Council Orientation and Education Workshop

0:10All right, everybody, I'm going to call the meeting to order.

2:11And this is awesome. Thank you for everybody being here.

2:17I all of a sudden feel a little bit like I knew what the past mayors of Toronto felt like with that was huge councils.

2:26So I really, really appreciate everyone being here. Councillor Billings is on the screen there and just something came up and she really wanted to be here, but she couldn't be here, but she's waving on the screen to us there.

2:39So thank you for joining us online and I believe I have regrets from Councillor Gibson, unfortunately for today as well. But other than that, here we all are and this is awesome.

2:51And thank you so much to all the behind the scenes staff for putting this together for us all. I think we're kind of banking on sort of a two hour, you know, sit down session discussion, just so we can kind of keep each other accountable for time and how many people are asking questions and going around the room and whatnot.

3:10So just keep that in mind. And I do want to just quickly, and I'm going to say it again quickly, go around the room. If you could just just say who you are and where you're from, maybe that would be great because we have sort of counsellor but not like, okay, from where, right?

3:26So it'd be kind of nice to do that. I'll start with the warden here on my right and we'll do the circle here and back to me at the end and then we'll kick things off.

3:36Go ahead. Oh, and yeah, sorry, I was asked the microphone and some of the wealth counsellors can kind of show how it works. Obviously, it's just one button on and one button off.

3:48Hopefully, I didn't mess up those those instructions. So yeah, I'll start right there with you, Warden.

3:56Thank you, Worship. Delighted to be here today. I'm Andy Lennox. I'm the warden of Wellington County and I also play another role in that I'm the mayor of Wellington North at the north end of the county. So glad to be here.

4:10Scott Wilson, County CAO.

4:15I am Jeff Duncan. I'm a county councillor for the town of Aaron. So that's at the far east end of the county and then the chair of the county's economic development committee.

4:23Sean Waters. I'm a county councillor but also the mayor of Centre Wellington and for those folks who don't know where Centre Wellington is, Fergusellora area. So.

4:36I'm Erin Caighton. I am the Ward 1 City councillor and Guelph.

4:39Good afternoon everybody. It's Greg Davidson, mayor of the township of Mapleton. That's Drayton and Moorfield area and a little bit of Alma just a little bit north of Sean Waters area.

4:54Hello everyone. Rodrigo Gholder, Ward 2 City councillor, which includes downtown here in Guelph.

5:00Chris White, mayor of Guelph-Faramosa and you'll know where that is because you've annexed half the township in the last 100 years.

5:06Phil Alt, councillor, Ward 3 Guelph which is the exhibition park, Willow Road area. We're going to annex the rest of Aramasa pretty soon.

5:24I'm councillor Doug Breen, Ward 8 which is also basically Guelph-Faramosa Highway 6 around to Rockwood, Eden Mills, that part of the county.

5:31Before that I was in Guelph-Faramosa township so yeah you've annexed a bunch of our area for sure and I'll fight you for the rest.

5:40Mary Lloyd, I'm a councillor for Centre Wellington on the north side of the river that includes Alora and Fergus and I'm also the chair of information heritage and seniors with the county.

5:51Hi everybody. I'm Ken Yichu, Ward 6 City councillor. Everything south the court rate towards Maltby and we apologize Chris.

6:04I'm Dominique Roark, Ward 6 with councillor Chu here and we are neighbours to our friends in Puslinch.

6:16I'm Diane Ballentine, Ward 6 County Council Centre Wellington south of the Grand River from Inverhaught-Bellwood.

6:24Kathy Downer, Ward 5 City councillor which is, encompasses the university, Stone Road Mall up to Courtright and I was actually on council only annexed half of Puslin.

6:36Hi I'm councillor Matthew Bulmer, County Ward 7 which includes the remnants of Puslinch township and the west side of Guelph-Faramosa so along the south end of Guelph and around the west side of Guelph all the way up to Eris on the west side.

6:59I'm Linda Pousatil, I'm a Ward 4 City councillor so that's the good part of Guelph, the west end, west side of the Hanlon and we dynamics here.

7:07David Anderson, I'm from Ward 1 in the County of Wellington which is the town of Minto.

7:14So Ward 1 means that's where the best of the county starts and then it sort of goes down from there to the bottom so I will always tell my fellow county councillors that.

7:22I also chair social services for the County of Wellington.

7:27Michelle Richardson, City of Guelph, Ward 3 councillor with councillor Alte over there.

7:34James Sealy, Wellington County councillor.

7:37I am also chair of planning, not finding the annexation jokes funny.

7:42I'm also the chair of TAPMO for the top aggregate producing the supplies of Ontario.

7:49Hi there, Carly Clason, City councillor for Ward 2 and Guelph alongside of Rodrigo Gowler.

7:55Michael Dane, Mayor of the Town of Aaron County councillor.

8:01Dave Turton, Mayor of the Town of Minto and County councillor.

8:06Good afternoon, Scott Turton, CAO with the City of Guelph and welcome.

8:10Awesome and waving on the screen for us actually is councillor Downer.

8:16I'm sorry councillor Gibson as well.

8:19So thank you for joining us then that's Ward 1 with Aaron Aaron Aaron and then Billings is a Ward 4 with Linda in the West End as well.

8:30And I'm sorry I mentioned Councillor Cron.

8:32She actually may be jumping on so she just isn't a little bit of a bind but she may you may see her pop line.

8:39Before we continue I just want to mention this, this old thing.

8:44This was a gift from the county and I just see it on here says 1993 presented by Warden Robert Wilson on behalf of the Wellington County Council.

8:58And in my nine years as mayor I've only used it once and I forgot that it was called a gavel when I used it.

9:04I called it Thor's Thunder Hammer or whatever and yeah it was only one unruly time and I remember asking Stephen or clerk there like give me the gavel or the thunder bolt or whatever, the thunder hammer.

9:17So it's still in good shape and I was told that I think in your chambers I think is maybe a podium that actually came from us.

9:26Is that right? Yeah, to you.

9:27So kind of a neat little thing there.

9:29So we love this.

9:32This is great to be together relationship wise and educational wise.

9:36And I'm looking forward to the discussion and it's going to be a great presentation now from staff.

9:41So I'll call up Colleen Clark or a clock bush or deputy CAO for public services.

9:48And we'll just flow it from there.

9:52And oh I'm sorry I'm getting a reminder.

9:55I've got to remember it's a meeting.

9:57Is there any disclosure of pecuniary interest or any general nature thereof for the item in front of us today.

10:03Hearing and seeing nine and I'll turn it over to Colleen. Go ahead.

10:08Good afternoon. Thank you Mayor Guthrie.

10:11As the mayor said I'm Colleen Clark Bush and then I'm the deputy CAO here at the city of Guelph responsible for public services, which means that I have the great privilege of having the paramedic services team within my service area.

10:22And so thank you for meeting with us this afternoon. This is very monumental. I was saying to Chief Dewar it feels like we've been working toward this moment for absolutely I don't know months if not longer.

10:34And so it's really exciting for us to be here this afternoon. And I'd like to thank the warden and the mayor for agreeing to this joint meeting.

10:40And I really want to give a particular thanks to the teams in our city clerk's office who with great enthusiasm agreed to host this joint meeting and helped us figure out the logistics for this afternoon.

10:53So thank you to those teams, several of whom are sitting here in the middle and I know others are supporting in the background.

10:59So our goal for this afternoon is really to make sure that we're all working from the same shared set of information.

11:05Our objectives for today we want to provide a review of the history and the operations of the Guelph Wellington paramedic service, which is a service provided by the city of Guelph, but to our collective area and serving the communities of Guelph and the entire Wellington County.

11:19We want to take a few moments to celebrate the incredible successes of this team and to talk about the great work that they've been doing.

11:25But we also want to talk this afternoon and highlight some of the issues that are affecting our ability to provide this service efficiently and effectively to our communities.

11:34And we want to look forward to how and talk with you about how the two councils can work to support and assist us in moving the service forward in the coming months and years.

11:43So we're going to ask if you hold questions until the end of the presentation, just sort of keep track of any questions you may have, because we've got a significant amount of information that we're going to share with you in about the next 40 minutes.

11:55So we're going to take a few moments to celebrate the presentation and then we're going to stop talking and we'll turn it over for questions. We have a number of staff here who are available to answer your questions.

12:05But with that I am going to stop talking and introduce Stephen Dewar, who is the general manager of paramedic services here for the city of Guelph and the chief of Guelph Wellington paramedic service and let him kick things off.

12:17Thanks Colleen and welcome.

12:20Again, as Colleen said, we're here today to provide you with a review and an update of our service.

12:25And there are two areas that we're going to ask for your or highlight the fact that we need some assistance with. So I'll get to those as we go.

12:37Before I get there though, I know there it is.

12:41Before I get there, I wanted to review a little bit of our history and how our service came to be where it is.

12:49Prior to 2000 paramedic services in Ontario were provided by the provincial Ministry of Health.

12:56In some areas, the province provided those services directly, but in many areas, including Guelph and Wellington County, the services were contracted to a third party provider.

13:07In our case, that was Royal City Ambulance.

13:09They provided and operated the service under a license with the province and they were subject to the compliance with the Ambulance Act and regulations.

13:16And then the province changed how paramedic services were provided and in the year 2000, responsibility for providing services was transferred to the upper tier municipalities.

13:28Under the new arrangement, which continues today, paramedic services in Ontario are managed by municipalities under license and again, subject to the terms of the Ambulance Act and under the scrutiny of the Ministry of Health,

13:40we need to follow all of the regulations and comply with all of the Ambulance Act, but basically run the service.

13:50The province under this arrangement provides an annual grant equal to 50% of the services previous years operating budget, which specifically I specified operating budget because that includes lease payments, not capital investment.

14:07There is some depreciation, which our finance people can get into a little bit later, but that becomes significant when we talk about stations.

14:17So, given the relatively unique relationship between the City of Guelph and the County of Wellington, there was some debate about who paramedic service provider would be in our area.

14:35And it was eventually determined that the city would provide the service and the municipal share of cost for the service would be split between the city and the county based on the percentage of calls that occur in our area.

14:47That percentage has varied slightly from approximately 60% in the calls in Guelph and 40% in the county.

14:54And in 2022, the ratio was 63% of calls in Guelph, 37% in the county and resulting in costs being shared approximately 50% by the province and that's 50% of the 2021 budget.

15:08And then leaving 31.5% for the city and 18.5% for the county.

15:18The City of Guelph initially contract continued to operate the service under contract to Royal City Ambulance until 2009 when the city elected to bring the service in house, we're relatively new addition to the city.

15:31Guelph Wellington was eventually renamed Guelph Wellington paramedic service to better reflect the services that we provide.

15:39The service was initially added under the Guelph Fire Department's management team and the existing paramedic stations, resources and infrastructure were carried over from those used by the previous service provider.

15:50The city did include the paramedic service in the plans for the Claire Road Emergency Service Center that was under development at the time and our headquarters and administrative functions are housed there.

16:03But most of the other paramedic stations remained and still remained least spaces that were not established based on the needs and efficiency of the service and more on the availability of space at the time that a station was being established.

16:17The city council has recently received a report outlining the findings of a consultant looking into facility needs of paramedic service and will elaborate a little bit more on those issues in this presentation.

16:28In 2016, the city brought in a consultant, O-R-H, to assess future needs and develop a business plan for the service.

16:40O-R-H used some sophisticated computer modeling and they considered proposed and approved developments and growth in both the city and the county in determining the future needs of our service.

16:51The resulting report included a prediction of increased call volumes through at least 2026 consistent with increases experienced by paramedic services in Ontario and internationally.

17:02They predicted that the services call volume would increase by as much as 43% over that 10-year period.

17:09The consultant's report included some recommendations for growth to match the increased demands and from that report, a business plan was established to incrementally increase paramedic staffing to address those demands.

17:22By increasing the staffing incrementally, that allowed us the opportunity to measure and monitor the increase in the call volume and measure the impacts of staffing as we added them every year and the impacts on our performance.

17:37The predictions that were included in the O-R-H report have been shown to be very accurate even with the impacts of the COVID-19 pandemic that could not have been predicted in 2016.

17:50Our call volume has already increased approximately 40% from the time that it was the end analysis was initiated in 2016 through the end of 2022.

18:01The business plan that we developed and approved by council in 2017 included other processes in addition to increasing staffing to improve the paramedic services efficiency and cost effectiveness.

18:13The computer modeling showed that relocating paramedic stations to identified areas could improve our response times to emergency calls and the business plan included those station movements.

18:23A plan was created with the county of Wellington in which the county would construct purpose built efficient stations in identified areas and lease them to the city.

18:33And again with the provincial grant being operating, the lease payments would then be covered in that grant.

18:41The construction of those stations is included in the county's long term budget forecast when the first was to have been constructed in 2019.

