FEATURE 

When The Communications Centre Staff Cannot Go Home: Staff Sustainability

By Dennis Brown and Christina Summers

For over four decades the Ontario Ministry of Health and Long-Term Care has been involved in the delivery of ambulance and ambulance communications services. Through the Emergency Health Services Branch (EHSB) the ministry continues to ensure that high-quality ambulance communications exist in the Ontario ambulance system.

 Until the mid-1970s ambulance communications services were provided by individual ambulance operators. In 1977 the MOHLTC began centralizing ambulance communications. Centralization allowed for the development of a balanced and seamless provincial system of both ambulance and communications services. Greater flexibility in the ambulance system came with the integrated ability to seamlessly and electronically pass requests for ambulance services and to move ambulance vehicles from the control of one ambulance communications service to another. Centralization of communication services brought a greater reliance on the need to ensure that services could be maintained in the event of a major service or utility disruption.

 Ambulance service in Ontario has been punctuated by several major emergency events, which became benchmarks for emergency preparedness (e.g., 1979 Mississauga train derailment, 1998 Eastern Ontario ice storm, 2003 SARS, and the Eastern Seaboard Blackout). Evaluations and lessons learned from each event led to the development and implementation of specific policies and standards for service provision and emergency response. Nowhere in the provision of ambulance services is this more important than in emergency ambulance service call taking and dispatching.

 A 2005 review of Ambulance Communications Services (ACSs) continuity of operations planning revealed a significant gap. Each of our 23 ACS locations has excellent emergency response/evacuation plans, including access to short term back-up sites. The emergency plans are premised on evacuating the centre and providing a reduced level of service in a back-up site. Back-up sites do not provide access to full call taking and dispatching telecommunications or to the IT infrastructure. The option to shelter-in-place in the ACSs, when the facility or the infrastructure has not been compromised had not been explored. 

 EHSB management initiated a project to determine what would allow ACS staff to shelter-in-place for an extended period of time, without needing to access additional equipment, supplies or human resources. 

 Emergency Management Ontario advises residents to have an emergency survival kit allowing a family to be self sufficient for 72 hours. A Task Group of experienced ACS and field office managers developed the framework and criteria for ACS sheltering-in-place and decided ACS self-sufficiency should exceed the target for the general public and planned for 96 hour (4 day) sheltering-in-place sustainability kits.

The Task Force searched for commercially available emergency survival kits that might be suitable and found the majority of such kits were designed for outdoor survival or included a significant number of unnecessary elements (e.g., a tent, a whistle, or luminescent vests).

 ACS management was surveyed to determine staffing levels and the equipment/supplies normally stored in each centre (e.g., water supply/systems, electrical extension cords). The survey helped establish the number of staff and the basic level of equipment and supplies that would be required in an ACS and in the kits. Policies ensure that equipment and supplies are standardized in all centres.

 Each of Ontario’s 23 ACS is equipped with Uninterrupted Power Supply (UPS) and a liquid fuel generator with an extended capacity fuel tank, which supports the HVAC and lighting along with the IT and telecommunications functions in each ACS. As such each ACS can support a microwave oven to heat meals for staff that need to shelter-in-place.  

A list of essential food, equipment and supplies was developed and local suppliers engaged to develop the kits. Communications officers, who routinely work long shifts/overtime, often have a “stash” of food and other supplies in the kitchen and/or lockers. When the food and supplies lists were being developed this was taken into account. 

Numbers

ACSs vary in size and staffing levels and can range from three (James Bay area) to 46 in a large metropolitan area (Toronto). The maximum number of call takers/dispatchers for a regular daytime shift for each centre was used as the threshold for the number of operational staff that would need to be sustained. In addition, one management and one administrative assistant position was added to the list in order to establish a total staffing count that would need to be sustained. It is accepted practice for an ACS to up-staff (increase number of staff on site) and for there to be technical support officers on site. Additionally, since there may be other staff that would be required to be in attendance, the total staffing requirement counts were increased by 15%.This final number was used to determine the size of each centre’s sustainability kit 

The selected kit configuration was established to meet the needs of 6, 8, or 10 persons. These sizes allowed single kits of an appropriate size for smaller ACSs or combinations of various kits sizes for larger centres. For example a site with a total staffing level of 14 would receive one 6-person kit and one 8-person kit, a staffing level of 46 would receive one 6-person kit and four 10-person kits, and a staffing level of six or less would receive one 6-person kit. 

