Fire-based EMS

[mariomike]

TORONTO, June 26, 2013 /CNW/ - The Toronto Paramedic Association strongly supports the majority of recommendations concerning EMS in the 'City of Toronto/Pomax report on Toronto EMS and Fire Services' released on June 25, 2013. The majority of findings are in line with what the Toronto Paramedic Association has been advocating for years.
http://www.newswire.ca/en/story/1190393/toronto-paramedic-association-pleased-with-pomax-consultants-report-on-toronto-ems-fire-services-encourages-city-council-to-rapidly-accept-and-impleme

City of Toronto/Pomax report recommendations:

1) "Do not consolidate TFS and TEMS. Consolidation of TFS and TEMS is not well suited for Toronto given the maturity of its fire and paramedic services."

2. "Do not consider implementing a firefighter-paramedic model of pre-hospital emergency medical care in either an organizationally consolidated entity or in the existing separate organizational design."

No Johnny and Roy for Toronto.

3. "There has been a 28% increase in emergency call demand for paramedics over the last ten years."

4. "Implement dynamic staging and use predictive modeling and pre-emptive traffic controls to better predict demand and more effectively deploy fire resources and apparatus."

I don't imagine Dynamic Staging will be a popular recommendation with the Firefighters, especially since they switched to the 24-hour tour city-wide.

5. "Demand for fire response has remained flat or declined over the last ten years and the number of actual fires in Toronto has declined even though the population has increased."

 

[pbi]

Mariomike: What are your views on other cases (Canadian and US) where the two services have been combined?

I'm aware of two in Canada: Calgary attempted it while I was stationed there in the 1990's, but it was very unpopular with both sides and eventually it failed. (Don't know the status today: I think they're still separate).

Winnipeg has had a "Fire-Paramedic Service" for some time now (it existed when I lived there 2002-2005). It seemed to work (more or less), but I got the impression that there may still have been some friction and unhappiness.

In the US, the provision of paramedic services by large, well-established city FDs is quite common. Sometimes the FD is the sole provider of public EMS, sometimes there are other providers, but in any case this practice isn't really news in the US.

It actually might be a wise move by FDs with an eye on the future, since the number of calls to actually fight fires seems to be dropping in most places (except Detroit, maybe...). When I was a VFF in suburban Virginia (just outside DC) I would say that 60-70% of our runs were non-fire.

Cheers

 

[mariomike]

Pbi, this is the report. "A Service and Organizational Study of Toronto's Emergency Medical Services and Fire Services":
http://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59903.pdf

It's a lot of reading, but it discusses much of the above.

Cheers 

 

[pbi]

Aaaaah! 320 pages!!!! You're killing me!!

OK...I will have a look and get back to you.

Cheers

 

[Scott]

I think the Winnipeg FireMedic example is still one of growing pains, least from what I hear rumbling online and through some acquaintances.

Some great examples would be Red Deer and Ft. McMurray - both medium sized cities who have had established combined services for some time now. I have good friends serving, or who have served, with both and they say it works - save for the arguments and short straw draws over who has to run on the medic unit for the shift >

I do not, however, see it working in a place such as Nova Scotia where the paramedic service is "nationalized" with a strong component of enhanced FA services rendered by fire. One of the issues I have seen with the separation of services (including dispatch) is that sometimes through stage shifts the medics responding do not know the area and there is a time loss when either they, or their dispatch, do not push the button to have fire co-respond. But that's nothing that better comms on both sides hasn't fixed (until next time)

My experience with EHSNS has been pretty much positive. I dealt with them as a fire officer overseeing MFRs (mine lapsed and I have zero interest in regaining that cert) and found them to be nothing but positive in dealing with issues such as above, training sessions, debriefs, etc. I also found that when we lucked out with crews we knew we suffered zero sense of overlap and everyone worked with one another.