18:51Unfortunately, the construction of the paramedic stations did not occur and the resulting efficiencies have not been realized because shortly after the provincial election of 2018, the newly elected government announced a plan to modernize paramedic services across Ontario.

19:12The specifics of modernization, the modernization plan were not clear, but could potentially have resulted in fewer paramedic services in the province and therefore management of the service in our area might no longer fall under the control of the city.

19:26The province began a consultation process with stakeholders around the concept, but those consultations were stopped with the declaration of the COVID-19 global pandemic.

19:37The pandemic not only shifted the focus of the provincial ministry of health, but also allowed the existing municipalities, the municipal run paramedic services to step up, demonstrate our abilities, our effectiveness and our agility.

19:51The potential for significant change had remained a possibility and sort of stayed in the back burner until as recently as last week.

20:00On May 23rd, we finally received confirmation from Assistant Deputy Minister of Health Susan Piccarillo that the province is no longer considering the scope of change that was initially proposed and that future modernization of paramedic services will focus on technology improvements to the ambulance dispatch and radio systems that are provided directly by the Ministry of Health.

20:20In our annual budget approvals and confirmations since 2017, as consistent with our business plan, we presented them to council and council has approved successive staffing increases for Guelph-Fallington paramedic service.

20:38The additional staff members have allowed the service to maintain response times, so relatively recently, and then, and to improve the equity of response times as much as possible, considering the rural and urban mixture of our coverage area.

20:53Response times to an emergency calls are one of the metrics by which paramedic services are measured and compared.

20:59Our target response times are set by Guelph City Council and the targets for 2024 will be presented for approval in July.

21:08After the end, at the end of the year, the actual response times are then required to be reported to the province and our 22 response time results will be presented in that same report in July.

21:19Our target and actual response times do not compare favorably with the other municipalities, in part to the relatively large rural area and the fact that our urban area is not in the center of our county as it is in other areas.

21:34It's a bit of a spoiler alert.

21:41While the service has not been able to fully meet the response time targets set by council in 2022, our paramedics have provided and continue to provide an excellent service to the residents.

21:51We are fortunate to have highly trained individual paramedics, professional motivated paramedics on staff who provide exemplary care to the community.

22:01Guelph Wellington paramedic service employs both primary and advanced care paramedics and all the paramedics are trained and equipped to provide a wide variety of life saving and comfort level procedures and treatments.

22:14As just one example, our paramedics are able to acquire and interpret a 12 lead ECG in the field and then differentiate specific kinds of heart attacks.

22:23They can then discuss the findings with cardiologists at the heart catheterization lab in Kitchener and divert appropriate patients to St. Mary's Hospital.

22:31The process can make a significant difference in the patient's outcome.

22:35And again, that's just one of the many processes that our paramedics are able to take responsibility for and do.

22:41Our service receives many thank you notes on a regular basis.

22:47Perhaps the most notable of these includes some that we've received from families of patients whose injuries or illnesses are so severe that the result that they result in an unfortunate and poor outcome.

22:58These people still took the time to express appreciation for the care and compassion shown to them by your paramedics, which we think is remarkable and we appreciate our staff for showing this kind of care.

23:09I'd like to specifically recognize and bring to your attention some of the work of some of our paramedics during the COVID-19 pandemic.

23:21I know that you recall at the onset of the paramedic before a vaccine was available and the risk of infection were significant and less well known, less well known than they are today.

23:32In the early stages, we had some of our paramedics living in their basements and garages to avoid potentially passing on infections to their children and families.

23:41Despite those risks and uncertainties as outbreaks developed in nursing homes and long-term care facilities and public health was stretched to address the needs.

23:50Some of our paramedics volunteered to go into these locations and initially test and then administer vaccines to the residents.

23:59Well, this is out of the scope of the normal work of paramedics.

24:02Our staff wanted to make an additional contribution in the face of a global emergency.

24:07Later in the pandemic, more of our staff answered the call when the province asked for assistance to transfer COVID-19 positive patients between hospitals and out of the greater Toronto area.

24:17Again, these paramedics acted for the greater good of the community despite the risks involved.

24:22Public health has since recognized and thanked our paramedics directly for providing invaluable service to the community.

24:29There's another initiative that Guelph Wellington paramedic service has undertaken to better serve our community that we'd like to highlight today.

24:40Many of you are familiar with our community paramedic program and I'd like to now introduce our deputy chief Lance Wonco to give you a brief overview of that program.

24:56Thank you chief.

24:57Your honor, Marigot 3 and council.

25:00My name is Lance Wonco. It is my pleasure to have a brief opportunity to talk about our community paramedic programs throughout Guelph Wellington.

25:07Our program was developed and started in 2014 from a grant from the province and the program aims to reduce emergency calls.

25:15In 2020, Guelph Wellington paramedic service applied and successfully received 6.1 million through the Ministry of Long-Term Care.

25:23This funding is over a three-year period with aims to support patients in our communities that are waiting to gain entry into long-term care homes or need to support themselves while staying safely in their home.

25:36The program well lines well with our aim to reduce calls to the emergency department.

25:41We are well integrated with our health teams and our systems.

25:45We work with each and every one of your local health teams.

25:48We work with mental health agencies.

25:50We work with the hospitals and we continue to work with our community to ensure that we're providing outstanding care outside the hospital.

25:58Our program has demonstrated to reduce the demand for emergency room and hospital visits.

26:04In 2022, our program monitored and enrolled over 13,000.

26:10That program when surveyed indicated approximately 10% would have reached out to use either 911 or got themselves to the emergency department for their acute needs at that time.

26:22Those residents have been served.

26:25They felt that they would have called 911 and we're extremely pleased and proud of our community paramedics that do great work in the city of Guelph and in Wellington County.

26:32Thank you.

26:33Thanks again.

26:45Earlier in the presentation, I mentioned that there were two issues that are affecting our ability to provide our services effectively and efficiently.

26:53And the first involves hospital offload delays.

26:57When paramedics arrive at a hospital with a patient, they transfer care of that patient to the emergency department staff.

27:04Provincial guidelines suggest that the transfer should occur within 30 minutes of arrival.

27:08When the hospital is unable to accept the care of the patient, paramedics must stay in the department and care for the patient until that transfer can occur.

27:16And when paramedics are required to stay beyond the 30 minute timeframe, they're said to be an offload delay.

27:22Hospital offload delays are a significant factor in our increasing response times.

27:27As paramedics are required to stay in the hospital to care for the patient, unless resources are available to respond to further emergencies in the community.

27:35And yes, there are even instances where there are no ambulances available in our community to respond due to offload delays.

27:42And in which case we're required to rely on our neighbouring services from Waterloo or Dufferin or Halton to respond to emergencies in our area with an obvious lengthy response time.

27:55And that's assuming that they are not having issues of their own and that they can respond.

28:01Although offload delays are a problem at hospitals across Ontario and international, the issue is arguably more significant at Guelph General Hospital.

28:09Guelph General is consistently has the longest delays in the highest average of ambulance offloads times among hospitals in Waterloo region.

28:17And all of last year Guelph General was in the top 10% of the 115 hospitals in Ontario that report data on offload delays and the fourth longest offload delays in the province.

28:29Offload delays not only increase response times to emergency calls and potentially cause an adverse effect to the other patients in the community, but they also have an effect on the patients being cared for by the paramedics in the hallway and affect the paramedics as well.

28:44Paramedics are well trained and capable of providing emergency care on the scene and during transport to the hospital, but not in a position to provide the appropriate ongoing care, diagnostic tests and treatment that patients need causing significant delays for those patients.

29:02One of our paramedics describes some of the stressful interactions that offload delays create, including the patients that we give care to in the hallway for hours, watching them suffer in pain or deteriorate from their illness.

29:15We care for them as best we can, but there's a point where there's nothing more that we can do to help them within our scope of practice.

29:23We also hear the stress and distress in their loved ones voices when we update them because they know that person is still sitting in a hallway and suffering.

29:31There are also patients we don't meet, but here they're 911 call being dispatched over the radio, needing prompt life saving care that we are trained to provide and want to give, but cannot because we're waiting in offload delay.

29:45As we understand from our peers at the Gulf General Hospital, the causes of offload delays include a high number of patients in the hospital that need to find long term care placement, a hospital that's simply too small for the patient volume and staffing shortages.

30:01Late last year and into the early part of this year, the province provided funding to the city of Guelph to flow to Guelph General Hospital to hire staff specifically to care for patients in offload delay referred to as dedicated offload nurse funding.

30:15Unfortunately, Guelph General Hospital was unable to find the staff to provide that care in the funding timeframe.

30:21The most recent provincial budget included enhanced funding for the offload nurse program and we've worked with our partners at Guelph General Hospital to submit another application for this funding for the current year.

30:33I do want to stress that we do have a good working relationship with the Guelph General Hospital and we work with them at operational and strategic levels to try to minimize the impact of offload delays.

30:43The city of Guelph CAO Scott Stewart and Deputy CAO Colin Clark and I met with the new incoming president and CAO of the Guelph General Hospital, Mark Walton, who's here with us today about offload delays.

30:56During that meeting, Mr. Walton committed to addressing the offload delays and said it was mission critical for himself and the hospital board.

31:05And he pledged to take steps to try to lessen the impacts of paramedic services and we've met fairly recently to continue those discussions.

31:13I wanted to take the opportunity to introduce you to Mr. Walton. He's new to our community. He's our new CAO of Guelph General Hospital and given the opportunity to make a few comments and to introduce himself.

31:26Thank you, chief. And good afternoon, your honor. Mayor, members of council, my name is Mark Walton and I am the new president and CEO of Guelph General Hospital.

31:38It's an absolute pleasure to be here today. Somewhat symbolically, but also operationally to talk a little bit about what we're going to do together to resolve this particular issue.

31:49When I came into this job seven weeks ago, I met with a number of interesting challenges of which this was one.

31:58You will be familiar with some of the news articles that were circulating about the level of care and the challenges in our emergency department.

32:06And as such, identified that this was neither ideal for our patients, their families, but more importantly, perhaps when it comes to managing our staff within the emergency department, our hospital and with our partners, the paramedics.

32:22This is not a situation that anybody wakes up in the morning and says we need to continue this. This is something that we take very seriously.

32:29When I had a chance to meet with both the CEO, deputy and with the chief, we did commit to making this a priority and it is a priority.

32:40Part of that is of course, recognizing that this is a system issue. This is neither a paramedic issue, nor is it an ED issue, but it is a system issue.

32:49And I've used the term many times team Guelph. That is what it's Guelph Wellington in this particular case, one that we need to focus on as a system.

33:01It's a complex issue. The inputs that we receive through our paramedic partners translate often into inpatients that have nowhere to go.

33:12That implies that we need to be better at discharges, home and community care, long term care placements, etc.

33:19The work that the chief paramedics and my emergency department will be doing over the next little while will focus on offload times, but we have a much larger job ahead of us.

33:29Not only to create capacity within our hospital, but also capacity within the system.

33:35So simply want to say that I'm here today, first of all, symbolically to show my alignment with the chief, with the city, with the county, say that you are a priority, your residents, your citizens are a priority for us.

33:50And of course, in their time of need, their time of care, we will make sure that we rally to do that.

33:55I also want to provide you assurance that when they need care, we will be there, regardless of the challenges that we face internally.

34:02I'm so proud of the quality of care that we provide at Guelph General Hospital and certainly of the work that we do with our paramedic partners.

34:09But at the same time, as we move forward and try to create capacity within our organization within the system, we'll be looking to the likes of you as well for your support.

34:19This is something that's addressed at many levels of government, both local, provincial, federal, and again, we'll be looking for your support on that as well.

34:28But I do want to say I'm here largely today symbolically to stand shoulder to shoulder with the city, the county, and of course our paramedic colleagues to make sure that this gets resolved.

34:38So I thank you for your time today. It's a pleasure to meet each of you and I'll be here for the rest of the presentation. Thank you.

34:45And I want to thank Mark for joining us today and introducing himself.

34:56The second issue that I want to bring up to you today and require your assistance around is paramedic station.

35:07Our paramedics respond from one of 10 stations, seven in the county and three in the city of Guelph.

35:13And then there's an additional county own location in Drayton that our community paramedic teams work from.

35:18With the exception of the Claire road emergency services center, some of these stations, none of these stations were purpose built to provide amenities required by paramedics and many are not located in locations that provide the most efficient use of our services.

35:33The city of owns two of these stations, the county owns the one station used by our community paramedics and the other seven are owned by landlords that include the lower tier municipalities.

35:43And in some cases, private individuals.

35:47As previously mentioned, the plan was created in 2017 involved constructing purpose built paramedic stations in the county of Wellington, but that's not been enacted at this time.

35:57City staff recently shared a council city council report. Sorry.

