Paramedic Services

Paramedic Services is a service that provides emergency care to stabilize a patient’s condition, initiates rapid transport to hospitals, and facilitates emergency transfers between hospitals. Paramedic Services also provides a community paramedicine service which provides in-home assessments, referrals, treatment, and support to patients to meet their goals of care to prevent 911 calls and hospital admissions. The community paramedicine program is currently temporary in nature as such assets under this program are not planned for replacement and excluded from this plan. Given the nature of paramedic services, it is critical that the assets in this portfolio are well managed and risks to service delivery are minimized.

This portfolio is categorized into four components, because of differing life spans and maintenance strategies. They are stations, which include the related furniture and fixtures, equipment (including equipment that may be installed in ambulances), ambulances, and other fleet utilized to provide the service.

Inventory

As part of the annual budget process, Paramedic Services obtains current replacement costs for its equipment and fleet assets. If an updated replacement cost is not available, inflated historical costs are used. As other fleet are due for replacement, they are anticipated to be converted to lower carbon emissions through alternative fuels and energy efficiency in support of the County’s 100% renewable goal. As such, the replacement costs are based on cost of replacement with an eco-friendlier model. These vehicle types are still relatively new to the industry and replacement costs will continue to fluctuate over the next several years. A lower carbon option is not currently available for ambulance replacements.

Condition

The percentage of assets in poor or critical condition has decreased from 19% as reported in the 2024 AMP to 16%. The percentage of assets in good or excellent condition has decreased from 56% as reported in the 2024 AMP to 55%. 

New ambulance delivery times have significantly increased because of the pandemic and have yet to return to prepandemic delivery times. The longer delivery times result in fleet remaining in service longer than originally anticipated, resulting in lower average condition ratings. As a mitigation measure, ambulances are now being ordered earlier to time delivery with anticipated replacement needs, which will lead to improved ambulance condition ratings.

Key Performance

Paramedic Services long-term asset needs are based on achieving response times as set out in the annual Land Ambulance Response Time Performance Plan, which is benchmarked for consistency with other municipal plans.

Proposed Levels of Service Review

Information on the scenarios reviewed is contained within the AMP document. As the reserve balance and proposed funding are sufficient to fund the short-term lifecycle needs, the average anticipated condition of the portfolio is the same under all scenarios for approximately 10 years.

Risk mitigation measures are similar across all scenarios. Evolving work environments, such as work from home, naturally allow for this type of environment to be used more extensively in the event of failure, or to complete more extensive lifecycle needs. This mitigation measure would only be available for some administrative staff due to the nature of the service and would not be ideal in the long term as it would result in additional strain on the services provided by Information Technology. Impacts may potentially be mitigated using alternate space on a temporary basis, either County owned, or non-County owned at a cost. Consideration needs to be given to service continuity and meeting response times when determining alternate space options. Debenture funding would be a likely source of funding when an entire facility replacement is the most effective lifecycle strategy.

Based on the analysis, staff are recommending Scenario D, the proposed level of service target is to achieve 80% funding for this portfolio. It is important to achieve a higher funding level to manage this portfolio, as adherence to ministry regulations, including asset useful lives, and meeting response times demand lower risk and higher quality assets. Staff identified an improvement area to review lifecycle strategies for various facility components as it may be beneficial in the long-term to not anticipate a run-to-failure strategy for some assets. Once incorporated this may result in reductions to the annual investment required. Through the 2025 budget survey nearly 93% of respondents indicated that the service levels related to paramedic services should be maintained or enhanced.

Funding Gap Analysis

Planned Investment Level
An estimated inflationary rate is used in the table below in both the required investment and planned investment figures. Fluctuations in the anticipated reserve balance resulting from annual contributions and anticipated annual expenditures result in changes to the interest contribution.

Proposed Investment Change
In addition to the planned investment level changes, an increase in the contribution to the Paramedic Services - Capital reserve of approximately 1% annually is proposed to commence in 2028, increase to 2% in 2030 and continue through 2035. This is reflective of the need for additional contributions to the reserve to support growth assets as they are put into service.

Comparison of required investment to proposed investment (millions)