Ministry of Health (ON)

Ambulance Communication Services (ACS)

Dispatching of ambulances is done through Central Ambulance Communication Centres, or CACC. The service provider is the entity that controls the CACC. For example, Toronto and Ottawa self-dispatch and run their own CACCs whereas Hamilton and Cambridge CACCs are run by the Ministry of Health (Provincial Government).

Procedures and additional information for Ottawa CACC (but still applicable to other areas) can be found on this page: https://www.ottawaparamedics.ca/communications/

List of Central Ambulance Communications Centres (CACC)

Detailed talkgroup listings for MOH CACC's can be found for:

• Zone 1: https://www.radioreference.com/apps/db/?sid=861
• Zone 2: https://www.radioreference.com/apps/db/?sid=2560
• Zone 3: https://www.radioreference.com/apps/db/?sid=3511
• Zone 4: https://www.radioreference.com/apps/db/?sid=5490

• Cambridge CACC

Service provider: Province

Coverage: Waterloo Region and Dufferin and Wellington Counties

Address: 15 Reuter Dr, Cambridge, N3E 1B1 [1]

• Georgian (Barrie) CACC

Service provider: Province

Coverage: Simcoe County (excl. southern Ramara Township) and York Region

• Hamilton CACC

Service provider: Province

Coverage: City of Hamilton and Brant, Haldimand and Norfolk Counties

• Kenora CACC

Service provider: Hospital

Coverage : Kenora District (excl. Ignace and east of 85°W), western Rainy River District and Savant Lake

• Kingston CACC

Service provider: Hospital

Coverage : Frontenac, Hastings, Lanark, Leeds & Grenville, Lennox & Addington and Prince Edward Counties

• Lindsay CACC

Service provider: Province

Coverage : City of Kawartha Lakes, Haliburton, Northumberland and Peterborough Counties and southern Ramara Township

• London CACC

Service provider: Province

Coverage : Middlesex, Bruce, Elgin, Grey, Huron, Oxford and Perth Counties

• Mississauga CACC

Service provider: Province

Coverage: Peel and Halton Regions

• Muskoka ACS

Service provider: ???

Coverage : Muskoka District

• Niagara CACC

Service Provider: ???

Coverage: Niagara Region

• North Bay CACC

Service provider: Hospital

Coverage : Nipissing District (excl. Algonquin Park & South Algonquin Township), Parry Sound District and southeast half of Timiskaming District

• Oshawa (Whitby) CACC

Service provider: Province

Coverage : Durham Region

• Ottawa CACC

Service provider: Municipality

Coverage : City of Ottawa and Prescott & Russell and Stormont, Dundas & Glengarry Counties

• Renfrew CACC

Service provider: Province

Coverage : Renfrew County, Algonquin Park and South Algonquin Township

• Sault Ste. Marie CACC

Service provider: Hospital

Coverage : Algoma District (excl. Spanish) and Chapleau area

• Sudbury CACC

Service provider: Province

Coverage : Sudbury District (excl. Chapleau-Gogama area), Manitoulin District and Spanish

• Thunder Bay CACC

Service provider: Province

Coverage : Thunder Bay District (excl. Savant Lake), eastern Rainy River District and Ignace

• Timmins CACC

Service provider: Municipality

Coverage : Cochrane District, Kenora District (east of 85°W), northwest half of Timiskaming District and Gogama area

• Toronto CACC

Service provider: Municipality

Coverage: City of Toronto

• Wallaceburg CACC

Service provider: Hospital

Coverage : Municipality of Chatham-Kent and Lambton County

• Windsor CACC

Service provider: Province

Coverage : Essex County

Vehicles

Vehicle Standards

Authorized Manufacturers

Ontario Paramedic services in Ontario are only allowed to use ambulances that have been certified to the "ONTARIO PROVINCIAL LAND AMBULANCE & EMERGENCY RESPONSE VEHICLE STANDARD". As of 2019, only 2 manufacturers sell certified ambulance conversions for use in Ontario: [2]

• Demers Ambulance
• Crestline Coach

In 2017, there were 3 manufacturers selling approved ambulance conversions. The two listed above, and Malley Industries. Malley Industries had one ambulance that was certified for use in Ontario, but as of 2019 they were dropped from the Ministry's list of approved ambulance manufacturers. [3]

In September of 2018, it was announced that Demers Ambulance had acquired Crestline.[4]

MOH Vehicle Unit Numbers/Call Signs

4 Digits

See these forum threads for more information: https://forums.radioreference.com/threads/ambulance-numbering.292497/ https://forums.radioreference.com/threads/ambulance-unit-numbers.405909/

Each ambulance, ERV, or support unit has a dedicated MOH unit number or callsign, and is the number used by CACC when communicating with ambulance crews. MOH unit numbers aren't permanently assigned to a specific vehicle, and can be moved from vehicle to vehicle if desired (for example, if an ambulance has reached end-of-life, the same MOH unit number can be used on its replacement).

