superior treatment for diabetics through the delivery dextrose using IV. Additionally, 
there are other medical conditions that can be treated through IV, such as nausea with Gravol, 
low blood pressure with a fluid bolus, pain management with Ketorolac and, opioid overdose 
reversals with Naloxone. 

This hybrid level would appear to be the future in Ontario Paramedicine. It allows expansion of 
skill sets and treatment paths for municipalities with smaller emergency call volumes that don’t 
support the requirements or cost of a full ACP program. HCPS should be commended for having 
the vison to start this program. The PCP Plus program will continue to evolve with new 
treatments over the next ten years and the goal for HCPS is to have every paramedic in their 
service at this level. 

**Note: The Haliburton PCP Plus paramedics treated 2,746 patients in 2017 and 3,661 patients 
in 2021; an increase of 33% in just four years (as per CEPCP) 


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SECTION 2: CURRENT ASSESSMENT 

2.1 HCPS Call Volumes 

A paramedic’s workload is unquestionably based on call volume. Paramedics report to work 
with daily uncertainty. They often take advantage of any idle time focussing on continuing 
education, station duties, or decompressing after calls. However, they must be ready to 
respond quickly when an alarm is initiated. A paramedic’s career undoubtedly captures the 
phrase, “hurry up and wait”. 

There are two main datasets from which to obtain information from Paramedic calls; the CACC 
(Central Ambulance Communication Centre) derived Ambulance Dispatch Reporting System 
(ADRS) data, and the Paramedic derived iMedic Electronic Patient Care Report (EPCR) data. 
ADRS data comes from the MOH through data collected by the local CACCs. Obtaining this data 
has been a challenge for many years due to the MOH practice of “scrubbing” the data once it is 
obtained. In the past, if significant and pertinent information was not gathered correctly, the 
call could be abandoned and not show up in the system data. A great deal has changed over the 
years and while ADRS is still not 100% accurate, it is consistent in gathering information and can 
be used for planning purposes. 

A key component of a paramedic’s role is to produce a report for every patient that they 
encounter which is known as a patient care report (PCR). Traditionally, these PCRs were 
completed in quadruplicates on paper, however, in the early 2000’s electronic charting became 
available and is being utilized throughout Ontario with the software iMedic. This software 
allows paramedics to record patient data during calls which will transfer over to the hospital 
once they are brought in by ambulance. 

Data presented within this report has been retrieved from either ADRS, for geographical 
responses, as well as EPCR for patient related reports. Where possible, the most current data 
has been acquired. To understand different types of call volumes, it is important to understand 
a few key concepts in relation to paramedic response and patient acuity. 

2.1.1 Dispatch Priority Codes 

Every ambulance is dispatched based upon one of various Priority Codes. Currently, the 
Haliburton Paramedic Service is being dispatched by the Lindsay Central Ambulance 
Communication Centre (CACC). Every dispatched service call is labelled a dispatch priority code. 
These codes are based on the dispatch priority card index (DPCI) system which, through a series 
of algorithms, provides a response code based on the 9-1-1 callers’ interpretation of the 
medical emergency. 


The following are the codes and definitions that CACC can apply to a call: 

• Code 1 - non urgent and deferable. 
• Code 2 - scheduled i.e., diagnostic hospital interfacility transfer. 
• Code 3 - prompt response. 
• Code 4 - urgent lights and siren response. 
• Code 8 - standby i.e., local paramedic response time coverage, land paramedic 
ambulance coverage for neighbouring municipality, local fire, or police situation. 


Once the patient is assessed by the paramedics, they will denote a return patient priority when 
hey are prepared to leave the scene of the incident. They will use the same codes noted for 
CACC purposes; however, a Code 7 can be added if the patient is not being transported to the 
hospital. 

2.1.2 Paramedic CTAS Codes 

Once the paramedics arrive on scene, they can rapidly assess a patient and indicate their acuity 
based upon a widely used system known as the Canadian Triage Acuity Scale (CTAS). 

The CTAS is the same scale used by doctors and nurses in hospitals to triage their patients based 
on need. Utilizing this same system allows for better communication and consistency amongst 
healthcare providers. This scale has five levels and is an essential part of the provincially 
legislated Response Time Standard. The five levels of response within the scale are: 

• CTAS 1 – Resuscitation (threats to life or limb or could deteriorate requiring 
aggressive treatment interventions). 
o Patients need to be seen by a physician immediately, 98% of the time. 



• CTAS 2 – Emergent (conditions that are a potential life or limb threat). 
o Patients need to be seen by a physician within 15 minutes, 95% of the time. 



• CTAS 3 – Urgent (conditions that could become serious). 
o Patients need to be seen by a physician within 30 minutes, 90% of the time. 



• CTAS 4 – Less-Urgent (conditions that relate to age, distress, potential for deuteration 
or complications). 
o Patients need to be seen by a physician within 60 minutes, 85% of the time. 



• CTAS 5 – Non-Urgent (minor complaints that do not pose any immediate risk to the 
patient). 
o Patients need to be seen by a physician within 120 minutes, 80 % of the time. 






CTAS is collected at a variety of times during care with the patient to reflect the current 
condition of the patient. It is collected beginning with patient contact, leaving the scene, and 
upon arrival at the destination facility. 

2.1.3 Total Call Volume 

Call volumes for paramedic services in Ontario have been continually rising since provincial 
download in 2000. There has been only one abnormality, since 2000, regarding call volume 
progression which was in 2019. This data is valid for Haliburton County as well. For analysis 
purposes, this report will consider call volumes from 2017 to 2021 and will utilize data 
percentages right up to September 2022 where possible. 

Figure #8 – Ambulance Dispatch Reporting System (ADRS) 

 

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2.1.4 Call Volume – Dispatch Priority 

The HCPS deployment model requires balanced coverage. Frequently when an ambulance is 
sent on a priority call (Code-1, -2, -3, or -4) an additional ambulance is dispatched on standby 
(Code 8) to provide supplementary coverage. The data represents and documents that the code 
8 responses account for approximately 50% of the dispatched call volume. 


Figure #9 – ADRS by Priority 

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Figure #10 – ADRS by Priority 

 

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In Ontario, typically, code 4 calls account for most of the dispatched service calls. In Haliburton, 
however, code 4 calls are dispatched less frequently than in most other paramedic services and 
by percentage (not call volume) appears to be declining. This possibly can be attributed to the 
increased volume of urgent interfacility transfers that are being booked by the local hospitals. 

While the dispatch priority code system investigates beyond the urgency of the call, it is strictly 
based upon the DPCI program as well as the information that the dispatcher acquired from the 
caller. For an assessment of patient acuity, the Canadian Triage Assessment Scale must be 
considered. 

2.1.5 Call Volumes – CTAS 

Once the paramedic arrives on scene of an incident, they perform a quick assessment and notify 
CACC of the patient contact and CTAS assessment. This gives a rank of the patient’s acuity, or 
level of need to be transported to definitive care. It should be noted for response time 
purposes the CTAS 1 category is broken down to indicate the SCA (Sudden Cardiac Arrest) 
requirement of reporting. A patient in SCA is still technically considered a CTAS 1. 

Additionally, CTAS 0 is noted when a patient has died prior to the paramedics’ arrival, has end of 
life do not resuscitation orders, or is declared deceased during paramedic care. This ensures 
proper tracking of response times under the MOHLTC Standard. 

In Ontario, most of the patients’ that are encountered by paramedics are prioritized as CTAS 3. 
This indicates a level of urgency requiring care; however, it is not emergency nor requiring 
resuscitation. These patients are typically sick however their ailment is not immediately life 
threatening. 

The changing acuity over time can be seen in the differences between 2017 through 2022. 
Percentage gains in the CTAS and 3, 4, and 5 are offset by percentage losses in CTAS 2 and CTAS 
1 and 0 when those categories are combined. To someone who is not familiar with the 
paramedic system, this would seem to indicate that patients being transported by ambulance 
are less sick, however, we know that there has been a substantial increase in urgent interfacility 
transfers of non-critical patients adding to the CTAS 3 category over time.


Figure #11 – CTAS – Breakdown by Year

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Figure #12 – CTAS – Call Count 

 

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2.1.6 New Definitions for Call Volumes 

There are numerous facets to consider when reviewing the volume of calls, however, they are 
required to be defined. Understanding the deployment model for Haliburton County and the 
call volumes within the County can be broken down into three categories: 

• Incidents 
• Emergency Responses 
• Patient Carried (Transports) 



Incidents – the number of times a resource is dispatched to deploy. This includes 9-1-1 calls as 
well as the movement of vehicles to balance emergency coverage. 

Ambulance deployment is discussed in further detail later within this report. HCPS utilizes a 
balanced emergency coverage approach wherein resources are sent to balance coverage when 
an emergency call takes another resource out of circulation. For example, when the Village of 
Haliburton ambulance takes an emergency call, the Tory Hill ambulance will redeploy to the 
Village of Haliburton to better cover an area more likely to receive another emergency call. 

Emergency Responses –the amount of times resources are sent to a patient in need. This is 
what most paramedic services would refer to as “true” call volume. 

Patient Carried (Transports)–represents every time a patient is transported (typically to a 
hospital). 

**Note: Occasionally, a patient decides that they do not want to seek definitive care. This would 
be a considered both an incident and an emergency response but not a patient transport. 

Figure #13 – Call Volume Breakdown by Year 

 

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Overall, since 2017 call volume has risen significantly with incident volume increasing to 41.1%, 
emergency response has risen to 56.2%, and patients carried growing to 51.0%. 


Figure #14 – Percentage Change by Year 

 

 

 

 

 

 

 

 

 

 

 

2.1.7 Call Volume – Age 

While past call volumes already factor in patient age, it is important to realize that continued 
growth in an aging population will intensify the increase in calls. As per the Ontario 2021- 2046 
population projection, older adults currently make up for 17.6 percent of the province’s 
population. Within the Haliburton area, currently the older adult population makes up for 35.7 
percent11. The chart below reveals that the aging population, over the age of 65, makes up 
most of the call volume. The data also shows that call volumes are rising for both the 65 plus 
age group as well as the 15 - 64 age bracket. 

11 Ontario Population Projections, Ontario.ca, accessed January 2023, https://www.ontario.ca/page/ontario-
population-projections 


Figure #15 – Calls by Age and Year 

 

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Figure #16 – Percentage of Calls by Age and Year 

 

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In 2021, 35.7% of the population of Haliburton was 65 years of age or older. Throughout 2021, 
those 65 years of age or older represented 60.35% of the call volume. This information must be 
a component of future planning as this statistic is not uncommon due to the older population 
requiring an increase in healthcare needs. Understanding this disproportionate requirement is 
key when looking at future population predications. 

Figure #17 – Haliburton – Age Composition and Call Volume by Age 

 

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The above noted call volumes dealt with vehicle utilization and paramedic work, but they did 
not consider patient acuity. Patient acuity requires examining and analysing the call data to 
calculate a further patient driven focus. 

2.1.8 Call Volumes Non-Permanent Residents 

Assessing the number of HCPS calls that are provided for non-Haliburton residents is difficult to 
calculate with accuracy. Many seasonal residents and visitors have been known to use their 
seasonal addresses for iMedic reporting. Reviewing the iMedic report data for 2021, it was 
discovered that 931 calls had mailing addresses with postal codes that were not local to 
Haliburton County (K0M/K0L). Furthermore, there were 391 calls where the mailing addresses 
were not or could not be obtained. 

2.1.9 Call Volumes – Time of Day/Day of Week/Month of Year 

When evaluating paramedic resource needs, it is important to note when there is an expected 
increase in services. Obtaining information to observe time of day, day of week, and month of 
year s will allow us to obtain an overall picture of increased activity in correlation to time. 


Time of Day 

It is important to note the time of day when establishing a start and an end time in relation to 
resources. Since the start of 2021 (most recent trend timing with appropriate data), 68.6% of 
calls occur between the hours of 08:00h – 20:00h (8 a.m. and 8 p.m.). This time aligns with the 
start and end times for two of the three 24-hours shifts. 82.1% of the calls occur between the 
hours of 08:00h – 23:00h (8 a.m. – 11 p.m.) 

Figure #18 – 2021 – 2022 Number of Calls by Time of Day 

 

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Over the last 5 years, nearly 75% of calls occur between the hours of 07:00h through 20:00h (7 
a.m. - 8 p.m.). This timing coincides with the start and end of shift times of the third 24-hour 
HCPS ambulance. The day shift (fourth ambulance), deploys from 11:00h to 23:00h (11 a.m. to 
11 p.m.). 

Upon review of the analysis of Code 3 data calls, there appears to be an incline at 09:00h, 
11:00h, and at 20:00h (8 p.m.). Additionally, an analysis of the pick-up locations for Code 3 calls 
since 2017, reveals that nearly 55% occur at hospitals. There would appear to be a correlation 
between the increase in interfacility transfers with increase in Code 3 calls over time. 


Figure #19 – Hour of Day Breakdown 

 

 

 

 

 

 

 

 

 

 


Day of the Week 

Day of the week statistics are also significant when assessing the amounts of resources that are 
required throughout the week. 

Figure #20 – Percentage of Calls vs. Days of the Week 

 

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As noted above in figure #21, the busiest day of the week is Saturday which is a full percentage 
greater than the second busiest day being Friday. The rest of the days are relatively close in the 
overall calls received per day. 

Up until recently, there were upstaffing conditions at the Tory Hill location on weekends and 
day shifts. With data supporting the busiest days being Friday, Saturday and Sunday acquiring 
full staff for the weekends is a definite asset. Therefore, recently there was an increase in 
staffing at the Tory Hill station, providing this station the ability to function 24 hours a day 365 
days a year. With Friday, Saturday and Sunday being the busiest days, this again speaks to the 
increase in the seasonal population on weekends. 

Month of the Year 

The month of year yields substantial findings for Haliburton County. For an area of the province 
with a high number of seasonal residents, it is essential to review the influx of population 
during specific months of the year. As expected, the busiest months of the year unquestionably 
are July and August followed by the months of September and June. The months of February 
throughout April are the least busy in the County. To maintain appropriate coverage and 


ambulance availability for the duration of the summer months, the paramedic service would 
typically upstaff extra ambulances on weekends. 

Figure #21 – Percentage of Calls vs. Time of the Month 

 

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2.1.10 Assessment of Underserviced Areas 

A review of deployment includes an assessment of emergency calls being performed by other 
jurisdictions in Haliburton County. In the Ontario system of “seamless coverage” the closest 
most appropriate ambulance will be dispatched to an emergency regardless of borders. 
Reviewing calls performed by other services details a challenge to respond within your own 
area. 

Algonquin Highlands is the only area of the County without a regularly deployed Paramedic 
Station. Algonquin Highlands saw a population increase of 10.1% to 2588 people according to 
the 2021 Canadian Census (Dysart et al 14.4% [7182], Minden Hills 14.5% [6971], Highlands East 
14.6% [3830]). 

Currently, there is a Paramedic Post at the Stanhope Fire Station, however the ambulance is 
only present when all four-day shift ambulances are available. Below is a listing of calls 
performed within Algonquin Highlands for 2022 by HCPS and other neighbouring Paramedic 
Services. 


Figure #22 – 2022 Calls by Paramedic Services in Algonquin Highlands 

 

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Responding From 

# of Calls 

% of Calls 

Response Time (min) 

Haliburton County EMS 

176 

67.95 

20.28 

Muskoka Paramedic Service 

77 

29.73 

28.62 

North Bay & District Ambulance Service 

5 

1.93 

24.45 

City of Kawartha Lakes EMS 

1 

0.39 

41.00 

Total 

259 

100.00 

22.92 



While 68% of the 9-1-1 emergency calls in Algonquin Highlands are being performed by HCPS, 
32% are being performed by other services. The average response times for the calls being 
responded to by outside services is often 8 minutes longer than for HCPS. As funding and 
resources become available HCPS should consider a paramedic station and ambulance 
deployment within Algonquin Highlands. 

While Algonquin Highlands had a high percentage of emergency 9-1-1 calls being performed by 
other Services, Dysart et al and Minden Hills had nearly all calls performed by HCPS. 


Figure #23 – 2022 Calls by Paramedic Service and Location 

 

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Highlands East has a large percentage of calls being performed by other Services even though 
there is a Paramedic Station within the municipality in Tory Hill. The primary reasons are the 
ambulance in Tory Hill is frequently redeployed when other paramedic resources are in use, and 
many calls is Cardiff are served by Hastings County which has an ambulance in Bancroft. 
Bancroft is utilized as it is only 17km to Cardiff whereas Tory Hill is 23km. 

Figure #24 – 2022 Calls by Paramedic Services in Highlands East 

 

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Responding From 

# of Calls 

% of Calls 

Response Time (min) 

Haliburton County EMS 

359 

68.51 

18.64 

Hastings – Quinte EMS 

151 

28.82 

16.86 

Peterborough EMS 

14 

267 

14.32 

Total 

524 

100.00 

18.01 




Figure #25 – Haliburton County Calls 

 

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Looking at potential locations for an Algonquin Highlands Station, four areas (Carnarvon, Maple 
Lake, West Guilford and Stanhope) were considered and have been mapped with emergency 
response travel times. Considering travel time coverage and overlap with other stations, the 
two most viable options would appear to be Stanhope or Carnarvon.


Figure #26 - Proposed Carnarvon Station

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Figure #27 - Proposed Maple Lake Station

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Figure #28 - Proposed Stanhope Station

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Figure #29 - Proposed West Guilford Station 

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2.2 Haliburton County Patient Acuity 

CTAS is a true measure of patient acuity and determines the urgency of the patient’s condition. 

There are two data fields to review in relation to the purpose and cause of the patient requiring 
an ambulance. These data fields for review are dispatch problem codes and primary problem 
codes. 

A dispatch problem code relates to a determination by CACC and what they interpret to be the 
issue as detailed by the 9-1-1 caller. The primary problem code is what the paramedic 
determines to be the general issue with the patient upon their examination. Dispatch problem 
codes are far less reliable as they depend on the information given by the caller, including the 
hospital on interfacility transfers. Where interfacility transfers are concerned, a correlation of 
both codes needs to be assessed. When paramedics are dispatched for an interfacility transfer, 
they may choose to code the primary issue or concern, or they may choose to use the patient’s 
actual diagnosis (e.g., chest pain, respiratory, etc.). This is where the discrepancies within the 
two datasets will be found, and the appropriate dataset must be used for accurate intent. 

The top patient primary problems, as recorded by the paramedics on the EPCR, are noted in the 
table below. Over the last three years, it is noted that most primary problems do not appear to 
represent critical emergencies. While there are 51 distinct generalized codes that paramedics 
have the ability to use for primary issues, the top ten primary problems make up 77.4% of all 
calls performed by paramedics with interfacility transfers being first (and increasing yearly). 

Table #5: Top Incidents – 2020-2022 


A review of patient acuity, using the data from CTAS, the top ten primary problems would 
confirm that these patients are in a less serious condition. As figure #23 shows, over 80% of the 
time a patient’s acuity is CTAS 3 or lower. Emergent or resuscitative calls (CTAS 1 & 2) make up a 
small percentage of overall work at 15.7%. 

Figure #30 – Top Incidents - Categorized by Acuity 

 

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Additionally, trends in relation to primary patient problems can be noted. Over the last 5 years, 
interfacility transfers have grown in quantity and now is overwhelmingly the primary call 
performed by paramedics followed by weakness/dizziness/unwell, and musculoskeletal issues. 
As per ADRS data, the bulk of interfacility transfers now makes up over 30% of paramedics 
dispatched calls.


Figure #31 – Primary Problems (Noted by Paramedics in EPCR) 

 

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A review of dispatch problem codes over the same course of time reveals an even larger gap 
growing between interfacility transfers and other codes. As noted previously, a dispatch 
problem code noting interfacility transfers is generally more accurate than using primary 
problem codes. 

Figure #32 – Dispatch Problems (Noted withing Dispatch ADRS Data) 

 

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The relationship between patient acuity and primary problem is noteworthy. Highly critical 
patient classifications are either SCA or CTAS1. Top call types falling within this category over 
the last 5 years are cardiac arrest (130), followed by unconsciousness (22) and traumatic arrest 
(13). It should be observed that there has only been approximately 231 CTAS 1 calls over the 5 
years (average of 46 CTAS 1 calls per year/one every 8 days). 

Figure #33 – CTAS1 - Primary Problems 2017-2021 

 

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Points for Consideration 

Response time standards place a major focus on SCA and CTAS 1 calls although they only 
account for 1.67% of all calls over the last 5 years. Patients in sudden cardiac arrest and those 
classified as CTAS 1 are truly the individuals in need of the greatest care. The outcomes for 
those patients are generally not optimistic and often rely on bystander actions for a greater 
chance of success. In the case of SCA, bystander CPR, ease of access to defibrillators, as well as 
proximity to a definitive medical centre are critical to a favourable outcome. The challenge of 
SCA and CTAS 1 in any rural environment is the distance and related response time. 

A review of CTAS 2,3,4 and 5 levels show the prevalence of Interfacility transfers at or near the 
top of each category. This data is based upon paramedic entry into the EPCR which can 
underreport the value of interfacility transfers since primary problems are noted as patient 
condition. 


igure #34 – CTAS 2 – Primary Problems 2017 - 2021 

 

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Figure #35 - CTAS 3 – Primary Problems 2017 - 2021 

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Figure #36 - CTAS 4&5 – Primary Problems 2017 - 2021 

 

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Patient CTAS can be analyzed throughout the past years to assess whether patients are 
becoming sicker and the most prevalent types of calls. Only focusing on community emergency 
calls, over the past 5 years the overall order of CTAS has not changed, however, the percentage 
breakdown has slightly. In 2017, 26.82% of patients required immediate life saving care (SCA, 
CTAS 1 & CTAS 2) and in 2022 that percentage fell to 23.28%. Conversely, patients who were in 
less serious conditions (CTAS 3, 4, 5) increased from 73.18% in 2017, to 76.72% in 2022. 
Therefore, percentage wise, although serious emergencies have increased, patients that 
paramedics had encountered in 2022 are not as ill than the patients faced in 2017.


Figure #37 – 2017 and 2022 – CTAS on Contact 

 

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2.3 Response Times 

The most reviewed and scrutinized metric in the paramedic service is response time. Someone 
experiencing a medical emergency for a few minutes will feel like hours for both the patient 
and family. Therefore, it is not surprising that a large area of concern is over paramedic 
response times. In the past the Ambulance Act required each service provider to publicly report 
yearly response times, but things have changed with this legislation over the years. 

Prior to the provincial download and until 2010, the response time standard was based upon 
dispatch priority Code 4 calls and the calculation of a 90th percentile measured against the 1996 
response data. This measure was outdated, not based on patient outcome, and did not 
accurately reflect what performance-based services were focusing on. 

In 2011, a new response time standard was legislated; one that took patient acuity into account 
utilizing the CTAS score. While this was a marked improvement over the previous response time 
standard, there were still concerns being overlooked in the separation of other emergency call 
factors, and regarding the focus of the new standard on an overwhelming minority of calls. In 
Haliburton County, the response time criteria were based on less than 2% of the calls. 


2.3.1 New Response Time Standard 

Utilizing the CTAS scale, the current response time standard is laid out into six categories. Under 
the Ambulance Act Regulation 257/00 paramedic services must report: 

1. Sudden Cardiac Arrest (SCA) Patients – the percentage of time that any person with a 
defibrillator provides defibrillation within 6 minutes. 
2. CTAS 1 Patients – the percentage of time that a paramedic arrives to a patient deemed 
to be in SCA or classified as CTAS 1 in 8 minutes. 
3. CTAS 2, 3, 4 & 5 – the percentage of time that a paramedic arrives to a patient classified 
in CTAS 2, 3, 4 or 5 within a municipally directed time limit. 


There are many things to note about this standard, including that a patient that is in cardiac 
arrest counts for two of these response times. A cardiac arrest situation generally makes up less 
than 2% of all calls to which a paramedic service will respond. This is considered a low 
volume/high acuity call in that it is not a frequent event, however, when it does occur, it is very 
serious. 

Response time figures for the vast majority of calls (CTAS 2, 3, 4 and 5) contain a double 
variable. Paramedic services not only determine the percent of time, but the service is also able 
to determine the timeframe. This double variable makes it extremely hard for services to 
compare against each other, however, it does allow for each service to customize their times 
based upon their needs. 

Haliburton County Paramedic Service has maintained their response time standard within the 
same parameters since 2017, as detailed below. 