I digress. Personally I don't promote or decry the idea. I think it works who it works for and those it isn't working for, either model, are the ones who look for a change. It is not something simply for the good idea fairy, that is for certain. Neither is it for the lobbyists looking solely to save positions in X service.
There are benefits and drawbacks to each model and what they are largely depend on your area.

Just my opinion.

 

[pbi]

OK: I skimmed the report, but read the Fire-EMS model part pretty thoroughly. The conclusions I find interesting are:

-Alberta tried it but is moving away from it quickly;

-Winnipeg has it, but it tgook 15 years to sort out so that it worked well;

-there isn't any conclusive evidence that a combined model is necessarily better, or even cheaper than an effective FD and an effective EMS working in a coordinated and cooperative way. It might be a good idea if one (or the other) service has a particular weakness, but otherwise it migt just be change for change's sake.

Maybe this is like that idea that was popular in the 1950s in the US and parts of Canada (Esquimalt, Fort Garry, etc) of a combined Fire-Police service. This was touted as being more "efficient" and, of course cheaper (Amazing how some of the worst ideas have the characteristic of supposedly saving money...). As far a I know it has largely vanished, although Esquimalt was still doing it when I was stationed there in 1983-86.

Cheers

DJB

 

[Scott]

-there isn't any conclusive evidence that a combined model is necessarily better, or even cheaper than an effective FD and an effective EMS working in a coordinated and cooperative way. It might be a good idea if one (or the other) service has a particular weakness, but otherwise it migt just be change for change's sake.

This is about where I stand on the whole thing.

 

[mariomike]

Some great examples would be Red Deer and Ft. McMurray - both medium sized cities who have had established combined services for some time now. I have good friends serving, or who have served, with both and they say it works - save for the arguments and short straw draws over who has to run on the medic unit for the shift >

Scott, that would not be a concern in Toronto. 

"TFS does not require a PCP level of training, and instead, relies upon an appropriate, but less qualified level, similar to an emergency medical responder (EMR)."

"...the training does not provide eligibility to practice or work in a patient care capacity in a land ambulance service in the Province of Ontario."

 

[Scott]

Mike, I know. I was referring to buddies of mine relating their own experiences in places outside of TO.

 

[mariomike]

In the US, the provision of paramedic services by large, well-established city FDs is quite common. Sometimes the FD is the sole provider of public EMS, sometimes there are other providers, but in any case this practice isn't really news in the US.

It actually might be a wise move by FDs with an eye on the future, since the number of calls to actually fight fires seems to be dropping in most places (except Detroit, maybe...). When I was a VFF in suburban Virginia (just outside DC) I would say that 60-70% of our runs were non-fire.

Cheers

That's what their General President was saying ten years ago.

"Our next frontier is Canada.":
http://www.iaff.org/03News/061203has.html

"But as one of this union's most fundamental responsibilities, our involvement in EMS has also helped us create and save jobs for our members."

The long awaited City of Toronto/Pomax report recommendations one month ago are clear on that subject.

In yesterday's paper.

"Toronto firefighters question changes to 911 protocol regarding medical calls
Toronto firefighters are worried that patient safety is at risk after they were removed from dozens of urgent medical calls.":
http://www.thestar.com/news/gta/2013/08/02/toronto_firefighters_question_changes_to_911_protocol_regarding_medical_calls.html

"Based on the data, the medical experts recommended that firefighters only be dispatched to types of urgent medical calls where they intervened (or could have intervened) in at least one per cent of cases, a threshold Schwartz called “medically quite reasonable and ethical.”

Dr. Brian Schwartz is co-chair of the city's tiered response committee.

"John MacLachlan, executive officer of the EMS committee for the union that represents Toronto firefighters, was concerned about the changes, and asked area captains to keep him abreast of any medical calls where they believed that they had not been dispatched soon enough — or at all."

 

[241]

Red Deer Alberta currently has fire-medics and from what I have heard it is very practical and convenient as it means there are always extra bodies available at the scene, they are all trained the same of course. With Alberta Health Services apparently taking over all ambulance service that will end soon.