2xxx - First digit is Region.

• 1 is the London, Oxford, Grey County and Perth area
• 2 is Waterloo, Wellington, Hamilton, and Niagara area
• 3 is Halton, Peel, and York area
• 4 is Ottawa, Renfrew

x1xx - Second digit designates the vehicle type.

• 0, 1 and 2 are usually transport ambulances (can carry a stretcher).
• 3 usually refers to Supervisors or First Response Units (i.e., no patient transport capability)
• 4, 5 and 9 are also used for transport ambulances in some regions such as Peel and Renfrew[5]

3 Digits

3 digit call signs that begin with 7 usually refer to Ornge Air Ambulances. For example: 792, 799.

Ontario Ambulance 10 Codes

10 codes

• 10-3 All Vehicles stop Transmitting
• 10-4 Acknowledged
• 10-6 Busy-Stand by unless Urgent
• 10-7 Arrived(or OUT of Service)
• 10-8 Departed (or IN service)
• 10-9 Repeat last Transmission
• 10-13 Unable to reply (Relative near by etc.)
• 10-19 Return to Base
• 10-20 What's your Location
• 10-21 Phone by Landline or Cellular
• 10-25 Non-Violent Psychiatric Patient
• 10-26 Call is cancelled
• 10-27 Hostage Taking or SWAT Standby
• 10-34 What's the Hospital status
• 10-36 Emergency is CLOSED (Critical care Bypass)
• 10-37 Emergency is OPEN to Code 3's only (ReDirect Considerations)
• 10-38 Emergency is CLEAR
• 10-50 Violent Psychiatric Patient
• 10-100 Bomb Threat
• 10-200 Have Police Attend (often abbreviated to 10-2's)
• 10-2000 Send Police IMMEDIATELY

Service Status Codes

Ambulance Availability

Different CACCs use different terminologies in order to convey ambulance availability on the radio.

• Waterloo Region Paramedics/Cambridge CACC - Code Yellow is 3 or fewer ambulances; Code Red is no ambulances available

• Durham Region/Oshawa CACC - Code Capacity is 6 or less ambulances available, and Code Critical means 1 or 0 ambulances available [6]

• Oxford County/London CACC - Code Critical is 3 or fewer ambulances available, Code Zero or Code Capacity is no ambulances available [7]

• Essex County/Windsor CACC - Code Black is zero ambulances available [8]

Hospital Status

Cambridge CACC

Condition Red = Hospital is at capacity. Lower acuity patients (CTAS 3-5) will be diverted to other hospitals.

The codes below are used by Cambridge CACC to denote the hospitals available capacity for lower acuity patients with COVID symptoms in the Waterloo Region (St. Mary's, Grand River, and Cambridge Memorial). They are not the same codes used internally by hospitals. [9] [10] Critical or high acuity patients (CTAS 1-2) will usually be routed to the closest or most appropriate hospital (such as stroke/trauma/STEMI bypass) as normal.

• Green = Available capacity for patients screened with COVID symptoms
• Black = No space available for patients screened with COVID symptoms, ambulance will instead be directed to a Green hospital. If all hospitals are in Black, they will route to the nearest hospital or one with lower offload times as per normal procedures.