Sudden Cardiac Arrest 

20% of the time, within 6 minutes from crew being notified, Haliburton County Paramedic 
Service will endeavor to have a responder equipped with an AED at the location of a patient 
that is believed to be in sudden cardiac arrest. 

CTAS 1 

30% of the time, within 8 minutes from crew being notified, Haliburton County Paramedic 
Service will endeavor to have paramedics as defined by the Ambulance Act and duly equipped 
at the location of the patient considered to be CTAS 1. 

 


CTAS 2 

65% of the time, within 15 minutes from crew being notified, Haliburton County Paramedic 
Service will endeavor to have paramedics as defined by the Ambulance Act and duly equipped 
at the location of the patient defined to be CTAS 2. 

CTAS 3 

65% of the time, within 20 minutes from crew being notified, Haliburton County Paramedic 
Service will endeavor to have paramedics as defined by the Ambulance Act and duly equipped 
at the location of the patient considered to be CTAS 3. 

CTAS 4 

65% of the time, within 25 minutes from crew being notified, Haliburton County Paramedic 
Service will endeavor to have paramedics as defined by the Ambulance Act and duly equipped 
at the location of the patient determined to be CTAS 4. 

CTAS 5 

65% of the time, within 30 minutes from crew being notified, Haliburton County Paramedic 
Service will endeavor to have paramedics as defined by the Ambulance Act and duly equipped 
at the location of the patient defined to be CTAS 5. 

Over the last 5 years, with maintaining the same targets, we can review a 5-year average of 
percentage achievements. The 5-year average on all accounts has been above the set targets. 

Figure #38 – 5 Year Targets based on CTAS 

 

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In the past years, HCPS has met or exceeded the standard with the exception of 2020. This was 
due to the CTAS 1 target which was unobtainable by 9% and the CTAS 2 target by less than 1%. 

The MOHLTC is committed to reporting key performance indicators (KPIs) within the ground 
ambulance system in Ontario, not just for the paramedic services but also the performance of 
the CACCs. 

Listed below are the longest average response times within Ontario for emergency (Priority 4) 
calls. It is important to note geographical features such as size and population density when 
considering the ability of services to have a favourable response time. Less dense, more 
geographically sparse areas are more likely to experience longer response times due to the 
distance an ambulance must travel. 

Figure #39 – Ontario Average Response Time for Priority 4 Calls 

 

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2.3.2 Station Response Time Maps 

In a review of station response times, there are many factors that must be considered. To 
completely understand the ability of response, a review of drive-time maps can be utilized. It 
must also be understood that there is an allowable reaction time of 2 minutes (noted within the 
Deployment Plan). This reaction time, also known as chute time or turnout time, is the amount 
of time it takes from the alarm bell to the paramedics responding in the ambulance. The two-
minute standard is acceptable to the MOHLTC and considers that paramedics must safely finish 
their tasks at hand prior to proceeding to the ambulance to respond. The following maps detail 


some of the above noted response times with the reaction time removed. These maps 
represent the distances that can be travelled at speed limits without consideration of weather, 
traffic, road closures/construction and intersection signals. 

The three maps reveal that the SCA 6-minute response time (minus a 2-minute reaction time = 
4-minute travel time) is highly aggressive and very difficult to achieve for the HCPS. It is 
important to note, however, that the SCA time is for a responder with a defibrillator to arrive, 
not necessarily a paramedic. A responder could be a firefighter, police officer, lifeguard, 
workplace first aider, or civilian with an AED prepared to provide CPR and use the AED. 

The 8-minute CTAS1 response time (minus a 2-minute reaction time = 6-minute travel time) is 
more attainable on a regular basis. The goal of station placement is to be positioned in the best 
possible location to respond to the most calls for service within expected and published 
timeframes. 

The 15-minute CTAS2 response time (minus a 2-minute reaction time = 13-minute travel time) 
covers a wider area of the county. 

The Haliburton station map reveals a minor challenge responding westward in a quick manner. 
The position of the station is on the far east side of town so when responding to the west side 
the ambulance is required to travel through the busier areas within the village. This is reflective 
in the 4- and 6-minute drive time maps. Within the 13-minute drive time map, it is evident that 
the most populated areas of Dysert et al are well covered. 


Figure #40 – Station #1 - 4-, 6- and 13-minute Drive Time

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Figure #41 – Station #2 – 4-, 6-and 13-minute Drive Time 

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Upon review of the Minden Station, it is apparent that Highway 35 allows for prompt response. 
Within 4-minutes, most of the town can be responded to, under optimal driving conditions, 
while practically the entire municipality can be reached within 13-minutes. The location of the 
Minden Station is optimal considering the population centres and the geographical position.


Figure #42 – Station #3 – 4-, 6-, 13-minute Drive Time 

 

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A review of the Tory Hill Station reveals that the station is also well situated being adjacent to 
Highway 118. Travel along main roads and highways are always the best option as they are 
usually well maintained throughout all seasons and generally allow for quicker speeds. This 
station is geographically centred within the Municipality of Highlands East and has excellent 
access in all directions. The ability to respond quickly due to the road system is evident in the 4-
minute travel time which has extensive range. Being in a central location is of paramount 
importance when population is highly distributed. 

2.4 Deployment Strategy 

2.4.1 Deployment Plan 

Annually, every paramedic service in Ontario is responsible for submitting a service deployment 
plan to the MOH. These deployment plans serve to direct the CACCs on how to deploy the 
resources under their control. The four paramedic services primarily dispatched by Lindsay 
CACC have come together to produce a single Deployment Plan for the ambulance 
communications officers (ACOs) to follow. As noted in the plan, 


“It is the intention of the above noted land ambulance service providers to incorporate 
certain policies that provide rapid out of hospital care to citizens in need of medical care 
and to ensure a more effective and efficient delivery of service within the Lindsay 
Central Ambulance Communications Centre (CACC) catchment area. This plan will permit 
the necessary latitude to the Communications Officers in order to ensure balanced 
emergency coverage accordingly with the available resources and applicable legislation.” 

While each paramedic service maintains their own operational requirements, the singular plan 
lays concepts out in a similar and consistent approach which creates ease of implementation. 
There are many operational policies dictated within the plan including sections on staffing 
levels, shift patterns, emergency coverage reinstatement, standby coverage, management 
notification, offload delays, excessive overtime/end of shift management, meal breaks as well 
as inclement weather. 

The formation of the four-service deployment plan creates a simplified comparison amongst 
the services regarding the emergency coverage reinstatement. Haliburton County has a listed 
critical - minimum emergency vehicle count (C-MEC) of one vehicle between 07:00h – 23:00h (7 
a.m.-11 p.m.) and zero vehicles from 23:00h – 07:00h (11 p.m. to 7 a.m.) for up to 60-minutes 
before mitigation strategies are put in place. The other services maintain two to three 
ambulances, as per the C-MEC statement. Additionally, the deployment plan for Haliburton 
does not allow for any public delay for lower priority calls when in C-MEC, whereas the other 
services allow for a 30-minute delay for less serious calls. 

The decision to only communicate a C-MEC 0 to management after 60-minutes was based on 
the significant workload the managers face as well as frequently being called after-hours. 


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Table #6: Emergency Coverage Reinstatement (C-MEC & Response Delays) 

Emergency Coverage Reinstatement 

Critical – Minimum Emergency Coverage (C-MEC) is a trigger that recognizes that the level of available 
ambulance resources cannot sustain/maintain the EMS service’s “Minimum Emergency Coverage” 
level. 

Critical – Minimum Emergency Coverage and Response delays for: 



 

 

 

 

 

 

 

In comparison with the other local services, Haliburton, due to its low population density has 
the least number of ambulances available at any given time. 

Table #7: Deployment Numbers by Location 

Service 

Minimum Deployment 

Maximum Deployment 

Haliburton 

3 

4 

Kawartha Lakes 

5 

7 

Northumberland 

6 

9 

Peterborough 

7 

10 




Many factors are reviewed when determining the resource allocation including call volume, 
geographic area, response times, and risk tolerance. 

For comparison purposes, the following information has been gathered from the three services 
under Lindsay CACC in addition to other provincial neighbours12. 

12 Emergency Health Services, Land Ambulance Program, Ministry of Health and Long-Term Care, accessed January 
2023, https://health.gov.on.ca/en/pro/programs/emergency_health/land/responsetime.aspx 

Figure #43 – Neighbouring Response Times for Priority 4 Calls 

 

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The average response time in the County of Haliburton is nearly three minutes longer than any 
of its neighbours. 

There is no guaranteed method of analysis regarding population density, land area and 
response times. Areas such as Nipissing, while large in area, have distinct population centres 
(North Bay) contributing to much of the call volumes, therefore response times can be lower as 
resources are focused on the call demand centre. Areas like Muskoka, comparable in size to 
Haliburton, have a far greater population density, which would suggest more calls for service so 
response times may increase. 

Comparing results for response times for SCA and CTAS1 can be done relatively easily as the 
time variables are the same as noted above six minutes for SCA and eight minutes for CTAS1. 
Response percentage goals, are determined by each service based upon risk tolerance, funding 
resources, population densities, community goals, and approved by Council.


Figure #44 – 2021 Response Time Standard – SCA and CTAS1 Results 

 

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Haliburton County achieves the lowest response time of an eight-minute CTAS1 event with a 
result of only 36%. Haliburton County also attains the second lowest response time of time of a 
defibrillator response of only 29% for a patient in sudden cardiac arrest. 

Standby Coverage 

According to the four-service deployment plan, 

 “…stand-by coverage for other UTM’s will be completed from the County stations unless the 
other Municipality is at 0 coverage in which case Stand-by will be completed at the County 
boundary in order to ensure appropriate coverage to the rest of the County.” 

Internally, it is important to note the deployment plan balanced coverage statement for HCPS. 
This section refers to ‘internal’ standbys whereby HCPS resources are redeployed based upon 
set criteria relating to the number of units available. Order of coverage would be noted as: 

1. Haliburton (due to volumes and being centrally located within the County) 
2. Minden (due to volumes and location) 
3. Tory Hill 
4. Algonquin Highlands at Stanhope 



Table #8: Staffing Levels by Location 

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Emergency Coverage Statement 

A current situation of increasing concern, within the Ontario ambulance services, also presents 
the greatest threat. Critical-Minimum Emergency Coverage (C-MEC) is a concept which has 
become prominent in relation to the current pressures of the healthcare system. Within 
provincial deployment plans, the paramedic services signify critical levels of ambulance 
coverage with steps required when those thresholds are met. The issue has gained media 
attention in major centres where hospital pressures are forcing patients to remain on 
paramedic stretchers due to lack of beds in the hospitals. Not having any ambulances available 
in the county, nor any standing by at the county border will result in extended response times in 
the event of an emergency. 

Interfacility Transfers 

Within the four-service deployment plan, there are varying procedures for dealing with 
interfacility transfers. The repatriation or returning of patients to their home community is 
noted for three of the services. Haliburton is once again the most lenient on this matter as they 
will wait up to 60 minutes at the receiving facility (out of the County) to determine whether the 
patient can return. This contrasts with Northumberland waiting 30 minutes and Kawartha Lakes 
and Peterborough not waiting at all. 

The four-service deployment plan states, “A medical escort is required for all Urgent – Code 4 & 
Prompt – Code 3 interfacility transfers except Stroke & STEMI protocols”, however in the 
section for Haliburton there is an exception stating “a medical escort is not required for all 
emergency interfacility transfers”. 

Requiring a medical escort to accompany a patient serves two objectives. 

1. During transportation the patient remains an inpatient of the sending facility. This 
essentially means that the patient is under the care of the originating or sending 
hospital. 


By taking a patient without a medical escort the paramedics are taking full responsibility for the 
hospital’s patient. Paramedics, however, are not employees of the hospital and may not have 
the ability to tend to the patients advanced medical needs (i.e., giving prescribed medications). 
Having a medical escort ensures that there is a representative of the facility responsible for 
their care. 

2. With an escort accompanying the patient the paramedic crew could leave the 
destination facility should the need arise to return to their home community due to 
emergency response pressures or C-MEC situations. 



Without a medical escort the patient cannot be left alone as the receiving facility will not take 
responsibility for their care. All services allow for non-urgent interfacility transfers; however, 
they all minimize the ability to perform these under only the highest of deployment times when 
resources are at their fullest. 

Management Notification 

There are many circumstances where management is notified by the CACC in all four-service 
deployment plan, with some specific situations for each service. C-EMC situations are an 
example of when CACC notifies the local paramedic service management. HCPS indicates 
notification at C-MEC 0 between the hours of 23:00h and 07:00h (11 p.m. and 7 a.m.) only if it 
lasts longer than one hour. This notification delay is an internal decision due to the significant 
workload on the management team after-hours. 

Additionally, the other three services have after-hour management notification if their 
ambulances are transferring a patient outside of the County. However, this is not part of the 
Haliburton deployment plan. 

Tiered Response (Fire) 

The tiered response section of the deployment plan is standard though it is worth noting 
herein. 

“A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction 
with the response reference chart, for the following emergency requests for service: 

1. Vital Signs Absent (VSA) 
2. Unconsciousness 
3. Airway Compromise (Airway Obstruction, Absence of Breathing) 
4. Chest Pain 
5. All Code 4 (Life Threatening Emergency) calls with Paramedic Services, ETA greater than 
20 min. 
6. All Motor Vehicle Collisions (MVC’s) with Paramedic Services responding Code 4” 


These conditions are in addition to regular situations where the fire department would be sent 
in an allied response situation. Tiered responses do not apply to medical or correctional 
facilities. 

Patient Destination Agreements (Bypass) 

There are three areas to note for HCPS: 


• Stroke Bypass status 
• STEMI Bypass status 
• Hospital Consideration status 


Typically, an ambulance will bring a patient to the closest most appropriate hospital, which in a 
rural setting is almost always the closest hospital. Recently, in cases where a specialized 
treatment would provide life preserving care, the MOHLTC has allowed paramedic services to 
bypass the closest hospital. Two cases would be for patients suffering from a stroke or 
experiencing a certain type of myocardial infarction (heart attack). 

Definitive care for patients suffering from an ischemic stroke is the act of dissolving a clot, 
known as thrombolysis. There are drugs that can assist in certain circumstances, however, due 
to the different causes of a stroke, a stroke caused by a bleed could prove thrombolysis to be 
fatal. 

To determine what type of stroke a patient is having requires a CT scan. There have been 
hospital stroke centres designated by the MOH where patients can be brought to receive care. 
Time is vitally important for the thrombolytic (fibrinolytic drugs) to be successful from the time 
of symptom onset. If all conditions are met, the paramedic may bypass a local facility and bring 
the patient to a stroke centre, typically Peterborough or Huntsville locations. 

In the case of an ST-Elevation Myocardial Infarction (STEMI) definitive care is an angioplasty. A 
person suffering from a STEMI or heart attack will be experiencing chest pain brought on by the 
heart receiving insufficient blood flow or a blocked artery. Inserting a stent via angioplasty will 
open of the blockage to allow blood flow to the affected area of the heart. To perform this, a 
hospital must have a catheterization lab and a cardiologist on-site to perform this procedure. 
Time is important for this procedure. The time from patient contact to the STEMI Centre must 
be 90 minutes or less. The only regional STEMI Centre is located in Peterborough. 

Lastly, a unique feature in Haliburton is a process called Hospital consideration status. This 
status was created by HCPS and approved by the MOH field office. This includes instances 
where the HHHS Emergency Department physician needs to accompany a patient to another 
hospital for care in the back of an ambulance. This leaves the originating facility without a 
physician until they return or until a replacement physician is called. When this occurs 
ambulances will bypass the local facility and proceed to the next closest. This situation, albeit 
rare, can occur. 


It should be noted that in cases where patients are brought to facilities outside of the County 
there is an inevitable delay in getting the ambulance back into service within the County due to 
the distances having to travel. 

2.4.2 Community Paramedic Program 

The Community Paramedic Program is a non-traditional program that takes paramedics out of 
their normal emergency 9-1-1 response role and moves them into a proactive healthcare role 
with the aim of keeping people out of the 9-1-1 response and hospital emergency department. 

In 2014, the provincial government detailed $6M in funding to expand community paramedic 
programs throughout the province. In 2017, based upon the success of the programs, the 
government announced base funding for these programs to be distributed through the 
community LHINS at the time. 

The focal point of community paramedicine is medical outreach rather than the emergency 
treatment/transportation role that ambulance paramedics have traditionally played in Ontario. 
Many smaller rural communities, such as Haliburton County, are lacking in the primary care 
provided by family physicians or walk in clinics. Additionally, many of the vulnerable or frail 
seniors in Haliburton County lack transportation to access medical care for their chronic disease 
management. If left on their own, these individuals can “fall through the cracks” of the health 
care system and, inevitably, become patients in an emergency department. This only serves to 
add stress to the already overworked paramedic and hospital systems. 

Paramedics, being well trained emergency medical caregivers greatly experienced in 
communicating with patients, have been able to use their experience and education to help 
many individuals live longer and healthier within their own homes. In Ontario, we see many 
community paramedic programs address the unique needs of their community by designing 
specialized mobile ‘patient-centred’ programs. These programs are designed on a local level 
allowing for the customization required to serve the unique aspects of each municipality. 
Haliburton County is a rural community with an aging population and the Community Paramedic 
Program was designed to look after vulnerable frail seniors. 

“The true measure of a society can be found in how it treats its most vulnerable members.” 

-Mahatma Gandhi 

The HCPS Community Paramedic Program has two focuses that are similar in their core nature 
due to the funding sources: 


1. The initial program was associated with the Geriatric Assessment and Integration 
Network (GAIN). The program was funded by the Central East LHIN (now under 
Ontario Health East Region). 
o Its focus is those living in geographical isolation and in need of assisted living. 
In 2016, it was identified that 1,418 frail seniors were living in Haliburton 
County. 
o This initial program required approximately 100 different patients annually 
with 25 patients on the roster at any given time. HCPS conducted 
approximately 35-40 visits a week equating to nearly 2,000 visits for the year. 



2. The second source of funding is directed from the MOHLTC with a similar focus of 
keeping people out long-term care and safe at home to age in place. 
o Today, the program interacts with approximately 300 patients per year in 
Haliburton. Routinely, three new referrals occur every week. Patients may be 
in the program for several weeks or months as their specific needs require. 
o In August 2022, the Community Paramedic Program saw 400 patients in one 
month within both programs. 





Data for 2022 reveals a robust program that is positively affecting the lives of many vulnerable 
citizens within the County. 


Figure #45 – CPP Patients 2022 

 

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**Note: Many of these patients are seen multiple times over a month or year. For 2022, the 
volume of appointments was impressive. Community paramedics making on average 383 visits 
per month (over 13 visits/day) to their rostered patients.


Figure #46 – Number of Visits per Month (2022) 

 

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When interviewing the commander of clinical programs, who currently oversees the Community 
Paramedic Program, it became very apparent that not many mobile resources exist in 
Haliburton County to help frail seniors with chronic disease management. 

Community paramedics make house calls which eliminates the need for transportation to 
medical appointments. The paramedics visit the patient’s home, thus making it easier for them 
and their families to access ongoing medical care. These paramedics access, evaluate and 
update both their medical director and the medical community of the patient interactions. The 
paramedics also become a much-needed social link for the patient. They see the same patients 
regularly and, therefore, create very strong rapport with both the patients and their families, 
which is providing and supporting more than just physical health care. 

Going hand in hand with physical wellness, mental wellness comes by providing a positive state 
of health. Supporting seniors and families by giving them someone to rely on, talk to, confide in 
and trust. Paramedics help them to understand and better manage their chronic medical 
conditions (i.e., time spent making their home safer to avoid a fall or educating them on the 
proper use of their medication etc.). Confidence in the community paramedic brings about 
discussions concerning new healthcare matters and even sometimes social welfare needs such 
as food insecurity or the stress of paying the heat or electricity bill. The HCPS community 
paramedics and caregivers have learned how to navigate the social networks that are unique to 
Haliburton County and therefore ensure the wellness and quality of life of their patients. 

Many community paramedic programs in Ontario focus on homelessness. In the case of 
Haliburton County, homelessness may not be a visible issue, but the community paramedic 
commander conveyed that ‘couch-surfing’ is frequently occurring and that many people in 
Haliburton County are living in poverty. This vulnerable sector of society is also being supported 


by community paramedics who are navigating social welfare programs to keep these people 
healthy. This includes mental health needs. 

The future of this extremely well received program depends on a variety of factors including: 

• Long term sustainable funding to meet an aging population. 
• Expanding the scope of practice for these paramedics in the use of pain medications 
(palliative care), antibiotics, extensive wound care, substance abuse awareness and 
mental health awareness and support. 
• Public education focused on community preparedness and call reduction on certain 
call types (i.e., how, and when to call 9-1-1, cardiopulmonary resuscitation (CPR), 
automated external defibrillation (AED), opioid overdose recognition, naloxone use, 
fall prevention, heart attack / stroke awareness, diabetic clinics, water safety, safe 
recreational vehicle use etc.), which should be based on CTAS data. 


2.4.3 Public Access Defibrillation Program 

Haliburton County Paramedic Service manages the community automatic external defibrillator 
(AED) program. Over 40 AEDs have been placed in high-risk sites for sudden cardiac arrest 
(SCA). Locations like arenas, curling rinks, community centers, libraries, county, and municipal 
buildings are just a sampling of the locations the service has addressed for better preparedness 
in the event of a serious life-threatening medical situation. 

SCA or sudden death affects about 35,000 Canadians a year. HCPS responds to approximately 
35 SCAs per year and most of these occur in the home. SCA is more than a paramedic service 
issue, it is a community issue. Citizen cardiopulmonary resuscitation (CPR) education, placing 
defibrillators in all emergency service vehicles (i.e., police, fire and paramedic vehicles), as well 
as a coordinated effort to place AEDs in public spaces is a researched recommendation by the 
Canadian Heart and Stroke Foundation. This program includes a few loaner AEDs that can be 
used if devices require repair (e.g., battery replacement), and a replacement is immediately 
needed. Haliburton County Paramedic Service has done an excellent job in managing the public 
AED program for the County and continue to maintain these devices. 

2.5 Assets 

2.5.1 Vehicles 

Haliburton County has an asset management program (AMP) last updated in 2019. At that point 
it was noted that, 

“…the County’s Land Ambulance Services department maintains a fleet of seven 
ambulances and three support vehicles. An ambulance is replaced every year with two 


ambulances being replaced in the sixth year. This ensures that the ambulance fleet is always 
less than six years old and that vehicles are replaced before the odometer surpasses 
300,000 km. Usage of ambulances is rotated in order to ensure usage is distributed evenly 
among vehicles. Support vehicles are considered for replacement at eight years of age 
depending on odometer reading and general condition.” 

The replacement plan for an ambulance within the County is set to every 72 months or 
300,000km. This plan is not overly aggressive and falls within a normal range for rural paramedic 
services. Some more urban services have replacement plans at 60 months. 

The service has a recognized preventative maintenance program for all vehicles that requires 
mechanical inspections based upon kilometers driven since last inspection. The current vehicle 
maintenance program guidelines are: 

• ‘A’ Inspection: Every 7,000 km +/- 25% 
• ‘B’ Inspection: Every 14,000 km +/- 25% 
• ‘C’ Inspection: Every 28,000 km +/- 25% 
• ‘D’ Inspection: Every 84,000 km +/- 25% 
• ‘E’ Inspection: Every 135,000 km +/- 25% 


A vehicle requiring regular maintenance will be out of commission for varying time ranging from 
6 hours for an ‘A’ Inspection to a maximum of two days for an ‘E’ Inspection. These times do not 
factor in time to schedule and transport vehicles to the service centre. 

When the AMP was drafted, there was an expected population growth for Haliburton of 4500 
people by 2036. Understatedly, the latest Canadian census data, for Haliburton County, shows 
an increase in population of 2,509 people from 2016 to 2021. Additionally, the Ontario Ministry 
of Finance produces population predictions for planning purposes and the most recent 
estimate produced in the summer of 2022 estimated a population increase to 23,056 in 2036. 
With the growing population, and in conjunction with corresponding call volume being 
increased, an additional vehicle (ambulance) will be required shortly to ensure timely 
maintenance and vehicle rotation. 

Another item to note is the supply chain issues that most consumers are faced within the 
current marketplace. Due to the COVID-19 pandemic, there has been a massive automotive 
parts supply shortage also affecting the maintenance of ambulances. There is a shortage of 
chassis, on which the ambulance boxes are placed upon, which has caused unprecedented 
delays in receiving ambulance orders. Wait times to take possession of an ambulance used to 
take approximately 6 months with the current wait time being over a year. 