36:03This city staff recently shared with city council consultants report on the needs associated with paramedic stations and reporting on their findings. The consultant described the overall conditions of the station and the amenities available for paramedics as deplorable and needed needing immediate action.

36:23So to to help it raise this issue.

36:29Not going to move.

36:33We help illustrate this wire stations are not meeting the needs of our service. Please allow me to share a short video in which two of our paramedic supervisors share in their own words some of their concerns.

36:45I've been with well falling to paramedic service for 17 years. I love being paramedic. It's different every day.

36:56We're dealing with patients just trying to get them to the higher medical care and keep them alive. There are times where unfortunately patients don't make it. You have to have those difficult conversations with families and there's nothing more than we can do.

37:09We have about 170 paramedics 100 full time staff and approximately 70 part time paramedics. I love the people that I work with. We are with our coworkers often more than we're with our spouses and families at home.

37:22We currently have 10 paramedic stations. Only one of those stations was ever purpose built for paramedics. A lot of our stations are in fire halls that were built and and then ambulances were put in that stations as an afterthought.

37:35It's challenging for our paramedics to see the amenities that our local fire departments and police services are given. And it's certainly not about what they have and that we don't have it but it's that we need it.

37:47We're obviously pretty limited on space here. It was quite a challenge for us during COVID. Obviously we weren't able to social distance properly. There would be two paramedic crew, two paramedics in this room, sometimes a student for a 12 hour shift.

38:01Another barrier is the location of the ambulance. Heart and Stroke Foundation says that your chances of surviving a cardiac arrest decrease 7 to 10 percent. For every minute you're without definitive care.

38:12We have to respond down to the ambulance in two minutes. The space just doesn't allow that.

38:18They could be responding to calls that are a simple medical concern but they're also providing life saving care sometimes in places that are very challenging. They might be upside down in a car. They could be working in the middle of the night with flashlights.

38:37We have been asking staff to work upwards of 16 hours lately in a space where you're cramped. You don't have a room to just kind of de-stress after calls. A lot of our stations you don't have like a wash tub to just clean, say, blood or bodily fluids off of your equipment.

38:53It's a shared space with the fire department. They rent this out to community organizations.

38:58There have been times where we're not able to go back to our station after a call because we might be covered in blood. We might be emotional and we can't risk running into a group of girl guides or a community event.

39:11And we've actually had to go to colleagues' homes and shower in their families' bathrooms.

39:16An ideal station I think would have something like a mental health room where somebody can just go in and just de-stress a proper report room where you could sit down at a computer.

39:27We would benefit from more storage for equipment, laundry facilities, showers, larger washrooms, well-ventilated space. We want to keep our staff healthy so that they're able to do this job for years to come.

39:39There's definitely been an increase in staff off due to mental illness.

39:43We're having trouble retaining staff and right now our staff is working as much as they can just to try and keep vehicles on the road.

39:50I would just love for our team to have better facilities and a space to feel valued.

39:54We need to have the right space for our paramedics so that we can provide the best care possible.

40:13So my thanks to those two parents that's unscripted basically their thoughts on their stations and obviously heartfelt

40:21In order to elaborate on some of the issues allow me to take you on a little bit of a tour of our current stations

40:27And some of them are in your areas

40:29Start with paramedics in the Guelph-Ferremasse township

40:33Station in the fire hall located in Rockwood and owned by Guelph-Ferremasse

40:37Two paramedics and sometimes a third person observer are stationed in a nine by eleven foot room

40:42Which houses chairs a desk computer storage and communication equipment

40:47Access to the kitchens on another floor and the ambulance space is located on the furthest section of the garage area

40:55City staff and city of Guelph legal staff recently

41:00Renegotiated the lease for this space and needed to agree to a 50 percent increase in the rent charge

41:04Does no alternatives were readily available

41:07The location of the response station is good, but the amenities available to paramedics are

41:14Not optimal

41:18In the town of of erin in in hilsburg

41:22We are also in a fire hall and it's also owned by the township

41:26This provides somewhat more space for our paramedics than in rockwood

41:30Although it's still cramped and the ambulance bay in the is located in the garage adjacent to the crew area

41:35So the advantage there the washroom and shower facilities are shared with the community groups who may rent the space in the fire hall

41:41leading to the concerns that

41:43that was talked about in the video

41:46The the 2016 computer modeling conducted by or h showed that that the station is not in an optimal location

41:54And that relocating the station could save as much as one minute of response time to cause in the erin area

42:00And that's a significant difference for us and it could make a big difference for patients outcome

42:06Movement of the stations was one of the highest priority recommended in the 2016 report, but we haven't been able to action it yet

42:13And the lease on this station is also recently

42:16Renegotiated by city of guelph legal staff and in their opinion the city is required to pay what they say is more than fair market value for the space provided

42:26In Arthur, it's the the third of our paramedic station that's located in a fire hall and is

42:32Located in wellington north

42:34Similar to the other co-located station the kitchen and bathroom

42:38facilities are shared sometimes with community groups and

42:41Similar to the condition in rockwood the ambulance space is located across the garage past an assortment of fire

42:46apparatus in a great distance from the paramedic crew area not conducive to to a rapid response time

42:52It is a good location as far as coverage area

42:56But the amenities again for the paramedics are are not what we would prefer

43:03In drayton the space that we lease for our paramedics is very small and inadequate to house our staff

43:09The conditions are made tolerable because the rest of the facility is shared only with the mapleton fire department and not open to the public

43:16And our good working relationship allows our paramedics to use the larger rooms when they're not required by the firefighters

43:22Our paramedics access to amenities is dependent on the goodwill and schedule

43:26The schedule of events for the mapleton fire staff

43:29We're currently renewing the lease for that station again the location of the station is a is a

43:34Is a great place, but it's just difficult for our paramedics

43:40So when we we received the grant funding that deputy chief swanko mentioned for our community paramedicine program

43:46We were looking for

43:48We began searching for a location that we could provide office space

43:52And space to keep vehicles in a climate controlled area

43:55We approached the county and learned of an available empty building in the town of drayton

44:00However, it was in need of renovations. We reached an agreement to fund the renovations with lease payments

44:06Unfortunately, not all of the office could be renovated with the allotted funds of the cost as the cost increased during the covet 19 pandemic

44:14We believed a staff that we could not only use this facility for community paramedicine the community paramedicine project

44:21But also address some of the needs

44:24For office and vehicle space for our paramedic supervisor

44:27And potentially even address some of the short and median term needs for paramedics in mapleton

44:32Not addressed in the drayton fire hall

44:34Ultimately county staff determined they still needed to maintain use of some of the garage area in this building

44:39And the rest of the building is not sufficient to meet the needs of the service

44:43The city and the county were able to reach a lease agreement in which the county recovered the cost of the renovations in the first two years of the lease

44:51and then we're paying

44:53Fair market value at the top end of fair market value according to our legal department for the ongoing lease payments for that building

45:02in fergus

45:04The the station in center wellington's in the town of fergus and it's a building that's owned by the city of guile

45:10The building meets many of the requirements for the paramedic station

45:14Although relatively small and cramped

45:16It does lacks efficient states for storage and lacks a separate wellness area and the

45:22Less an area for the paramedics to decompress

45:26The station previously housed an office and garage space for the paramedic supervisor who supports the activities of paramedics in the county area

45:34The paramedic staffing was increased in 2021 to include a second ambulance during daytime hours

45:41In the center wellington area and this increase displaced the supervisor

45:45Currently the guile fulington supervisor working in the county has no house

45:50Uh, no office no space to to to work from

45:56In minnow that the the station is located in the town of haristan in the building owned by the township

46:02While the building meets many of the requirements of our service

46:05It's and it's in an appropriate location. It lacks sufficient space lacks bathroom facilities

46:11Lacks a decontamination

46:13decontamination area and the wellness facility for paramedics

46:19in mount forest

46:20The station in the other station in wellington north

46:23We maintain a lease on a building that's owned by a private company

46:28The building meets some of the the requirements of the paramedic station

46:31But it lacks adequate washroom facilities a separate report room wellness and documentation facilities and also decontamination area

46:39In addition, it's also located in close proximity to the border with gray county

46:44And this means that guile fulington ambulances are often the closest available ambulance and dispatch to calls in gray county

46:50Location does not support efficient delivery of the service in wellington county

46:57In the city of guilef for the downtown area. We recently

47:00Relocated to a building owned and leased by a private company

47:04The the location of the facility is appropriate for responses into the downtown area

47:09But the city was required to complete major renovations to the building to make it adequate to provide the necessary amenities for paramedics

47:16Despite these renovations, there are still ongoing issues with the facility

47:20Including a steep ramp leading into the garage that creates issues over the long-term use of this facility

47:29The station in the in the west end of guilef is located

47:33On almire road in an industrial plaza in a unit owned and leased by a private company

47:40Access the main problem with this station is that access and egress from the garage area out onto the street

47:45Including for emergency responses is sometimes blocked by trucks making deliveries to other building occupants

47:52Um this

47:54The location of the station is not appropriate as it's in close proximity to waterloo region and we're we're often

48:01Needing to respond into their areas again as we're the closest ambulance

48:05and

48:07but but more the stress of the

48:09Blocked entrance ways make it extremely difficult for us to to respond to emergency calls

48:17And then finally clear road

48:19Again, this the station was built as an emergency services station

48:23Um

48:26It's a purpose built city owned emergency

48:29Response station that was designed to meet the needs of the emergency services the location

48:33Provides access to the south end of guilef and to pusslench township

48:37Response times in the pusslench area may need to be reevaluated as clear mulberry areas redeveloped

48:43Recent changes to the use of the building by the guilef police service have allowed us are us to expand our administration area

48:51Um

48:52And and be able to provide more room for us to for training and administrative purposes, which we sorely needed

49:01That concludes our virtual tour. Well, thank you for for sort of allowing me to take you through that

49:08As I turn this back over to to dco clock bush

49:10I want to summarize by assuring you that your residents are receiving excellent emergency care

49:16I'm fortunate to be allowed

49:18The position to lead an extraordinary team of paramedics and managers who are dedicated to providing that service

49:24But again, we do need some help from you. Um with some of our needs

49:28No, turn it back over to koleen

49:35Thanks, steven. So before you the charts on the screen

49:38I matches the chart that was in the facility needs assessment report that uh, the city

49:43Put out just a couple of weeks ago and we can certainly provide that to anybody who hasn't seen it

49:48And just to reiterate what chief doer said paramedic stations, they're key hubs for emergency responders

49:54They're more than just an ambulance bay

49:56So there are places to recover to recharge

50:00To restock to record calls

50:04This information in this chart gives a good visual synopsis of all of our stations

50:08And this is not simply a city problem or a county problem

50:12We have uh issues with all of

50:15With most every one of our stations that we need to start to look at and I also just want to mention the facility needs assessment report

50:21We've been doing these facility needs assessments for all of our city facilities

50:24This was phase two where we looked at both our fire and our paramedic stations obviously today

50:30Given the nature of the presentation. We're focusing on our paramedic stations

50:34Every day we expect the highest standards from our paramedics and I know so do you

50:40But most of the stations that we work in aren't meeting the needs

50:43And they're not meeting the needs in terms of what we provide to other staff in terms of their work spaces

50:48We have problematic layouts to meet our two-minute standard response

50:52To to get out into the ambulance when a call comes in

50:56Oftentimes we have insufficient washrooms sometimes shared with the public that lack of space to decompress separate from work areas

51:03the storage space

51:05In some cases the insufficient parking

51:07Um spaces that are not accessible

51:1024 7 to our paramedics only so that they have those safe private spaces

51:15And and we need to be able to have training facilities

51:19New and upgraded stations will ensure that the gulf wellington paramedic service is future ready

51:24And it'll help us meet the needs of a growing population both in the city of gulf and the county of wellington

51:29Because we're seeing increasing 911 call volumes. We've seen that in in the last few years

51:34We need to ensure proper decontamination and disinfection after every call so that we're not putting public safety at risk

51:41And I really want to emphasize we need to support mental health and wellness of our paramedics

51:46Having spaces where they can go to decompress where they can go to get cleaned up after calls where they can have a private conversation with their supervisor

51:53That's all critical to the health of our staff

51:56But it's also really important in terms of our paramedic staff retention and attracting new paramedics

52:02Vacancies are higher than they've ever been and recruitment is

52:05Challenge and we want to make sure that we're doing everything we can to make sure that the facilities

52:10We're providing to our staff are meeting their needs

52:12And as I said, these problems are not unique to the city or to the county

52:15Their systemic across our system and our goal today when talking about the stations was simply to share the information

52:22with you and

52:24Ask for your ongoing support as we look at future opportunities to address our station needs

52:28So just in conclusion

52:31Our paramedic service is providing a great service to the residents of the city of guelph in the county of wellington

52:36And I want to reiterate that

52:39The service has taken steps to be proactive

52:41Efficient and effective some of these were highlighted today

52:44I want to thank chief doer and deputy chief swanko and all of the staff at well wellington paramedic services

52:49They've delivered exemplary service and I don't think any of us could have imagined the pressures that would have been on that service

52:55And all of our paramedic services over the last number of years during the pandemic

52:59So let me reassure you that the residents you represent are receiving exemplary care from wellington paramedic services

53:06Our purpose today as I said, we wanted to

53:10Just provide that shared set of information

53:13Obviously you're sitting as joint council. So you can't pass motions or give direction today

53:18We're here to answer any questions that you may have but I just want to close by sort of maybe summarizing

53:23So what are you asking of us? So what we're asking of you is this support us in our advocacy work with the province and the ministry of health

53:30To address the systemic health care issues that are causing hospital offload delays

53:34I'm so grateful to mark walton that he joined us here today

53:37I know he's available if you have questions for him as well

53:40We have a great working relationship with the hospital and we've seen really productive conversations with mark since his arrival

53:47But that advocacy work with the province is really key because the ministry of health

53:51Has to be part of the solution. These problems are systemic

53:54They're not gulf specific or wellington county specific or gulf general hospital specific

53:59But they are systemic health care issues and we need your help and support as we advocate to the province to help us solve them

54:05And then in terms of the paramedic stations, we wanted you to be aware

54:08We've been having really great productive conversations and i'll give credit to our two scots

54:13wilson and steward the cios of the county and the city

54:18We have had a number of conversations between our staff teams our treasures have been involved our facility staff

54:24We're moving forward and looking at what is the priority for how we address some of these station

54:29Needs what is the best model for moving forward with addressing our station needs?

