A Brief History of the Ambulance Service in Ontario
Not unlike other jurisdictions, Ontario's ambulance
services have emerged from roots embedded in both health care and the
private sector, evolving along a somewhat convoluted path into the current
municipally controlled service delivery models. While the first municipally
funded ambulance services appeared in Toronto as early as 1880, and
were similarly well established in Berlin-Waterloo (now Kitchener-Waterloo)
by 1903. Emergency Medical Services (EMS) were not municipal priorities
in other parts of the province.
During the first half of the 20th century, it was not uncommon to see
private ambulance services operating as sidelines for funeral homes,
or even furniture stores, taxi and towing companies. While some would
see providing ambulance service as a serious conflict of interest for
the funeral director, their involvement was generally borne out of a
commitment to provide a much needed community service. not to mention
that theirs was often the only equipment in town capable of comfortably
transporting patients lying down! The funeral home was already staffed,
the telephone answered 24 hours a day, and the staff's education in
the natural sciences, second only to that of the local physician.
In larger communities, a number of commercial ambulance services were
often available, although no means existed to co-ordinate their efforts.
There was no provincial funding for ambulance services, payment was
on a full fee-for-service basis, and there were no uniform standards
for patient care, training or equipment. No 9-1-1 telephone or centralized
dispatch systems were yet in place, and a competitive element often
affected quality of care provided. Unlike today, it was sometimes better
to be the last ambulance arriving at the scene of a motor vehicle collision,
rather than the first and fastest. Arriving ambulances commonly blocked
the ambulance ahead to prevent them from being able to transport patients.
Thus, the last arriving ambulance was the only one assured of a paying
customer. Despite the competition, there was no guarantee that the personnel
aboard any of these ambulances were even marginally trained. No standard
of training was prescribed, and one 1963 study revealed that only 141
of 181 operators contacted, even had staff with basic first aid training.
During the late 1960s, Dr. Norman McNally, then Director of the Emergency
Health Services Division (EHS) of the Ontario Hospital Services Commission
(forerunner of today's Ministry of Health and Long Term Care), was charged
with developing "a balanced and integrated system of ambulance services."
out of a "hodge podge" of 425 services of widely varying quality that
existed around the province. Under his direction, EHS set out to first
standardize training levels among ambulance attendants, then improve
vehicles and equipment. McNally's stated goal was eliminating the private
services, then consolidating them to gain benefits of scale, and placing
them under the control of hospitals where stable funding, training and
quality assurance could be maintained. Unfortunately, the cost of this
worthwhile venture was grossly underestimated, and financial limitations
negated the government's wholesale purchase of all private ambulance
services.
From 1968-1973, licensed ambulance services could not be sold between
operators. only back to the Ontario Hospital Services Commission (the
Ministry of Health after 1971). The mid-1970s however, saw a reversal
of this trend towards public consolidation, with a new emphasis on private
sector involvement in the management and delivery of ambulance services.
From 1973 on, service licenses and assets were bought and sold as business
undertakings.
What remained in place from the 1970s was an ever-evolving mix of approximately
175 publicly contracted (hospital and municipal), private, and directly
operated (OPS) ambulance services, that were all fully funded and directed
by the Ministry of Health. Some 40% of these services were operated
by private individuals/corporations. Operations of the services were
managed centrally through six Regional Offices of the Emergency Health
Services Branch. Ambulances and major capital equipment were provided
at no charge to the Operator, while other expenses were detailed in
Ministry-approved line-by-line budgets, and then cash flowed automatically
to the Operator. As any expenditure required prior Ministry approval
before proceeding, there was little if any capital risk to the Operator.
Despite two government initiated major reviews of EMS governance and
structure, this rather eclectic mix of "private", hospital, municipal
and OPS ambulance services remained in place until the 1998 Local Services
Realignment initiative of the Harris Conservative government.