Table #9: Replacement Schedule 

Type 

Vehicle 
Number 

Year 

Make 

Km 

Notes 

Ambulance 

4917 

2016 

Ford CTV 

330,194 

Due for replacement spring 2022, 
expecting delivery February 2023. 

4916 

2016 

332,715 

Due for replacement spring 2022, 
expecting delivery February 2023. 

4929 

2017 

304,857 

 

4930 

2017 

266,495 

 

4939 

2019 

Chev ETV 

268,981 

 

4279 

2020 

143,924 

 

4904 

2021 

155,663 

 

ERV 

4378 

2013 

Ford 
Explorer 

114,219 

RFP issued for replacement, utilized by 
Deputy Chief of Quality Assurance. 

4377 

2015 

Chev 
Silverado 

97,622 

Pick-up truck, utilized by Deputy Chief 
of Operations. 

4397 

2022 

Ford 
Explorer 

3,837 

Previously Chief vehicle but being 
utilized for Community Paramedicine. 

4292 

2022 

Ford 
Explorer 

3,454 

Community Paramedic vehicle 

As of August 2022 




2.5.2 Stations 

Haliburton County has a total of 14 structures. Of these, the HCPS has three paramedic 
deployment stations located in Haliburton, Minden, and Tory Hill, and one post in Stanhope. 
While paramedic stations make up 21% of the County building stock, these three stations make 
up one third of replacement value costs. 

For the purposes of this report, commercial building inspections were performed to assess 
safety and maintenance issues. The inspections did not contain recommendations regarding 
usage as paramedic stations nor current or future space requirements. 

Minden Paramedic Station 

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The Minden Paramedic Station was 
built in 2015 as a purpose-built 
paramedic station. It contains four 
garage bays capable of holding four 
ambulances within a climate-
controlled environment. Ensuring 
climate-control for the vehicles can be 
crucial for patients comfort as well as 
keeping the medications and the 
fluids onboard at controlled 
temperatures to keep their stability. 
This is an expectation of the MOHLTC which is noted within ambulance service reviews. 


Figure #47 – Minden Paramedic Station Floorplan 

 

Diagram, schematic
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The completed commercial building inspection noted that there is not any serious structural or 
system conditions at this time. There are some minor maintenance items noted which are 
presented in Appendix ‘B’ and can be addressed as soon as practicable. 


Haliburton Paramedic Station 

A picture containing tree, grass, outdoor, field
Description automatically generated
The Haliburton 
Paramedic Station was 
built in 1994. It was 
expanded by the 
addition of another 
garage bay in 2006. It 
currently contains 
three garage bays that 
can protect three of 
the ambulances from weather. The station can be considered headquarters as it houses the 
management offices. The station is undersized for its purpose of both a response station and 
administrative offices. 

Figure #48 – Haliburton Paramedic Station Floorplan 

 

Diagram, engineering drawing
Description automatically generated
The completed commercial building inspection noted that there is not any serious structural or 
system conditions at this time. There were some important safety issues with electrical systems 
and some doors that require replacement. Other issues deal with exterior lot drainage and 
should be addressed as soon as practicable. 


Tory Hill Paramedic Station 

The Tory Hill Paramedic 
Station was built in 2012 as 
a Paramedic Station. It 
contains two garage bays 
that can keep two 
ambulances out of the 
weather and is a modest size 
for just one crew. Only one 
washroom is available which 
is inadequate for a station 
staffing an entire team of 
emergency responders. 

A picture containing tree, outdoor, grass, sky
Description automatically generated
Figure #49 – Tory Hill Paramedic Station Floorplan 

 

Diagram
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The completed commercial building inspection noted that there is not any serious structural or 
system conditions at this time. There is an important safety issue that does require attention; 
the eye wash station and minor maintenance issues surrounding heating and plumbing. There 
are many areas that have evidence of biological growth which need to be remedied and the 
shower stalls should be replaced. Other noted issues involve repairing the driveway. 

2.6 Internal Stakeholder Consultation 

To better understand the expectations of various parties for this project, interviews were held 
with Haliburton County CAO, Haliburton County Council, Paramedic Service Management team 
and the Paramedic Union Executive. An online voluntary survey was also sent to the frontline 
Paramedics. Lastly, community consultation was completed using Haliburton County survey 
software. Telephone calls and various discussions took place throughout the process. 

2.6.1 Common Internal Stakeholder Themes 

All internal stakeholders identified that Haliburton Highlands Hospital (HHHS) diagnostic 
transfer volume was severely challenging their paramedic system. Concern was expressed by all 
groups involving the 9-1-1 response times. Concerns were also conveyed regarding both 
paramedics and management staff as they are feeling fatigued attempting to balance the 
needs of HHHS, while trying to ensure public safety. This issue was expressed as the number 
one concern by most internal stakeholders. 

Internal stakeholders want to strive to have a high-performance paramedic structure, focused 
on providing the best emergency medical care. The provision of future education, based on 
community and patient needs, was an expectation for all the groups interviewed. 

The Community Paramedic Program was a point of pride for the internal stakeholders with 
many describing the positive impacts the program has made in the community. It was 
mentioned that this program was serving the local vulnerable seniors with care and compassion 
while aiding with food insecurities and lack of heating sources. The Community Paramedic 
Program has become a larger program that not only looks after medical needs of the 
community of Haliburton, but also has found the paramedics advocating for those living in 
poverty. 

2.6.2 CAO/Council 

Another area of concern was the shortage of funding for resources despite the increase in the 
aging population. The increase in population within the area has also been contributed to by 
residents relocating to the area to work from home or retiring individuals converting their 
seasonal residences to permanent homes. The CAO and Council are mindful, that due of the 


population influx, the paramedic service workload would naturally increase. This component is 
part of the justification for this ten-year Master Plan. The ultimate objective is to ensure that 
the County can meet future demands and can continue to deliver optimum emergency care for 
the citizens. 

The level of care provided by the paramedics (emergency and community ), must continue to 
meet the needs of the municipality (ongoing evaluation and commitment). 

It was noted that HCPS must continue to work collaboratively with local municipal fire services, 
OPP and HHHS to ensure peak services levels as well as emergency preparedness and planning 
for major events/incidents. 

2.6.3 Management/Union Executive 

Both management and the union executive discussed the need for improved frontline 
supervision. This upgraded supervision is being requested to manage the frequent system 
stressors such as: 

• Deployment challenges 
• HHHS (Haliburton Highlands Health Services) transfers that compromise response. 
• Working with Lindsay CACC – in real-time 
• Providing on scene leadership for dynamic patient scenarios, etc. 


In a well performing system, there is a clear division between the roles of administrative 
managers and front-line supervisors. It is highly unproductive for proactive long-term planners 
to deal with reactive front-line issues. Presently, the chief and deputy chiefs, deal with ongoing 
deployment and paramedic needs while performing their core management, planning and 
administration duties. Therefore, this creates delays in being proactive and, in turn, causes 
these managers to be reactive. 

Modern day paramedicine is very fluid and is in constant motion. A major challenge is working 
with and managing the HHHS interfacility transfers in real time. Working with hospital staff will 
ensure management of the interfacility transfers while ensuring 9-1-1 response is not 
compromised. Currently, afterhours supervision is provided by the chief and/or deputy chief on 
call. With restrictions in notification, this method of providing offsite leadership to the 
paramedic system appears to inefficient to meet the current needs. 


Points for Consideration 

Beginning to manage any deployment challenges or serious medical emergencies from the 
patients’ home is stressful for both the paramedics and the managers. This is a reactive way to 
deal with issues and does not serve any benefit to the county. Additionally, this model is not 
very desirable for potential future managers and will create future succession issues. This is a 
key issue that must be addressed to provide everyone a healthy work life balance. 

2.6.4 Management / Administration: 

The most thorough and comprehensive interview with the stakeholders occurred with the 
management/administration team. The meeting was held at Haliburton headquarters and 
included the chief, deputy chief and commander of clinical programs. . The position of deputy 
chief of quality assurance was vacant at the time of interview. 

A great concern that was brought forward and observed was the appearance of an overworked 
team in serious need of assistance. There was a remarkable amount of dignity that the team 
displayed regarding the community, positions as well as responsibilities. While they would not 
admit to being overwhelmed, it was quite evident that management structure was 
overextended. Adding frontline supervision would benefit the chief and the deputies in 
managing immediate challenges and assist in ensuring that the quality assurance is frequently 
reviewed and monitored (Paramedic Service Standard in neighbouring counties). The addition 
of administration staff is also necessary for the added reporting requirements included with the 
Community Paramedic Program. 

Currently, paramedic recruitment and retention are a genuine concern. It was noted that many 
of the new hires are employed from other areas and either do not have access to local housing 
or are reluctant to relocate. This again is not a unique situation for the paramedic service as 
many industries within Haliburton are experiencing the same difficulties. Numerous hours are 
spent recruiting, interviewing, and placing new employees into the certification process. 
However, once the new recruits gain some experience, they are relocating to the larger 
Paramedic Services in the greater Toronto area. Although housing is a contributing factor, the 
other issue revolves around the call types and the volume of calls that the County receives. The 
eager and enthusiastic recruits crave the excitement and the exhilaration of a larger service 
with a larger call volume and varying call types. 

Paramedic services collect an immense amount of data through patient reports and CACC ADRS 
information, but in Haliburton County the minimum legislative requirement is being reported 
regularly. This is mainly due to the lack of staff time to organize, develop and regularly report 
on data. Reportable data and key performance indicators (KPI) are required to inform the Chief, 
CAO and Council on future municipality needs and budgeting. High performance paramedic 


services throughout the province can collect and review the data to ensure their system keeps 
up and meets future demands. 

2.6.5 Union Executive 

An important stakeholder within the paramedic service is the union executive . The union 
representatives, being paramedics themselves, were clearly a passionate and committed group 
who focused on the best interests of the paramedics as well as enhancing their service. Their 
primary concern, as well the leading cause of paramedic frustration and exhaustion, was related 
to the hospital transfer volumes. There is awareness when it comes to the requirement for 
interfacility transfers; however, they want to see a resolution allowing more resources to 
remain in the County to respond to emergencies. 

Another issue noted by the union was the aging infrastructure. They note stations as well as the 
vehicles, are not currently meeting the needs of the paramedics or the serving communities. 
They bring forth the example of the newer constructed Minden Paramedic Station, has already 
been outgrown due to the expanding Community Paramedic Program, which requires 
additional vehicles and office space. 

The Stanhope post located within the fire station is seen by the union as an unsuitable 
deployment site due to its size and current use. The Tory Hill Paramedic Station was noted as an 
improvement to Stanhope but still needs replacement. Additionally, they felt that the 
geographic location of Stanhope did not maximize the quickest routes to move quickly 
throughout the County. Lastly, the union noted that the Haliburton Station was outdated, small 
and did not meet the requirements of either a paramedic deployment location or as 
administration headquarters. 

2.6.6. Voluntary Paramedic Survey 

The viewpoint of the employees providing the frontline work is critical. A survey was conducted 
to ascertain the issues that have been concerning and impacting the paramedics. A voluntary 
online survey was provided to all 56 paramedics and was completed by 17. The following are 
the common themes communicated through their responses: 

• The leading staff concern was compromised 9-1-1 coverage due to the number of 
Haliburton Highlands Health Services (HHHS) diagnostic transfers (classed as urgent 
transports). 
o Numerous deployment challenges were noted by staff, not due to 9-1-1 call 
volume, but rather the number of interfacility transfers from HHHS. 






o Many noted that frequently, back-to-back urgent transfers from HHHS would 
occur before ambulance resources were re-allocated to ensure public safety 
for 9-1-1 response. 
o The paramedics expressed the need for someone whom they see regularly 
observing their work life and being their support and advocate through 
stressful situations. 
o Many paramedics either skipped this question, stated the program was 
adequate or wanted a better definition of its role. 
o The medical directives used by the paramedics were seen as sufficient but a 
need for expanded pain management was expressed by several respondents. 
o Common complaints included vehicle age, visible rust, and seats in need of 
repair/replacement. 





• Management staff were praised for minimizing the cutback of ambulances due to 
sudden paramedic absenteeism. 
• Paramedic respondents felt management needs frontline supervision to provide 
continuous leadership to the paramedic system and improve the relationship between 
management and the frontline paramedics. 
• Paramedics expressed a concern that HHHS transfers can compromise response 
times. 
• The purpose of the Community Paramedic Program is misunderstood by some of the 
staff. 
• Relationships with HHHS and Central Ambulance Communication Centre (CACC) were 
found by many to need improvement. The Central East Prehospital Care Program 
(Base Hospital) was considered good by most. 
• Infrastructure: the facilities were noted as overcrowded, in poor condition and in need 
of replacement or significant upgrades. The only exception to this was the Minden 
Base. 
• Vehicles were assessed by half of the respondents as good and the other half as poor. 
• The County Mental Health program was another area of mixed reviews. Most 
respondents reported this as an area in need of significant improvement for 
paramedics that are in a role where mental health trauma and PTDS is real. 


**Note: This survey summary represents 30% the paramedics on staff who participated in the 
survey. It is included to help understand the impressions of those working directly within the 
structure (i.e., frontline paramedics). Occasionally respondents use evaluations or surveys as an 
opportunity to voice personal criticisms regarding management and the organization. This is 
not an appropriate venue for such complaints; therefore, these comments have not been 
included in this survey summary. 


2.6.7. Voluntary Community Survey 

An online community survey was posted for nearly one month on the County’s website and 22 
citizens responded (survey responses located in Appendix ‘A’). While this is a small response to 
the survey, the respondents must be taken into consideration as these are citizens who have 
encountered Haliburton County Paramedic Service (HCPS) personally or know a family member 
or neighbour who have. 

The primary age group of the respondents was 60-69, followed closely by those aged 30-39. 
Many of the responses were from residents with knowledge of the challenges faced by the 
health care system in Ontario, including many of the urban paramedic challenges (i.e., hospital 
offload delay and Code 0 or ambulances availability). 

One respondent was fully aware of the health care challenges affecting Haliburton County 
Paramedic Service (HCPS) deployment (i.e., Haliburton Highlands Health Service interfacility 
transfer volume). When asked about the difference between 9-1-1 response and community 
paramedics, the majority of the people understood the difference and supported both 
initiatives. In fact, majority of the respondent felt paramedics were and integral part of the 
Ontario Health Care system. Specifically, most of the respondents felt the local paramedics 
were caring, kind and compassionate to the needs of their patients. 

The foremost respondent areas for improvement: 

• 36.84% of the respondents placed skill level for Haliburton County paramedics as most 
important and knowledge as second most important. 
• 50% of the respondents placed inexpensive service as the least important. 



Figure #50 – Community Survey Results 

 

98B3B4A14A9045FD8DD453AD994A29B8.png
• The need for Advance Care Paramedics (ACP) was a leading theme for numerous 
respondents. 
o A few of the respondents gave specific firsthand cases concerning lack of pain 
relief for fractures and the lack of paramedic ability to control seizures in a 
pediatric case (ACP skill set). In both cases, it should be noted that these people 
may have experienced paramedic care in an area that offers ACP care. 
o It is important to remember that people coming to the community i.e., visitors, 
cottagers or people from the larger urban who are retiring to the Haliburton 
County, will expect similar care to what they have experienced in the past. 



• Response time for 9-1-1 calls was of concern to many respondents. There were a few 
people who talked about the current long response times and expected improvement. 
• Paramedic skillset / education was also seen as crucial to be kept at a high standard. 
• Vehicles and equipment were seen as being required to be top notch. 
o It is worth noting that some respondents referred to rust on vehicles and 
stretchers that did not load well into an ambulance. These personal accounts 
need to be considered and a review for the fleet and equipment must be 






articulated in an annual report detailing ongoing maintenance as well as 
paramedic skill practice. 





• 59% (13) of the respondents were interested in courses designed on prevention and 
preparedness like CPR, first aid, fall prevention etc. 
• Over 93% (14) of respondents were either satisfied or very satisfied with the patient 
care they received from HCPS however over 50% (7) were neutral or dissatisfied with 
the equipment and vehicle they encountered. This would seem to indicate a need to 
review the state of assets. 
• Over 57% (12) of respondents rated their overall experience with HCPS as excellent or 
very good with 9.5% (2) rating their experience as poor. Many indicated in their 
comments that the Paramedics themselves were professional, prompt, and welcoming. 


Figure #51 – Survey Results Q9 

 

Chart, pie chart
Description automatically generated 


 

 

 

 

 

 

 

 

2.7 External Stakeholder Consultations 

In developing this report, interviews were held with three major stakeholders to get their 
thoughts and reactions of HCPS. Meetings were held with members of Central East Prehospital 
program (CEPCP), Lindsay Central Ambulance Communication Centre (CACC) and the 
Haliburton Highlands Health Services (HHHS). The objective was to assess their perception of 
current, as well as future operations and challenges within Haliburton County Paramedic 


Service. Many common subjects were documented which have helped to produce the focus of 
this report. 

2.7.1 Central East Prehospital Care Program (CEPCP) 

Every paramedic service in the province must have medical supervision in the form of an entity 
called the base hospital. Within each base hospital there is a medical director under whose 
license the paramedics deliver authorized medical actions. However, there is a team of 
educators that assist, provide direction, and training as required by the MOH in conjunction with 
the needs of the local area. 

The manager of CEPCP advised that the working relationship between the CEPCP Base Hospital 
and the team at HCPS continues to be extremely good. The ongoing education for HCPS 
paramedics as well as the continuous monitoring of medical direction/delegation/compliance 
was found to be equal to their direct peer groups. The Regions of Durham and York and the 
Counties of Haliburton, Kawartha Lakes, Peterborough, Northumberland Counties are all 
provided medical direction under the legislated supports of the CEPCP. 

The manager believed the PCP Plus program was a complete hybrid emergency medical care 
model for the County. Training to this level is entirely voluntary, however the current plan is to 
have every paramedic at the hybrid enhanced level within the next few years. 

The CEPCP manager also advised that more medications, such as various controlled substances 
to better manage sedation and pain, are close to becoming a reality for the PCP Plus 
prehospital caregiver. The Controlled Drugs and Substances Act has recently changed, and an 
opportunity for the program to expand its present care abilities now exists. 

According to the CEPCP, the leading challenge for HCPS is paramedic recruitment and 
retention. Due to the proximity of other paramedic services a paramedic certified by a base 
hospital can easily work part time in multiple services. It is common for new staff from other 
communities to leave once they get a position in the GTA. This not only creates staffing issues 
but leads to a cycle of countless lost hours for recruitment, interviews and arranging 
certification processes within the CEPCP. 

2.7.2 Lindsay Central Ambulance Communication Centre (LCACC) 

In 2000, the municipal download approach enabled the province control over dispatching 
ambulance services mostly through Central Ambulance Communications Centres. All CACCs in 
Ontario are funded 100% by the MOHLTC and most of them are also directly managed. The 
current Lindsay CACC Operations Manager has a direct understanding of the HCPS deployment 
plan. The operations manager was able to highlight the major challenge for HCPS as the urgent 


medical transfer volume (Code 3 CTAS 3). With the high volumes of transfers they perform, the 
HCPS response time to 9-1-1 medical calls is being compromised. These frequent transfers 
cause stress to the HPCS team as they attempt to manage core business need simultaneously. 

Unlike the three other paramedic services dispatched by Lindsay CACC (Kawartha Lakes, 
Peterborough, and Northumberland Counties), HPCS does not have a frontline paramedic 
supervisor. Most Ontario paramedic services today employ frontline supervisors to manage 
deployment issues and challenges. This absence of HCPS supervision leads to delays in decision 
making and challenges to deployment. 

Neighbouring paramedic services provide emergency standby coverage for Haliburton County. 
While those neighbouring services are assisting, they must also maintain a position that allows 
them to respond quickly to their municipality. Ultimately, response times for other paramedic 
services responding into the County can be more than 30 minutes in these situations. 

Medical Priority Dispatching System (MPDS) is a dispatch system being adopted within the 
Ontario CACCS that provides an enhanced triaging system which aims to ensure the sickest 
patients get help first and implements delays in servicing minor ailment patients. This new 
process is designed to ensures that resources are not fully exhausted. The MOH decided to pilot 
this new system at the Mississauga CACC which is the busiest location within the province to 
work out any errors and assess implementation throughout the province. 

The COVID-19 pandemic has delayed implementation and the latest information obtained from 
Peel Region Paramedic Chief, suggests that launch would be December 2022. Currently, the 
MPDS system is operating in both Toronto and Niagara Paramedic systems as those services 
directly dispatch their own ambulances. Currently the Lindsay CACC is in the process of 
implementing the dispatching ambulances with this method, however, does not have a timeline 
for when MPDS will be put into place for the HCPS. The potential change when dispatching 
ambulances to an urgent patient hospital transfer, for diagnostic purposes, currently notes 
MPDS would triage a Code 3 CTAS 3 as a lower priority code than a Code 4 or Code 3 who are 
patients currently not in medical care. 

Points for Consideration 

Many paramedic systems are battling with hospital challenges such as interfacility transports 
and offload delays which are created by overcrowded emergency departments. The County 
should start a discussion concerning the priorities of the Paramedic Service, whether they are 
there to serve the public, 9-1-1 callers who are not under medical care, or whether they are to 
serve the hospital patients, who already are under the care of medical personnel. 


2.7.3 Haliburton Highlands Health Services (HHHS) 

Within Haliburton County, there is currently one hospital organization, the Haliburton Highlands 
Health Services which operates two hospital locations: one in the village of Haliburton and one 
in Minden Hills. The Haliburton location has a small number of inpatient beds, while the Minden 
location only is comprised of an emergency department. Both locations house long term care 
facilities. The Haliburton Highlands Hospital CEO advised that the working relationships 
between HHHS and HCPS team was excellent. The CEO stated there was terrific collaboration 
during the initial COVID-19 outbreak. The two services worked very diligently together and 
simultaneously developed a plan for safely managing resuscitation patients. Furthermore, they 
were very pleased with the community outreach that the HCPS was performing through their 
Community Paramedic Program. They felt this program was allowing vulnerable seniors to live 
independently at home longer, which was keeping these seniors out of the emergency 
department and long-term care. 

Joint challenges were discussed, and recruitment/retention of staff was identified as a major 
issue effecting both services. The challenge of maintaining nurses at HHHS is like maintaining 
paramedics within the County. The other issue identified was that HHHS relied on HCPS to 
move their patients for diagnostic imaging to places like Ross Memorial Hospital Lindsay, as well 
as the South Muskoka Regional Health Centre in Bracebridge and the Peterborough Regional 
Health Centre. 

In recent years, diagnostic imaging has gone from being discretionary to becoming the standard 
of care for physicians to determine treatment options. Without the benefit of diagnostic 
imaging machines (i.e., MRI machine, computerized tomography (CT) scanner) within the 
County, patients must be transported to receive these essential diagnostic tests. The high 
volume of diagnostic patient transfers was discussed, and the CEO seemed to be receptive to 
working with Haliburton County and the HCPS to formulate interim and long-term solutions to 
this concern (i.e., lobbying the MOHLTC or Ontario Health East for special funding to assist with 
the medical transfer costs like funding for offload delay nurses). It was suggested that seeking 
out other areas of the province where similar hospitals also lack diagnostic imaging to assist and 
provide solutions for the current situation in Haliburton. 

2.8 Additional Pertinent Documents 

2.8.1 Community Safety & Wellbeing 

Community safety and wellbeing is an essential priority for the provincial government. The 
comprehensive Police Services Act legislatively requires every municipality to develop a plan 
with specific conditions. The Solicitor General defines community safety and well-being as 


“…the ideal state of a sustainable community where everyone is safe, has a sense of belonging, 
opportunities to participate and where individuals and families are able to meet their needs for 
education, health care, food, housing, income, social and cultural expression.” 

With this comprehensive definition in mind, it is required that these plans be developed with a 
varied cross-section of municipal, service, and policing members who represent different 
sectors of the community. The legislation is not very prescriptive regarding the areas of concern 
and leaves it highly customizable to the needs of the individual communities. Therefore, the 
plans for the various areas will appear to be unique based on the area of impact. The four 
municipalities within Haliburton County requested that the County coordinate the construction 
of this plan. 

Over the course of many years and much consultation the Community Safety and Wellbeing 
Plan (CSWB) was established. This plan, while not directly involving HCPS, directly involves much 
of what HCPS is currently accomplishing through both emergency response and the Community 
Paramedic program. The CSWB Plan has identified four priorities and 12 goals, as depicted 
below. 