54:33And so we're really looking to you to simply be aware of those conversations support the staff

54:38And and and be aware that we're going to have continued conversations with both city and county council about the needs

54:45And my thanks to the staff teams who've been involved in having these conversations with us

54:50So there's good news here. We have a great paramedic service

54:53And i'm very very proud of the the the group of people who serve our communities

54:58And so thank you for your time and attention today

55:01I will say apologies the video the audio was awesome. The actual video was a little bit jumpy

55:05So we're going to send the link out to you. I would encourage you to watch it share it

55:09There was a great group of staff who put that together and I think it does a really good job of capturing

55:15the the

55:17The feelings of our paramedic services team and what they need in order to make sure they're delivering exemplary service

55:22So we'll get that link sent out to all of you and with that i'm going to stop talking and i'll turn it back to mayor gathrey

55:28And let him then lead us through the questions and answers

55:32Stephen and I will do our best and then we'll call up others if there if we need to phone a friend

55:36We have both city and county staff here and available to answer any questions you may have

55:42Well, first of all, thank you. I'm sure we're all nodding our heads

55:45Thank thank you for so much for putting that together and I see some paramedics like here like you know

55:50Thank you so much for for all that you do

55:52And to the senior leadership team of our paramedics deputy and chief here like thank you so very much and

56:00um

56:01Yeah, it's it's eye-opening and i'm glad that we're getting the the information all at the same time

56:06It's nice to be all on the same page. So I really appreciate it

56:10um

56:11So questions only

56:13Uh, no no comments maybe at this time just just straight up questions

56:19Please no huge long preambles, you know through what why when where you know like just just get right to questions

56:25And uh, and that way we can try to get to as many as possible

56:29I'll start with uh, kateen and then galler it looks like i'll go those two for now and and we'll go from there

56:36Thank you, mr. Mayor through you. Um, so I know when we had the gulf library audit they found that there was

56:44um, the the rental of the spaces was

56:48The bulk of the cost has there been an audit done in a similar vein like for the renovations versus building our own buildings

57:00Through you mr. Mayor, uh, councillor caiten

57:02The costs of rental the lease payments are included in an operating budget and so therefore they're funded 50% by the

57:11By the ministry of health and then the rest of the costs are shared when we construct our own building

57:16The ministry of health does not contribute to capital purchases. They do contribute to the depreciation of those buildings

57:24When we get into the exact analysis, I have to rely on my friends and finance

57:27But my understanding is there's a definite advantage to leasing rather than only overbuilding

57:33And and through the mayor if I can just add because of the slightly not complicated the the situation that we have

57:39There's a slight difference in how we do things in the city and in the county

57:42So we're working with our partners at the county to look at what options there might be

57:46For the county to in fact build the station lease it back to us

57:50And then we in turn pay the lease cost

57:52And that's because the city is the operator of the paramedic services and so we have a different

57:57It's just a different

57:59Situation dependent on on who is building. So as chief doer says

58:04Somebody else purpose building a station and leasing it back to the city

58:08Then allows us to access the most funding through the ministry

58:12And that somebody else can be the county

58:15If that is sort of clear

58:19It's a really good question council. Okay, I was thinking about the same thing during the presentation

58:24Then I forgot and then you asked the question. So thank you for doing that

58:28dollar

58:29white

58:30Ororke sealy

58:33Thank you, sir worship. Um, thank you for the presentation. I really appreciated the context that

58:39Part of the reason why we haven't been working on this is because the province

58:43Had us in limbo until a couple weeks ago. So I appreciate that we're not really behind but now is the opportunity to act

58:49So, um, following along the questions of of my fellow councillor

58:53Will we see

58:54And ask as part of the 2024 to 2027 budget with prioritized for like the gulf stations

59:00You know, this is how much we need to spend for

59:02To get some of those reds into whites on the chart you gave us

59:07So through the mayor, I think yes and those are parts of the conversations and I don't want to speak

59:12Ken can jump up and down if I'm answering incorrectly for the county

59:15But I know there's been conversations or of course, mr. Wilson can there's been conversations as well as what the county budget

59:20Has contained within it what the city budget has and that's part of what we're now going to look at now that we have

59:25That clarity from the province that we can start to move forward

59:28And know that we have that stability. So in short, yes

59:32Those are the exact conversations that we're having here at the city

59:35Auntie vilko is our general manager who looks after our corporate facilities is now heading up that work for us and looking at

59:40All of our stations and prioritizing

59:42What are the needs that we need to bring forward and then working with our partners at the county?

59:47Perfect. Thank you so much

59:49And knowing that that's that's coming down the pipeline through your worship

59:52How does that play into the other responsibilities? I mean we have our

59:57our

59:59Assessment our management plans for the city facilities, you know our age and infrastructure

1:00:04We have the new operational campus that has been so will this be prioritized so that maybe

1:00:09We pass some other things to move this ahead or or how does that get taken into account?

1:00:15So through the mayor, um, I will defer and we may want to get back to city council

1:00:20With information from our finance department because generally it's actually not that the city's going to be putting

1:00:26The city's going to be doing this as operating budget. So lease payments

1:00:30There is probably less of an impact on our capital budget

1:00:34Because we are looking generally at the model of leasing stations wherever possible because that allows us to maximize

1:00:40How much we get back from the province?

1:00:41So we'll take that away as a follow-up for our finance team

1:00:44So we make sure we give you that context for how that will look in a budget that's coming forward for consideration

1:00:51Thank you. And my last question to your worship. How do we compare to other?

1:00:56paramedic services outside of well-being ton?

1:00:59And you know that chart of how well our stations are doing

1:01:02Are we about average in terms of of level of discomfort that paramedic space or are we

1:01:09Doing particularly worse

1:01:12Through you, mr. Mayor. I have had the opportunity to

1:01:15Visit several of the stations from paramedic services in our area

1:01:19Respectfully, I would say we're we're considerably worse. I don't have the the data. I can't I can't show you all of them

1:01:26but certainly

1:01:27stations in waterloo and

1:01:30dufferin and

1:01:32We've been up to to the Durham region

1:01:34all of them have have facilities that

1:01:38And sort of halten and peel have facilities that have been renovated or purpose built in the last

1:01:4410 years and meet the needs of their paramedics better than we're meeting ours

1:01:50Thank you, councillor

1:01:51white auroric sealy

1:01:54This is almost impossible to do without

1:01:58This is almost impossible to do without comments. So without sounding flippant

1:02:03What do you need from the county of wellington to help resolve this specific problem?

1:02:07Like specifically, how do I get a new ambulance station in rockwood knowing you need seven?

1:02:11I know it sounds very simple but with no comments. That's really the issue. We're here. What can we do to help move this forward?

1:02:17And without making comments, I will just that video was excellent. It actually brought it into context for me

1:02:23I hadn't really had some of that information before so thank you for that. It was perfect

1:02:28and clearly

1:02:30I'd like to do whatever I could to help support move this forward

1:02:34Thank you, and

1:02:36Through you area three. That's quite exciting actually for for myself and for our whole team to hear

1:02:41What can the county do? I think there's a discussion that needs to take place between our city

1:02:47facility staff, but the plan is already there

1:02:50the the issue is already there and I know that it was held up by the ministry of health and

1:02:56We believe we have that result. We have it in writing that they're not going to move forward with that. So

1:03:01I think

1:03:02Carrying on with a plan, you know, whatever modifications need to be made but carrying on with the plan

1:03:07We've already developed is is where we need to go

1:03:12And aurora can then see Lee

1:03:15And then alt

1:03:18Thank you, margothry. Um, so it's tempting to think

1:03:21Particularly because there are two separate things right the offloads delays

1:03:25And the state of the facilities so with respect to the offload delays

1:03:30It's tempting to think if we just hire more paramedics and have more ambulances. We will solve this problem

1:03:35So I just like confirmation

1:03:38um

1:03:40Is you know, how would you describe the number of new paramedics over the last several budgets?

1:03:46Um, is the city of gulf meeting its obligations under the master plan. So have we been hiring?

1:03:52Uh, paramedics

1:03:54Do we need to hire more? What does that look like from an hr perspective?

1:03:58So through the mayor to councillor work, we have been keeping pace with our master plan

1:04:02With minor tweaks. We've in fact in some cases been able to go faster

1:04:07And so we have been keeping pace with our master plan and chief doer can comment as well

1:04:12I think we've had that question before well

1:04:13Will we will we will we solve offload delays by hiring more paramedics and the challenge there is that doesn't solve the underlying systemic issue

1:04:22Which is we need to work with our partners at gulf general to figure out

1:04:25What are the underlying systemic issues that are putting gulf general in a position that they can't accept patients from us?

1:04:30Because what we don't want to do is be in the position of just having more paramedics waiting an offload delay

1:04:35And then the other thing is just and chief doer mentioned it in terms of the one station in the north

1:04:39And I do want to just sort of reemphasize paramedics are dispatched provincially not locally the way fire is dispatched

1:04:47And so we could end up having more ambulances who simply then just get diverted elsewhere outside of the region as well

1:04:54So it isn't to say that of course

1:04:56We don't want to keep pace with our master plan and keep bringing on more paramedics as our call volume increases

1:05:02And we have been doing that and so thank you to the councils for that funding

1:05:06But it isn't as simple as solving offload delays by just adding more paramedics

1:05:10And I'm going to stop and let either chief doer or in fact, mr. Walton

1:05:14I suspect both may have comments on that so i'm going to defer to them both

1:05:20So thank you. Um through you mr. Mayor councillor roark. Um, yes, we need more paramedics

1:05:27The um what we try to measure out is is responding to the increased number of calls

1:05:34Despite offload delays and making sure that we have enough resources to do that and and then reality is offload delays are

1:05:40Um with respect to mr. Walton, we're not going to resolve them tomorrow. So we need to consider them a

1:05:45Real issue we can't even if we could we couldn't possibly staff enough paramedics to deal with the surges when we have

1:05:53A maximum number of people in offload delay and if we did we'd still have paramedics that we need to worry about who are in the hallway

1:05:59Um, but that said, um, you will see the incremental increases continue the predictions from or h

1:06:05Which appear to be very accurate our our call volume will continue to increase

1:06:09Plus we have the housing initiative from the province where our population is going to continue to increase

1:06:13We expect our our call volume to continue to increase

1:06:17So

1:06:18Assuming I can get past bco bush. I will be bringing forward additional requests for more paramedics in future budgets

1:06:27Thank you

1:06:29Through the mayor if I may as well, I you know, I'm always supportive of more paramedics

1:06:33So I'll throw my weight firmly behind that for the chief

1:06:37But what I would say is that the old models of care that surround this are being challenged

1:06:45And so even within the hospital itself, we're looking at what other duties can ps w's do

1:06:50What other duties can rp n's do what other duties can nurses do that push the boundary of their scope of practice?

