Throw a dart at a map of Ontario and it will likely land on a community facing a crisis in paramedic care, with long ambulance wait times, offload delays at hospital and staffing challenges.
At the same time more investment is needed to ease those operational issues, Ontario taxpayers are constantly footing the bill to replace ambulances and other essential equipment, with a price tag far outpacing inflation.
The ambulance is a critical tool for any front line paramedic, safely carrying the crew where it is needed, carrying all of the essential equipment needed to stabilize patients and transport them for care.
Ambulances are not built from scratch, instead the supplier purchases a chassis from an auto manufacturer like Ford, General Motors or Mercedes and fits it with an ambulance package that includes the patient module body shell, flashing lights and a laundry list of other enhancements required by front line paramedics.
Five years after a merger of the only two companies certified to sell ambulances for Ontario paramedic services, a virtual monopoly has resulted, along with price increases that so far has cost northern Ontario taxpayers millions.
“Once the competition went away, we have noticed the costs have been increasing significantly," said Mike Nadeau, CEO of Social Services in Sault Ste. Marie during a recent budget presentation to its board.
Ambulances operating in Ontario can only be sold by companies certified by Ontario's Ministry of Health and Long Term Care.
When two of those companies merged in 2018 it created a virtual monopoly, forcing municipalities and social service boards in Ontario to buy from a single source.
In 2018, Ohio-based Braun Industries, Saskatchewan-based Crestline Coach or Demers Ambulance out of Quebec merged.
A spokesperson for the Ministry of Health and Long Term Care told SooToday that Crestline and Demers are currently the only companies certified to sell ambulances to Ontario paramedic services and that both companies are operated under the parent company Braun.
Although prices for just about everything are expected to increase year over year as a normal part of inflation, the costs associated with the replacement of ambulances since the merger are far outpacing inflation.
In 2018, the Sault Ste. Marie Paramedic Service purchased ambulances at the cost of $125,000 per unit.
Three years later, in 2021, the service was quoted a similarly-spec’d ambulance with a unit price of $165,000 — a 32 per cent increase in just three years.
That year, the service ultimately opted for a $197,000 model that had an additional power lift system. The service had previously been purchasing ambulances without the power lift and adding it after market.
Now, two years after that, the cost of purchasing an ambulance with power lift included has jumped from $197,000 to $231,000 — another 17 per cent increase.
In 2021, a letter from Northern Ontario Service Deliverers Association (NOSDA) to the Ministry of Health and Long Term Care noted the 11 paramedic services that operate in northern Ontario have a combined fleet of over 200 ambulances and, with a replacement cycle of five years, purchase an average of about 40 ambulances per year.
At $150,000 each in 2021 dollars, those 40 ambulances totalled about $6 million.
To buy those same 40 ambulances at the 2023 rate of $231,000 each that cost has skyrocketed to $9.2 million.
Those 200 ambulances that service northern Ontario are a drop in the bucket.
A 2015 annual report by the ministry said at the time there were more than 800 ambulances operating across the province and a 2021 annual report by the Toronto Paramedic Service says it maintains a 234 ambulance fleet in Ontario’s capital alone.
That same price increase is being experienced by municipalities and social services boards across the province.
NOSDA said its members received word in the summer of 2021 from Demers/Crestline that the cost of an ambulance, which was $150,000 at the time, would increase by up to 15 per cent, effective immediately.
In its letter to NOSDA, the company cited 'circumstances beyond its control, for the 2021 price hike.
"Our real concern is the lack of competition in this sector, and we want to know what the province plans to do to ensure we have strong and vibrant economy where private companies prosper and competition in the marketplace is alive and well," said NOSDA chair Michelle Boileau in the 2021 letter to the minister.
That increase set up a $197,000 price tag per vehicle for the Sault Ste. Marie Paramedic Service in 2022, followed by another increase to $231,000 this year.
Ministry spokesperson Bill Campbell noted the province allows for a remounted ambulance program to provide paramedic services a cost saving option to re-use the patient module component of the ambulance and replace the only chassis.
In 2020, the Toronto Paramedic Service awarded a contract to Crestline Coach to remount up to 24 decommissioned ambulance patient modules on to new Chevrolet chassis at a cost of $2.6 million, or about $130,000 per ambulance.
In an interview with SooToday, Boileau said the increasing prices are not the only issue, but also how difficult it is to actually get a brand new ambulance when it is needed.
“Supply chain issues and unavailability of ambulances are making it a little more problematic in ensuring adequate service delivery,” said Boileau. “[We] are asked to put down about a 30 per cent deposit, whereas in the past it was about 15 per cent, which means we pay more for a deposit for an ambulance we don’t expect to see for 18 to 24 months.”
Those difficulties come at a time when paramedic services across the province are facing operational pressures like staffing shortages, offload delays, among others. Boileau said the rising costs of purchasing equipment is coming at the same time more money is needed in the system to address those operational pressures.
“It’s compounding the current issues. Not only are staffing and all of the other logistics, but the rising call volumes as well, especially in response to the opioid crisis,” she said. “Put all of those together and there are a lot of compounded issues that are making it a lot more difficult to deliver paramedic services.”