Ontario Priority Codes

Priority Codes

• CODE 1 Deferrable call - can be delayed without physical harm to patient (e.g., transfer of CTAS Level 5 patient to hospital)
• CODE 2 Scheduled call - non-emergency calls with a time element (e.g. scheduled transfers)
• CODE 3 Prompt call - not life threatening or not in immediate danger, lights and siren optional
• CODE 4 Urgent call - life threatening or in immediate danger (life, limb or function threatened). Lights on, siren optional.
• CODE 5 Obviously dead (Rigidity, Decomposition, Vivisection, Decapitation...)
• CODE 6 Legally dead
• CODE 7 Unstaffed at station OR out of service; down staffed vehicle[11] (see First Response)

    *71 = No patient found
    *72 = Patient refused care/transport
    *73 = Patient expired [as in decease]
    *74 = Patient in police custody
    *75 = Transported by another ambulance
    *76 = Canceled before patient contact

• CODE 8 Standby at location
• CODE 9 Unit in for servicing (Not Usable)
• CODE 19 non-essential call

CTAS Levels

The Canadian Triage and Acuity Scale (CTAS) has five levels:

Level 0: Obviously dead or TOR

Level 1: Resuscitation – Conditions that are threats to life or limb, needs immediate medical intervention

Level 2: Emergent – Conditions that are a potential threat to life, limb or function. Rapid intervention required to prevent further deterioration that may require resuscitation

Level 3: Urgent – Serious conditions that could progress, requiring emergency intervention

Level 4: Less urgent – Conditions that relate to patient age or distress, or has potential for further deterioration/complications. Would benefit from intervention.

Level 5: Non-urgent – Minor complaints, such as conditions that are non-urgent or that may be part of a chronic problem. Investigation/intervention can be delayed.

Acronyms

ACP    Advanced care paramedic (provides ALS)
ALS    Advanced Life Support
ASA    Acetylsalicylic acid (Aspirin)
BLS    Basic Life Support
CACC   Central Ambulance Communications Centre
CCP    Critical care paramedic (currently only used by Toronto EMS and Ornge)
CMH    Cambridge Memorial Hospital (in Cambridge CACC coverage area)
COPD   A lung disease that can cause breathing problems (Chronic obstructive pulmonary disease)
CVA    Stroke (cerebrovascular accident)
ETOH   Ethyl Alcohol (related to HBD below)
FREI   Febrile Respiratory/Enteric Illness (screening and precaution set)
GCS    Glasgow Coma Scale
HBD    Intoxicated (has been drinking)
JB     Joseph Brant Hospital (in Mississauga CACC coverage area)
LOA    Level of awareness
LOC    Level (or Loss) of consciousness
MVC    Motor vehicle collision
OTMH   Oakville Trafalgar Memorial Hospital
PCP    Primary care paramedic (provides BLS)
QCH    Queensway Carleton Hospital (in Ottawa CACC coverage area)
T1     The time when a call entered the queue at the CACC
TOC    Transfer of care. Time which patient has been transferred into the care of a receiving facility (such as hospital or air ambulance)
TOR    Termination of Resuscitation
UTM    A coordinate system, see UTM in Terminology
VSA    Vital signs absent

Terminology

Patch - Usually refers to patient reports from the ambulance to the receiving hospital. Each hospital has a 'patch phone' which is connected to a talkgroup on the radio network. The dispatcher will then 'patch' the appropriate talkgroups together, therefore allowing the ambulance to communicate with the hospital directly over the radio.

Tiered - A multi-agency response. Depending on the call and local procedures, Fire or Police will respond alongside EMS. For example, if there's a call for a cardiac arrest, Fire will be 'tiered' and respond to the call with EMS. A major highway collision will usually have Police, Fire and EMS respond, a 'fully tiered' response.

UTM - Coordinates that specifies a 1 KM block on a map. You can use this converter (http://www.bpsmicro.com/utmgoogleapp.htm) to see the approximate area on Google Maps. Set the ellipsoid to 'WGS-84', and for Waterloo/Wellington, set the UTM zone to '17T'. Enter the 7-digit UTM in the 'CACC UTM' box, and then press 'Display'. See this forum thread for more information: https://forums.radioreference.com/threads/how-does-the-utm-work.202680/

First Response - Usually a dedicated First Response vehicle staffed with 1 paramedic. Sometimes referred to as ERV/ERU (Emergency Response Vehicle/Unit) or RRU/RRV (Rapid Response Unit/Vehicle). Can also refer to transport ambulances with only one paramedic (since they are unable to transport patients without a second paramedic in the back). First Response vehicles can clear scenes and become available for service faster, as they don't need to transport patients to the hospital. Therefore, they are not subjected to hospital offload delays and don't need to go out of service for cleaning after transferring care of patient to hospital (TOC).