 

[mariomike]

Red Deer Alberta currently has fire-medics and from what I have heard it is very practical and convenient as it means there are always extra bodies available at the scene, they are all trained the same of course. With Alberta Health Services apparently taking over all ambulance service that will end soon.

That may be very practical and convenient ( or used to be ) in Alberta, but not here.

"New ( TFS ) recruits therefore receive a total of approximately 120 hours of EMR training."

That can be compared to PCP training on page 115: "Skills and Knowledge Guide for Pre-hospital Skills in Ontario"
http://www.toronto.ca/legdocs/mmis/2013/ex/bgrd/backgroundfile-59903.pdf

The cost - assuming it was even possible - of upgrading Toronto's 3,100 full-time firefighters to just a PCP level would be enormous.

To put just one PCP into each of the city's 82 firehouses would require training 411 "fire-medics".

"Therefore, the estimate to train 411 firefighters to the PCP level would be approximately $6.16 million for tuition, books, and other requirements, plus a direct replacement wage cost of $67.11 million (411 complement, minus 100 [current trained EMCA complement *] multiplied by $107,896). This calculation assumes a 100 percent success rate in both the program and the provincial certification examination, which has not been the actual experience. Prudence would suggest at least a 10 percent remediation rate, further increasing the cost."

They would be assigned to fire trucks, not ambulances. Patients would not be arriving at hospitals any sooner than they do now.

Because there are no "fire-medics" at this time, the salary for their new job classification, if it could not be negotiated, would have to be decided by an arbitrator.

*The estimated 100 EMCAs currently employed by TFS may already be certified which might reduce the costs of training or the duration of the tuition option.



 

 

[pbi]

Red Deer Alberta currently has fire-medics and from what I have heard it is very practical and convenient as it means there are always extra bodies available at the scene, they are all trained the same of course. With Alberta Health Services apparently taking over all ambulance service that will end soon.

True, but from what I understand, as mariomike says, AB is abandoning that system.

 

[241]

True, but from what I understand, as mariomike says, AB is abandoning that system.

Yeah, as I stated in the last sentence.

That may be very practical and convenient ( or used to be ) in Alberta, but not here.

"New ( TFS ) recruits therefore receive a total of approximately 120 hours of EMR training."

That can be compared to PCP training on page 115: "Skills and Knowledge Guide for Pre-hospital Skills in Ontario

....

Sorry didn't read any of the links, was just responding to earlier where pbi had mentioned that there were 2 cities that were doing this and was just mentioning that there were at least 3.

 

[HTFUAlberta]

I'm currently working for an integrated Fire/EMS system in one of the cities adjacent to Edmonton and can offer up my $0.02.

For smaller sized cities the integrated Fire/EMS system seems to work really well. The IAFF put out a really interesting  position paper on integrated services which shows a solid argument http://www.iaff.org/tech/PDF/FB%20EMS%20Whitepaper%20FINAL%20July%205%202007%20.pdf

In the smaller sized cities outside of Calgary and Edmonton integrated services are generally the norm and seem to work very effectively. Larger cities would have way bigger challenges compared to smaller ones implementing and integrated service. IMHO it seems to work really well for our city and we provide great value and high service. After all most fire services seem to have a high ratio of medical calls regardless. We're all certified to at least PCP level so we're able to start up a lot of interventions and treatments before a transport crew arrives. It's always funny to see an out of town crew show up and we (the knuckle dragging firefighters) already have a pt. tubed with a line.

As far as AHS goes we're still waiting on our contract after 17 months of negotiations. We just dropped $500,000 on new medics and the contract will be for 7 years so it's looking like we're still getting our ambulances (which are generally sent outside of our are due to roving deployment, hence the outside crews coming in to cover our red alerts). AHS is having a lot of growing pains as far as the provincial EMS roll out and I'm of the opinion that there is still a long way to go before fire/ems systems in Alberta get split up. With that being said the AHS EMS system has some great advantages too (don't want to sound negative) but it is costing more $$$ than they ever expected which is no suprise.