1:06:57and so

1:06:59As the chief indicated earlier community paramedicine is a good example of that where we try to avoid people ever coming to the hospital at all

1:07:07Because they're seen and treated and released on site as opposed to coming into the emergency department

1:07:13That's the type of thing that we need to be looking at is alternative models of care

1:07:18efficiencies within the hospital

1:07:20Efficiencies and how we transfer patients from one site to the other so that we can actually increase our efficiency and our scope of practice

1:07:29And hopefully in doing so

1:07:31Maximize and utilize paramedics to the greatest extent of the scope provided to them possible. So

1:07:37Absolutely, we could probably use many

1:07:40But what I would also say is the more space we build the more we fill it up

1:07:44If you build it, they will come

1:07:46We've all been talking about getting an additional or a new hospital

1:07:50for for gulf wellington

1:07:53Um

1:07:54Came from oakville where we moved from an old site to a new site

1:07:58Tripled the size of the hospital and within the first week we had filled it up

1:08:02And we had many of the exact same problems that we did at a smaller site. So it's not about capacity

1:08:07It's about leveraging and optimizing the roles that we have and I think the paramedics are a great example of that

1:08:14Thank you. You want to follow up? But just before you do that if you don't mind our CAO would just like to jump in down

1:08:18I'll go right back to you

1:08:20So thanks, mr. Mayor, and I just wanted to add in

1:08:23So because we shouldn't lose sight of the ministry of health has a role as well

1:08:28As much as you know, we might want to leg wrestle over more paramedics or not

1:08:32Ministry of health and you'll see in the agenda. There was also a letter sent to the ministry on May 18th

1:08:37And and there's specific asks for them and I think that's where both councils can also play a role in terms of

1:08:44Advocacy and that helps both Scott and I in terms of expenditures, whether it's capital or operated or how do we get to

1:08:51What's the next step?

1:08:53They have to play a role as much as you know, I am loving mark

1:08:57He has a breath of fresh air in terms of gulf general hospital

1:09:00But the ministry has to play a leadership role that offload delays are unacceptable

1:09:06And that probably will mean money from them as well

1:09:10And so that part's very important. So, you know, we take this collective burden on

1:09:15But also there's another player here called the province

1:09:18And your expectations should be that they are participated with us in a very positive way

1:09:24This is not just an issue for us, but it is a big issue for us when you see the numbers and where we stack up

1:09:29That's not a reflection of our particular hospital

1:09:32There's another hospital in this region that doesn't have these institutes. So there is ways to tackle them

1:09:36We need the ministry of health to be with us side by side as well. Thanks, mr.

1:09:42And back to you our work. Thank you, megatha. We just supplementary to that actually exactly in alignment the province

1:09:47Is asking paramedics to do palliative care and community care

1:09:51um, which actually keeps people out of hospital which saves money for the hospital so

1:09:57um, two things how does that impact the number of paramedics who are available to respond to emergencies does it require the

1:10:04municipality to then fund a greater number of paramedics and

1:10:08Does the province look at a mechanism whereby when the paramedic service?

1:10:14Relieves a pressure on a hospital or reduces cost to a hospital. What's the funding mechanism to recognize that?

1:10:25Through you mr. Mayor, councillor work. Thank you for the question

1:10:28Community paramedic is funded 100 by the province. Um, in our case the six million dollars was the ministry of long-term care

1:10:36um

1:10:37The our our hold up right now is that it is um temporary funding

1:10:41So we originally received a three-year grant

1:10:44They have since announced that it will be extended by two year two more years

1:10:47We're able to take experienced paramedics off of the road and

1:10:51Have them complete those very necessary duties

1:10:54But and we backfill them but we backfill them with contract employees. So we are

1:10:59Hoping hopeful not just our service but across the province that they make the community paramedic program a permanent program

1:11:05And that will allow us to hire those people on a full-time basis

1:11:08Obviously a contract employee if they see a full-time opportunity somewhere else then we have a high turnover rate

1:11:15So so the funding for the people doing the work is 100%

1:11:21Funded by the province in the grant funding. We're happy to be able to provide that service

1:11:25of course we provide the the background support the scheduling and the

1:11:29many of the of the functions

1:11:32because hey, we have lots of room on our desk to do that work, but

1:11:36But we're just waiting for it to become permanent that would make it much more efficient. Sorry, did that answer your question?

1:11:45Well, the second part is when when a municipality and a county fund

1:11:49Uh a program that takes pressure off of a hospital and so it it's an avoidance of a cost there

1:11:56Does the province recognize uh and fund the municipality in order to be able to do that more efficiently?

1:12:02Right are there are there sufficient dollars attached to these initiatives, right?

1:12:06And you have more staff they're going to need more space

1:12:11How does the province with dollars recognize that?

1:12:16So through you mr. Mayor um again the six million dollar grant two million dollars per year for three years has been very helpful in that way

1:12:23Um

1:12:24We obviously can always use more money and we are doing some of the work to support that team

1:12:29um with municipal resources such as scheduling and and

1:12:33Um

1:12:34Many of the other functions um and our biggest push now not just our service

1:12:39But eventually is make it permanent funding so that we can plan it better

1:12:45Thank you. I just got a list growing so just making sure of time just so we can keep moving through

1:12:50Um, so I got sealy all green loyed waters. So um, and then yeah, I'll go to your phone. So uh right now it's uh sealy

1:13:00Thank you, mr. Mayor um just for clarity the city are they looking to

1:13:06Deal with the city-owned ambulance stations separately from the county

1:13:10What I'm hearing is that it would be advantageous that the county builds

1:13:16these buildings within the city

1:13:19Uh, so that would be a total of nine builds sounds like claire rhodus fine

1:13:23So if that's the case

1:13:25I would be supportive of that in the lease arrangement

1:13:29I would ask our treasurer though

1:13:31That a there's a year

1:13:34Um, not the delay in the funding

1:13:38But in these lease agreements

1:13:40We're able to leverage likely the costs of say borrowing money to fund these stations

1:13:45So if all in

1:13:48We can borrow money put some reserve money in build nine stations lease back to the city

1:13:55And these things get built

1:13:57I'm okay

1:13:58um

1:13:59Now I have I have a plethora of questions and I'm not going to go through them all

1:14:03um

1:14:04But because it's something that gets down into the weeds

1:14:06But that's the nuts and the bolts of it because I'll give one example

1:14:09There's a lot of discussion about decon. Well, do we need to build?

1:14:14Decon in every station or do we have a centralized one these types of things that could find cost efficiencies?

1:14:19That's down the road if you're looking for support to build stations on a lease thing and build them in the city

1:14:25I think i'm okay as long as mr. DeHark and ensure that

1:14:28We don't jeopardize our reserves. There's and you're laughing. I think maybe there's been these conversations already. So that's fine

1:14:35There's a big conversation around county council around a continuum of care with borrowing money. So these things come into play but

1:14:41Ultimately if it means that we can get it done, I'm I'm okay

1:14:45the other thing I want to state is

1:14:48um

1:14:51Adding paramedics is likely a good idea, but I I'm hearing from the ceo and the the other end of the

1:14:58offload delays is the

1:15:00Discharging and things like that

1:15:02So I would a be concerned that you've already stated in your presentation that we don't have room for the paramedics

1:15:06We have so to add more and that was one of my notes is well should any additional up service

1:15:12Have to you know have a component of can we fit them?

1:15:16um

1:15:17But also the last thing I think all of us want to see is more amos is parked on delhi street

1:15:22So that that's challenging. So

1:15:24I'll just leave it at that high level and I don't know if mr. DeHark wants to speak to that or you

1:15:29Deputy ceo

1:15:30So through the mayor to councillor ceo and then I'll look to see if mr. DeHark wants to come and speak

1:15:34So we have not had conversations with the county about the county building stations in the city

1:15:38um, although

1:15:40I'm not sure what that would look like. Um, we have had conversations with the county about the county building

1:15:45stations in the county

1:15:46Within the city we have three stations of which one we own

1:15:51One is the the fairly new purpose built and leased space at 34 gordon

1:15:55So really the one within the city that we're looking at is elmira road

1:15:58Which we are looking at a number of different options for how we might replace the elmira road station and where we would replace it

1:16:05But to the same point others building the station and the city leasing it back is advantageous from a financial point of view

1:16:11Certainly within the county those have been the conversations

1:16:14We've been having and as as chief doer said

1:16:17We only just got that assurance from the assistant deputy minister within the last two weeks

1:16:21So I think we're now in a position to move those conversations forward in a more productive way

1:16:26But I'll look to mr. DeHark to see if he wants to no I got the thumbs up

1:16:29Okay, so we're I think those conversations are going to continue

1:16:34Now in earnest as we move forward

1:16:37And then to the comment about the upstaffing certainly as we look at our master plan and the rh report

1:16:43We always want to be mindful of where we're upstaffing and making sure that we have the facilities available for those paramedics

1:16:48And so that's been part of um part of the discussions

1:16:52And I'll look to chief doer who can maybe comment on where we have upstaffed

1:16:56And I know one of the challenges for example is in the rockwood station

1:17:00Where we really couldn't fit more than two paramedics in that room that would be a challenge to upstaff

1:17:04So that's a good example. So maybe I'll see if chief doer wants to comment further on that

1:17:09Only only to confirm thank you

1:17:11To confirm that as much as as the room is a problem

1:17:15The increase in call volume needs to be addressed and so

1:17:19The delicate balance on what we can do is is

1:17:23In an operating budget ask for more staff to address those calls

1:17:27And it makes it more uncomfortable for paramedics, but we hope we see the light at the end of the tunnel as far as the station's go

1:17:36and I'm just going to ask a question because

1:17:38I need to know what does de con mean

1:17:44Sorry, sir, uh through you to you mr. Mayor decontamination

1:17:47Uh and more of an issue after the the pandemic, but before that, I get it. Okay. I just didn't know what the acronym is

1:17:55Was I the only one?

1:17:57Don't leave me hanging one extra

1:18:00All right decontamination. Thanks everybody. It sounds like my kids rooms

1:18:05All right, um, so councillor alt, please then I'm going to go brain and Lloyd

1:18:11Thank you very much america three through you. I have about three questions

1:18:16The first one stems from something that

1:18:19CEO waltons

1:18:20Stated and I believe that was asked also by councillor rick. I want to put it in different languages

1:18:27Are we

1:18:29Becoming victims of downloading more transferring responsibilities to paramedics for many of the the services that councillor work

1:18:36Was meeting reference to in other words. Are we just it's a straightforward transfer from provincial funding to county and city funding

1:18:46So through the mayor, I will simply say that um community paramedicine is a great example

1:18:51But the province does fund it 100 percent

1:18:53So I'm not I'm not necessarily offering an opinion on if that's the right model or not

1:18:58But the province does fund community paramedicine 100 percent other than the back office support. And so I think that

1:19:04I don't think I'm making a huge leap forward by saying that that is a good example of if we are taking pressure off of the hospital

1:19:11At least it's being 100 percent funded by the ministry of health

1:19:14Um paramedics is is a unique service. It is the only thing that means the municipality offers that is has this

1:19:22this

1:19:23Strange funding, maybe strange isn't the fair word this split funding relationship with the province

1:19:27And so day to day it's a 50 split but on that program in particular

1:19:31It's 100 percent, but I don't know if others want to uh comment on no, I think we're good there. Thank you

1:19:37The next one is for um

1:19:40The ceo walton. You made reference to scope of practice

1:19:44And I'm wondering are we within the hospital actually operating a hospital that is that that is that 100 percent?

1:19:53staffing and

1:19:54If not, is this affecting

1:19:56The offloading of of patients

1:20:00So it's a great question.

1:20:01So through the mayor, the later stages of the pandemic

1:20:06had a significant impact on our health human resources.

1:20:09And this is true not only for the hospital,

1:20:11but I would argue for all services, including paramedics.

1:20:17It meant, in many cases, the retirement or attrition

1:20:21of more experienced doctors and nurses and managers

1:20:24out of the system, either into other industries

1:20:27or into retirement in totality.

1:20:29And so currently at Guelph General Hospital,

1:20:32as an example, we're currently sitting at a vacancy rate

1:20:35for our ends of approximately 15%.

1:20:3915% relative to what we would have seen

1:20:41pre-pandemic, which was about 5% to 6%.

1:20:45So we do see absences in the hospital at this point in time.

1:20:49And it translates quite well across a number

1:20:51of other disciplines as well.

1:20:52RPMs, lab techs, radiology techs, et cetera,

1:20:56are all in high demand at the moment.

1:20:58I would say this is not peculiar to Guelph Wellington.

1:21:01This is actually a global issue.

1:21:03And the competitive forces associated

1:21:05with that are quite significant.

1:21:07So your question is, are we working at full capacity

1:21:09from a staffing compliment?

1:21:10The answer is no.

1:21:12So we do have a challenge there.

1:21:15We have stretched nurse to patient ratios

1:21:18to a point where we feel they are still safe,

1:21:20but they are a stretch.

1:21:22Prior to the pandemic, we would have been looking

1:21:24on an inpatient unit at one nurse for every four patients.