 

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The Community Paramedic Program is directly noted within goal 11 as well as goal 12, however, 
a review of the goals would suggest that there are other areas where HCPS can assist. 

2.8.2 Review of Eastern Ontario Paramedic Services 

In 2019 the Eastern Ontario Wardens Caucus (EOWC) commissioned an assessment and review 
of the Eastern Ontario Paramedic Services. Subtitled “Situation Overview” this report was 
competed in November 2019. This report contained a review of data and statistics concerning 
the 13 Eastern Ontario Paramedic Services (land ambulance) between 2014 and 2018. The main 
findings of the report were: 

• Eastern Ontario has a rapid aging population. 
o According to this report, people over age 65 represented 22.3% of the 
population but accounted for 55% of all the paramedic calls for service. The 
report forecasted that citizens over 65 would grow to 26.9% of the Eastern 
Ontario population by 2024. 






**Note: 2021 Census data reveals that Haliburton already has a population 65 years of age or 
older of 35.72% 65 making up over 60% of all Ambulance calls 

• There is an increased need and role for Paramedic Services directly linked to the 
Ontario Aging at Home Strategy 
o Provincial health care decision that has led to the need for Community 
Paramedic Programs that are reliable and mobile to better serve this 
vulnerable senior population. 



• Paramedics spending increased amount of time in external jurisdictions performing 
patient transports or cross boundary services. 
o Specifically, for Haliburton County Paramedic Service, the primary driver for 
this is the work / time being allocated for the two campuses of the Haliburton 
Highlands Hospitals (HHHS) to move their urgent patients for diagnostic 
imaging that does not exist in their two hospitals. 



• Increased levels of offload delay. 
o This generally is an issue for Ross Memorial Hospital and the Peterborough 
Regional Health Centre, but Haliburton County Paramedic Service gets caught 
up in this due to the urgent diagnostic transfer volume moving from the HHHS 
campuses to these other hospitals that are facing the offload challenges. 



• Increased costs associated with post traumatic stress disorder (PTSD) and mental 
health supports. 
• CACC current triage system prioritizes responses as medical emergencies and 
ultimately overcommits resources. 
o Ontario has committed to upgrade their CACCs to the “Advanced Medical 
Priority Dispatching System (AMPDS)” but the first expansion outside of 
Toronto and Niagara CACCs (pilot groups) has still not been realized. 
o Continued strain on resource availability over commitment will continue for 
Paramedic Services until this provincial responsibility is addressed. 





Haliburton County Specific Facts within Report: 

• Haliburton County Paramedic Service (HCPS) was the only Primary Care Paramedic 
(PCP) service in Eastern Ontario 
o That has changed with the PCP IV or PCP plus program (intravenous therapy 
matched IV medication and expanded scope of practice). 



• Smallest response volume (i.e., 2% of the total for Eastern Ontario). 
• Second longest call durations i.e., response, scene time and transport time. 
• This would be due to the large geographical area for Haliburton County and the fact 
that 33% of the paramedic service resources are serving hospital urgent diagnostic 
transfer volume for diagnostic imaging. The time for an urgent diagnostic imaging 



transfer ranges from 3.5 to 5 hours depending on wait times and the patient 
returning to HHHS facility. This is unique to Haliburton County as the other 12 
paramedic services have hospitals with diagnostic imaging capabilities in their 
municipalities. 


2.8.3 Other Paramedic Master Plans 

Paramedic Master Plans are gaining popularity within Ontario. Many municipalities within the 
province have completed reviews of their Paramedic Master Plans Their respective master 
reports were completed between 2014 and 2021 and were designed to be ten-year forecasts 
for their corresponding Ontario municipality. Numerous common themes were reported that 
are similar challenges for Haliburton County. These include: 

• Aging population - All the reports discussed the rapid aging of the citizens of their 
municipalities. Presently people over age 65 represented 25-35% of the population 
but accounted for 45-55% of the paramedic calls for service. In fact, some of the 
reports were predicting 50-100% call volume increase by 2031. 
• CACC upgrade to the AMPDS – The reports discuss the long delay of the MOHLTC’s 
CACCs upgrading to the AMPDS communication system. This system will better 
manage municipal emergency responses and improve availability of paramedic 
ambulance resources. This new system should reduce needless lights and siren 
responses and keep the paramedics and citizens safer. The technical infrastructure 
upgrade should also improve messaging and reduce human error. 
• Community Paramedicine and alternative routes to traditional paramedic approach - 
Each report discussed new approaches to the traditional paramedic ambulance 
regarding response, treatment, and transport programs of the past. 


New concepts like proactive community paramedics could better protect the 
vulnerable and keep them in good health at home. Performing routine visits aids in 
keeping citizens out of the rotating door of emergency health care. The role of a 
community paramedic is to prevent and maintain patients from going to the hospital. 
Alternative pathways are presently being looked at by linking paramedic services with 
other community supports so that patients can be treated by paramedics and safely 
left at home with follow ups conducted by community nursing / paramedics. 

• Public Education - The citizens of Ontario and Haliburton County have learned and are 
accustomed to dialling 9-1-1 for a medical emergency. Many of these citizens may 
need urgent care but data suggests few require critical or emergency care. Public 
education is needed to instruct and educate residents on the appropriate occasions to 
call 9-1-1 and use the local emergency department. 



• Covid Pandemic (Public / Paramedic Service) - Many citizens now can work from home 
as the result of the pandemic. As such many citizens are no longer required to work 
within a reasonable commute of their worksite. This remote working allows citizens 
the opportunity to relocate their residence to a municipality of their choice. This could 
directly affect rural Ontario due to their more desirable lifestyle. Areas like Haliburton 
County may experience a larger than expected growth in their population. The other 
lesson learned is preparedness of the paramedic service for the next possible 
outbreak. Ongoing education, protective equipment supply, and mitigation strategies 
for maintain staffing continuity need to be considered and invested in. 


2.8.4 County Community Risk Assessment 

Ontario Regulation 378/18 under the Fire Protection and Prevention Act requires all 
municipalities to complete a Community Risk Assessment (CRA) by July 2024. CRAs must then 
be assessed every year thereafter with a full redo every 5 years. CRAs are designed to inform 
and advise the municipality on the risks associated with their community. With this information, 
the municipality can make informed decisions about their emergency protection services. 

The CRA for Haliburton County was completed during this assessment; as well as for the four 
Haliburton municipalities for their fire departments. The County CRA is an important document 
to refer to within this Master Plan. 

It is important to understand that risk measures the probability, as well as the possibility, that 
an event will adversely affect the health, property, organization, environment, and community. 
The CRA indicates that County Council is responsible to determine, with input from the 
paramedic chief, an acceptable level of risk to manage within the community based on its needs 
and balanced with the circumstances to deliver the services. 


Figure #52 – Risk Level Matrix 

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Much of the County CRA was dedicated to HCPS but critical infrastructure, systems, and 
emergency management were also covered within that report. Here are some highlights that 
were observed in relation to HCPS: 

• The risk of persons becoming injured in forested areas requires HCPS to request a fire 
department and have UTVs attend the call to transport patient(s) out of the forest. 
• HCPS members may be required to travel on a boat at any time to pick up, treat, and 
transport patients from remote locations. They should have a good understanding of 
marine rules and safety equipment and consider acquiring their Pleasure Craft 
Operators Card, which is available online. 
• As the number of residential occupancies increases in Haliburton County, so will the 
demand for service from HCPS. 
• This change in residency is being missed in the MPAC occupancy classification data 
and results in lost revenue for the Municipalities and the County. 
• Each of the four communities in Haliburton County has also experienced a double-
digit percentile increase in population over the past five years. 
• With each census, the average and median ages raise higher and there is a significant 
increase in the senior demographic. 



• Increase of permanent residents due to individuals relocating to their seasonal 
property and making it a year-round residence. Many are older and choosing to retire 
in the County. 
• Haliburton County is susceptible to significant weather events causing high dollar loss 
and injuries, such as flooding, windstorms, and tornadoes. 
o There is a history of flooding in the spring, causing widespread damage in the 
County. 



• HCPS should take advantage of collaborative training opportunities with allied 
agencies and partnering with local businesses and service clubs to aid in the delivery 
of personal and medical care messaging. 
• Monitor the age demographic that uses HCPS at a higher rate and investigate 
programs that could be delivered by the Community Paramedic Program to reduce 
the number of calls. 


Once the CRA is reviewed and acknowledged, the following phase should be developing a 
Community Risk Reduction Plan (CRRP). A CRRP coordinates emergency operations with 
community outreach and response efforts throughout the community. Having HCPS involved is 
critical for gathering local risk data and performing activities necessary to implement the CRRP. 
A CRRP can positively impact the paramedic service by improving paramedics’ safety and 
occupational health, reducing burnout of staff, and helping with retention issues. Utilization of 
a CRRP is another tool in the prevention toolbox. 


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SECTION 3: CURRENT AND FUTURE CHALLENGES 

3.1 Interfacility Transfers 

Interfacility transportation is the movement of patients from one medical facility to another, 
typically between hospitals or hospitals and long-term care homes. These patient transfers can 
be classified as critical, emergent, urgent, or non urgent depending on patient condition. Using 
the Ontario DPCI system, most of these transfers are booked as a Code 2 (scheduled) transfers 
throughout the province, however in Haliburton most of these transfers are classified as Code 3 
(urgent) transfers. The correlation between dispatched priority code and the CTAS can be 
summarized as follows: 

• Code 1/2 (non urgent/deferable/scheduled) patients classified as CTAS 4 or 5 
transport typically booked Code 2 when prescheduled due to a scheduled 
appointment i.e., cancer treatment, or Code 1 when not prescheduled (note that 
Paramedics are only sent a facility Code 2 but transport the patient Code 1). 
• Code 3 (prompt response) patients classified as CTAS 2 or 3 rarely utilizing lights and 
sirens but can be considered. 
• Code 4 (urgent lights and siren response) patients are classified as CTAS 1 or 2 
utilizing lights and sirens for transport. 


When considering interfacility transportation t is important to note the definition of what an 
ambulance is under the Ontario Ambulance Act. Ontario Ambulance Act Part 1 Section 1 (1) 
defines: 

“Ambulance means a conveyance used or intended to be used for the transportation of persons 
who, 

(a) have suffered a trauma or an acute onset of illness either of which could endanger 
their life, limb or function, or 

(b) have been judged by a physician or a health care provider designated by a physician 
to be in an unstable medical condition and to require, while being transported, the care 
of a physician, nurse, other health care provider, emergency medical attendant or 
paramedic, and the use of a stretcher; (“ambulance”) 

In many cases the requirement to urgently transfer a patient to another facility would fall under 
the first section of the definition. The acute onset of illness is typically related to a neurological 
ailment that requires the diagnostic imaging of a computerized tomography (CT) scan. In many 
cases a CT scan has become the standard of care required by physicians to determine the 


proper care for a patient. Currently there are no diagnostic imaging capabilities within 
Haliburton County. 

As we have seen earlier in this report interfacility transfers are the largest call type for the 
HCPS. From January 2021 through and including September 2022 (21 months), interfacility 
transfers is the top call type accounting for 33.66% of dispatch problem codes and 25.58% of 
noted primary problem. 

Figure #53 – Dispatch Problem Call Times (2021-2022) 

 

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Figure #54 – Primary Problem Call Times (2021-2022) 

 

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The dispatch problem codes are determined by the CACC based on the information provided to 
them. The primary problem is determined by the paramedics upon their assessment of the 
patient. The discrepancy between the two can be attributed to inconsistent documentation by 
the paramedics whereby most note a dispatched transfer as the primary problem however 
some note the primary problem as how the patient is presenting. In the case of interfacility 
transfers the dispatch problem code appears to be more accurate in assessing volume as 586 
dispatched transfers had differing primary problems even though it was a facility-to-facility call. 
Conversely, only 31 calls were noted as interfacility transfers in the primary problem code 
where the dispatched problem code was not interfacility transfer. 


**Note: For every patient encounter a paramedic collects the patient information and is 
required to enter this data in over 60 data fields. With that volume of data required there are 
definite errors in data entry. While most of the data is correct and valid there can be some 
inconsistencies in totals where averages are concerned. 

For example, there was on call for service where the date was transcribed backwards resulting 
in a response time of over 400,000 minutes. That call was eliminated from the average call 
times. 

While interfacility transfer volume is the principal call type, a greater review into average call 
times can reveal the total impact that they have on the deployment of resources. Interfacility 
transfers are the lengthiest call type to complete, taking on average 44% longer an average call. 
Since most interfacility transfers are out of the County, this is an expectation. 

It is important to note that the majority of these interfacility transports do not have an HHHS 
medical escort. From a medical-legal perspective these transfer patients are the responsibility 
of the sending hospital. Many of the paramedic surveys stated that some of these patients 
receive pain medication prior to transportation. This practice needs to be reviewed, as not 
having a medical escort creates a high-risk situation for the Haliburton County paramedic 
caregiver. 

Figure #55 – Average Call Length for Out of County 

 

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**Note: Greater than five calls. 

**Note: UNDOCUMENTED sending facility details where no sending facility was recorded, 
however the pickup location type was noted as hospital. 


**Note: The above data does not include the time to return the County without a patient as 
those trips are not recorded. Over the last 21 months only 1405 recorded out-of-County patent 
transfers with 614 transfers returning. 

Figure #56 – County Average Time of Transfer 

 

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The Deployment Plan states that,” no County vehicles will be sent empty to repatriate a patient 
in another Upper Tier Municipality (UTM)”. It is expected that of all the 614 transfers returning 
into the County were a result of either waiting for the transferred patient at the receiving 
hospital (according to the Deployment Plan up to 1 hour) or returning a patient back to HHHS 
who was sent out of out-of-County testing/treatment. Of the 570 transfers back into the 
County (HHHS) they were coded as either Code 1 or Code 3 which indicates that they were not 
prescheduled for transfer and most likely patients who paramedics had waited for. 


Figure #57 –Average Time of Transfer 

 

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While interfacility transfers account for approximately 33% of total calls for service over the last 
21 months those same transfers account for nearly 49% of total workload time. Which 
therefore presents that interfacility assignments have a lengthier completion time than 
conventional 9-1-1 community calls. 

Figure #58 – Responses - Interfacility Transfer vs Calls (2017-2022) 

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Figure #59 – Time - Interfacility Transfers vs Calls 

 

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Paramedics are high functioning, highly trained professionals whose skills are sharpened for 
quality emergency response. Having a third of their operations designated as interfacility 
medical transports is unreasonable. 

While ambulance services are the responsibility of the municipal government, healthcare is the 
responsibility of the province. The demand within the County for this high volume of transfers is 
due to a lack of investment in local healthcare, more specifically the lack of diagnostic imaging 
services. With 32% of the work being attributed to hospital needs, 32% of the operating budget 
for the HCPS is also going towards hospital needs. 

The actual number of diagnostic transfers from Haliburton Highlands Health Services (HHHS) is 
difficult to determine as this specific data was not being collected by HHHS or CACC. Haliburton 
County Paramedic Service (HCPS) was requested in the fall of 2021 to provide HHHS 
information pertaining to CT transfers. The HCPS Paramedic Chief manually reviewed the 
completed HHHS transfers. 


Table #10: Haliburton Highlands Hospital - CT Transfers 

 

2019 

2020 

2021 

CT Transfers 

218 

252 

357 

% Increase from 2019 

 

13.5% 

39% 



This increasing number is a significant issue that is clearly unsustainable and needs to be 
resolved. The accuracy of the above noted data provided is subject to paramedics recording “CT 
Transfer” on the patient report. While the reported number should be close to the actual 
number completed, the subjectivity needs to be discussed as the actual number is most likely 
higher. To better track this information in the future the HCPS should work with iMedic to 
create a tracking system for diagnostic transfer problem codes, in addition to noting 
repatriation transfers within their electronic data base. This would then enable HCPS to report 
on this specific call types (i.e., diagnostic transfer or repatriation transfer) with improved 
accuracy. This in turn can be corelated to cost and time in provision of this service to HHHS. 

In short, the lack of Provincial funding is compromising the HCPS 9-1-1 response time and 
creating continuity issues with the frontline paramedics. Both the union executive and several 
frontline Paramedics expressed the concern that their background and education surpass their 
current responsibilities as a patient transfer unit. They feel ambulance deployment for 9-1-1 
response has been compromised due to the interfacility transfer volume. 

When examining the 13 municipal land ambulance paramedic services in eastern Ontario, it is 
noted that Haliburton is the only County not to have an internal diagnostic imaging available to 
for the residents. This is an environment that does not currently exist in the rest of the eastern 
Ontario region. There are many programs throughout the province that aim to reduce hospital 
pressures on the paramedic services. Many of these municipalities and counties receive offload 
nurse funding from the MOHLTC to provide nurses in the local emergency departments that 
assist with watching patients being offloaded by the ambulance. Additionally, many of the 
municipality and counties fund low acuity interfacility transfers. Haliburton County, HCPS and 
HHHS need to investigate and create a report that specifically outlines these unique challenges 
to both the MOHLTC and Ontario Health East to request funding. 

3.2 Critical Medical Emergency Coverage & Ambulance Offload Delays 

Two major challenges to Paramedic Services within the Province are the concepts of critical 
minimum emergency coverage (CMEC) and ambulance offload delay (AOD). Within provincial 
deployment plans (as noted earlier within this report), paramedic services denote critical levels 
of ambulance coverage with steps required when those thresholds are met. As defined within 
the Service Deployment plan CMEC is, “a trigger that recognizes that the level of available 


ambulance resources cannot sustain/maintain the EMS service’s “Minimum Emergency 
Coverage” level. The paramedic provider’s deployment plan strategy for CMEC is to delay 
response to Code 3 calls except for Haliburton who do not delay response to calls in the 
community”. 

CMEC 0 mean that there are zero ambulances available within the entire County. A CMEC 1 
means that there is only one ambulance remaining for the entire county. 

An ambulance offload delay (AOD) is the term that is used to explain the wait time that the 
paramedics experience in the emergency department for a hospital staff to assume 
responsibility of the patient. An AOD causes the ambulance to be removed from deployment. 
The aging population, sicker patients, and staffing difficulties are overwhelming previously 
inundated emergency departments, reducing the capacity to accept incoming patients in a 
timely manner. While the delayed patients wait on the ambulance stretchers, the community is 
without an emergency response unit or resource. In many larger centres, these AODs have 
caused great issues where at times communities are left without any ambulances that are 
accessible to respond to the next 9-1-1 call. 

3.2.1 Critical Minimum Emergency Coverage – 0 (CMEC 0) 

Using resources to capacity and many times beyond has resulted in daily occurrences of Critical 
Minimum Emergency Coverage (CMEC). In Haliburton County, the CMEC 0 is generally the direct 
result of the quantity of interfacility transfers and emergency calls that are being completed 
simultaneously within the County. 

Tracking the CMEC count is particularly challenging which often relies on manually tracking the 
number of times the CACC advises a Superintendent of low vehicle counts. 

Utilizing the ADRS data, a detailed breakdown of each ambulance call can be made. The system 
can calculate the number of calls that were in progress and determine the number of 
simultaneous calls. This process, however, is providing only a portion of the data. The remaining 
information to determine is the number of resources that were deployed at a particular time. 
Due to HCPS utilizing an active deployment, it is extremely difficult to calculate the number of 
times that CMEC 0 was attained. 

Data was reviewed for the last three years (2020-2022). The following is a table that indicates 
the number of simultaneous calls in minutes.


Table #11: Number of Simultaneous Calls in Minutes (2020 – 2022) 

 

Number of Calls Occurring at the Same Time in Minutes 

Year 

2 Calls 

3 Calls 

4 Calls 

5 Calls 

6 Calls 

7 Calls 

8 Calls 

2020 

41544 

10832 

2314 

461 

203 

20 

1 

2021 

54743 

15904 

2933 

624 

194 

23 

0 

2022 

59410 

16464 

3279 

520 

174 

7 

8 



There are a varied number of deployed resources at any given time. Generally, there are four 
ambulances deployed during the hours of 11:00h - 23:00h (11:00 a.m. – 11:00 p.m.) and three 
deployed between 23:00h – 11:00h (11:00 p.m. – 11:00 a.m.). 

**Note: Within the County’s Deployment Plan, the HCPS regards a serious and critical situation 
when there is only one unit available between 11:00h – 23:00h (11:00 a.m. – 11:00 p.m.) and 
zero units available between 23:00h – 11:00h (11: p.m. – 11:00 a.m.). 

Whenever four calls occur simultaneously, there would be no ambulances available in the 
county at peak day-time staffing. Based on the data provided in table #11, in 2020 four calls 
occurred simultaneously for a total of 38 hours and 34 minutes. In 2021, that total was 48 hours 
and 53 minutes and in 2022, the total hours were 54 hours and 39 minutes. 

Based on the above data, there is a significant number of instances where there are more than 
four calls occurring concurrently. With only four ambulances deployed at a maximum, these are 
calls that account for the community paramedics, within the paramedic response units, 
responding as well as any upstaffed ambulances (summer long weekends, community events, 
etc.). In 2022, there was a severe instance when there were eight calls occurring at the same 
time. This incident was reviewed and there was a simultaneous utilization of resources. 

Data also provided evidence on the total amount of time an ambulance is out of County waiting 
for patient diagnostic testing to be completed at a regional health centre. This data does not 
consider the travel time back into the County after completion. There is a lack of ADRS data to 
support returning to base empty. Taking this into consideration, the CMEC numbers should be 
considered as understated. The true amount of time listed above will be greater than reported. 

The issue of critical ambulance coverage is undeniably present within Haliburton County. 
Therefore, the current Deployment Plan should be reviewed and modified to adapt to best 
practices as seen in other services. While each Deployment Plan is based upon the individuality 
of the community, having zero ambulances accessible for operation is unacceptable. 


3.2.2 Ambulance Offload Delays (AODs) 

In Haliburton County, Ambulance Offload Delays (AODs) concerns are not as substantial as they 
are in major Ontario cities. They do, however, occur in the County hospital sites at a reduced 
level. It should be noted that not only have the number of AODs been rising over the last five 
years but the average time delay is also increasing quite considerably (almost 34% increase in 
the last 5 years). 

Table #12: Ambulance Offload Delays (2017-2021) 

 

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The four-service deployment plan details the levels at which the services are willing to let the 
resources be depleted and indicates mitigation delay measures that should be applied in those 
cases. This is done with the Emergency Coverage Reinstatement table. 

3.3 Lean Management Structure 

Haliburton County Paramedic Service’s (HCPS) management and administration staff is 
extremely lean when compared to their direct peer group (Kawartha Lakes, Peterborough, 
Northumberland, and Muskoka Paramedic Services). This leads to many challenges when 
ensuring that they are meeting their core responsibilities (see job description responsibilities 
found in the appendix of this document for chief, deputy chief operations, and deputy chief 
quality assurance). Attempting to be a frontline supervisor, on top of performing core job 
responsibilities, creates a situation where both functions can not be completed effectively. This 
results in an extra amount of time being spent on immediate needs, leaving some tasks 
incomplete which can contribute to future challenges. 

3.3.1 Frontline Supervision within the Paramedic Service 

Presently, the chief and the two deputies alternate in managing the supervision of frontline 
paramedics. This is being accomplished during work hours as well as after hours from their 
homes. This method of frontline supervision has proved ineffective, based on several 
established issues, including: 

• Currently, management of deployment resources is reactive and not proactive. 
o Many times, issues occur without an attempt at a mitigation strategy because 
the senior department manager is undertaking other necessary job functions 
and the senior manager is alerted only after paramedic resources are 
depleted. (i.e., Lindsay CACC and the HHHS hospitals are moving interfacility 
patient transports). 



• Limited time for effective communication with staff creating morale challenges as 
paramedics feel uninformed about service issues. 
• Paramedic staff and outside agencies have noted concerns of inadequate 
management resources. 


**Note: Paramedic Service operation is a 24/7/365 operation. Work/life balance for the chief 
and two deputy chiefs is hampered due to being tied to the immediate supervision role after 
hours. Their direct peers in other counties are on call, but as a resource role since those 
departments have a frontline superintendent/supervisor to deal with immediate needs. 


3.3.2 Administration 

Currently, many tasks are provided to the executive assistant; however, the most important 
assignment is paramedic scheduling. These administrative tasks can be exceptionally 
overwhelming from scheduling to compiling daily ADRS and iMedic data. Other administrative 
tasks include but are not limited to: 

• Payroll 
• Paramedic expense management (e.g., meal receipts) 
• Reviewing departmental gas/credit card statements 
• Maintaining HR files for paramedics as legislated (i.e., tracking driver licence or CPR 
expiry, flu/covid vaccination status etc.). 
• Data entry for County reconciliation (i.e., vehicle fuel consumption). 
• Creating processes for sudden needs (i.e., public mobile vaccine clinics, forms required 
by Community Paramedics patient interactions when challenges occurred with 
electronic patient form). 


