#	Recommendation	Management Response	Est Comp Date	Status Updates (In Progress; Pending; Complete; Requires Resolution)
1	That the City of Ottawa develop an intergovernmental advocacy strategy for major system reform that focuses on securing control over the necessary components of a high performance EMS system.	Management agrees with this recommendation. Ottawa Paramedic Service will develop an intergovernmental advocacy strategy as part of the strategic branch review exercise in 2009.	Q4 2009	December 2009: In Progress. There is a new contract in place for Ottawa CACC between City of Ottawa and MOHLTC. The intergovernmental advocacy strategy is being developed as part of the Ottawa Paramedic Services Master Plan which will be completed at the end of Q1 2010.
2	That the Paramedic Service performance measurement and reporting framework, upcoming strategic branch review exercise and existing service planning process be focused on the management of risk events and performance erosion trends identified in this audit’s 2001-07 land ambulance system performance overview.	Management agrees with this recommendation. The Paramedic Service performance measurement and reporting framework, upcoming 2009 strategic branch review exercise and existing service planning process will be focused on the management of risk events and performance erosion trends identified in this audit’s 2001-07 land ambulance system performance overview.	Q4 2009	December 2009: In Progress. The performance measurement and reporting framework, which consists of monthly & quarterly monitoring of key performance indicators (KPIs) by senior management team, has been focussed on the management of risk events and performance erosion trends, as evidenced by quarterly performance reports to Council, and monthly & quarterly monitoring of key performance indicators (KPIs) by OPS’s senior management team. The strategic branch review, now known as the Ottawa Paramedic Services Master Plan will be completed at the end of Q1 2010. The existing service planning process focussed on the management of risk events and performance erosion trends, as evidenced by the 2008 Annual Report/2009 Trends report presented to CPS Committee October 15, 2009.
4	That, once AMPDS is in place, the City pursue a centre of excellence designation to emulate best practices from across North America, including Niagara and Toronto.	Management agrees with this recommendation. Timelines and funding to pursue this designation are dependent upon negotiations with the Ministry of Health and Long-Term Care.		December 2009: Pending. There is no commitment from MOHTLC to approve implementation of AMPDS in OCACC. However, upon future approval for Ottawa to become an evaluation site, the City would pursue a centre of excellence designation.
6 6	That the measurement of patient offload delays be refined to include a “patient transfer to emergency triage nurse” time log in order to correct for potential overestimation of offload duration.	Management agrees with this recommendation. Currently the data is captured in the hospital’s Emergency Department Reporting Systems (EDRS). The proposed new provincial Ambulance Call Report will include a “transfer of care” time, which will support this recommendation.		December 2009: Pending. Awaiting an MOHTLC announcement regarding new documentation standards. Anticipated implementation is Q3 2010.
10	That the Ottawa Paramedic Service bring forward a long-term master plan and budget for additional staffing and resources required to service growth.	Management agrees with this recommendation. An external consultant will be engaged to develop a long-term master plan and budget for additional staffing and resources required to service growth. Ottawa Paramedic Service has already initiated this process (see Paramedic Trends Report ACS2008-CPS-OPS-0003 received by CPS Committee at its meeting of October 16, 2008), which includes a three-year staffing plan to be incorporated into the branch’s 2009, 2010 and 2011 budgets.		December 2009: In Progress. An external consultant, Performance Concepts Consulting Inc., has been engaged. The Ottawa Paramedic Services Master Plan will be completed by the end of Q1 2010.
16	That the Chief of the Paramedic Service develop a contingency plan to address this critical unit availability shortfall on an immediate basis.	Management agrees with this recommendation. Operational processes are currently in place and will be put into a policy framework by Q4 2008.	Q4 2008	December 2009: In Progress. At present, the Deployment Plan identifies mitigation strategies for critical levels. A best practice review & Deployment Plan revision is underway. Timeline for completion is Q2 2010.
17 17	That the Chief of the Paramedic Service report quarterly to Council on the incidence of critical resource levels and their associated next call 90th percentile response times.	Management agrees with this recommendation. Ottawa Paramedic Service does not currently have the reporting technology necessary to implement this recommendation. The branch will solicit the Ministry of Health to assist with the acquisition of reporting technology to be able to report on critical resource levels.		December 2009: Requires Resolution. Management agrees that it would be ideal to report quarterly to Council on the incidence of critical resource levels and their associated next call 90th percentile response times; however reporting limitations will not allow this recommendation to be implemented. The Province has acknowledged the reporting limitations that exist within the Computer Aided Dispatch (CAD). Reference document: ARIS Replacement Project: Evaluation of the SSM Plan CAD Module Pilot at Ottawa CACC v1.4 Pg. 12 “the current configuration of VisiCAD ARIS II does not include the ability to automatically trigger a notification …when certain SSM Levels are reached. Dispatch staff must manually initiate a message to be sent…but this notification is often delayed (as staff are busy) or gets forgotten. Ottawa CACC management recommend that automatic notification …be addressed” Pg. 13 “…VisiCAD does not contain any specific reports or reporting capability for SSM Plans or for reporting on deployment plan status or compliance. …” In a subsequent email from the ARIS 2 Project Manager, when asked to run a critical levels report for us, responded “…It was made clear when we implemented the pilot of SSM at Ottawa that what you saw was what you were getting in terms of functionality (or lack thereof) and although the lack of reporting capabilities was identified as an issue in the Pilot Review Report, we are not in a position to provide resources to fill that void.”