1:21:29You'll see pretty consistently now

1:21:30across Ontario hospitals, one to six.

1:21:33During the height of the pandemic, however,

1:21:34I would note we were sitting as high as one to 10,

1:21:36one to 12, significant pressures in the system for sure.

1:21:41So we do recognize that we are stretched.

1:21:45I will argue we have enough to provide

1:21:48consistent quality care.

1:21:50But when it comes to our emergency departments,

1:21:53we live on a razor's edge.

1:21:54Should somebody call in sick on a given shift?

1:21:57Should a physician become unavailable?

1:22:00It seriously impacts on our ability

1:22:02to respond to excessive calls.

1:22:06I'll also make note that surges aren't always predictable.

1:22:10The few that are, I can tell you,

1:22:13I think I was mentioning this to Chief earlier this week,

1:22:17never go to the ED two days after a long weekend.

1:22:20I can guarantee you we're going to be Choco Block

1:22:22because people wait, they don't want to waste their weekend.

1:22:25They hope the next day that the pain will go away

1:22:28and then they show up in our emergency department

1:22:30on the Wednesday.

1:22:32We were Choco Block on Wednesday.

1:22:33Now we can predict some of those things,

1:22:35but there are other unforeseen events

1:22:37where they just show up and we can't explain why.

1:22:41But again, that puts us into serious offload delays

1:22:44during those points in time.

1:22:45We do our best to surge,

1:22:46but we inevitably fall victim to the chews

1:22:49and froze of nature.

1:22:52Thank you. I'll take that bit of advice

1:22:54and hopefully not show up there or on a full moon.

1:22:58The same question is for Mr. Dewar as well, essentially.

1:23:01And sorry, I'm just going to jump in.

1:23:03It's just random that I'm jumping in with you, Councillor Olt.

1:23:06But as you've been asking questions,

1:23:08and by the way, I really appreciate that question

1:23:10for myself personally,

1:23:12nods are coming to me about other people asking

1:23:14and the list is really growing.

1:23:16And I'm just looking at the clock 325,

1:23:19and I still got one, two, three, four, five, six, seven, eight

1:23:22people on a list.

1:23:23If each people just takes five minutes

1:23:25or two, almost our end.

1:23:27So I'm just asking everybody to just get right to your questions

1:23:31as quickly as possible

1:23:32so we can get as many people in as possible.

1:23:33Go ahead, Councillor Olt.

1:23:34And thank you.

1:23:35The same essential question is for Mr. Chief Dewar.

1:23:39I'm wondering about the retention

1:23:40and the attraction of staff to Guelph Wellington Paramedics.

1:23:45Whether facilities and whether working conditions

1:23:48are having a significant impact on that,

1:23:50are we fully staffed?

1:23:54Through you, Mr. Mayor,

1:23:55we are fully staffed and are full-time compliment.

1:23:57We staff to minimum and then backfill any absences,

1:24:01including vacations in sick time with part-time staff.

1:24:03Start part-time staff recruitment is a challenge

1:24:08as it is for all services.

1:24:10I believe that our stations do provide

1:24:13a negative repercussion for us in attracting staff,

1:24:16but we also have a service that's known to be exceptional

1:24:21as far as the culture, the exceptional care of the paramedics.

1:24:26We students who go to college come to us for work terms

1:24:30and a lot of them apply to work here

1:24:31because we're attractive in that way.

1:24:33So it's a balance, but stations is definitely an issue.

1:24:36What's the length of service for a paramedic on average?

1:24:42Our retention rate, really.

1:24:43So I'm not sure I can answer that.

1:24:45Part times, when we hire somebody part-time to backfill,

1:24:49they will find the next available full-time job.

1:24:51So it may be in one of our neighbouring services.

1:24:53Our full-time paramedics tend to stay with us.

1:24:56And I can't tell you the years, but they do tend to stay with us.

1:25:01Okay, Parine then Lloyd.

1:25:04Thank you very much, Mr. Mayor.

1:25:05I will be brief.

1:25:08Those of us who've been around for a while,

1:25:09remember that in 2000, this was all supposed to be revenue neutral.

1:25:13And clearly, I don't even have to ask the question clearly is not.

1:25:17Here's where we are.

1:25:19My question's a purely practical one.

1:25:22Out in the county, again, thank you for your video.

1:25:25That was a particularly poignant way of making it clear

1:25:28what exactly it is that the shortcomings are.

1:25:32I guess it's, I'll get right to the point.

1:25:34Is there a way?

1:25:35I mean, clearly with the best of intentions,

1:25:39there was a lot of partnership between fire halls

1:25:41and ambulance in the past.

1:25:43Perhaps that was never a good idea.

1:25:45Perhaps it was a good idea at the time.

1:25:46And now isn't.

1:25:48And I guess that's what I'm asking.

1:25:49Are these salvageable?

1:25:51A place like Rockwood, a place like, you know,

1:25:53there's four or five that were listed there.

1:25:55I won't go through them all.

1:25:57Is there a way that if there wasn't public access

1:25:59and it was only firefighters and paramedics together,

1:26:03is there a way to salvage those buildings?

1:26:05Or is our only practical route forward

1:26:08is to actually start looking at other buildings

1:26:11either purpose built on that site

1:26:13or purpose built somewhere else nearby

1:26:15or in some place in a better spot.

1:26:17So are these salvageables

1:26:18might be shorter version of the question?

1:26:20Through you, Mr. Mayor, not easily,

1:26:22if I could answer it that way.

1:26:23We have certainly assessed the fire halls and looked at,

1:26:25is there a way to adjust different rooms

1:26:28and what if we could put a kitchen into that spare room?

1:26:31And it is not, there are competing interests,

1:26:34competing needs, fire needs to be in the closest bay

1:26:39to reload their truck to refill their water tankers.

1:26:44And so that pushes us further out.

1:26:46It would not be easy if I could just say it that way.

1:26:49And there's no short-term or simple solution

1:26:51we have looked at it.

1:26:53When you look at paramedic purpose built stations

1:26:55are significantly different.

1:26:57And it would be an absolute challenge.

1:27:02Thank you, Lloyd and then Waters.

1:27:06Thank you, Mayor Guthrie.

1:27:08My question actually touches on the fact

1:27:11that we have three hospitals in the county.

1:27:13We have Groves, Louise Marshall and Palmerston.

1:27:15My question is, do we have offloading issues

1:27:18in those hospitals?

1:27:19Cause we've been focusing on city of Guelph,

1:27:21but we do have three hospitals, which you are servicing.

1:27:24And I just wondered, do we have those same things

1:27:27in those hospitals?

1:27:28Also, just to say, we're facing shortages

1:27:32or closures of those emergency rooms

1:27:34because we don't have staffing levels

1:27:37in those spots as well.

1:27:38So maybe Chief Doerr can give the answer

1:27:41and I do have a supplement.

1:27:43Through you, Mr. Mayor.

1:27:44The offload delays occur very less, far less frequently.

1:27:49Groves in Fergus, we do see offload delays,

1:27:52especially when we have a high call volume

1:27:53and sometimes we divert patients from the city of Guelph

1:27:56and we overwhelm that emergency department,

1:27:58but statistically nowhere near the level

1:28:00that we have in Guelph.

1:28:02The other two hospitals, we tend not to see offload delays

1:28:04just because of volumes.

1:28:06And yes, you're right.

1:28:08The bigger concern is that we have seen,

1:28:11not recently, but in the past year,

1:28:12we've seen some closures of emergency departments

1:28:15and that's a big concern for us.

1:28:18Thank you, Chief Doerr.

1:28:19And my second question is to do with the question

1:28:22around funding.

1:28:24It was talked about in the presentation around funding

1:28:26from the province to provide for a nurse

1:28:30regarding the offloading in Guelph General Hospital.

1:28:34And I wanna know, did we lose that funding

1:28:37because we didn't do it or are we doing it?

1:28:39We need more to bring in more nurses.

1:28:43Thank you, through the mayor.

1:28:44That funding, yes, unfortunately,

1:28:46it was lost for that particular moment,

1:28:48but it was based on a fiscal year.

1:28:50So at the end of the fiscal year,

1:28:51if it's not used, it's returned.

1:28:54We are subsequently reapplying for that funding.

1:28:56The challenge really goes back

1:28:58to the previous councillor's question,

1:29:00which was around nursing and our ability

1:29:02to attract and retain nursing

1:29:04because of the vacancies that we have.

1:29:07Unfortunately, we weren't able to fill that position,

1:29:09but had to focus on other positions

1:29:10within the inpatient

1:29:12or in the emergency departments themselves.

1:29:14So we are, and as the chief indicated earlier,

1:29:19going to be facilitating a session

1:29:20with our respective organizations,

1:29:22both paramedics, emergency nurses, and doctors together.

1:29:26We're gonna look at what other models are out there

1:29:28so that we can take advantage of this.

1:29:30We do know that there are other ways to do this

1:29:32and to optimize that particular role.

1:29:34And whether that means shifting nurses from within the hospital

1:29:36or utilizing the medics in a different way,

1:29:39part of what we're gonna be discussing.

1:29:41So we do not want to lose that,

1:29:42but at the same time, we were in a very cost constrained,

1:29:45or pardon me, resource constrained environment at the time.

1:29:49Sorry, through the matter, if I can also just add,

1:29:50it was only three months of funding that we received, correct?

1:29:53So the province only gave us three months.

1:29:55So even though it's tied to the fiscal,

1:29:57they only gave us funding for January, February, and March.

1:29:59And so in fairness to the hospital,

1:30:02hiring somebody for a three month contract

1:30:03was virtually a fool's errand.

1:30:05And so we will reapply and hope that we can get the funding

1:30:08for a longer period of time

1:30:09to maybe assist with attracting someone.

1:30:14I appreciate that context.

1:30:15I was gonna jump in there a little bit

1:30:17because it wasn't for lack of effort mark and others.

1:30:20It was, it was, because I remember asking,

1:30:25and it was a very clear response back

1:30:29that they actually were trying very quickly

1:30:31and no one was actually grabbing at it.

1:30:34And then it was three months.

1:30:35So it was, yeah, it wasn't for lack of trying.

1:30:38Okay.

1:30:40Water is in Boomer.

1:30:42Yes, thanks, Mayor Guthrie.

1:30:45I'm looking at it more in terms of what we can control

1:30:47and that's particularly on your comments on facilities

1:30:51and things like that.

1:30:52The one thing that, and more in particular with the county

1:30:55because we're here as a county,

1:30:57we've always been very good at building things.

1:30:59You know, our library program is an amazing program.

1:31:03So when we put our minds and our energies

1:31:05to doing something, we can do it very right.

1:31:08For me, what I wanna know, and also this made me more

1:31:12for expression to the rest of the county counselors here

1:31:15is tell us what the expectations on those facilities

1:31:20and we'll look at it.

1:31:22We'd work with you to develop a master plan in my mind

1:31:26to how would we upgrade those facilities?

1:31:29We all know that we're all going through

1:31:30this tremendous growth in our area,

1:31:32Central Wellington, as well as Guelph and area.

1:31:35We're expected to more than double.

1:31:37So I look at this as immediate emergency now

1:31:40because we're gonna, not only we have these inadequate

1:31:43facilities that we're dealing with now

1:31:45and then on top of that, we're gonna throw the growth

1:31:47in there.

1:31:48So we, in my mind, we gotta get on this program

1:31:51right, right, right now.

1:31:53So you tell us what we need.

1:31:56We figure out a plan and then just like we've dealt

1:31:58with our library program, let's get it done.

1:32:03Let's build something.

1:32:04This is something that we can deal with in terms

1:32:07of facilities here.

1:32:08We don't need the expectations of the province to jump in,

1:32:11but this is something that we can take control of.

1:32:14Thank you.

1:32:15Through the mayor, if I can just say thank you for that.

1:32:17And what has been exceedingly helpful is that news

1:32:20that we got from the ADM within the last two weeks

1:32:22because it was very difficult to move this forward

1:32:24if we were still in a state of,

1:32:25well, are they changing the model for paramedics?

1:32:28And so it was a difficult conversation to ask

1:32:30either the county or quite frankly, any landlord

1:32:33to work with us and partner with us

1:32:34on purpose built paramedic stations,

1:32:37whether it's renovations or new build,

1:32:38if we didn't know what the operating model was gonna be,

1:32:41if we didn't have that sort of assurance

1:32:45that we had some sustainability.

1:32:46So I think the timing is great for both that response

1:32:49back from the ADM as well as for this meeting

1:32:51because now that enables us as the two staff teams

1:32:54to move forward in our conversations.

1:32:59Thank you.

1:33:00Boomer, then I'm gonna go to the warden after you.