For a comprehensive list of the executive assistants responsibilities, please see the job 
description on the County’s website. Tasks that are not deemed as time sensitive may go 
unmanaged when the executive assistant is absent. This leads to an intensifying workload upon 
return to the office. 

3.3.3 Supervisor Rationale 

The purpose of frontline supervision would be to manage the paramedic system in Haliburton 
County in real time. Dealing with leadership of the paramedics in both emergency and non-
emergency situations creates relationships with the frontline workers. With dedicated frontline 
supervision, paramedics will feel that they have an advocate and decision support within the 
department. 

A dedicated frontline supervisor would make a difference in the following areas: 

• HCPS leader at dynamic scenes ensuring paramedic health and safety, assisting with 
paramedic needs to manage their patient(s), and paramedics’ wellbeing post response. 
• Awareness of stressful situations that are presented to paramedics and ensuring that 
staff are aware of mental wellness supports. 
• Providing praise and gratitude to those performing above and beyond in real time, and 
conversely performing investigations and providing discipline where warranted. 



• Providing Paramedic response when ambulances are delayed or not available. 
• County representative at multi-agency scenes can provide a different perspective than 
front line paramedics at a major response; where liaising with others (police and fire) is 
essential to minimize negative impact on the community and its citizens. 
• Handling deployment challenges prior to them occurring by monitoring paramedic 
deployment and regularly communicating with Lindsay CACC allows issues to be handled 
effectively and efficiently. 
• Similarly, regular communication with both HHHS facilities will allow the supervisor to be 
aware of challenges before they occur. Regular visits to the emergency department will 
also build relationships with the lead nurses and physicians, which aids with any future 
aimed at mitigating the impact of interfacility transfers. 
• Additionally better relationships and communication will allow the supervisor to adjust 
and: 
o ensure 9-1-1 emergency response, 
o reduce HCPS overtime by ensuring paramedics get off work on time, and 
o ensure paramedics are getting proper meal breaks. 



• Maintaining paramedic certification allows the on-duty supervisor to be another medical 
response resource in times of depleted resources. This can reduce the number of 
delayed responses due to no ambulances immediately available and help improve 
response time performance. 


Neighbouring paramedic services (City of Kawartha Lakes, Peterborough, and Northumberland 
Counties) follow a best practice standard and ensure one supervisor for up to 20 paramedics. 
Currently, Haliburton County has 56 paramedics on staff which should equate to employing 
three supervisors. The role of a paramedic supervisor (known as a superintendent in the Ontario 
paramedic environment) is what has already been stated above in addition to: 

• Monitoring / mentoring paramedics in their work environment (quality assurance and 
quality improvement in real time i.e., patient’s who call 9-1-1 and refuse to go to the 
hospital can be reviewed in real time to ensure the counties legal risk of leaving these 
patients has been greatly reduced) 
• Providing a link (as well as a buffer) between the senior management team and the 
paramedics. 



• Investigate complaints of the paramedics under their command immediately. 


As noted previously, the lack of front-line supervision has been observed as challenging 
throughout the consultation process. The paramedic union also noted that they would welcome 
the addition of a superintendent. Everyone thrives on positive reinforcement and paramedics 
are not any different, the current management structure does not allow for the luxury of 
providing such. 

There needs to be a clear division in role between front-line and administrative manager. The 
superintendent manages downwards to the paramedics. Their main focus is on the paramedics 
and providing all they need to perform effectively and efficiently. The chief and deputies should 
focus on the accountability, to Council and CAO, for the strategic direction of the community 
service. When the line between front line and senior managers becomes obscured, so does the 
delivery of the service. 

Overall, the addition of a paramedic superintendent (supervisor) role would increase the 
confidence of the paramedics as well as increase effectiveness of the HCPS deployment plan. 
This addition would also decrease legal risk to the County, provide support for the paramedics 
as well as the paramedic system and provide the chief and deputies updates on work done by 
the frontline. 

3.4 Aging Infrastructure 

There are three major areas of infrastructure that need to be referred to in long term planning: 

1. Stations 
2. Vehicles 
3. Equipment 



3.4.1. Stations 

There are four stations that the paramedics work from, one of which is out of control of the 
County, as it is a municipal fire station in the community of Stanhope. Being the largest 
investment for any paramedic service, it is of utmost importance that stations are planned 
properly for both now and future considerations. Fundamentally, only the Minden station was 
built as such. 

The Minden station is the most modern (2014) and has been customized specific areas, 
including purpose built changerooms and stock rooms. It is well positioned on Highway 35, 
which is a major route within the County. This location allows for quick deployment in any 
required direction. The garage bays are also of proper size for modern ambulances, which are 
much larger than ambulances of 20 years ago. Built for the use of a single deployed crew at any 
given time, the base functioned well, and space was utilized properly until recently. The 
Community Paramedic Program is operated out of the Minden base which has now made the 
accommodations tighter. The commander of community paramedicine has assumed the office 
in the Minden base, relegating the crews to performing paperwork in the crew lounge. With the 
additional vehicles of the Community Paramedicine Program, the garage bays have become 
overly crowded as staff squeeze SUVs in between ambulances to keep them out of the weather. 

Minden Station had the least emergency community (non-hospital) responses, with 913 calls in 
2021. As noted on the map below, most calls occurred along Highway 35 and over towards 
Haliburton along County Road 21. The location of the station is appropriate as it is located along 
a major roadway and, by the map below, appears central to the call volumes. 


Figure #60 – Minden Station – Call Cluster (2021) 

 

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The Haliburton Paramedic Station is no longer adequate for current needs. This location 
provides the paramedic service headquarters and is also an area where management offices are 
stationed. There is a lack of usable space for storing files, ambulances, as well as equipment. 
There is not adequate separation between top level management and front-line staff, which 
results in a lack of privacy when dealing with human resource concerns or discipline. While it is 
appropriate to have management offices within the deployment station, there needs to be 
sufficient separation to allow for staff to unwind and decompress. Currently, there are many 
shared facilities including washrooms, kitchen and garage areas that do not allow for the proper 
division of staff. 

The current location of the Haliburton station is in the southwest corner behind the arena and 
fire station. It is not centrally located within the community nor is egress to a major route to the 
other side of the community easily accessible. The Paramedics are required to travel through 
busier downtown traffic to access areas to the west of the community. 

The Haliburton station was the busiest of the three stations in 2021 with 1386 community (non-
hospital) calls. This station reach is quite a distance however, it must be noted that Haliburton is 
the only double deployed station on day shift, with a second ambulance located there from 11 
:00h -23:00h (11:00 a.m. – 11:00 p.m.). This ambulance, if all others are not on calls will deploy to 
the community of Stanhope, and will also deploy to Minden or Tory Hill if their ambulance is 
deployed. Due to this, the map data for Haliburton resembles a County wide response. 


Figure #61 – Haliburton Station - Call Cluster 

 

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The Tory Hill station is a small station containing a single ambulance crew. 14 of 17 respondents 
on the Paramedic survey rated the Tory Hill station as either poor or very poor. The Tory Hill 
station responds to the second most calls in the County at 915. Within the last year, the Tory Hill 
location became permanently a 24-hour station meaning that staffing there is constant. The 
most noted concerns were regarding the lack of space, lack of privacy and poor ambulance 
radio reception. The garage space is small for the current ambulances. There is a lack of space 
within the base for their equipment and supplies which, some mentioned, have led to supply 
shortages. 

With only one washroom for up to four paramedics, privacy is an issue at shift change. There is 
no dedicated space for study or continuing education which can lead to frustrations amongst 
partners. It is essential to understand that paramedics work 12 hour shifts together, often many 
days in a row. As in any other workplace, there are personality differences and habits between 
partners. It is important in a work environment to foster good working relationships which 
occasionally requires personal space. An absence of personal space within the Tory Hill station is 
a major concern. With the station now being staffed 24 hours a day, it is important to have an 
area where paramedics can decompress and relax between calls. It was observed that the only 
area to sit at the station are two office chairs. Most modern paramedic facilities note the 
importance of downtime due to the stress of the profession and support the frontline staff 
with accommodations that are appropriate. While a desk chair is appropriate for computer work 


and continuing education, it is not the best choice for rest when all duties have been 
completed. 

As would be expected, a lot of the calls for the Tory Hill station were in the eastern part of the 
County and within the larger community of Bancroft in neighbouring Hastings County. 

Figure #62 – Tory Hill Station – Call Cluster 

 

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Lastly, paramedics will periodically be dispatched at the Stanhope Firehall. This is the posting 
location for the 11:00h – 23:00h (11:00 a.m. – 11:00 p.m.) if they are not in use and occurs only 
when the other three stations have ambulances located within. This location aims to serve the 
northwest portion of the County. Paramedics can use the facilities when not in use by 
firefighters and to use the washroom facilities when needed. 11 out of 17 respondents noted 
the location as poor or very poor. Main concerns brought forward are the uncertainty of 
availability due to firefighter usage, no dedicated indoor parking and poor CACC radio reception 
within the station. It is noted that some paramedic crews prefer to sit in the ambulance in the 
parking lot rather than wait in the station. 

3.4.2. Vehicles 

HCPS deploys seven ambulances and four emergency response vehicles (ERVs). When all 
ambulances are available two are deployed from Minden and Tory Hill allowing each shift (day 
shift / night shift) to utilize a separate vehicle with three being deployed from Haliburton (all 


shifts). The practice of alternating vehicles between shifts is a practical one that allows for the 
cross shift to be ready even if their opposing shift is on a shift extension. If there is only one 
vehicle per station that unit would have to be deployed 24/7 which means if a crew is on a shift 
extension there would be no ambulance available for the new shift-start paramedics to deploy 
in. Currently, managers do their best to ensure a spare ambulance is available for all incoming 
shifts. 

In todays post covid environment, there are great shortages in replacement parts as well as 
used and new vehicles. There is a great possibility that once an ambulance requires parts based 
on service needs or breakage, it may be out or service for a greater period of time. 

Of the four ERVs, two are deployed within the Community Paramedic Program and the others 
are utilized by the deputy chiefs. The chief formally had a vehicle to utilize during his duties but 
it is now part of the community paramedic fleet. HCPS has ordered a fifth ERV to ensure 
adequate vehicles are available. 

The vehicle fleet overall is lean. If staffing resources are increased additional vehicles will be 
required to ensure proper fleet deployment. 

Nine of 17 paramedic survey respondents indicated they feel the vehicles and equipment is 
either poor or very poor with seven noting as either adequate or good. Most common 
complaints on vehicles related to older higher mileage vehicles that have visible signs of age 
(rust, worn out seats, etc.). Due to supply chain issues management has advised delays in 
obtaining new ambulances which has resulted in the current fleet being extended past its 
normal replacement plan. 

3.4.3. Equipment 

In the field of paramedicine there are constant advancements in equipment from both a patient 
needs and a paramedic safety perspective. Recent advancements in equipment include power 
stretchers, power extrication equipment, and advanced monitoring equipment. Currently, 
major equipment in use by the HCPS includes: 

• Seven (7) Stryker Power Cots 
• Ten (10) Physio-Control Lifepack15 defibrillator/monitors 
• Automatic Vehicle Locator (AVL) Systems, located in each response vehicle. 
• Panasonic Toughbook Computers 



The current replacement plan is to replace as required. The AMP notes an amortization period 
of five years. Without a planned replacement cycle, the replacement costs associated with 
these major pieces of equipment can become extreme in any given year. 

When it came to the equipment the paramedics use, the voluntary paramedic survey revealed a 
few common themes. Many respondents noted the lack of the power load stretcher system as a 
major deficiency within the service. While it is impossible for paramedic services to get to a 
zero-lift environment due to the nature of on scene response, the power load system works in 
tandem with the power lift stretchers to eliminate the heaviest of lifting that paramedics must 
endure. The power lift system lifts the stretcher up and down from the ground to transport 
height and the power load system attaches to the ambulances and takes all the weight of the 
patient and equipment while the wheel rise upon entering the vehicle. Many services 
throughout the province have adopted both the power lift and power load systems within their 
fleet and the paramedics in Haliburton are aware. There is much research on the effects of the 
full no lift stretcher system for paramedics with services detailing reductions in strain related 
WSIB injuries. HCPS may wish to consider adding power load stretcher systems as part of each 
new ambulance purchase. 

Another area of note was lack of full functioning GPS mapping systems within the ambulances. 
Most services within the province have adopted alternate GPS systems to allow their 
paramedics to map the quickest route to an emergency call. HCPS should review the 
effectiveness of the current GPS mapping systems. 

3.5 Growing and Aging Population 

It has been abundantly clear for years that the population in Ontario is aging at a great rate. 
While the Province is bracing for the senior population to grow, Haliburton already has 
experienced an increase in the aged population. Additionally, the recent pandemic has altered 
the way to we work allowing for more opportunity to work from home which makes a more 
rural community like Haliburton a more desired location to live. This has been substantiated by 
the largest population increase in the province and fourth largest in the country was in 
Haliburton, within the last five years. This combination of growth and aging presents a unique 
challenge to the County when it comes to delivery of services, the least of which being 
healthcare. 

Planning for future services requires a combination of analysis of demographics and history. 

3.5.1 Call Volume – Forecasting 

Utilizing the forecasting function within Microsoft PowerBI based upon ADRS Emergency 
Response data, the following chart has been produced showing upper and lower bands as well 


as anticipated growth in call volumes. This forecast only considers history and does not include 
the growing and aging demographics. It is evident that call volumes will continue to rise. 

Figure #63 – Ten Year Forecast - iMedic Calls 

 

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3.5.2 Ontario Demographic Projections 

Looking at age demographics, the Ministry of Finance produces annual projections for 
population growth. The latest publication produced during the summer of 2022 highlighted the 
following: 

• Ontario’s population is projected to increase by 37.7%, or almost 5.6 million, over the 
next 25 years, from an estimated 14.8 million on July 1, 2021, to over 20.4 million by 
July 1, 2046. 
• The number of seniors aged 65 and over is projected to increase significantly from 2.7 
million, or 18.1% of population, in 2021 to 4.4 million, or 21.8%, by 2046. Rapid 
growth in the share and number of seniors will continue over the 2021–2031 period 
as the last cohorts of baby boomers turn age 65. After 2031, the growth in the 
number of seniors slows significantly. 
• The number of Ontarians aged 15–64 is projected to increase from 9.9 million in 2021 
to 12.9 million by 2046. This age group is projected to decline as a share of total 
population for most of the projection period, from 66.6% in 2021 to 63.2% by 2040, 
and to increase slowly thereafter to reach 63.3% by 2046. As baby boomers continue 
to turn age 65, the growth in population aged 15–64 slows until 2027–28 and then 
accelerates over the remainder of the projection period. 
• In 2021, the share of seniors aged 65 and over in regional population ranged from a 
low of 15.9% in the GTA to a high of 22.9% in the Northeast. Among census divisions, 
it ranged from 14.1% in Peel to 35.7% in Haliburton. 
• By 2046, the share of seniors in regions is projected to range from 19.7% in the GTA 
to 27.9% in the Northeast. Among census divisions, it is projected to range from 
17.4% in Peel to 40.2% in Haliburton. 



• In 2021, the highest share of children [aged 0-14] was found in Kenora at 21.5% and 
the lowest share in Haliburton at 9.4%. By 2046, Kenora is projected to still have the 
highest share of children at 19.4%, while Haliburton is projected to continue to have 
the lowest at 9.1%. 
• The highest share of people aged 15–64 in 2021 was in Toronto (70.6%) while the 
lowest was in Haliburton (54.9%).13 


13 Ontario Population Projections, Ontario.ca, accessed November 2022, https://www.ontario.ca/page/ontario-
population-
projections#:~:text=Ontario%E2%80%99s%20population%20is%20projected%20to%20increase%20by%2037.7,to%20over%2020.4%20million%20by%20July%201%2C%202046. 

Looking deeper at the statistics from the MOF, the breakdown of age over the next ten years 
within Haliburton. Ontario reveals a substantial difference in age composition. Haliburton is 
projected to continue this trend over the next ten years albeit with a lesser increase as 
compared to Ontario as a whole. Haliburton County currently has an aging population of 60 or 
older at 47.5% whereas the entire province was 24.8%. In 2032, it is projected that Haliburton 
will have 49.9% of its population aged 60, while Ontario will be at 27%. 

Figure #64 – Population by Age – Haliburton vs. Ontario 

 

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As detailed previously in this report, older citizens utilize a unbalanced amount of healthcare. In 
Haliburton those over the age of 60 represent 47.5% of the population but they account for 
68.2%% of ambulance calls. A greater review reveals that those aged 70 and above are 
projected to increase in overall population percentage in a large way from 24.5% in 2021 to 


30.6% in 2032. Which indicates, those aged 70 and above utilized 51.4% of ambulance services 
in 2021. 

Figure #65 – Percentage of Calls by Age 

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Figure #66 – Haliburton Age Breakdown vs Calls by Age 

Understanding this, combined with MOF projections indicating the population will continue to 
age, it is essential that healthcare is ready to respond. Based upon current projections, and if 
ambulance utilization continues, there is the possibility of an increase in call volume of over 26% 
over the next ten years. That kind of percent increase will require increases in staffing and 
changes in deployment. 

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It must be reiterated that Haliburton had the highest percentage increase in population in 
Ontario since 2016. This was clearly not expected as the most recent MOF projection for 
Haliburton for 2021 was 19,719. The actual census data showed a population of 20,571. 
According to MOF projections Haliburton wound not reach that population until 2025. Utilizing 
data to determine whether this population shift is due to the recent pandemic or lifestyle 
changes within society will be key in establishing these statistics for formulation and 
preparation. 


3.5.2 Being Prepared 

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Regardless of the whether projections are understated, 
accurate or overinflated, the County must be prepared. 
Following an Emergency Management philosophy can be 
beneficial. 

The first step within the emergency management phase 
of a disaster is prevention and mitigation. Prevention of 
population growth would not only be ineffective but also 
detrimental to growth of a community. Therefore, 
mitigation strategies must be pursued. Many mitigation 
strategies, regarding the challenge of population and 
aging community, can be found within current programs 
and reports such as the Community Paramedic Program and the County Community Safety & 
Wellbeing Plan. Being part of different committees and community groups can play an essential 
part in being prepared. Paramedics are trained to respond. Response is the easiest part of this 
cycle for emergency services. A coordinated response is essential, and the relationships built 
during mitigation and preparedness efforts go a long way in creating an efficient and effective 
response. Recovery, for purposes of this master plan is a review and evaluation of efforts in the 
first three stages. 

The benefits of the Community Paramedic Program have been noted previously within this 
report. It is important to continue to monitor its accomplishments and track its achievements. 

The Community Safety & Wellbeing Plan has been noted previously within this report however 
it is essential that HCPS be highly involved in planning and responding within the guidelines of 
the CSWP. While HCPS is noted within the plan in relation to the Community Paramedic 
Program, the program can be more involved in the plan. Paramedics are experts in home 
medical care and are very accustomed to meeting a patient and their needs within a home 
setting. A community paramedic involvement within the CSWP benefits the community. There 
needs to be a greater coordination of services to ensure that efforts are not only in alignment 
with each other but also not duplicated. 


The CSWP has 12 goals, with the Community Paramedic Program being directly noted goal 11 
and 12. 

Goal 1: Align policy priorities. 

Align policy priorities and activities across existing programs and initiatives to the 2020-2029 
City of Kawartha Lakes & the County of Haliburton Housing and Homelessness Plan 

Goal 2: Develop wraparound support. 

Develop wraparound support for community members struggling to access housing through 
greater service integration, communications, and outreach. 

Goal 3: Support service provider collaboration. 

Continue to support housing service provider collaboration and information sharing to improve 
wraparound services, system navigation, and greater recipient autonomy and agency. 

Goal 4: Reduce barriers to employment access. 

Reduce existing barriers to access, and advocate for improved employment opportunities for 
low-income groups. 

Goal 5: Elevate service integration and information sharing. 

Elevate and amplify existing service integration and information sharing efforts to alleviate 
poverty across key focus areas such as housing, transit, food, education, early learning, 
children’s services, and energy. Poverty is an inherently interconnected issue that is both a 
cause and consequence of the other identified priority areas. 

Goal 6: Innovate to address food insecurity. 

Identify innovative opportunities to address food insecurity through closed loop referral 
processes. 

Goal 7: Improve access to mental health and addiction support services. 

Increase access to, and awareness of, mental health and addiction support services. 

Goal 8: Co-design mental health and addiction services. 

Co-design and develop experience-based mental health and addiction and substance use 
support services and programs. 


Goal 9: Improve education on substance use and addiction. 

Improve education, awareness, and information sharing on substance use and addiction, harm 
reduction, and mental health. 

Goal 10: Increase awareness on benefits of health and physical activity. 

Increase awareness on the importance of physical movement and increase access to active 
transportation as a central mode of mobility (where applicable). 

Goal 11: Develop a Health Equity Working Group. 

Develop a Health Equity Working Group to support equal access to health across priority groups 
such as low-income, BIPOC, LGBTQIA+, and Seniors. 

Goal 12: Enhance Virtual Health and Mental Health Care. 

Enhance and expand service scope of Virtual Care for health and mental health in the County. 

Upon closer review of the CSWP, the Community Paramedic Program could be involved on a 
greater scale. In addition to goals 11 and 12, the community paramedics could also play a role in 
goals 3, 5, 6, 7, 8, 9 and 10 as many of these goals relate to referrals and education. There is a 
referral system already in place within the Community Paramedic Program and it would not be 
unconceivable that a paramedic could provide education to patients on healthy living. Playing a 
larger role in the CSWP would be a benefit to the community. 

3.6 Paramedic Recruitment & Retention 

3.6.1 Recruitment 

Many hours are dedicated to paramedic recruitment for HCPS by the various management and 
administration teams. Frequently, many of the new paramedic recruits leave once they secure a 
hometown or GTA paramedic position. This cost to Haliburton County is significant in lost time 
and effort of its recruitment process. This also has an impact on the job satisfaction/stress level 
of those recruiting, educating, equipping, and preparing recruits for job readiness only to have 
those recruits move on to other services. Here are few ideas to consider in trying to stabilize the 
recruitment process: 

• Career days at the local high school in the vocation of health care 
o i.e., consider having both Haliburton Highlands Hospital and Haliburton County 
Paramedic Service work together to showcase well paying careers for students 
that can be found in their home community. 






• Approach local high school regarding first aid, CPR & AED education (Scouts Canada 
Ventures program) to develop interest in becoming a paramedic. 
• Investigate possible involvement in high school health sciences courses. 
• Consider high school coop placements that don’t involve patient interactions. 
• Bursary programs for high school students entering the paramedic program. 
• Recruitment Fairs at local colleges that offer the paramedic program i.e., Fleming, 
Georgian, Durham etc., 
• Signing bonus for local applicants (local home-grown paramedics will more than likely 
stay). 
• Consider a recruitment of seasoned GTA paramedics who are looking for a lifestyle 
change. 


Recently, the province has introduced the Learn & Stay program for nursing, paramedic, and 
medical support careers in priority communities where staffing is a challenge. This program 
provides free tuition including fees, books, and other educational costs, in exchange for the 
participants agreeing to learn and work in the region where they study. HCPS should work 
closely with the eligible paramedic programs to promote the Learn & Stay program in 
Haliburton. 

3.6.2 Retention 

Paramedics are like any other employee in society today. They are looking for competitive 
compensation, work-life balance, supportive leadership, and an inclusive culture. 

Paramedics choose their desired field to provide emergency medical care. If a significant 
portion of their work hours is performing interfacility transports or sitting on offload delay at a 
hospital, the paramedics are bound to feel that this is not the job they had envisioned. Pre-
emptively informing paramedic candidates of the reality of the position will ensure you have an 
informed employee. This may work to entice more seasoned paramedics who are looking for a 
different work assignment or slower pace from urban services. 


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SECTION 4: RECOMMENDATIONS 

The following recommendations present the best-case scenario to assist in moving forward. They are based upon best research on 
the challenges of the HCPS. While they present the best solutions for the service, they are not the only available solutions. These 
recommendations attempt to make the greatest impact in the most effective and efficient manner based upon industry standards. 
While they are presented in a numerical order, items may be skipped and the path may be altered depending on continued risk 
tolerance, desire to change and willingness to consider financial challenges. Some of the recommendations are part of a progression 
within a certain program and that must be understood so that the effectiveness of a certain change may not have full impact if steps 
are skipped. 

