Despite 20 years of issues, Peel paramedics are still being dispatched using a flawed system 

For almost 20 years, issues with the Mississauga Central Ambulance Communication Centre (CACC) have persisted, impacting response times and creating unnecessary delays to providing critical services. 

The Ministry of Health (MOH), which operates the facility, has failed to address the problems plaguing the facility despite ongoing advocacy from the Region of Peel. 

These issues are detailed in a staff report that went before regional councillors on February 22. Regional Chair Nando Iannicca, on behalf of Regional Council,  has since been tasked with writing to the Minister of Health—Dufferin-Caledon MPP Sylvia Jones— to flag concerns with the persistent performance challenges at the CACC. 

Council also ordered staff to coordinate with the Regional Municipality of Halton, which shares the facility, to come up with ways to address performance issues. One option being considered is a request to shift control over operating the facility from the MOH down to Peel Regional Paramedics Services.

“Despite advocacy efforts, the Ministry has neither indicated any plans to move forward with addressing these issues nor shared any insights or directions from its EHS Modernization consultations conducted shortly before the COVID-19 pandemic,” the staff report states. 

The MOH directly operates the facility which coordinates and deploys emergency services in Peel. The report states the existing model “limits Paramedic Services’ ability to further explore upstream approaches to healthcare, including opportunities to implement a secondary triage model to enhance efficiency and effectiveness of ambulance dispatch.” Change is needed to bring the Region forward, it says. 

Peel’s paramedic service has been very open about the significance of finding new ways to deliver healthcare within the growing region. Modern, streamlined approaches are necessary to deliver services to a growing community in a variety of housing options. As Peel intensifies, delivering paramedicine to residents in high-rise buildings will become commonplace compared to the usual response within Brampton and Mississauga sprawling subdivisions. 

Of the many concerns pertaining to operation of its CACC, delayed response times for low acuity calls is top of the list. Low acuity calls generally pertain to injuries or illnesses that are less severe and non-life threatening, and do not require as much urgency. Minor burns and fractures, or headaches and sore throats, are examples. 

According to the report, in several instances ambulance communications officers “inappropriately held low acuity calls when resources were available,” something that does not comply with MOH policy. This has led to unncessary delays in responding to these calls.

Peel residents served out of this poorly operated facility have not been silent about it. 

“Though we are seeing an improvement in response times for our most critical patients under the [Medical Priority Dispatch System] model, ongoing performance issues at the Mississauga CACC have resulted in delayed responses and complaints from members of the public,” the report states. 

The Region has been raising these concerns with the Province for close to two decades. But nothing has changed. 

The Province completed a “Health Services Modernization” review in March 2020, but the Region is not aware of the findings of that consultation or whether it recommended any changes to the current dispatch model. 

These and many other issues have made it difficult for Peel Paramedics to respond to the growing number of calls. Inadequate staffing levels are putting pressure on the local system, made worse by chronic underfunding in Peel which has historically received less per capita for such services compared to other municipalities. Peel Paramedics has long needed sufficient funding from Queen’s Park to help it meet demand of its growing population, struggling to navigate the strained collective healthcare system. In 2019, a projected $4.9 million cut by the PC government threatened to remove 39,000 paramedic hours from the Region of Peel. 

As the Region of Peel has grown, the number of calls coming in to Peel paramedics has consistently increased year over year.

(Region of Peel)

The Pointer asked the MOH if it will support the Region of Peel Paramedic Services’ intentions to potentially take over operations at the Mississauga CACC. The MOH was also asked why it has not addressed the issues the Region of Peel has advocated for over the last 20 years, including paramedic offload delays, increased pressure on paramedic resources and the negative impact on public confidence in emergency health services.

In response, a spokesperson from the Ministry of Health stated that “[a]ny change to leadership and operation of Peel Region’s CACC would require a proposal to be submitted to the Ministry of Health,” and that it “is not in receipt of any proposal regarding a change in leadership and operation of Peel Region’s CACC.”

“Our government’s four-part strategy to tackle ambulance offload times is focused on improving patient flow in hospital, reducing ambulance offload time, and avoiding unnecessary trips to emergency departments. We continue to work with hospitals and paramedic services across the province to reduce their offload times,” the spokesperson stated in an emailed response.  “Our government has also rolled out the Medical Priority Dispatch System (MPDS) at the Peel Region’s CACC. They are one of the 5 CACC’s, province wide, that uses the…(MPDS). This system is the international industry standard for ambulance dispatch, used in over 3,000 jurisdictions globally, to triage emergency medical calls and dispatch paramedics to send the right resources to the right location, at the right time, ensuring urgent patients receive critical care.” 

The Pointer asked the Region of Peel why it has not submitted a proposal for a change to the leadership and operation of its CACC to the Ministry of Health and to confirm if it plans to do so. 

Paramedic Chief Brian Gibson told The Pointer that with Regional Council’s endorsement, “we will begin to explore options with the Ministry of Health – including potential changes in governance, oversight, and operations of the Mississauga CACC.” He stated that because the work is still “in the earliest stage…we cannot confirm that we will submit a proposal nor do we have a timeline.”

The Regional report details how in 2019, Peel Paramedics and colleagues at Halton Region were directed to explore “alternate dispatch models” and opportunities for enhanced efficiency. They reviewed other jurisdictions for their ambulance communications and dispatch and found that the “integration of ambulance communications and dispatch within paramedic services created additional capacity and cost-efficiencies.” Direct oversight and accountability by the municipalities themselves were critical to success, they concluded. 

Ottawa Paramedic Service, Niagara EMS and Toronto Paramedic Services all operate their own ambulance communications and dispatch directly, which the report states increases “capacity to respond and allocate resources efficiently and effectively in real time.” It highlights how the model is funded entirely by the Ministry and states “[i]ntegration also enables paramedic services to develop innovative upstream approaches to healthcare that meet the evolving needs of residents.” 

It also highlights how Niagara EMS has specialized teams of paramedics to respond to its 911 calls for mental health, addictions and overdose related calls, allowing it to deliver “enhanced paramedic care on-scene, direction to community supports and follow-up.” The municipality also has a Registered Nurse-support secondary triage program within their CACC that assesses low acuity calls. 

“Initiatives such as these are crucial in reducing the relentless strain of call volume and offload delay and are only possible with enabling systems in place, including accountability mechanisms that align structure and function,” the report states. 

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