City vs. County: The rising cost of ambulance service

CBC Windsor's City vs. County is a series looking at the state of the relationship between the City of Windsor and the municipalities that make up Essex County.

The annual budget of Essex-Windsor EMS has more than doubled since it was first formed in 2001.

The ambulance service is run by Essex County, but serves the City of Windsor as well.

• County vs. City: Tensions still high between Windsor, Essex

The gross budget for Essex-Windsor EMS in 2001 was $14.9 million. It's more than doubled since then, coming in at $38.2 million in 2016.

There are many explanations for the sharp increase, according to Brian Gregg, the county's chief administrative officer. Many of them related to a substantial rise in the number of calls for emergent and life-threatening situations. People are also staying home as they age, meaning their illnesses become more severe as time passes, he said.

There were 31,000 of those calls in 2001, compared to 53,000 in 2015. That's a 70-per-cent increase.

Gregg says EMS has responded to the higher demand by increasing staffing hours and putting more ambulances on the road.

That, in turn, has led to rising costs for fuel, vehicle maintenance and medical supplies.

Reasons for rising cost:

• Staffing hours added to respond to increased call volumes.
• Additional ambulances acquired to be "on the street" to respond to additional call volume.
• Increased repairs and maintenance for ambulances, reflective of additional kilometres driven responding to increase number of calls.
• Increased fuel costs, both the quantity used and price increases.
• Increased volume and out-of-town transfers to cities like London, Hamilton, Toronto and Detroit for services not able to be delivered locally.
• Increased consumable medical supplies used in responding to increased call volumes.
• Increased capital costs for newly constructed and additional bases.
• Additional capital and operating costs for implementing GPS tracking of vehicles, electronic ambulance call reports.
• More frequent cycling of ambulances due to more kilometres and shorter life spans of the vehicles.
• Acquisition of capital for equipment, such as stretchers, stretcher lifts, stair lifts, etc., some of which reduce physical strain on paramedics.

Gregg said there are several reasons for the large increase in call volumes, including:

• General aging demographic in the region.
• Lack of long term care beds in the community and therefore people remaining in their homes longer.
• The effect of "age at home" strategy. As people remain in home longer, when they do get ill, they are inclined to be more ill and they tend to be more susceptible to injuries such as falls, breaks, cuts, scrapes, burns, etc.

How the county took over EMS

The Conservative provincial government of Mike Harris downloaded the responsibility for ambulance service to the municipal level. Prior to that, the province was responsible for the service.

The city and county each submitted applications to manage EMS.

In 1999, the fire chief in Windsor at the time, Dave Fields, proposed housing ambulances in fire halls.

But the province chose the county's submission and, after toying with an appeal, former Windsor Mayor Mike Hurst announced in March 2000 that the city would stop fighting.

Essex-Windsor EMS was formed on Jan. 1, 2001.

By 2009, it had completed process of taking over four existing ambulance services: the provincially-run service based in Windsor, privately-run operations in Leamington and Harrow, and a volunteer service in Amherstburg.

Gregg said "comparing the 2001 service levels to 2016 service levels is not comparing apples to apples."

One other factor contributing to the increase in the gross budget is the increase in paramedic wage rates, he said.

When Essex County assumed service delivery, paramedics rates were about $20/hr.

"These rates were recognized as being rather low. Pay equity adjustments and a series of arbitration awards have resulted in current rates of $39.76 for primary care paramedics and $40.14 for advanced care paramedics," he said. "Wages and benefits are a significant component of gross costs."

Challenges of coming together

Gregg started his job as county CAO in 1999, so he was there to see the whole process through, and admits there were challenges in the early days.

"Just being able to merge the cultures I think was as difficult as anything else, because now we had folks that may have at one time worked in the county now having to work in the city and vice versa, getting used to the different areas," he said.

With so much to hash out, Gregg says some changes to operations were needed.

"I think there was some pent-up frustrations and some pent-up service response issues with respect to the way it was realigned to us. So we've added service hours. We've added equipment. We've added bases that will allow our ambulances to have better response times," he said.

Despite the increases in costs, Gregg believes the county and city are both served more effectively now.

"I think everything being under one roof certainly allows us that consolidation," he said.

The service has been able to consolidate things like training, equipment purchases and staffing across the entire region.

"Having one region-wide system really allowed us that flexibility to be able to cope and respond as the service demands require," Gregg said.