**Note: all cost estimates are based upon best current day information. Future costs would need to be estimated based upon County 
expectations. 

The following chart provides definitions and time frames for the recommendations chart to follow. 

Recommendation 

Time Frame 

Definition 

Immediate 

(Present - 1 year) 

These recommendations will have the most impactful outcome on the 
immediate future of Haliburton County Paramedic Service (HCPS). They 
are noted as immediate recommendations either because they can be 
implemented relatively easily or because they are so crucial to the 
continued operation of the Service. In cases of increased costs, there 
needs to be consideration for in year reconfiguration of budget lines or an 
analysis of potential cost savings in other areas due to the increased costs. 

Short-Term 

(1 - 3 years) 

The following short-term recommendations can be achievable with a 
focused direction and support. 




Recommendation 

Time Frame 

Definition 

Mid-Term 

(4 - 7 years) 

When considering a ten-year plan there is great importance in reconciling 
progress to date. Yearly however at or around 5-year it is beneficial to 
review the validity of all the recommendations as long-term plans can 
require revision. 

Long-Term 

(8 - 10 years) 

Long term recommendation are more than 7 years. These are either larger 
capital projects, difficult and comprehensive or require review later. Future 
predicting is very difficult when it comes to municipal and health services. 
However, there must be direction to assist and guide services in the right 
direction. 




4.1 Immediate Recommendations (Present – 1 year) 

IMMEDIATE (PRESENT – 1 YEAR) 

Recommendation #1 

#1 - Create an interfacility transfer working group. (In progress at time of release of this Master Plan) 

Consisting of Haliburton County, HCPS and HHHS (at a minimum) a working group must be established with the aim 
of looking at solutions that meet the needs of all parties. The utilization of ambulances for interfacility transfers has 
been noted as a major challenge within this report. This working group will help establish clear guidelines to ensure 
the appropriate balance of resources to patient needs and ensure urgent interfacility transfers are truly code 3 
CTAS 3 and are not compromising 9-1-1 paramedic response. Additionally, this group must be the leaders working 
towards a solution to the core need of diagnostic imaging. 

Through this working group the County should explore the requirement for a patient escort on interfacility transfers that 
are not directly admitted to other facilities. If not directly admitted during the transfer the patient remains the 
responsibility of Haliburton Highlands Health Service (HHHS). The receiving facility, where the patient is receiving 
treatment/diagnostic imaging, does not assume care and responsibility for the patient. This responsibility remains that of 
the sending facility and HCPS are assuming that responsibility in the absence of an escort. The County should consult 
with others and/or seek legal advice on the matter of liability when transporting in-patients of a hospital. HHHS needs to 
maintain responsibility for their patients and provide a qualified escort to accompany their patient for legal and medical 
reasons (i.e., proper care, pain management and medical liability). 

The Interfacility Working Group lobby the local MPP, MOHLTC and Ontario Health East for funding a solution to the 
number of interfacility transfers. The County is in a unique position in that there are no advanced diagnostic imaging 
services located within. There are different solutions to the volume of interfacility transfers (i.e., transfer vehicle, 
diagnostic imaging HHHS hospitals, etc.) however this is a provincial healthcare issue that is negatively affecting County 
Paramedic response to 9-1-1 calls. Any solution will require an investment of funding. 




IMMEDIATE (PRESENT – 1 YEAR) 

Benefits 

Joint discussions along with an increase in communication on focused goals will lead to a greater understanding of all 
parties’ requirements, which will work towards a united on a solution. Discussions will help assist the HHHS in the 
understanding that HCPS is an extension of their emergency department. HCPS primary purpose is for patients who are 
not yet in medical care as opposed to a transportation service for patients requiring diagnostic imaging in another facility. 

The focus of the HCPS must be emergency first response. Emergency response is the primary legislative responsibility and 
is the service that is expected to be monitored with yearly reporting requirements. Creating a plan to minimize 
interfacility transportation out of the County will ensure more appropriate use of highly trained paramedic staffed 
ambulances. 

Minimizing out of County interfacility transportation will improve response times to those patients in greatest need. 
Current response time goals have not been set at a very aggressive level that promotes active improvement, since the 
service is handcuffed by the volume of interfacility transfers which are booked by physicians as a part of their standard of 
care. Core goals of this working group from the County perspective must revolve around: 

• Booking interfacility transfers that consider not only HHHS needs but respects HCPS 9-1-1 response. 
• Assisting HHHS in lobbying Ontario Health East for funding for their unique interfacility requests due to not having 
onsite diagnostic imaging. 
• Exploring the option of HHHS sending a qualified escort to manage their patient medical needs. There is a medical 
liability concern for the County. The patient is the responsibility of the hospital and County Paramedics are 
assuming direct care for long periods of time without the ability to properly care for the needs of the patient. 
o Additionally, with an escort in care of the patient, HCPS may be able to leave the patient and escort at the 
receiving facility therefore returning to Haliburton County if deployment is suffering. This safeguard is 
essential for improved deployment. The requirement for an escort falls in line with HCPS neighbours in the 
four County Deployment Plan and many other Services in the Province. 








IMMEDIATE (PRESENT – 1 YEAR) 

• The funding of non-urgent and repatriation interfacility transports from the Provincial Government instead of the 
County tax base. 
o Securing funding from the proper sources will ensure that current funding is being utilized appropriately. 
Currently the municipal tax base is funding and supplying the solution to a deficiency in local provincial 
healthcare. A collaborative approach ensures that all parties are fully aware of their responsibilities and the 
challenges of others. Using resources from Haliburton County, HCPS and HHHS to draft reports, make 
presentations and business cases to solve the funding issue (i.e., transfer ambulance or HHHS onsite 
diagnostic imaging) will help balance the workload ensure that all effected parties have a part in the 
solution. 



• Collaboration on any required business cases leading towards obtaining Diagnostic Imaging within the County 


Disadvantages 

The disadvantages of starting a working group revolve around added workload for an already understaffed management 
team. Continuing under the current system is not sustainable. 

Cost 

Minimal - The cost is time of salaried employees working for the County and the Service. 

Consequences of Inaction 

Collaboration is often the best method of conflict resolution. Without the formation of a working group the matter of 
interfacility transfers will either continue to grow or one party will determine the future on their own. It is essential that 
this issue be resolved as quick as possible since a large proportion of current Paramedic “work” is not being devoted to 
community emergency medical response, which is the core responsibility of the Service. Doing nothing will just cause the 
situation to persist with a continual increase of interfacility transfer volumes furthering undue stress on HCPS 
management and paramedics 

 

 




IMMEDIATE (PRESENT – 1 YEAR) 

Recommendation #2 

#2 – Re-evaluate/update HCPS deployment plan to support recommendations. 

System Status Management (SSM) or dynamic deployment of paramedic resources is predicting call volumes based on 
historical data. Many urban paramedic systems use this method to move ambulances and paramedic response units (PRU) 
into locations where data would support the most likely location for next 9-1-1 call. Human behaviour in emergency 
medical care is predictable. An example would be the fluctuation of seasonal population. SSM may also be used by an on-
duty superintendent to manage deployment and provide adequate rest time to paramedic crews who have been busy. 

Concepts from SSM can be applied to, or should be re-evaluated regularly for effectiveness, a rural municipality like 
Haliburton County such as: 

• Managing HHHS interfacility transfer volume, so they don’t compromise 9-1-1 response. 
• Ensuring that rested paramedic crews are assigned long distance diagnostic transfers (mitigating shift overrun to 
not only decrease overtime but to safeguard paramedic well being). Currently using 11-23 Ambulance 
• Having HHHS provide a qualified escort to go with their patient’s so HCPS ambulances can return to the County to 
provide emergency coverage. 
• As ambulances are committed to 9-1-1 response, other ambulances / PRUs move to geographical locations based 
on the most likely next response. 
• Increase deployment based on historical data that supports call volume increases i.e., summertime long weekends, 
community events like fairs / festivals, forecasted severe weather events, local hospital surge exceeding capacity 
etc. 
• HCPS has been actively taking some of these measures. The deployment plan should be updated to reflect the 
needs of the community as well as the actions being taken and presented to Council for formal approval. 


Benefits 

Being proactive and updating the deployment plan to support modern approaches to paramedic service delivery will 
better serve the citizens and visitors of Haliburton County as well as the HCPS workforce. 




IMMEDIATE (PRESENT – 1 YEAR) 

Disadvantages 

There would be significant time required to updating the deployment plan, reviewing the circumstances continually and 
making decisions based on the information. The current management workload would prohibit this being used in a 
constant and timely manner. 

Cost 

The cost to revise the plan would be dedicated management time. Once implemented there may be deployment costs 
such as increased staffing for severe weather events. 

Consequences of Inaction 

Not updating the deployment plan in an everchanging environment adds to a stressed system potentially increasing 
CMEC-0 events and increases the workload on Paramedics during the predictable call volume increases. These could lead 
to delayed emergency response, staff burnout and consequences related to recruitment and retention. 

 




IMMEDIATE (PRESENT – 1 YEAR) 

Recommendation #3 

#3 – Development of key performance indicators (KPIs). 

The Ministry of Health requires certain benchmarking based on response times for various patient types. That information 
is currently being reported as legislatively required, but there are several other performance-based criteria that should be 
collected on a regular basis. Best practice would suggest reporting quarterly (at a minimum), as this information will help 
to direct community needs (preparedness), assess level of care (meeting patient needs), and identify stressors affecting 
HCPS deployment (9-1-1 vs. HHHS transfer volume). Regular reporting will help the County stay well-informed of any 
issues and enable the service to address emerging issues as they begin. 

Paramedic services have an abundance of data; however, the issue is data processing and analysis. There are many 
software solutions available such as business intelligence systems, but they require some knowledge or training to build 
the appropriate dashboards. Once created these dashboards are often self completing and require only minimal 
maintenance to continue to produce accurate and poignant reports. 

To start, analysis of patient CTAS can help provide a base of data upon which to build. Examples of some areas of focus 
utilizing CTAS upon Paramedic arrival include: 

CTAS 1 

a) Response time and location (public space resuscitation calls need to consider preparedness i.e., CPR/First Aid 
education, AED placement, naloxone kit [latter based on true need]). 
b) Patient age and sex (age and sex helps focus people most likely to focus on for recognizing when to call 911). 
c) Presenting cardiac rhythm (determines if defibrillation [key paramedic intervention] would be completed and an 
average should be kept of successful defibrillation patients). 
d) Patient pulse at hospital (to be followed up for survival [emergency department vs discharge]). 
e) Patient pre-existing disease (futile resuscitation i.e., age, presenting rhythm not appropriate for defibrillation and 
significant pre-existing disease). 





IMMEDIATE (PRESENT – 1 YEAR) 

CTAS 2 

a) Response time and location (public space resuscitation calls need to consider preparedness i.e., CPR/First Aid 
education, AED placement, naloxone kit [latter based on true need]). 
b) Patient age and sex (age and sex helps focus people most likely to focus on for recognizing when to call 9-1-1). 
c) Patient presenting problem (drives paramedic care i.e., does it meet the patients needs?). 
d) Patient condition upon arrival at hospital (similar cases (iv, did paramedic care make a difference in the patient’s 
condition upon arrivals at hospital, public education campaign based on recognition of similar complaints i.e., 
water safety accidents etc.). 


CTAS 3 

Follow similar outline to CTAS 2. Patients over 65 who seem to have a mobility or chronic health issue should be referred 
for follow up by Community Paramedic Program to keep them out of the 9-1-1 / ambulance / hospital cycle. 

CTAS 4 and CTAS 5 

Consider referral or follow-up by Community Paramedic Program to find out needs of the patient and get them out of the 
9-1-1/ ambulance / hospital cycle. 

 

CMEC 

In terms of deployment challenges tracking CMEC Zero is essential. Actively tracking the number of times, the county is at 
one or zero ambulances and correlating such with a reason i.e., 9-1-1 call volume, multi causality incident (MCI), allied 
agency scene (police or fire standby, hospital transfer volume or combination of a few listed items). This is difficult to do 
because no inherent ADRs nor iMedic method currently exists in the correlation and calculation of this data. 




IMMEDIATE (PRESENT – 1 YEAR) 

Hospital Challenges 

In terms of hospital challenges tracking offload delays and details of all interfacility transfers (hospital name, transfer 
transport priority and reason) is important. Current data correlation exists within the Paramedic iMedic data. A business 
intelligence solution can pull this data automatically once set up and the information can be displayed on a dashboard as 
immediately as at time of call completion. 

Benefits 

The increased ability to track predict impending challenges will ensure that there are minimal surprises for the future. 
Staying on top of issues and being proactive instead of reactive is the greatest benefit of establishing KPIs. The ability to 
plan and advise the CAO and Council of current and future needs (i.e., expansion of paramedic care like some ACP 
procedures (i.e., pain relief) or a complete ACP program once a need is established. Focused community outreach and 
expansion of Community Paramedic Program based on true need). 

Disadvantages 

Although automated, they system will require administrative time to monitor and analyse. 

Cost 

Costs could be varied but staff time is critical to the success of an improved data program. This time will involve both 
training and research into developing appropriate KPIs for the County needs. There may be an upfront cost to software 
solutions (however the County already has access to business intelligence software), and developer time to create the 
proper ongoing KPIs. 

Consequences of Inaction 

Data is essential to the development of successful future solutions. Without an enhanced data program or KPIs it will be 
difficult to improve upon what is currently happening. 

 




IMMEDIATE (PRESENT – 1 YEAR) 

Recommendation #4 

#4 - Become more involved with the county community safety & wellbeing plan. (In progress at time of release of this 
Master Plan) 

Creation of a community safety and wellbeing plan (CSWP) is a legislated responsibility for each municipality. The four 
municipalities have deferred to the County for the coordination and creation of the CSWP. To meet the requirements of 
the CSWP, many stakeholders must be involved. The current CSWP refers to the Community Paramedic Program on two 
of 12 priorities however there is no direct paramedic service involvement on any CSWP committee or working group. 
HCPS should be more directly involved, and steps are currently being implemented to ensure this occurs. 

Benefits 

Becoming more involved on CSWP committees and working groups will allow the Plan to flourish. As noted previously 
collaboration is the key to success on any community plan. Working together the committees will have full knowledge of 
the capabilities and responsibilities of HCPS and especially the Community Paramedic Program. This will lead to better 
service to the community members in need and less duplication of effort. Additionally, having the addition of medical first 
responders working on the CSWP will provide a varied perspective which again can lead to better outcomes. Greater 
teamwork also works the other way in that the HCPS member will learn more about what other community services are 
capable of and available to its citizens. 

Disadvantages 

Committees and working groups that are too large can suffer from lengthy decision-making processes and longer 
meetings. Sometimes broad general groups can also lack in creativity due to the extremely high-level topics of discussion. 
It would be best to have smaller group that can identify true issues and action plans to deal with them. 

Cost 

Minimal - Costs would revolve around local travel. No accommodations should be required. The primary cost is time of 
salaried employees working for the County and the service. Many costs can be averted by utilizing online meetings with 
others however face to face interaction is essential at times. 




IMMEDIATE (PRESENT – 1 YEAR) 

Consequences of Inaction 

The absence of collaboration leads to assumptions. Also, a lack of communication can place unknown responsibility on 
different parties. Closed communication can promote ignorance and can lead to inefficient/ineffective solutions. When 
considering the needs of the community members it is of utmost importance that the best programs are produced that 
can positively affect the most. 

 

 Recommendation #5 

#5 – Expand the current annual report. 

This annual review of data should drive community requirements/needs based on actual HCPS patient information not 
only for 9-1-1 (emergency) response, but also community paramedic (prevention/preparedness) programs aimed at 
frequent and low acuity users. The current annual report details high level information based primarily upon legislatively 
required metrics. An expanded report would aid not only the Service in assessing needs but will also aim to advise Council 
and the community at large on progress and enhancements in Service. 

Benefits 

• Exploring the possibility of increasing the level of emergency (9-1-1) care provided by the existing PCP Plus (IV) 
program based upon true patient need. For example, a review of potential need for enhanced pain management 
due to cases of traumatic injury and great travel distances within the County. 
• Assessing the merits of moving towards a full advanced care paramedic program based upon true local patient 
need from annual data. 
• Development of prevention/preparedness programs based on data collected from KPIs Examples include public 
AED placement, CPR/First Aid education in high-risk areas of the community, falls prevention for seniors at risk, 
water/ATV/snowmobile/helmet safety, etc. across the County. 
• Community Paramedic Program expansion based on community need from KPI data collected from patients with 
chronic conditions as well as frequent low acuity calls. The focus should be on improved management of these 
patient types to keep them out of the 9-1-1/ambulance/hospital cycle. 





IMMEDIATE (PRESENT – 1 YEAR) 

Disadvantages 

• Reporting must be done in a consistent fashion to lead to effective change, and it is hard to be consistent in an 
everchanging environment. 
• Changing how/what is reported requires education on new features which takes time. 
• Altering standard reporting should necessitate the needs to review past performance data and that will require 
time and effort 


Cost 

The cost is time of the senior management and administration team to collect, review and write a report on the findings. 
Implementing programs based on findings would cost money and need to have a business case that is supported by the 
budget process (capital or operational). 

Consequences of Inaction 

Doing nothing will lead to not meeting community needs and HCPS falling behind provincial counterparts. 

 

Recommendation #6 

#6 – Explore synergies on future capital expenditures. 

There can be success in joining in with other community organizations when it comes to capital expenditures such as 
buildings and equipment. While building stations is not being considered in the immediate stage, there is a need for more 
space. It would be advantageous to begin exploring potential possibilities of growth with other community organizations. 
Many municipalities have been successful in building joint/combined stations with police and fire services, community 
centres, low-income housing, and private commercial space. Exploratory discussions should take place with other groups 
to assess if there are similar needs for the future. 

Additionally, in the past there has been success in seeking standardized pricing for supplies and equipment. In the years 
post municipal download some larger Services were able to secure fixed pricing for supplies and vehicles for any other 
Service wishing to join in. It is worth the effort to have discussions amongst neighbours and colleagues to assess the 
opportunity for standardized pricing. 




IMMEDIATE (PRESENT – 1 YEAR) 

Benefits 

Combined Services facilities share costs both on a capital front and operationally. For example, some joint facilities have 
multi-use rooms such as kitchens or training/board rooms where all tenants can share. Doing this clearly reduces the 
overall footprint for any one entity and the use of shared spaces creates monetary efficiencies. 

Disadvantages 

Different funding streams can often make this complicated. Additionally, competing interests can sometimes present 
barriers to success. 

Cost (current day estimate) 

No costs to explore opportunities. Ultimately the goal is cost containment. 

Consequences of Inaction 

Greater costs going alone as opposed to working with others. 

 




4.2 Short Term Achievable Recommendations (1-3 years) 

The following short-term recommendations can be achievable with a focused direction and support. 

SHORT TERM (1-3 YEARS) 

Recommendation #1 

#1 – Assist in the development of a business case for local diagnostic imaging. (Underway at time of release of report). 

The best solution for the issue of high interfacility transfer volume is to remove the need for the transfer. In many cases 
these interfacility transfer occur due to the need for diagnostic imaging. All parties need to participate in the creation of 
a business case to seek the implementation and funding of a local diagnostic imaging solution, or more specifically a CT 
scanner. Having a CT Scanner at one HHHS site will allow the ability for the emergency room physician to have immediate 
access to a standard of care diagnostic tool. 

Benefits 

The benefits of a CT scanner within the County are not only related to HCPS and HHH. Local diagnostic imaging is 
beneficial to the patient who does not have to travel for essential testing. The establishment of more diagnostic imaging 
capabilities in the province will help to reduce wait times all around as more supply of services helps minimize the impact 
of demand. 

Benefits to HCPS include less interfacility transfers out of the County which positively affects deployment (as noted 
previously). 

Benefits to HHHS include more timely care due to more timely diagnostic capabilities. Having Diagnostic imaging 
available within the facility will also be advantageous to physicians which can help in recruitment and retention. 

Disadvantages 

The disadvantage to local diagnostic imaging is cost; both capital and operational. There are capital costs for the actual 
machine as well as the facility (expansion / renovation) to host the specialized equipment, and operational costs 
surrounding maintenance/staffing required to operate the machinery. 




SHORT TERM (1-3 YEARS) 

Cost 

No cost to the County as this is a provincial healthcare issue. 

Consequences of Inaction 

Deployment remains compromised. Patients must continue to travel outside the County for diagnostic imaging. 

Recommendation #2 

#2 - Hire an administration assistant. 

Currently HCPS has one executive assistant whose role is essential to the operations of the service. The list of duties of 
the current executive assistant is as follows: 

• Scheduling and backfilling of shifts as required using scheduling software. 
• Verify time sheets with schedule and submit to County Payroll Department on a bi-weekly basis. 
• Co-ordinate, complete, and monitor all vehicle related matters including license plate renewals, insurance 
permits, vehicle readiness, preventative maintenance schedule, all repairs, accident reports, monthly/quarterly 
reports as required by the Ministry, loss of equipment forms and vehicle check forms 
• Maintain an adequate supply of inventory and equipment for the vehicles and bases and advise the director when 
additional inventory is required. 
• Code and submit invoices to the treasurer for payment based on approved budget lines. 
• Prepare correspondence for signature by chief/director of deputy chiefs. 
• Attend as required, meetings for the purpose of recording minutes. 
• Filing of records and correspondence as required by the chief/director 
• Provide clerical support for the maintenance and updates to the County Emergency Plan. 
• Assist chief/director as required with public events. 





SHORT TERM (1-3 YEARS) 

• Assist deputy chief, quality assurance with clerical components of the quality assurance and health and safety 
responsibilities. 
• Maintain internal department personnel records and ensure relevant information copied to the human resources 
co-ordinator. 
• Assist the deputy chief, quality assurance with the documentation and upkeep of the Quality Assurance Program 
for the Public Access Defibrillator Program and personnel documentation. 


The current executive assistant has seen an increase in workload with the creation of the Community Paramedic 
Program and associated administrative requirements. 

Benefits 

Additional administrative support allows others to perform their responsibilities more effectively. Relieving the two 
deputy chiefs from administration responsibilities affords them more time to perform the necessary role of supervisor 
with less interruption during Monday – Friday office hours (splitting of the role between the two). 

Additional administration office hours will also improve data collection, interpretation, and presentation for both the 
Community Paramedic and traditional Paramedic programs. Paramedic services have robust data requirements both 
from a MOH and Internal reporting perspective. This additional support will in turn provide the chief and deputy chiefs 
with information to better direct the service’s needs and inform the CAO and Council of challenges in a timely fashion. 

The hiring of an administrative assistant provides redundancy in the executive assistant position and allows for cross 
training of responsibilities. It can be said that taking vacation does not pay off when you are in a position with no 
coverage during times not at work. Having a second administrative support position helps ensure that there can always 
be someone in the office with that skill and knowledge during vacation and time off. 

 

Lastly, the hiring of additional administrative support will not only reduce the workload of the current executive assistant 
and management team but will also help the administrative responsibilities for the commander of clinical programs. 




SHORT TERM (1-3 YEARS) 

Disadvantages 

• Ongoing operational costs need to be realized including wages/benefits, office requirements (i.e., desk, 
computer, etc.), and office space. 
• Current headquarters has a lack of administrative space. 


Costs 

Capital 

• Computer Equipment 
• Office Space 


Operational 

Full Time Salary $65,000 + 30% Benefits 

Costs co-shared with MOHLTC EHS. 

Consequences of Inaction 

The current administrative team of HCPS will continue working status quo. Many of the other recommendations may be 
compromised due to lack of management / administrative capacity. 

 

Recommendation #3 

#3 - Hire two full time front-line supervisors/superintendents. 

Front line supervision is essential in emergency services. Generally, within Ontario, frontline supervisors in paramedic 
services are titled superintendents. While a paramedic superintendent is not always directly alongside their staff while 
they work, the nature of the job may involve responding to emergencies along, creating a greater than normal element 
of danger, health & safety concerns, legislative compliance and, critical decision making. It is essential to have some 
element of dedicated frontline supervision. The lack of dedicated frontline supervision has been noted on all fronts as 
one of the greatest challenges effecting the operations on HCPS. 