1:33:12Yeah, Chief Doer was mentioning during his comments,

1:33:14regarding the Claire Road station,

1:33:17the ability to reassess response times to Puslinch.

1:33:22This is great news for me when I think,

1:33:24listen to the comments about rebuilding stations

1:33:26in the county because when we go to,

1:33:28if the county decides to take this on

1:33:31as Mayor Waters is suggesting,

1:33:34we're gonna need to be able to speak to our residents

1:33:38about the need for these investments.

1:33:40And so I was wondering if Chief Doer,

1:33:42you'd be able to provide county,

1:33:46sort of a breakdown of response times

1:33:48between the county and the city

1:33:50so that when we go to make these capital investments,

1:33:53we have something we can point to our residents,

1:33:56say this is what we're getting in exchange

1:33:58for this investment.

1:34:00Here are the response times outside,

1:34:01here are the response times inside the city.

1:34:03We're making these investments to make this difference

1:34:06in the rural areas and hearing that you can already do it

1:34:09for Puslinch suggests you could do it

1:34:10for the entire county.

1:34:11Is that possible?

1:34:14Three, Mr. Mayor, it is quite possible.

1:34:16We can, right now we do breakdown response times

1:34:19in lower, in each individual township.

1:34:23The challenges that I don't have any comparators.

1:34:26I can tell you what it is in Puslinch.

1:34:29I can't tell you what it is in Elmira, for example,

1:34:32or Wellesley and it's not reported to the province

1:34:36that way, not every service reports that way.

1:34:39And so there's a challenge to set the expectations

1:34:43for your residents, but we do do that breakdown.

1:34:46And so we can compare against ourselves

1:34:48and see that we're actually making an improvement.

1:34:50Excellent, thank you.

1:34:51And one follow up question, if I could, Mr. Mayor.

1:34:56We're obviously, this kind of format,

1:34:58this collaborative cooperative speaking to each other

1:35:00is excellent.

1:35:01We're getting a lot done today.

1:35:04I seem to recall that social services

1:35:07and land ambulance at one time were joint committees

1:35:10of the city of Guelph and the county of Wellington.

1:35:14And I was wondering if there was any interest

1:35:16in the city from the city of Guelph

1:35:19and recoupling those committees

1:35:20so that these kinds of discussions

1:35:22can continue to take place even after today,

1:35:25so that we go back to a situation

1:35:27where those things are recoupled.

1:35:32So through the mayor, we can certainly look at opportunities

1:35:35for how to better engage city and county.

1:35:37Certainly our structures are different

1:35:39than they were back in.

1:35:41So paramedic services sits within

1:35:44the public services committee here at the city.

1:35:47Obviously social services has a committee

1:35:48at the county of Wellington,

1:35:50but I think this has demonstrated to us today

1:35:52the value of these collaborative conversations.

1:35:54So we can take that away to look at the opportunities.

1:35:57I will also say that we have,

1:35:59I will just put the little plug in for the fact

1:36:01that we for, I think the first time have Louisa Artuso

1:36:04from the county coming to speak to city council

1:36:06on June the 6th about social services.

1:36:09So I think we're seeing in general

1:36:12a more collaborative approach to making sure

1:36:15that we're reporting in both staff

1:36:16and to each council on both the social services

1:36:19and on the paramedic services side.

1:36:21And through you, Mr. Chair,

1:36:22just I didn't hear the going back

1:36:24to the joint committees on these,

1:36:26there's a possible discussion as well.

1:36:28I think we would, we'll take that away

1:36:30and have some conversations about that.

1:36:31Thank you.

1:36:34Great, we'll go to the warden and then Valentine.

1:36:39Thank you, Mayor Guthrie.

1:36:40Through you in this, excuse me,

1:36:43in the spirit of asking questions and not making comments,

1:36:47I would say, you know, we are partners in this,

1:36:50whether we talk about it all the time or not.

1:36:52And given the issue with bringing another partner

1:36:55to the table vis-a-vis the ministry of health,

1:36:58what role can we play in helping your advocacy

1:37:01in that regard?

1:37:06I think at the end, we should all stand together

1:37:08as a big picture saying we need this help from the ministry

1:37:12and we should send it out.

1:37:15I think we should do that.

1:37:16But Scott or the two Scots, do you have any,

1:37:20we also have our intergovernmental staff here as well,

1:37:23if I can see if there's some kind of role

1:37:25from an advocate, is he pointing to me?

1:37:27Well, thank you, Mr. Mayor, let me begin.

1:37:28And I'm sure I've got great words of wisdom here

1:37:31at whatever time it is this afternoon.

1:37:33But I think that's got to be one of the outcomes.

1:37:36And that's why I made the reference

1:37:37to the May 18th letter to Minister Jones.

1:37:40That's the beginning.

1:37:41When knocking on the door, you heard the chief say

1:37:44that he's had discussions with the ADM.

1:37:46Those are all important pieces.

1:37:48So that then collectively things like AMO,

1:37:52is there an organization where we would actually go

1:37:54and have a meeting with Minister Jones

1:37:57and our MPPs as well at AMO?

1:38:01So there's another place, but we've got to get some alignment

1:38:04to what's the discussion today.

1:38:07And then you've asked lots of questions of,

1:38:09well, how can we get to this?

1:38:11Is there a master plan?

1:38:12Those sort of things.

1:38:13I think if we can get that in front of both councils

1:38:15and Edson Dorst, there's the unity.

1:38:18And then then I think there's a wonderful moment

1:38:22so that when a minister's looking at,

1:38:24oh, the county and the city are here united.

1:38:26So that won't always happen in the regions and lower tiers.

1:38:29And that's a good thing.

1:38:31And I think that could be the beginning of something.

1:38:33And then we could put some details to that.

1:38:35So through the Mayor to the ward,

1:38:37and I think there's more to do,

1:38:39but listening to this afternoon,

1:38:41it doesn't sound like we're off site.

1:38:43So I think we could get there.

1:38:44And we haven't heard back, not it was only May 18th.

1:38:47So we haven't heard back,

1:38:49but this gives us a little follow-up.

1:38:51Do you know we had a joint meeting in minister?

1:38:53And those are the places that I think we could get

1:38:55some legwork done so that the advocacy can be done,

1:38:58but not in isolation.

1:39:00And I look to the other Scott over there,

1:39:03if there's anything that I'm missing on this one,

1:39:05because I don't want to speak for the county side.

1:39:08Your worship, I can only agree with my counterpart from the city.

1:39:15I hope that was captured in the minutes.

1:39:19Yeah, that's right.

1:39:23Why are we never having another meeting again?

1:39:24No, Valentine, please.

1:39:26And then Duncan and then Anderson.

1:39:28It's just like the warden to steal my question

1:39:30just before I was going to ask it.

1:39:33So there has already been a fulsome explanation

1:39:36of what does the advocacy look like

1:39:39for the systemic issue that the municipality cannot pay for.

1:39:43And you've already answered that.

1:39:44So thank you and thank you,

1:39:46Warden Lennox for thinking of that question.

1:39:50Good, great mindsink alike.

1:39:52All right, Duncan and then Anderson.

1:39:55Let's hear.

1:39:56So we had the number last year,

1:40:00it was for a year and a quarter time period.

1:40:01It was 7,400 hours of offload delays.

1:40:04And when you do that math, it was 616 12 hour shifts.

1:40:08So I think when we're having a discussion about,

1:40:10does additional resources or new staff hires

1:40:13need to be done at the paramedic level,

1:40:14probably the offload delay thing should be the A

1:40:17and then maybe the B is the other.

1:40:19The two questions here that haven't been brought up today.

1:40:23So the area myself and Councillor Dain,

1:40:27Mayor of Ayrton represent.

1:40:28So we border onto the region appeal that has been dissolved.

1:40:32And we also border onto the regional halting

1:40:34that may be dissolved and the county borders on

1:40:36to those two municipalities and Waterloo region.

1:40:40My question is,

1:40:41has we made any outreach to those regions,

1:40:46to those paramedic service as to what

1:40:49the contingency plans are?

1:40:51And the reason I ask is anyone that's been experienced

1:40:53or been around a long time as a councillor

1:40:55or as a senior staff member,

1:40:57you know, not to wait for an email

1:40:59or to wait for the phone or to wait for a knock on the door.

1:41:02It's, you know, it's up to us to,

1:41:04to make sure that we're on that agenda.

1:41:06So when they're doing whatever they're going to do,

1:41:08that they already know, oh, we got to, you know,

1:41:10we got to call up Chief Dewar or we have to call up

1:41:12the warden or the Mayor of Guelph.

1:41:15So that's my first question.

1:41:18So through the Mayor, in terms of the de-amalgamation

1:41:22of regions, other than anecdotal conversations

1:41:25that Chief Dewar may have had with neighbouring chiefs,

1:41:26I don't think we've heard anything officially or formally.

1:41:30I sit on the Amos Emergency Services Steering Committee

1:41:33and the meeting next week, I believe it is.

1:41:36This is the specific topic with John Saunders

1:41:39from Hicks Morley there to speak to specifically

1:41:41what does de-amalgamation look like

1:41:43in the context of emergency services.

1:41:45So hopefully we'll get some more information there,

1:41:48but I think we're all in a little bit

1:41:50of a state of limbo looking to see,

1:41:52but I think it's a really good question

1:41:53and one that we've discussed.

1:41:55As we look to what happens in the region of Peele

1:41:57and what they may end up doing with their paramedic service,

1:42:00does, you know, what does that look like

1:42:02as they look to other regions?

1:42:04You know, we're obviously in a different situation here

1:42:06because we aren't functioning in that regional environment,

1:42:09but as you point out, we are surrounded by those that are.

1:42:11And so I think we're all interested.

1:42:14I don't know if others have any other insight

1:42:17that they want to offer.

1:42:18No, it looks like no.

1:42:19I think we're all waiting to try to figure out

1:42:21what the answer to that question is.

1:42:23So part of that answer was that we did not hear.

1:42:25So I think part of the, what I would advocate for

1:42:29is for us to reach out.

1:42:32So that we're the ones that are heard.

1:42:35The last question here, offload advocacy.

1:42:38And it's around, I was wondering whether Chief Durr

1:42:41has reached out to any of the county fire chiefs

1:42:43to deal with the number of medical assist calls

1:42:46that the volunteer fire departments are still doing.

1:42:50Hillsburg, I live two doors down

1:42:52from the fire station and the station.

1:42:54And the report from their chief was that it's the same number

1:42:58as three or four years ago,

1:43:00except the paramedic service has gone from 12 hours

1:43:04to 24 hours.

1:43:05So it's an example of total inefficiency

1:43:07and wasting of a resource.

1:43:09So the volunteer fire departments,

1:43:12even though we've doubled the amount of service time

1:43:14for the community is still responding

1:43:15to the same number of calls.

1:43:16So wondering as part of the advocacy kind of thing,

1:43:19if you're able to gather up that info

1:43:20from some of the various chiefs,

1:43:22it could be part of another way of approaching the province.

1:43:27Thank you and through you, Mr. Mayor,

1:43:30I was fortunate to be involved by Mayor Waters

1:43:34to be invited to go to the Roma conference

1:43:37and advocate with one of my peers in the fire department,

1:43:40specifically to the, well, we talked to both ministry

1:43:44of health and ministry of solicitor general

1:43:46to advocate for and stress the impact

1:43:48that offload delays are having on volunteer fire services,

1:43:53not just because of the calls,

1:43:54but dragging them out of their primary employment.

1:43:59So I do meet with the fire chiefs monthly.

1:44:02We do have those conversations

1:44:04and we do advocate this just another stream

1:44:07that we do to try to convince the province

1:44:10that they need to address this issue.

1:44:13Thanks, Steve Durr and welcome, Mark.

1:44:15You kind of went from the expression

1:44:17is from the frying pan to the fire.

1:44:22Okay, and Anderson and then maybe just 10 minutes

1:44:26if there's any kind of wrap up comments

1:44:28that of those that maybe haven't spoken

1:44:30or something that's necessary to save.

1:44:32So I'll start with Anderson

1:44:34and then I'll get to go to Gibson to start with comments.

1:44:40Thank you, Mayor Guthrie.

1:44:42Excellent presentation again.

1:44:44You know, we've heard a lot today

1:44:45and I've seen the offload issues.

1:44:48I'm seeing the hospital issues.

1:44:49I'm quite aware of the hospital staffing

1:44:51and stuff like that.

1:44:52But you know what I see of this whole program

1:44:54is our community paramedic program.

1:44:56It's an excellent program

1:44:57and I'm glad that we're looking at full-time funding.

1:45:00And so, and it all connects and we heard the new

1:45:03the new CAO's indicate about how, you know

1:45:07if one thing works well,

1:45:08then it's going to be less stress on hospitals and staffing.

