Region of Waterloo Emergency Medical Services is going through an overhaul after a damning provincial probe found EMS management failed to ensure acceptable levels of patient care were being consistently provided by paramedics.

A Ministry of Health and Long-Term Care investigation found that EMS response to emergency calls did not meet provincial standards, according to a report released Friday afternoon.

The report analyzed 562 documented calls to ambulances made between Jan. 12 and Aug. 20 2012. It found that in 15.8 per cent of ambulance calls, EMS response time to Code 4 requests — the most urgent form of request for ambulance service —was "not appropriate."

It also found that 59 per cent of ambulance call reports had an inaccurate record of whether lights and sirens were used when responding to Code 4 requests. By law, paramedics have to record this information. Further, 46 per cent of calls reviewed found that lights and sirens either weren't activated when they should have been or that there was documentation lights and sirens were used when they weren't.

The provincial report cited studies that noted use of warning systems like lights and sirens can save "significant time" when responding to an emergency call.

In 9.7 per cent of calls monitored, there was no oxygen administered "when required by

[the] patient's condition," the report said.

The report concluded that EMS management was "not ensuring patient care is consistently being provided" in accordance with provincial legislation.

"As soon as we identified the problem we took action right away. We've been very transparent in sharing this information," said Dr. Liana Nolan, the commissioner and medical officer of health for Waterloo Region in an interview. 

"We re-educated staff on the policy to follow, set our expectations, did the discipline. We are now monitoring closely in terms of the lights and sirens and there are ongoing quality assurance measures."

The province's investigation came after the Region of Waterloo conducted its own investigation into paramedics. The investigation was sparked by a report that an ambulance last July did not deploy lights and sirens after receiving a Code 4 request.

2 paramedics fired, 24 more disciplined

Further investigation revealed the paramedics involved in that call had a "history of similar behaviour on multiple emergency ambulance calls," according to the region's report on the matter. When the region investigated even further, they found similar behaviours among "many" other paramedics.

As a result of the probe, 26 paramedics were disciplined. Eight were served with written warnings, 16 suspensions and two were fired. EMS has also stepped up regular monitoring of ambulance crews.

"There was no evidence of patient harm in the sample of call reports reviewed by the Ministry of Health and Long-Term Care," wrote Nolan in the region's report.

"However, the issues identified are serious and will continue be addressed to ensure ROW fulfills its role in ensuring proper patient care, documentation and quality assurance."

EMS has also appointed two staff from Toronto EMS to help run the department. Arthur Graham becomes the Interim Director, replacing former EMS  chief John Prno, who stepped down abruptly last month. Meanwhile, Sheryl Jackson has been appointed special advisor of quality assurance.