​The Ontario legislature has introduced amendments to its Ambulance Act regulations. Under the new regulations, ambulance services can transport 911 patients to pre-hospital care centres other than hospital emergency rooms. The amendments to O. Reg 257/00 under the Ambulance Act took effect on November 1, 2019. The regulations follow a comment period in October.

These amendments enable new patient care models for ambulance services, where care can be provided safely and appropriately outside of the traditional emergency room setting. The new models are to be published as they are developed, in a yet-to-be-published Ministry document titled "Patient Care Model Standards." Section 11 of the regulation has been amended to require ambulance services to comply with that document, once published.

Among the new patient care models specifically contemplated by the Ministry in its initial proposal are:

  • Transport to destinations other than the ED, such as specialty clinics suited to the patient's immediate needs.
  • On-scene treatment, either as a full incident of care or as pre-care before transfer to another community-based provider.

The practical changes would include granting the Ministry power to establish care standards and requirements for use of the new care models.

Also of note is that the proposal contemplates the employment of care providers, such as nurses, at ambulance call centres for the purpose of providing clinical advice during on-scene care. Currently, ambulance call centres rely on emergency care physicians for urgent clinical advice. Under the proposal, physician consultations would also be broadened to include different specialties.

It remains to be seen what alternative care models will actually be implemented and how those alternatives will impact pre-hospital care.

The government has also amended Reg. 552 under the Health Insurance Act to establish patient-paid charges for transportation to non-hospital destinations. The co-pay charge is set at the same amount as hospital transport co-pays ($45), which the proposal notes is one of the lowest ambulance co-pays in the province.