Allergens

In selecting food and personal care products every effort was made to ensure products were allergy free (e.g., did not contain latex). The manufacturer of the dehydrated food packages ensured common food allergens e.g., peanuts were not included in the ingredients.  

Personal Hygiene Kit and Equipment

The kits provided that each staff person sheltering-in-place would receive a personal hygiene kit, which includes hygiene products, over-the-counter medications, and personal equipment (e.g., socks and fleece blankets, and disposable wash cloths, towels, overalls, sleeping bags, pillows and thermal blankets). 

General Equipment and Supplies

In additional to food and personal care supplies, the kits also contained other common survival based devices and supplies (e.g., hand-crank AM/FM radios and flashlights, code red batteries, chemical light sticks, collapsible water carrier and water purifications tablets, candles and matches, disinfectants, can opener, 8-cup plastic measuring cup for heating dehydrated food (2 person portions) in the microwave oven, and duct tape). 

Water

Each ACS is routinely stocked with cooler dispensed bottled water (18.5 litre size). Each ACS must ensure a one-week supply of bottled water is always on hand for the total number of staff expected during a sheltering in place emergency. Routinely providing staff with bottled water ensures staff is not dependent on the municipal water supply, which may be shut off or under a boil-water advisory. Water bottled in smaller/individual sizes and purchased/stored as an emergency stockpile would require monitoring and stale date rotation. Through the ongoing routine use of this bottled water each ACS is able to ensure there is an adequate supply of fresh water on hand.  

Camp Cots

Basic folding camp cots are provided on a ratio of one cot for every three staff. For example a staffing level of 14 would receive five cots, a staffing level of 46 would receive 15 cots, a staffing level of six or less would receive two cots. 

Food

The dehydrated food is supplied by a local manufacturer that specializes in the camping and survival markets. A four-day supply of dehydrated food is packaged in two-person servings and assembled to ensure a balanced and nutritious menu package based on 1,700 calories per person per day. The food products are Soya-based, microwavable, and cover breakfast, lunch, dinner, dessert, and snacks.   

Storage

An Ontario-based medical equipment supplier was selected to assemble the equipment and supplies, which is stored in large, moisture-proof yellow plastic drums. For security the drum lids are secured by a bolted and padlocked metal band. Each drum was delivered with a laminated list of contents, which includes the expiry date for each item. The replacement supplies for the few items with a short shelf life (e.g., toothpaste and mouthwash) will be purchased on expiry and stored outside the drums. The stock can be replenished when the drum is opened during a sheltering-in-place event). The equipment and supplies for the sustainability kits are stored in 30, 60, or 95 gallon drums. Wheeled dollies were supplied for each drum to facilitate easier handling and movement. 

Drum sizes and packed weights

6 Person Kit = 1–65 gal drum: 161 lbs

8 Person Kit = 1–95 gal drum: 172 lbs; and 1 – 30 gal drum: 55 lbs

10 Person Kit = 1–95 gal: 172 lbs; and 1–65 gal: 161 lbs  

The collapsible cots are stored outside the drums in zippered canvas bags  The dehydrated food packets are stored in waterproof, lockable duffle bags. Disposable cutlery and dishes are included.

The dehydrated food has at least a two year shelf life and storage outside of the equipment/supply drums ensures easy replacement on expiry.  

Security

The management of each ACS is accountable for monitoring the security and use of the kits for replenishment or updating of supplies in the sustainability kits.  

Human Resource Emergencies

To reduce the impact of any emergency event on staffing levels (e.g., environment emergencies, seasonal influenza, and pandemic) policies, procedures and thresholds for reduced staffing levels have been developed.  Polices include a requirement for communications officers to have an annual N95 mask fit test. ACSs are provided with a stock of N95 masks and individual size bottles of hand sanitizer, which are stored separately. During a declared infectious disease outbreak, access to the ACS is strictly controlled and following proper screening for signs of illness, only approved ACS and technical support staff is allowed into the facility. 

For more information on the sustainability kits or our business continuity planning for the Ontario Ambulance Communications Services, please contact Ms. C. Summers at Christina.Summers@ontario.ca. 

Dennis Brown is a Senior Manager and Christina Summers is a Senior Program Analyst with the Emergency Health Services Branch of the Ontario Ministry of Health and Long-Term Care.