 




SHORT TERM (1-3 YEARS) 

Drawing upon job descriptions from other paramedic services across Ontario including neighbouring counties, a 
paramedic superintendent is generally responsible for oversight of the ongoing daily shift operations and deployment. 
They are to ensure safe, effective, efficient quality services are achieved in part by ensuring that structures, programs, 
systems, and processes comply with all requirements set out in legislation, policy and procedure, and standards for 
paramedic services. 

They provide leadership and mentorship to front lines crews and will additionally perform administrative, logistical, and 
program tasks as required. Some level of dedicated frontline supervision is the standard within Ontario Paramedic 
Services. More specific job requirements could include: 

• Conducting daily supervision of staff. 
• Monitoring and ensuring paramedic compliance with Basic/Advanced Life Support Patient Care Standards; 
accomplished through direct observation and review of documentation & patient care on a shift-by-shift basis. 
• Monitoring and ensuring paramedic compliance with all policies, procedures and regulations established by the 
County, the Paramedic Service, Ontario Ministry of Health and Long-Term Care, Regional Paramedic Program of 
Eastern Ontario and other various pieces of legislation that may relate to the paramedics’ daily duties and 
obligations. 
• Maintaining certification as a primary care paramedic to enable the ability to respond to calls when a delayed 
ambulance response is anticipated. 
• Monitoring the central ambulance communication center (CACC) radio system to ensure overall effective 
deployment enabling the ability to respond to calls, assist crews and provide onsite supervision where required. 
• Working cooperatively and effectively communicating with Lindsay Central CACC and Haliburton Highland 
Hospital (HHH) daily to ensure compliance of the established and approved Service deployment plan. This includes 
managing interfacility transfers that can compromise deployment. 





SHORT TERM (1-3 YEARS) 

• Protecting personal health and safety and that of others by adopting safe work practices and reporting and taking 
appropriate action with unsafe conditions. 
• Investigating accidents, WSIB claims, public complaints, etc. and providing written investigation reports to senior 
managers and County administration. 
• Assisting with the scheduling of paramedics on both short- and long-term timelines. 
• Conducting annual performance reviews and evaluations of staff, assisting with staff development, and delivering 
training programs to meet the educational requirements of the service/County. 
• Responding as designated site coordinator at multi-casualty incidents, acting as liaison between on scene 
paramedics, CACC, management and/or allied agencies. 
• Coordinating all aspects of supplies, fleet and equipment including ensuring distribution, preventative 
maintenance, inspections, repair of defective equipment and vehicles to ensure operational readiness and 
compliance with standards and health and safety legislation. 
• Conducting research and analysis as assigned. 
• Participating in the strategic and operational planning for the service, making recommendations for policies, 
procedures, and service improvements. 
• Promoting and assisting with Service/County communication plans, public relations activities, and community 
awareness programs. 
• Working as primary duty officer as required. 
• Maintaining a high level of confidentiality for the organization and its employees, as per the Municipal Freedom of 
Information and Protection and Privacy Act (MFIPPA), the Ambulance Act, the Personal Health Information Privacy 
Act (PHIPA), the Labour Relations Act, and the Ontario Ministry of Health and Long-Term Care regulations. 





SHORT TERM (1-3 YEARS) 

• Making recommendations for improvements to the deployment plan. 
• Listening and acting upon system feedback suggestions from paramedics. 
• Collaborating in “people management” involving mentorship, coaching, and fostering a collective team approach 
to achieve optimal employee performance and satisfaction in addition to enhancing the overall profile of the 
service and County as a whole. 
• Participating in committees and initiatives to promote a respectful working environment, fostering effective 
communication, and inspiring the delivery of high-quality service and teamwork with a focus on a consistent 
approach. 


Benefits 

The benefits of creating a frontline supervisor program are significant including, but not limited to: 

• Improving frontline supervision as listed above. 
• Providing for at least one medical response resource (superintendent paramedic response unit PRU) in the County 
when at CMEC 0. 
• Removing the need for frontline on call for chief and deputies and improving their work/life balance. 
• Ensuring the Service/County legislative and legal responsibilities. 
• Managing hospital diagnostic transfers to guarantee resources for 9-1-1 ambulance/paramedic response. 


Disadvantages 

The disadvantages of any staffing increase are primarily cost related. These costs must be weighed against the benefits. 
Cost for a paramedic Superintendent must include office space, ERV, response equipment, training, uniforms, wages, and 
benefits. 




SHORT TERM (1-3 YEARS) 

Cost 

Capital 

• Emergency response vehicle cost $90,000 (based on present models used by HCPS – to be amortized over the life 
span of the vehicle according to the AMP to be under 6 years or 300,000km). 
• Equipment for response vehicle $40,000 (non perishable to be amortized over item lifespan i.e., monitor / 
defibrillator, etc.). 
• Office space, office equipment and computing devices $10,000. 


Operational 

• The salary of one full time paramedic superintendent would be approximately $98,000 + 30% benefits (would 
need to be evaluated by human resources as no current positions exists). Total cost approximately $255,000 
annually. 
• Uniform 
• Costs co-shared with MOHLTC EHS. 
• Annual costs to maintenance/insurance/fuel/repair costs are estimated to be in the range of $20,000-$22,000 per 
year. 


Phased in Approach 

To provide 24/7 superintendent coverage would require four full time staff. To reduce the immediate costs, it is 
recommended to hire two Superintendents. The mid-term (years 4-6) would see the hiring of one additional 
superintendents, and a fourth position in the long-term (years 7-10) to complete the 24/7 coverage. 

Consequences of Inaction 

The current administrative team of HCPS will continue working status quo. The managers will continue to work well 
beyond their normal workday and staff will continue to have a delayed response to critical issues. An effective means of 
providing extra paramedic response unit (PRU) will not be achieved. Issues with deployment will continue to be reviewed 
not in real time after the most beneficial results could be achieved. 




SHORT TERM (1-3 YEARS) 

Recommendation #4 

#4 - Acting supervisor/superintendent program. 

During full time Superintendent vacation, statutory holidays, and sick time the position must be maintained to ensure 
consistent leadership of the paramedics and the operations in which they work. This can be accomplished by either hiring 
part time superintendents or creating a unionized acting superintendent. Hiring part time superintendents typically 
involves the hiring of staff from another Service to work part time. This could include either unionized paramedics or 
management superintendents from other services. The more common approach however is to hire paramedics from 
within the Service to assume the role of superintendent when the full time superintendent is away from work. There 
would need to be consultation with the Union on this role. Regardless, once the superintendent program is instituted, 
there needs to be a full-time commitment to always maintain this position due to its overall reliance and importance. 

Benefits 

The benefits of creating a frontline supervisor program are immense and have been discussed previously. The benefits of 
the acting superintendent program revolve around continuity of the position. 

Disadvantages 

The disadvantages of any staffing increases are primarily cost related. 

Cost 

Capital 

• None as the expenses are accounted for within the full-time program. 


Operational 

• $40,000 for vacation, statutory holiday and sick time backfill. 
• Costs co-shared with MOHLTC EHS. 


Consequences of Inaction 

Not creating an acting supervisor program alongside the full-time program will result in inconsistency in span of control. 
HCPS paramedics, local police / fire services, CACC dispatchers, HHHS and neighbouring paramedic service 
superintendents require certainty of appropriate leadership in a continuum for HCPS. 




SHORT TERM (1-3 YEARS) 

 

Recommendations #5 

#5 - Consider no longer certifying senior management. 

Currently, the chief and deputy chiefs are certified as paramedics. While on the surface this appears to be a good idea, it 
places unneeded stress and extra requirements on the senior managers. The role of senior managers is to manage the 
big picture and direct operations. The chief is responsible to the CAO and County Council and should be concerned with 
maintaining budgets, operations, administration, and planning. MOHLTC through the base hospital maintains a standard 
that paramedics are required to assess and treat a certain number of patients annually. This is extremely difficult for the 
chief and deputy chief to do to their management focus and workload. 

Immediate life saving skills such as defibrillation and CPR and the administration of epinephrine in anaphylactic shock and 
narcan in opioid overdose should remain as part of the senior managers scope of practice. Equipment and medications 
can continue to be stocked in the managers ERVs and the base hospital can support these skills and ensure that these 
minimums are met with yearly training. 

Benefits 

Senior managers can focus on moving the service forward and the core requirements of their positions. 

Disadvantages 

Fewer certified Paramedics within the system although they do not respond to calls on a normal basis. 

Cost 

No costs 

Consequences of Inaction 

Continuing to have Senior Managers certified will continue the current workload and need to recertify. 

 




SHORT TERM (1-3 YEARS) 

Recommendation #6 

#6 - Add another ambulance to deployment. 

Add one 12-hour ambulance, 7 days a week with shift hours based around historical call patterns. 

Benefits 

• Increased emergency coverage for the County and in particular Algonquin Highlands. 
• Reduced number of times emergency coverage is compromised when ambulances are outside of the County. 
• Improved response times. 
• Keeps HCPS resources inline with the increasing and aging population. 


Disadvantages 

Costs 

Cost (current day estimate) 

Capital 

• One ambulance vehicle (amortized over vehicle life span) = $200,000 
• Equipment for ambulance (non perishable amortized over items lifespan) i.e., monitor / defibrillator, stretcher, 
lifting tools etc. $50,000. 


Operational 

• Four paramedic salaries and benefits based on a 42 - hour work week equates to approximately $500,000 
(inclusive of benefits). 
• Costs for part-time replacement for time off and training. 
• Uniforms and safety gear. 
• Costs co-shared with MOHLTC EHS. 


Consequences of Inaction 

Failure to maintain pace with demands on ambulance deployment, allowing 9-1-1 response times to increase. 




SHORT TERM (1-3 YEARS) 

 

Recommendation #7 

#7 - Evaluate and plan for the future of the community paramedic program. 

The present Haliburton County Community Paramedic Program was created to assist underserviced frail and 
geographically isolated seniors (rural and without transportation). Community paramedics are part of the “Geriatric 
Assessment and Integration Network (GAIN)’. Funding for this initiative comes from two separate sources: the Ministry of 
Health and Long-Term Care as well as Ontario Health East (formerly the Central East LHIN). 

One of the greatest features of Ontario Community Paramedic Programs are their ability to focus on the specific needs 
of the municipalities they serve, typically with an end goal of reducing needless 9-1-1 medical calls. This in turn should aid 
in the overcrowding of Emergency Departments and Hospitals. In Haliburton County, the focus of the Community 
Paramedic program is on frail elderly, chronic illness, and isolation from continuing health care. Other municipalities may 
have a focus on homelessness or opioid overdose prevention. This creates many questions as to various focuses and 
funding for the future due to vastly diffident Ontario models. 

It is recommended that Haliburton County defines what it is they want their Community Paramedic program to be and 
where it should expand. Once defined and documented information gathering, and reporting must focus on the defined 
goals. There needs to be the inclusion of benchmarking and key performance indicators (KPIs) as well so evidence of 
program worth can be easily realized. 

Benefits 

Working with other Haliburton County health care and social service agencies, a focus to manage community healthcare 
and mental health outreach programs can be sought and completed collaboratively (i.e., reducing duplication). This can 
also be accomplished through involvement in the Community Safety & Wellbeing Plan. 

Seniors are staying at home longer and have a reduced demand on the hospital and long-term care services. 




SHORT TERM (1-3 YEARS) 

Disadvantages 

• The Central Ambulance Communication Center (CACC) is not set up to divert 9-1-1 calls that are not urgent to the 
Community Paramedic Program. 
• Permanent funding for the Community Paramedic Programs around the Province is uncertain. The importance 
and benefits of any provincially funded program must continually be promoted. 


Cost 

Presently Community Paramedic Programs are funded 100% by provincial health care sources and this must be 
maintained as health care is a provincial responsibility. 

Consequences of Inaction 

Without long-term program focus and funding, the Community Paramedic Program could be jeopardized. 

 

Recommendation #8 

#8 - Perform detailed facility needs analysis. 

As noted within the Asset Management Plan, the County is planning on engaging a consultant to review County owned 
facilities. This is to include a needs analysis along with assessments on valuation and replacement costs. 

A detailed facility needs analysis will assist the County in assessing current and future needs when it comes to Paramedic 
stations. 

HCPS has outgrown the Haliburton station and will require a new headquarters facility. Further, HCPS needs to be 
considering the addition of a paramedic station in Algonquin Highlands. 

Identifying proper sizing for management space, community paramedicine operations, crew areas, equipment rooms, 
and maintenance facilities will drive the new headquarter requirements. 




SHORT TERM (1-3 YEARS) 

In paramedic station design there has been increased focus on the prevention of contagious diseases including negative 
pressure rooms/garages and enhanced filtration systems. Any facility needs analysis should also include considerations 
for AODA. 

New builds will often have a focus on reduced carbon footprints and green technology. 

Benefits 

• Identifies true requirements and needs and prioritizes them appropriately. 
• Sets goals for future asset development 


Disadvantages 

Costs 

Cost 

No costs estimated. 

Consequences of Inaction 

Overcrowding will be compounded as the service grows to meet the needs of the community. 

 

 




4.3 Mid-Term Recommendations (4-6 years) 

MID TERM RECOMMENDATIONS (4-6 YRS) 

Recommendation #1 

# 1 - Hire a third superintendent. 

The progress towards 100% full time supervision (24/7) can be instituted slowly after the first 2 are hired. Hiring a third 
Superintendent will greatly expand the hours of on-site coverage. 

Benefits 

All the benefits listed in the first Superintendent recommendation only with more hours thus consistency. 

Disadvantages 

Costs 

Cost 

Capital 

• No cost - the first Superintendent recommendation involved the purchase of a response vehicle. 


Operational 

• The salary of one full time Paramedic Superintendent would be approximately $98,000 + 30% Benefits. 
• Uniform 
• Costs co-shared with MOHLTC EHS. 


Consequences of Inaction 

No progress towards full time frontline supervision. 

 




MID TERM RECOMMENDATIONS (4-6 YRS) 

Recommendation #2 

#2 - Add power load to all new ambulance purchases. 

As paramedic services evolve the health & safety of paramedics is of critical. Over the years, improvements to equipment 
continue and one of the most beneficial improvements ever is the introduction of power equipment that takes the strain 
of lifting away from the paramedics. Stretchers are used on nearly every patient call and within the last ten years power 
stretchers have become the standard for equipment. Many reports have been made on the benefits of these stretchers 
with a documented decrease in work-related injuries. HCPS utilizes power stretchers but there is a second component to 
a “zero” lift system and that is a power “load” system. While the current stretchers operate up and down by battery 
power, without a system to take the weight of the patient and stretcher while loading in, the Paramedic still needs to 
bear that weight while rolling the stretcher in. Many Services have utilized the full power lift/load system with success. 

Adding the cost of the power load system, which is mounted within the ambulance, to the cost of all new ambulances 
allows this improvement to made through attrition over time. Additionally, the power load system can last the lifespan of 
two ambulances ensuring all future purchases adhere to the requirement for a power load system can reduce costs. 

Benefits 

The core benefit to adding the power load component is to maintain a low rate of paramedic injuries. Adding this 
component to power equipment is part of the evolution in the care of the employee’s wellbeing. 

Adding the power load component to all new ambulance purchases allows the capital purchase to align with the largest 
purchase made on a regular basis and budgets can be adjusted to reflect such. Understanding that the power load 
system can span multiple vehicle lifespans the added cost to the ambulances will only be once every couple purchase 
cycles. 

Disadvantages 

Added costs, however many services have pointed to Paramedic injury cost avoidance to make this purchase justifiable. 




MID TERM RECOMMENDATIONS (4-6 YRS) 

Cost 

Capital 

• $36,000 (7-year life span) added to each new ambulance purchase. 


 

Recommendation #3 

#3 - New headquarters in Haliburton. 

The current paramedic base and headquarters in Haliburton no longer meets the needs of the HCPS. There is inadequate 
garage space for the fleet, a lack of administrative space for the management team, and the paramedic crew space does 
not meet their current requirements. Much needed increases for an executive assistant, superintendents and dedicated 
Community Paramedic Program creates further space challenges. 

A new station would appropriately house a response station, central warehouse for equipment/supplies, community 
paramedic offices and management offices. 

Collaborating with other community groups and allied agencies including other county departments, could be explored 
as part of a multi-partnered project. 

Benefits 

• Adequate space to meet the current and future demands. 
• Modern health & safety enhancements. 
• Reduced carbon footprint and green technology. 


Disadvantages 

Costs 

Cost 

Unknown due to needs of the facility and the increasing price to build commercially per square foot. 




MID TERM RECOMMENDATIONS (4-6 YRS) 

Consequences of Inaction 

Current facilities are overextended. Growing demands will continue to put pressure on the current facilities. 

 

Recommendation #4 

#4 - Assess the need for a dedicated resource in Algonquin Highlands. 

In the northwest area of the County, there is currently a Paramedic post in the community of Stanhope. This location is 
the last one provided with direct coverage and that only occurs when all four ambulances on day shift are available and 
not on calls. As this is a fire station the crews are given access to use the facilities. It is reported that frequently the 
paramedics remain in the ambulance and only use the fire station for washroom facilities. 

Over the course of the last 3 years 7% of HCPS 9-1-1 community calls (not hospital interfacility transfers) came from 
Algonquin Highlands. It is important to note that the concept of “seamless coverage” still exists in Ontario and that 
means that there are no borders when it comes to paramedic services. The closest most appropriate ambulance will 
always be dispatched to the emergency call. That said, reviewing all 9-1-1 calls within Haliburton County (including other 
county paramedic services), Algonquin Highlands accounts for 9.7% of calls. That difference equates to approximately 
34% of calls in Algonquin Highlands being serviced by other Paramedic Services. 

With a growing and aging population, the demand for paramedic service will increase in this area. Based on call trends 
HCPS should analyse call data to ensure the area is receiving appropriate coverage. 

Benefits 

Improve response times within Algonquin Highlands and the County. 

Disadvantages 

• Costs 
• Potential requirement for a paramedic station. 





MID TERM RECOMMENDATIONS (4-6 YRS) 

Cost 

Capital 

• One ambulance vehicle (amortized over vehicle life span) = $200,000 
• Equipment for ambulance (non perishable amortized over items lifespan) i.e., monitor / defibrillator, stretcher, 
lifting tools etc. $50,000. 
• Rental or construction of a paramedic station (no cost estimate). 


Operational 

• One 12-hour shift equates to four paramedic salaries and benefits based on a 42 - hour work week approximately 
$500,000 (inclusive of benefits) for four full time Paramedics. 
• Uniforms and safety gear. 
• Costs co-shared with MOHLTC EHS. 


Consequences of Inaction 

• Reliance of other Services to provide response in the northern area of the County will continue. 
• Failure to maintain pace with demands on ambulance deployment, allowing 9-1-1 response times to increase. 


 

Recommendation #5 

#5 - Assess progress on the master plan and re-evaluate where necessary. 

It is of utmost importance to assess progress on any guiding document and this Master Plan requires attention. 
Instituting the recommendations earlier in this timeline for enhanced systems and programs will allow for faster and 
simpler assessment of needs going forward. Any long-term plan requires regular updating and doing so at the mid point 
of the ten-year plan is prudent. 




MID TERM RECOMMENDATIONS (4-6 YRS) 

Benefits 

Allows for measurement of successes of previously implemented recommendations and assesses whether longer term 
recommendations remain valid. In the ever-evolving world of healthcare it is important to stay on top of issues and 
trends and doing so as recommended and assessing at the mid point will ensure that efforts are placed appropriately. 

Disadvantages 

It takes time and effort to reassess and re-evaluate what has already been stated. Taking a deep look at performance can 
yield unexpected results both positive and negative. Negative outcomes must be rectified. 

Cost 

If a review is completed internally the only costs would be in staff time and effort. Hiring external sources could require 
an RFP and unknown amount of funding. 

Consequences of Inaction 

Not stopping to review past performance and future goals that were established years earlier will not allow the Master 
Plan to address the real needs of the communities served. 




4.4 Long-Term Recommendations (7 – 10 years) 

LONG-TERM (7-10 YRS) 

Recommendation #1 

#1 - Hire a fourth superintendent. 

The progress towards 100% full time supervision (24/7) can be instituted slowly after the first two are hired. Hiring a 
fourth superintendent will greatly expand the hours of on-site coverage. 

Benefits 

All the benefits listed in the first Superintendent recommendation only with more hours thus consistency. 

Disadvantages 

Costs. 

Cost 

Capital 

• None, as the first Superintendent recommendation involved the purchase of a response vehicle. 


Operational 

• The salary of one full time Paramedic Superintendent would be approximately $98,000 + 30% Benefits (would 
need to be evaluated by Human Resources as no current positions exists). 
• Uniform 
• Costs co-shared with MOHLTC EHS. 


Consequences of Inaction 

No progress towards full time frontline supervision. 




APPENDIX ‘A’: HCPS SURVEY QUESTIONS 

To provide clarification of any challenges and gratifications within the HCPS a recent survey was 
sent out and completed via SurveyMonkey. This survey was released on November 04, 2022 and 
was closed on December 1, 2022. The survey was completed anonymously and had a 
completion rate of 88%. The following questions were presented. 

Tell us what HCPS currently excels at? 

1. Tell us a few points where you feel improvement is required? 
2. Does your present deployment plan work? (good points / challenges) 
3. Supervision: 
- does it presently meet the needs of the paramedics and the EMS system? 
- What would you like to see in the future? 
4. Does the present Paramedic workforce meet the needs of your patients? 
- i.e., response time, patient presentation for CTAS 1-5 transports? 



5. Community paramedic program: 
- Define the role? 
- Does it meet the needs of the community? 
- Future role? 



6. Haliburton Highlands Hospital (HHH) - Minden and Haliburton Campus: 
- How is the relationship between the paramedics and the medical staff? 
- How is the management relationship between HHH & HCPS? 
- HHH challenges to HCPS? 



7. What s the HCPS relationship like with Lindsay Central Ambulance Communication? 
8. Does the present CACC dispatch algorithm (priority card index) meet your community 
needs? 
9. Suggest changes for CACC in the future? 



10. HCPS and Central East Prehospital Centre (CEPCP) education: 


- does it meet your needs today? 

- ideas for the future? 

11. CEPCP medical direction. 
- Does it meet your patient needs? 
- Ideas for the future? 



12. Does HCPS infrastructure (buildings) meet the paramedic needs today? 
- List each station separately. 



13. Does HCPS vehicles (ERU / ambulance) & equipment meet the paramedic needs? 
- Suggest changes required for future. 



14. Does your management / administration team meet the paramedic needs? 
- Please expand on both positive and negative answers 



15. Paramedic well being and mental health programs: 
- What exists today? 
- What would you like to see in the future? 






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APPENDIX ‘B’: DEPLOYMENT PLAN 

Deployment Plan 

For 

 

Haliburton County 

Paramedic Service 

 

Version 2022-Fall 

 

 

O:\LOGOS\HCPS Logo.jpg 



Table of Contents 

 

 

Table of Contents 
Purpose 3 
Administration ........................................................................................................................ 4 
Staffing Levels & Shift Patterns ............................................................................. 5 
Emergency Coverage Reinstatement ............................................................... 6 
Response .................................................................................................................................. 10 
Community Paramedicine ........................................................................................ 12 
Manager on Call Notification .................................................................................. 15 
Standby Coverage ............................................................................................................ 16 
Offload Delay, End of Shift/Excessive Overtime ................................... 0 
Inclement Weather .............................................................................................................. 2 
Addendum A Tired Response .................................................................................. 3 
Addendum B Patient Destination Agreements........................................ 4 
Consideration Request Report Form ................................................................ 7 
 


PURPOSE 

 

It is the intention of the above noted Land Ambulance Service providers to incorporate certain 
policies that provide rapid out of hospital care to citizens in need of medical care and to ensure a 
more effective and efficient delivery of service within the Lindsay Central Ambulance 
Communications Centre (CACC) catchment area. 

 

This plan will permit the necessary latitude to the Communications Officers in order to ensure 
balanced emergency coverage accordingly with the available resources and applicable 
legislation. 

 

The Deployment Plan is a guide and our Manager on Call can override this document as long as it 
follows current legislation from the MOH. CACC Supervisors and ACOs must realize that potentially 
unforeseen issues could arise, causing our Manager on Call to alter the written plan based on their 
experience, knowledge and consultation with Senior Paramedic Service Command. In other words, 
our Manager on Call is in charge of the Deployment Plan. 

 

Further to the above statement, a working on-scene Manager on Call (regardless of UTM) is 
responsible for Paramedic Command until the UTM with the emergency response Manager on Call 
arrives on scene and assumes Command. 