1:45:11So if our community paramedicine program

1:45:14is still working well,

1:45:16and this might be my question to the chief,

1:45:18is there any opportunity to expand that program

1:45:21even further?

1:45:23If we can deal with a lot of people at home

1:45:26and we have the results, we have the stats,

1:45:28the chief and I have talked many times on this,

1:45:30that it is working well.

1:45:32People are better received at home

1:45:34than they are in the hospital setting.

1:45:35It takes pressure away from hospitals.

1:45:37It takes pressure away from our emergency calls on the call.

1:45:41If we expanded that program,

1:45:43would that be the beginning

1:45:45or helping the rest of these issues?

1:45:53For you, Mr. Ray, I think it's one of the pieces

1:45:55and I'm going to ask if Deputy Chief Swanko

1:45:58wants to comment further,

1:45:59but I think there's a lot of key pieces.

1:46:01I don't think that, you know, there's a magic bullet here,

1:46:04but it's definitely something that we can do

1:46:07and that we are doing.

1:46:11Through you, Mayor.

1:46:12Thank you.

1:46:13Excellent comments and thank you for recognizing

1:46:14the great work our team has done.

1:46:16One of our initial goals in 2014

1:46:19was to leverage the community resources

1:46:20that are already out there

1:46:22and to explore that with our paramedics.

1:46:24And over time, what we recognize is,

1:46:26oh, there's actually a role in our systems

1:46:29for our paramedics to get involved in home visits

1:46:31and remote patient monitoring.

1:46:33But our number one goal still is to work

1:46:35with those community partners,

1:46:36to work with those partners,

1:46:37get the patients into the best place

1:46:39and care that they can be with avoiding redundancy.

1:46:42And we're starting to see some growth

1:46:43in home and community care.

1:46:45Our Guelph and Wellington Ontario Health team

1:46:48is getting very active in co-ordinated care.

1:46:51And we have a role,

1:46:52but I wouldn't say that our role

1:46:53is to take everything off our current system partners.

1:46:56Our role, I think, is to keep engaging,

1:46:59keep referring, keep looking for those gaps

1:47:03where we can fill temporarily until the partner agency.

1:47:07And one example I can give that is wound care.

1:47:10We're noticing a lot of patients coming in

1:47:11to the community that needed wound care.

1:47:13Our community paramedics got trained up,

1:47:15started providing that care so their patients

1:47:17weren't going from home to hospital

1:47:20because they didn't know what to do with their dressing.

1:47:22But now we're starting to see the system recover a little bit

1:47:25and what we're recognizing are other opportunities.

1:47:27For example, our community paramedics

1:47:28are going to be taking on UTI, right?

1:47:32We can actually assess for UTI in somebody's house

1:47:34and connect with their primary care.

1:47:36So looking at those gaps,

1:47:37I think we're going to hit our capacity just in term.

1:47:40And as much as I can promote and say great paramedic program,

1:47:44we still rely on hiring paramedics.

1:47:46And we've taken a lot of our senior,

1:47:48our great clinicians out into community paramedicine work,

1:47:53but we still have to, our mandate is emergency transport,

1:47:56emergency care.

1:47:57So it's a bit of a balance there.

1:47:58Thank you for that great question

1:47:59because it does recognize the great work that the team's doing.

1:48:02But I think for now, our community partners

1:48:04really have to start moving their HR numbers up,

1:48:09start getting collaboration as a marked, indicated boy.

1:48:12If we could start working together

1:48:13and maybe take some other focus off our alternate level of care.

1:48:17So those folks who are waiting to get into wound care,

1:48:19maybe start looking at things like mental health crisis.

1:48:21Then is there a better way we can service those patients?

1:48:23I think we'll start finding some win-wins.

1:48:25Thank you.

1:48:27And anticipating your question, Mr. Mayor,

1:48:29it's a UTI as a unary tract infection.

1:48:35Oh, OK.

1:48:39I thought it was like ultimate taxes incorporated

1:48:42or something like that.

1:48:44All right.

1:48:44No, I did know that one because someone else told me about it.

1:48:48OK.

1:48:49So, Dean, did you have a comment or a question?

1:48:53Yeah.

1:48:53OK.

1:48:53Go ahead.

1:48:54Then I'll go to Councillor Kipchner.

1:48:55Thank you.

1:48:56Through you, Mr. Mayor.

1:48:57Would it be possible to review with the existing landlords

1:49:00the town of Aaron, for example, to do some upgrades

1:49:03to the existing spaces being leased to improve or make

1:49:06appropriate for the paramedic services for the short term

1:49:09until a larger solution is sorted out?

1:49:15Through the mayor, absolutely.

1:49:17And that's part of the work that our facilities team is now

1:49:19going to be doing.

1:49:19Now that we have this assessment is look at in each station,

1:49:23what are the opportunities if there are short term wins

1:49:25that we can get in terms of those conversations

1:49:27with our existing landlords while we in parallel

1:49:30have the broader conversations with our partners at the county

1:49:33about what the long term goals are.

1:49:35But in short, yes.

1:49:37OK.

1:49:37Let me know how we can help.

1:49:38Thank you.

1:49:40Thank you.

1:49:42OK.

1:49:42Just quick, like sprinkle like one, two sentence kind of comments

1:49:46before we try to wrap it up.

1:49:47Councillor Gibson.

1:49:49Yes.

1:49:50Thank you through Mr. Mayor.

1:49:51Just for our staff and our council,

1:49:53we just went through strategic planning.

1:49:54Pretty exhaustive process and didn't discuss this too much.

1:49:57But I understand the timing of today's meeting

1:50:00and then the timing of how this situation is unfolding.

1:50:04So maybe just as a comment to staff,

1:50:06building some capacity into our official plan.

1:50:09We oftentimes make our own plans, but opportunities arise

1:50:11and are created for us.

1:50:14So I would just ask that that be taken away

1:50:16and included in some capacity in our official plan,

1:50:19in our strategic plan when it's finalized.

1:50:24OK.

1:50:25Staff are nodding.

1:50:26There are accounts or kitchen and Turton.

1:50:30Thank you, Mr. Mayor.

1:50:31It's been an interesting afternoon.

1:50:32I've learned an awful lot about our systems.

1:50:34And I mean, it's our it's our ratepayers

1:50:37that are relying on us to bring this up and get it done.

1:50:41And I know that in mental, we certainly rely on our paramedics,

1:50:45our fire service.

1:50:46And if there's opportunities up there that we can do,

1:50:50certainly would certainly be interested in rebuilding

1:50:53that building.

1:50:54I think going to the province to get funding

1:50:58is going as a larger group.

1:51:00Three or four different stakeholders here

1:51:02is the right thing to do.

1:51:03So thank you.

1:51:07Thank you.

1:51:08Davidson, do you want to jump in?

1:51:09Yeah, Mr. Mayor, thank you.

1:51:12You know, Chief Dewar, I'm a big fan of your service

1:51:15and I'm a big fan of emergency services in particular.

1:51:19But definitely, I know that the paramedic services have

1:51:23been doing a wonderful job in the county

1:51:26and here in the city of Guilf.

1:51:27So I really appreciate that.

1:51:29Comments had been going around about the plan for the county

1:51:33and the county building.

1:51:35This plan has been in place for a number of years now.

1:51:37It's been in our 10-year plan for at least five years

1:51:41for building facilities throughout the county

1:51:43for the paramedic services.

1:51:45And there was actually a schedule on which ones

1:51:47were going to be built at which time,

1:51:49just for one's information.

1:51:50That's in place.

1:51:51We know what that plan is.

1:51:53Mr. Hart, if you wanted to, you could get up here and tell

1:51:56every dollar going to be spent for the next number of years,

1:51:59but we don't need that.

1:52:00But we do have the plan

1:52:02and it's not going to help the offload delays.

1:52:07That is a, man, that is a tough thing.

1:52:11Because you know, we look at this train,

1:52:14we have the need of more paramedics,

1:52:16but we can't really have more paramedics

1:52:18till we have better housing for the paramedics.

1:52:21You know, we have the paramedics that go to the hospital,

1:52:23the hospital has issues with staffing,

1:52:26can't offload the patients,

1:52:29so the paramedics have to stay there.

1:52:32And then the hospital's full

1:52:33and they have people that need to be moved

1:52:35to long-term care homes, which are also full.

1:52:38So there is a lot of steps that need to be put in place here.

1:52:41And certainly I understand all the steps

1:52:44that need to be put in place.

1:52:45But I'm going to say, Mr. Mayor, one thing

1:52:47that my granddaughter yesterday in the city of Guelph

1:52:51got hurt playing soccer, broke her arm.

1:52:54The paramedics went there,

1:52:55they took her to the Guelph General Hospital,

1:52:57which she didn't have to wait for my daughters.

1:53:02I checked on this chief that there was no offload delays.

1:53:05You go right there and just in surgery right now

1:53:09to repair arms.

1:53:10So just want to say thank you to the hospital

1:53:13and to the paramedic services for that.

1:53:17Well, we all hope that goes okay.

1:53:21Did the team win?

1:53:24Okay, all right.

1:53:26All right.

1:53:27Anything else before I turn it over for closing remarks

1:53:30just from the warden?

1:53:32Yeah, I'll do that then.

1:53:34So to the warden,

1:53:35then I'll have maybe some closing remarks

1:53:36and we'll go from there.

1:53:39Thank you, Mayor Guthrie.

1:53:40And first of all, I'd like to thank you and the city staff

1:53:45and the rest of council for inviting us

1:53:47to participate in this event today.

1:53:48I think it's a great step forward.

1:53:51We see it as a great step forward for Wellington County

1:53:54and that being more collaborative

1:53:57as has been alluded to a number of times today,

1:54:00we're stronger together than we are separated.

1:54:02So the people we serve, the citizens we serve

1:54:05are better served when we work together.

1:54:07And I hope that the showing of number of counselors,

1:54:12the number of questions that they asked today

1:54:15is a demonstration of how committed we are

1:54:18to making sure that the best outcomes

1:54:20for our residents and yours

1:54:22by working together collaboratively.

1:54:24So with that, on behalf of council, I would say thank you.

1:54:27And I think we look forward to what the next steps may be.

1:54:33Great, well, people from the county may not know this,

1:54:36but I often try to encourage people

1:54:38if they're about to say the same thing

1:54:40to say the word ditto here.

1:54:43And so I'm gonna just say the word ditto

1:54:45to what you just said

1:54:47because I can't really say it any better.

1:54:49Thank you very much.

1:54:50I echo the exact same sentiments.

1:54:52So I'm gonna just change it then from sort of this horseshoe here.

1:54:58And I'm just gonna say it sort of out to the public

1:55:01and to a few that are in the audience here.

1:55:03Thank you so much to our paramedics, seriously.

1:55:07Sometimes in the emergency services,

1:55:11I find that sometimes they can not on purpose,

1:55:14but sometimes our paramedics just can't be recognized enough.

1:55:18And so I just wanna really say thank you.

1:55:21I hope this message gets out to everybody.

1:55:25You deserve better when it comes to these locations.

1:55:31And I was so thrilled to hear positive comments

1:55:35from both county and Guelph all combined to say,

1:55:38like, what can we do to get this done?

1:55:40That is exactly the type of attitude that we need.

1:55:44And so we're gonna have to be quick.

1:55:46I think, you know, quick.

1:55:47There's some urgency behind it, bold.

1:55:50And we're gonna have to get it done.

1:55:52Gonna have to get it done for all the right reasons.

1:55:54So thank you for what you're doing.

1:55:57And thank you to our senior leadership

1:56:00within the paramedics, our WCAO of course.

1:56:03And we just really thank you for what you do in our community.

1:56:06And this, it will only get better from here.

1:56:09I feel it.

1:56:10I feel it in the room.

1:56:10It will only get better from here for you

1:56:12and then for our citizens.

1:56:13So thank you.

1:56:14This has been a great workshop.

1:56:16With that, I'm being serious.

1:56:19I think we should take a picture actually.

1:56:21Maybe you could put up on the screen clerks.

1:56:23Maybe like the over, like the picture of like the ambulance

1:56:27trucks or something like that is a nice background

1:56:30after we do adjournment.

1:56:31So maybe we could all stay here, all of us here,

1:56:35but all of the other counselors and our staff.

1:56:40This should be a group thing.

1:56:42Come on down into the center here and we'll take a picture.

1:56:45But with that, a motion to adjourn please.

1:56:48Alt and claus.

1:56:51I'm sure.

1:56:52Anyone against adjournment?

1:56:55Keep your hand down there, white.

1:56:58Yeah, careful.

1:57:00We'll move a motion to annex you.

1:57:03Yeah, all right.

1:57:04Anyone against adjournment?

1:57:05Nobody.

1:57:06Good.

1:57:06We're adjourned.

1:57:07OK, let's get a picture.

1:57:08Thank you very much, staff.