19	That the Ottawa Paramedic Service track and annually report the identified complete portfolio of performance measures set out in this audit.	Management agrees with this recommendation. Ottawa Paramedic Service will review the portfolio of performance measures set out in this audit for inclusion in future annual reports as part of the strategic branch review exercise scheduled for 2009.	Q4 2009	December 2009: In Progress. The portfolio of performance measures set out in the audit has been reviewed and will be considered for inclusion in future annual reports. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
20	That the Ottawa Paramedic Service include “scheduled unit counts versus actually deployed unit counts” performance data in its annual performance report to Committee/Council.	Management agrees with this recommendation. Ottawa Paramedic Service will review the portfolio of performance measures set out in this audit for inclusion in future annual reports as part of the strategic branch review exercise scheduled for 2009.	Q4 2009	December 2009: In Progress. The scheduled unit counts versus actual deployed unit counts performance data has been reviewed and will be considered for inclusion in future annual reports. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
21	That the Ottawa Paramedic Service establish ongoing performance targets in its operational planning using “scheduled unit counts versus actually deployed unit counts”.	Management agrees with this recommendation. Ottawa Paramedic Service will review the portfolio of performance measures set out in this audit for inclusion in future annual reports as part of the strategic branch review exercise scheduled for 2009.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
22	That the Ottawa Paramedic Service establish a target range for its key productivity ratio in the high-density system (calls per paramedic).	Management agrees with this recommendation. Calls per paramedic ratios will be discussed as part of the strategic branch review exercise scheduled for 2009 and will also be included in the scope of work being done by the consultant in developing a long-term master plan and budget as indicated in recommendation 10. This work is expected to be complete by Q4 2009.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
23	That the “calls per paramedic ratio” trend in Ottawa (and external peer ratios) be regularly reported and integrated into the recommended master planning framework and the upcoming branch strategic branch review.	Management agrees with this recommendation. Calls per paramedic ratios and external peer ratios will be discussed as part of the strategic branch review exercise scheduled for 2009 and will also be included in the scope of work being done by the consultant in developing a long-term master plan and budget as indicated in recommendation 10. This work is expected to be complete by Q4 2009.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
25	That the Ottawa Paramedic Service conduct an Advanced Care Paramedic (ACP) needs analysis before the end of quarter one 2009.	Management agrees with this recommendation. An ACP needs analysis will be conducted by Q1 2009.	Q1 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
26	That the Ottawa Paramedic Service refine and develop annual ACP capture targets based on patient transports as part of the annual business planning and reporting cycle.	Management agrees with this recommendation. Ottawa Paramedic Service will refine and develop annual ACP capture targets as part of the strategic branch review exercise scheduled for 2009 for inclusion in future annual reports.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
27 27	That the Ottawa Paramedic Service develop a deployment policy that would see ACP resources responding only to Code 4 calls, similar to their policy for Paramedic Rapid Response (PRU) response priorities.	Management disagrees with this recommendation. Present staffing precludes this recommendation from being implemented at this time. A change in legislation and the acquisition of a better dispatching tool (AMPDS) would be required for the branch to support and implement this recommendation. Current legislation requires that the closest ambulance be sent to any life-threatening call; therefore, the choice of an ACP resource being sent versus a PCP resource could not be accomplished without legislative change. With the acquisition of AMPDS and appropriate resourcing, the principle could be applied by sending a second unit with ACP after the closest unit is sent. Operationally, the first unit would then clear and be available for another call. This cannot be accomplished in a service that is always at critical levels of availability.		December 2009: Requires Resolution.
30	That the Ottawa Paramedic Service prepare a business case demonstrating the return on investment (ROI) and expected utilization associated with planned facility/base construction in the City capital plan.	Management agrees with this recommendation. An external consultant will be engaged to develop a long-term master plan for the Ottawa Paramedic Service and the scope of work will also include the preparation of a business case demonstrating ROI. This work is expected to be complete by Q4 2009.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
31	That the Ottawa Paramedic Service collaborate with public health and other stakeholders to research and develop a service demand-forecasting model that incorporates aging society impacts on call frequency, duration and acuity.	Management agrees with this recommendation. An external consultant will be engaged to develop a long-term master plan for the Ottawa Paramedic Service and the scope of work will also include the research and development of a forecasting model that incorporates the impact of an aging society on call frequency, duration and acuity. Work is expected to be complete by Q4 2009.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
32	That the annual paramedic growth staffing enhancements include proportional adjustments in support services staffing.	Management agrees with this recommendation. Ottawa Paramedic Service presently undertakes to include proportional adjustments in support service staffing when front-line paramedics are hired and will continue to review such staffing enhancements in future. Improvements to growth staffing enhancements will be reviewed as part of the strategic branch review exercise scheduled for 2009.	Q4 2009	December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
33	That the Ottawa Paramedic Service provide an annual system planning resourcing business case (i.e. reflecting the modeled required resource capacity) as part of the annual city budget process.	Management agrees with this recommendation. An external consultant will be engaged to develop a long-term master plan and budget for the Ottawa Paramedic Service. The scope of work will also include the development of an annual system planning resource business case. Ottawa Paramedic Service has already initiated some of this work (as indicated previously - see Paramedic Trends report), which includes a three-year staffing plan to be incorporated into the branch’s 2009, 2010 and 2011 budgets.		December 2009: In Progress. This has been incorporated into the scope of the Ottawa Paramedic Service Master Plan, which will be completed by the end of Q1 2010.
34	That quarterly and annual financial reporting integrate expenditure data with actual deployed units of service for the same period.	Management agrees with this recommendation. Ottawa Paramedic Service will review the integration of expenditure data with actual deployed units of service in quarterly and annual financial reporting as part of the strategic branch review exercise scheduled for 2009.	Q4 2009	December 2009: In Progress. Discussion with the FSU is in progress. Estimated date of completion is Q2 2010.