 


ADMINISTRATION 

 

 

Haliburton County Administration Office (705) 457-1616 

 

 

Amy Brohm, Executive Assistant 

 

Tim Waite, Chief/Director Cell: (705) 457-8728 

 

Jim Young, Deputy Chief/Operations Cell: (705) 457-0802 

 

David Dasti Deputy Chief/QA & Education Cell: (705) 457-0248 

 

Chris Parish Commander Clinical Programs Cell: (705) 935-1222 

 

Fax # 705-457-1203 

 

 

Haliburton Base (705) 457-2181 

Minden Base (705) 286-2424 

Tory Hill Base (705) 448-3472 

Community Paramedic Desk 1(833)809-0440 

 (705)809-0440 

 

Manager on Call: 1-866-749-6428 

 

 


STAFFING LEVELS & SHIFT PATTERNS 

 

Base 

Staffing Pattern 

Scheduling 

Haliburton 709-00 

1 crew 24/7 

08:00-20:00-08:00 

Haliburton 709-00 

1 crew 12/7 

11:00-23:00 

Tory Hill 709-02 

1 crew 24/7 

07:00-19:00-07:00 

Minden 709-01 

 

 

1 crew 24/7 

 

 

 

 

08:00-20:00 

 

 

 

 

 



 

 


EMERGENCY COVERAGE REINSTATEMENT 

 

“Critical – Minimum Emergency Coverage” (C-MEC) is a trigger that recognizes that the level of 
available ambulance resources cannot sustain/maintain the EMS service’s “Minimum Emergency 
Coverage” level. The Paramedic provider’s deployment plan strategy for C-MEC is to delay response 
to Code 3 calls except for Haliburton who do not delay response to calls in the community. 

Critical-Minimum Emergency Coverage (C-MEC) and Response Delays for: 

 

Service 

CMEC Vehicle 
Count 

Community Delay 

Inter facility 
Transfer 

Other UTM 

HALIBURTON 

1 vehicle (07:00-
23:00) 

0 vehicle (2300-
0700) 

 

No delay 

 

Up to 60 Minutes 

 

60 Minutes 

CITY OF KAWARTHA 
LAKES 

2 Vehicles (after 
21:00 to 07:00 
drops to 0) 

30 MINUTES 

Up to 60 Minutes 

 

60 Minutes 

NORTHUMBERLAND 

3 VEHICLES 

30 Minutes 

Up to 60 Minutes 

 

60 minutes 

PETERBOROUGH 

2 VEHICLES 

30 MINUTES 

Up to 60 Minutes 

60 Minutes 



This criteria applies at all times, regardless of Service status (C-MEC / no C-MEC) 

Code 3 CACC assignments are the responsibility of the municipal paramedic service in which 
the call originates. Neighboring paramedic ambulances in another county or region will only 
be assigned by CACC to a Code 3 if the Code 3 hold time has been exceeded. 


Staffing Level 

Standby Location 

Coverage by 

Readiness 

Time 

 

Algonquin Highlands 

Algonquin Highlands 

0 minutes 

4 Ambulances 

Haliburton 

Haliburton 

0 Min 

 

Minden 

Minden 

0 Min 

 

Tory Hill 

Tory Hill 

0 Min 

3 Ambulances 

Haliburton 

Haliburton 

0 Min 

Minden 

Minden 

0 Min 

Tory Hill 

Tory Hill 

0 Min 

2 Ambulances 

Haliburton 

Tory Hill/Minden 

15Min/20 Min 

Minden 

Haliburton/Minden 

20 Min/0 Min 

0 Ambulance 

CMEC 

2300 – 0700 – Notify 
Duty Manager if 
longer than one 
(1) hour 

 KLPS Kinmount 

 

 Muskoka Vankoughnet / Carnarvon 

 

 ACO to start movement of closest most appropriate vehicle for 
coverage 

 

 



 

• When at CMEC 1 and the remaining vehicle does not have relief, the Duty Manager will be 
notified 30 minutes prior to EOS to avoid CMEC 0 when all other crews are out of the County 
and/or CMEC 0 is anticipated for an extended period. 
• Algonquin Highlands should be covered from 1115-1515 by the 11-23 vehicle and from 1530-
1900 by the 08-20 vehicle when possible. 
• Algonquin Highlands vehicle will be the first option for Emergency Coverage in Minden 
• During weekend and summer night up staff, Algonquin Highlands will be covered from 1915-
2215 by the 11-23 vehicle. 


.When Paramedics are mobile, the acceptable Roaming Zones are displayed in the maps 
below. 


 

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RESPONSE 

Crew Reaction Time 

The normal reaction time of staffed ambulance from receipt of the call information to proceed on a 
Code 3, 4 and 8 calls will be a maximum of 2 minutes. In the event a crew’s reaction time exceeds 
the above noted 2 minutes, the CACC will report same to the Service. 

 

 ACO Direction of Paramedics and Ambulance Movement 

 

Paramedics are not permitted to refuse any direction given by an ACO unless such direction places 
the immediate health/safety/welfare of the crew in jeopardy as defined in the Occupational Health 
and Safety Act. 

 

In the event that a dispute arises with respect to the application of any Paramedic Service policy 
(inclusive of this deployment plan) and the direction given by an ACO, the crew is to proceed with 
following CACC direction and contact Paramedic Service Management for further clarification. 

Inter-Facility Transfer 

REPATRIATION OF PATIENTS 

No County vehicles will be sent empty to repatriate a patient in another UTM. 

 

Patients that meet the criteria in existing repatriation agreements (example: Stroke Protocol) will 
be repatriated according to the terms of the applicable agreement. 

 

The Paramedic crew will wait at the receiving hospital as per existing policy (maximum 60 
minutes), to determine if the patient will be admitted at the receiving hospital or returned to a local 
facility. 

 

NON-EMERGENCY INTER-FACILITY TRANSFERS (Code 1 & 2) 

Vehicles providing temporary up-staffing to meet deployment needs, or special event coverage, shall 
not be considered as part of the County when determining availability of vehicles for non-urgent 
transfers. 

 


Assigning Code 1 and 2 Low Priority Transfers 

 Non-urgent low priority transfers (Code 1 & 2) will be assigned from: 

• 07:00-23:00 if 3 vehicles are available and the transfer is within Haliburton County 
• 11:00-19:00 if 4 vehicles are available and the transfer is outside of Haliburton County 
• No Code 1 and 2 transfers are to be assigned from 23:00-07:00 
• Paramedic Crews will respond to all calls up to the end of their shift. With the exception of 
out of town inter facility transfers where excessive overtime will be occurred (Re: Section 9 
Excessive Overtime). 
• Palliative transfers may be done with less than the required resources available if approved 
by Duty Officer/Shift Superintendent 


 

If a patient is stable and able to wait (Code 3), utilize the 11-23 ambulance for all inter-facility 
transfers starting at 1800. This is to reduce shift overrun for the day units. This applies to both 
Minden and Haliburton Hospital sites 

 

• MVC’s > MULTI- PATIENT INCIDENTS 


 

• ERU/ERV’s logged on will be deployed to the unconfirmed Multiple Patient Incidents and 
will be tracked as a responding unit. 


 

• ERU/ERV’s not logged on will be monitored in the notes/comments section of the CAD and 
therefore will not be registered as a responding unit 


 

• Calls where the possible number of patients is unknown, a second unit is to be dispatched 
Priority 8 (available for priority calls), and will respond with emergency systems activated. 
The first unit on scene will update CACC if a second unit is required and the response 
priority. 


 

 

• Bariatric Response 


 

• Haliburton Paramedics Duty Manager will be notified if a crew has a patient that is more 
than their current stretcher capacity. Direction in how to proceed will come from the Duty 
Manager 


 


 

ALS BACK-UP 

 

Under NO circumstances is the transport of the patient to be delayed awaiting the arrival of an ACP 
crew. If the patient is packaged and ready for transport to hospital, transport is to be initiated by the 
PCP crew immediately. 

 

ACP back up will not be denied unless the service would be placed into CMEC or the PCP transport 
time to hospital is less than 10 minutes (PCP Crew ETA to hospital). Transfer of care (on scene or 
rendezvous) will not exceed 10 minutes and one of the two ambulances (PCP or ACP) will become 
available to LCACC to respond within 10 minutes of the ACP rendezvous. Deviation from this will 
require Shift Superintendent/Duty Manager notification. 

COMMUNITY PARAMEDICINE 

 

 

• Community Paramedics will book on and off with CACC at the start and end of their shift. 
• Community Paramedics will be rostered into CAD with the CAV (Conditional Availability) of 
“AD” (Administrative Duties) for health and safety reasons (To track the unit & 10-2000 
alarms). 
• Community Paramedics are unavailable for call assignment of any priority. 
• Community Paramedics may advise CACC that they are responding to a call if they choose to 
do so. 


 

 


DEDICATED INCIDENT STANDBYS: 

If a dedicated standby is requested, then the allied service is expecting the potential for patients. The 
crew will notify CACC that they are to be placed on an extended code three and will set up a staging 
area to receive patients. At this point the crew will work cooperatively with the allied agency commander 
and designate an area for receiving patients in a triage system. Vehicle(s) assigned to a Dedicated 
Incident Standby shall not be reassigned to another call until the vehicle(s) has been cleared by the 
Incident Commander/Superintendent/Management person in charge. Incident Standbys will be 
performed by the UTMs that the incident resides in. 

 

Police Incidents 

Police incidents will be assigned Code 8 unless there is a confirmed patient 

Standby unit may respond to these calls on an urgent basis with emergency systems activated if the 
situation warrants an urgent response or as per local policy and procedure. 

 

For calls where police are requesting staging away from the scene and where call details cannot be 
broadcasted over the radio, the ACO will dispatch the crew to the standby location and request that the 
crew phone the ACO. The ACO will then provide all call information via phone conversation. 

 

All call information will be given over the Fleet Net radio system and not by cellular phone except for 
tactical responses. The ACO will then provide call information via cell phone to the responding unit. 

 

Fire Incidents 

 

Fire Scene incidents will be assigned Code 8 unless there is a confirmed patient. The responding 
crew is to report to Incident Command for direction re: safe vehicle placement and update of the 
situation including possible hazard identification. If the crew makes patient contact, a second vehicle 
will be dispatched for the incident standby. The crew on scene will make the determination if they will 
transport or if the responding unit will transport based on patient(s) condition. 


 

Standby unit may respond to these calls on an urgent basis with emergency systems activated if the 
situation warrants an urgent response or as per local policy and procedure. 

 

Special Response Requests 

 

Dual deployment/response of ambulances will not occur unless initial information indicates the 
necessity of more than one vehicle. 

 

A PRU/RRV/ERU/ERV is not considered as part of the Dual Deployment/Response 


MANAGER ON CALL NOTIFICATION 

1. Compromise in Service Delivery: 
a. Communication failure 
b. CMEC-07:00-23:00 / greater than one (1) hour – 23:00-07:00 only 
c. Offload delays of more than 45 minutes 
d. Multiple hospital transfers 
e. Transfer relays 
f. Up-staffing or extended crew shift is required to maintain emergency coverage 
g. Down-staffing (mechanical failure, not full complement of crew, etc.) 
h. Vehicles are not tracking on AVL 
i. Complaint received or initiated by CACC concerning paramedic service delivery 
j. Paramedic response time greater than 2 minutes 
k. All MCI or potential MCI situations 
l. Deploying an ambulance code 8 for another UTM (County Border) 
m. Call assignment (any priority) which originates outside the service municipality 



2. Patient or Paramedic Health and Safety 
a. Inter Facility transfers that may be delayed due to Inclement weather or excessive 
overtime (>3 hours) for the paramedic crew 
b. Any paramedic(s) whose shift reaches 14 hours in length 
c. An incident that involves a delay to patient contact by staging for any reason 
d. An incident involving a Paramedic Service vehicle or an injury involving an ambulance 
crew, patient/citizen as the result of a Paramedic Service response 
e. When crews are required to wear enhanced PPE (full Isolation suits) for calls 
such as Chemo-therapy patients, drug overdoses, infectious diseases 
f. An incident involving hazardous materials (HazMat) or CBRNE (Chemical, Biological, 
Radiological, Nuclear or Explosive) materials; 
g. Police incident which involves bomb threats, hostage taking or use of weapons 



3. Other Situations 
a. A Public Access Defibrillator (PAD) is activated. 
b. An urgent request of another allied agency (i.e. Incident Standby) 
c. Construction or Industrial accident 
d. Any fatality caused by MVC, other accident or unnatural causes (including 
suicide) and all paediatric deaths. 
e. Paramedic crew request for ORNGE (scene or modified) and accepted by OCC. 
f. Rail or Air incident 
g. Remote access (ATV, Boat, Snowmobile, Trail, etc…) 
h. Bariatric patient response 
i. A Haliburton County Hospital is on Consideration or Time Consideration 



21. When at CMEC 1 and the remaining vehicle does not have relief, the Duty Manager will 
be notified 30 minutes prior to EOS to avoid CMEC 0 when all other crews are out of the 
County and/or CMEC 0 is anticipated for an extended period. 



STANDBY COVERAGE 

STANDBY WITHIN UTM 

 

❖ Duty Manager reserves the right to modify standby coverage. 
❖ Emergency Coverage within the County will be done by our service to the limit of our 
resources. 
❖ Standby coverage protocols shall be applied uniformly on a 24-hour basis throughout the 
County. 
❖ Paramedic Crews will respond to all calls up to the end of their shift. With the exception of out 
of town inter-facility transfers where excessive overtime will be incurred (Excessive Overtime 
pg.13). If a Paramedic crew is on a stand by, they may proceed back to their home station 30 
min prior to the end of their shift, or when a relief paramedic crew has booked on with CACC. 


STANDBY FOR ANOTHER UTM 

 

❖ Stand-by coverage for other UTM’s will be completed from the County stations unless the 
other Municipality is at 0 coverage in which case Stand-by will be completed at the County 
boundary in order to ensure appropriate coverage to the rest of the County. 
❖ Emergency Coverage for or by other UTM’s are to last a maximum of 90 minutes. In the 
event Emergency Coverage will be required over the 90 minutes maximum, the Duty 
Manager/Shift Superintendent of the UTM needing coverage will be advised to notify the 
Duty Manager/Shift Superintendent of the responding UTM. 
❖ Standbys for another county or region are to provide the emergency coverage and do not 
change the CMEC status for the UTM requiring assistance. The standby resource should 
only be sent to Code 4s or Code 3s when the delayed response time has been exceeded. 


The four services have agreed to send their closest most available ambulance to the edge of their 
county to better serve their neighbour when a UTM/DDA is at zero ambulances. CACC should choose 
the Paramedic Service system that can best assist the UTM/DDA without causing CMEC for that 
Paramedic Service system.


OFFLOAD DELAY, END OF SHIFT/EXCESSIVE OVERTIME 

 

EXCESSIVE OVERTIME 

In cases where an inter facility transfer may result in the responding crew incurring more than three 
hours overtime, the Service may decide to delay the transfer. If (in the best judgment of the ACO) 
there is a strong possibility that the call may exceed the guideline, CACC will inform the sending 
facility at the time of call receipt and request that the sending facility contact the Superintendent / 
Manager on Call. 

 

OFF-LOAD DELAY 

An off-load delay is when an ambulance arrives at a hospital with a patient and their stretcher cannot 
be cleared within 20 minutes of arrival. The crew is to notify CACC when they are on an off-load delay 
along with the assigned CTAS Level. CACC will log pertinent off-load delay information for each call 
and provide same to this Service. 

 

VEHICLE READINESS 

Upon arrival at a hospital, crews will have 20 minutes to notify CACC and prepare their vehicle for 
reassignment. Failure to provide information within 20 minutes will deem the vehicle available for 
reassignment. 

 

Upon arrival at a destination that is not a hospital, unless a crew advises of extenuating 
circumstances (i.e. extended cleanup or disinfection) once the vehicle’s stretcher has been cleared 
the unit will be considered for response to another call. 

 

 

 

 


END OF SHIFT PROCEDURE 

All ambulances (Up staff, 12 or 24 hour units) will automatically be booked off and removed from the 
CAD at the end of their scheduled shift (or upon arrival at their destination) when the call has extended 
past the end of their shift time. On the 24hr cars the replacement crew must have signed on in an 
ambulance. Any variance from the end of shift policy requires the approval from the Manager On Call 
prior to call assignment with the exception of during an MCI that is or has the potential to exhaust 
available resources. For the purposes of safety, crews shall keep their radios on until they return to 
base. CACC to communicate a change in status to each crew. 

 

* Any crew EOS outside of the Lindsay CACC Catchment area will contact their Manager on Call. The 
Manager on Call will contact Lindsay CACC to request Lindsay CACC notify the controlling CACC to 
place the unit on EOS 

 

 

 

 

 

 

 

 

 

 

 

 

 


INCLEMENT WEATHER 

In cases where severe weather is active, the Shift Superintendent/Duty Manager may implement the 
Inclement Weather Protocol. The inclement weather protocol is as follows: 

➢ All non-urgent transfers (Code 1 and Code 2) will be delayed until the Shift Superintendent/Duty 
Manager lifts the Inclement Weather Protocol. 


 

➢ All prompt (Code 3) inter-facility transfers will be delayed until the Shift Superintendent/Duty 
Manager lifts the Inclement Weather Protocol or approves the transfer with CACC informing the 
sending facility of said delay at the time of booking. 


 

➢ Stanhope/Algonquin Highlands coverage will continue as the crews have a Fire Hall to take 
shelter in with a well maintained road for travel.. 


 


ADDENDUM A TIRED RESPONSE 

 

A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with 
the response reference chart, for the following emergency requests for service: 

1. Vital Signs Absent (VSA) 

2. Unconsciousness 

3. Airway Compromise (Airway Obstruction, Absence of Breathing) 

4. Chest Pain 

5. All Code 4 (Life Threatening Emergency) calls with Paramedic Services, ETA greater than 20 
min. 

6. All Motor Vehicle Collisions (MVC’s) with Paramedic Services, responding Code 4 

NOTES: 

• These criteria for medical tiered response are in addition to the usual incidents requiring Fire 
Services response under their fire suppression, rescue and/or Hazardous Materials Spills 
mandate where CACC notification of fire departments is automatic. 
• Once a tiered response has been initiated, it shall only be cancelled if the request for service is 
cancelled by the call originator and/or Paramedic resource(s) have arrived on scene and made 
patient contact. 
• Fire services will NOT be tiered to Long-Term Care Facilities, Correctional Facilities, and 
Hospitals. 


 


ADDENDUM B PATIENT DESTINATION AGREEMENTS 

 

STEMI BYPASS DIRECTIVE 

If patient meets STEMI Bypass Protocols then the unit can bypass the local hospital and proceed to 
the nearest STEMI center. 

ACUTE STROKE PROTOCOL 

All patients that meet the current Acute Stroke Protocol can bypass the closest facility and transport 
directly to the closest stroke facility: 

• Peterborough Regional Health 
• Lakeridge Health - Oshawa 
• Belleville General Hospital 
• Huntsville District Hospital 
• Royal Victoria Hospital - Barrie 


PATIENT PRIORITY SYSTEM FOR HALIBURTON COUNTY EMERGENCY DEPARTMENTS 

Criteria for Hospital Consideration Status (CTAS Level 3-5 Only) 

The decision by an ED to request “Consideration” will be triggered by situations where, due to lack of 
available resources, an ED faces a significant deviation from key patient care benchmarks, such as: 

• Time to initial triage 
• Resource constraints including; 
o Nursing or physician overload 
o ED equipment 
o Bed overload 





Criteria for Hospital Time Consideration Status (All CTAS Levels) 

The decision by an ED to request “Time Consideration” will be triggered by situations where, due to 
lack of available resources, an ED faces a situation where there is no physician on site 

 


PATIENT DISTRIBUTION PROCESS 

NORMAL STATUS 

1. CTAS Level 1 and 2 patients will be transported to the closest medical facility, regardless of 
municipality or residential address, with the exception of patients requiring essential medical 
services as outlined in Point 3 below. 
2. CTAS Level 3-5 patients will be transported to the nearest medical facility unless; 
a. There is extensive or relevant history at one facility or; 
b. Patient preference (Patient preference will not outweigh system needs.) 





 The patient may request and be transported to a specific County ED. 

The Paramedic, upon departing the scene will advise the Communications Officer (ACO) that 
the patient has met one of the criteria (2.a or b) and has requested the facility. If PPS criteria 
1 or 2 have not been met, the ACO will direct the Paramedic to the closest hospital that is in 
Normal Status regardless of distance. 

3. Ambulances will bypass local hospitals when transporting patients who meet current Acute 
Stroke Bypass Protocols and proceed directly to either Peterborough Regional Health Center 
or Huntsville Hospital as per current policies. 


 

CONSIDERATION STATUS 

1. CTAS Level 1 and 2 patients will be transported to the closest medical facility, regardless of 
municipality or residential address, with the exception of patients requiring essential medical 
services as outlined in Point 4 below. 
2. CTAS Level 3-5 patients will be transported to the alternate County ED if on NORMAL status 
3. CTAS Level 3-5 patients will be transported to the closest hospital if both County ED’s are 
on CONSIDERATION 
4. Ambulances will bypass local hospitals when transporting patients who meet current 
Acute Stroke Bypass Protocols (Appendix 2) and proceed directly to either 
Peterborough Regional Health Center or Huntsville Hospital as per current policies. 


TIME CONSIDERATION STATUS 

1. Ambulances transporting CTAS Level 1 or 2 patients will bypass the local facility that is on 
Time Consideration, and will proceed to the next closest hospital ED. 
2. CTAS Level 3-5 patients will be transported to the alternate County ED if on NORMAL status 
3. CTAS Level 3-5 patients will be transported to the closest hospital if both County ED’s are 
on CONSIDERATION 
4. Ambulances will bypass local hospitals when transporting patients who meet current 
Acute Stroke Bypass Protocols (Appendix 2) and proceed directly to either 
Peterborough Regional Health Center or Huntsville Hospital as per current policies. 



EXCEPTIONS TO THE AGREEMENT 

This Local Agreement does not apply to the following situations: 

• Inter-hospital transfers 
• In the event of a major disaster, relevant disaster plans will be followed. 
• In the event of a biological, chemical or nuclear incident all CTAS Level 1 patients will be 
taken to the closest appropriate medical facility having the equipment necessary to 
accommodate those affected patients. All CTAS Level 2-5 patients will be directed away 
from the contaminated site unless access is required for essential medical service. 


PROCESS 

1. The Emergency Physician in consultation with HHHS management will agree that the 
criteria for CONSIDERATION or TIME CONSIDERATION have been met. 
2. Lindsay Dispatch will be contacted and advised of the need for Consideration or Time 
Consideration and the reason(s). 
3. Lindsay Dispatch will notify the Manager on Call of the Hospital request for Consideration 
or Time Consideration 
4. The Emergency Room Charge Nurse in consultation with HHHS management will complete 
and sign a Consideration Request Report Form. The completed form will be faxed to Lindsay 
Dispatch who will notify the Manager on Call of Haliburton County Paramedic Service of the 
Hospital Consideration or Time Consideration Request. 
5. HHHS will conduct a regular review of the decision to remain on Consideration or Time 
Consideration. 
6. Lindsay Dispatch will be immediately notified by fax of any change to status including return 
to NORMAL status. 


 


CONSIDERATION REQUEST REPORT FORM 

O:\LOGOS\HCPS Logo.jpg
cornerlogo3 


 

EMERGENCY DEPARTMENT 

CONSIDERATION or TIME CONSIDERATION REQUEST 

 

Date: ______________ Time: _________ 

 

Location: Haliburton: ______ Minden: ____ 

REQUEST: 

Type of Request 

Time Implemented 

Time Terminated 

Consideration 

 

 

Time Consideration 

 

 



 

Authorization: 

Emergency Physician: ____________________________________ 

 Name 

 

Emergency Charge Nurse: ____________________________________ 

 Name 

 

HHHS Management: Notified: __________________________ __________ 

 Name Time 

 

Reason(s) for requesting Consideration or Time Consideration: 

 

Lindsay Dispatch FAX Number: 1-705-324-1679 

Activation Notice: Verbal: ________ FAX Copy time: __________ 

Termination Notice: Verbal: ________ FAX Copy time: _________ 





APPENDIX ‘C’: PARAMEDIC STATION REVIEWS 

The following reviews have been completed by Done Right Commercial Inspections, on behalf of 
Emergency Management Group inc. The three paramedic stations that were evaluated were: 

 

• Minden Hills – 12410 Highway 35 
• Tory Hill – 18721 Highway 118 
• Haliburton – 6 South Street 


 

Please see the accompanying attachments for the applicable evaluations.