We don't have enough units to begin with and when your doing calls from CFB Edmonton, then downtown then to a nearby reserve in one day you know that your service is overstretched.

Like I said before only my $0.02

 

[mariomike]

We're all certified to at least PCP level so we're able to start up a lot of interventions and treatments before a transport crew arrives.

TFS does not require a PCP level of training, and instead, relies upon an appropriate, but less qualified level, similar to an emergency medical responder (EMR).

The cost of training their 3,100 firefighters to a PCP level would be enormous, if not impossible. As "fire-medics" ( no such job classification exists now ), they would also receive a salary increase. 

None of this expense would put any more ambulances on the street.

 

[Scott]

Toronto is not the centre of the universe. What works/does not work there might not work/not work somewhere else.

I did not gather that the post made by HTFU was reasoning towards TFS moving in this fashion. Rather, I gathered that he was stating his experience from a combined service in Alberta - one of the talking points here.

 

[HTFUAlberta]

I agree 110% 3,100 guys and gals to retrain would be an impossible challenge. I know when we went integrated (which I wasn't around for) all new hires had to have a PCP ticket to come on. A lot of other services in AB hire PCP/ACP and train them to the 1001 standard. As someone who started out Fire I have to say its easier to put a fit, willing PCP/ACP through a 4 month 1001 course than going the other way around. Now that we are so overwhelmed with EMS calls we are using ALS pumps to respond to all calls coded Charlie or higher. Once we arrive on scene we start treatment and assist the transport crew. On some bigger calls like a big trauma or code we will actually hop in the back and drive to the hospital with the transporting crew!

A big service like Toronto couldn't make this practical but for the small to medium sized cities it seems quite doable. Back in the late 80s early 90s a lot of fire services in AB saw that going dual service was good value for money. I'm not in a position to speculate on what a big city like Hogtown should do but I know that it always boils down to how much (or in this case little) $$$ there is to go around.

As the old adage goes at the end of the day the doors go up, the truck rolls out and hopefully everybody goes home!

Or you can come out to AB and come swimming in the money pool! Leduc just recently settled at $92,000 for first class FF, Strathcona salary matches and Fort McMurray issues you an oil sand size dumpy truck to drive your pay checks home!

But in all seriousness I know that the days of Johnny and Roy won't appear in TO anytime soon. In the meantime keep your head down, good luck and stay safe.

Regards, HTFU

 

[Scott]

I agree 110% 3,100 guys and gals to retrain would be an impossible challenge. I know when we went integrated (which I wasn't around for) all new hires had to have a PCP ticket to come on. A lot of other services in AB hire PCP/ACP and train them to the 1001 standard. As someone who started out Fire I have to say its easier to put a fit, willing PCP/ACP through a 4 month 1001 course than going the other way around. 

This!

Oilsands FDs seem to see the writing on the wall. Either come in as a trained medic or nurse THEN go through fire, or come with both sides. DO NOT apply as a firefighter without the med side. I have always agreed with this rationale for those departments wishing to do so. Because it makes sense.

 

[HTFUAlberta]

Toronto is not the centre of the universe. What works/does not work there might not work/not work somewhere else.

I did not gather that the post made by HTFU was reasoning towards TFS moving in this fashion. Rather, I gathered that he was stating his experience from a combined service in Alberta - one of the talking points here.

You can make it work in small to medium cities. I don't think it's doable for T.O. An oil tanker can't be combined with a cargo ship while sailing through rough seas right? Everybody has the best intentions on the floor but as you move up the totem pole there's less interest in playing together in the sand box. Edmonton tried back in the 90's and it fell apart over a $5,00,000 supplemental pension deal that would have to be offered to the oncoming EMS division. Amongst other things mind you. And the Fire/EMS split there has been entrenched ever since.

That old line if it ain't broke don't fix it may apply here. And in response to the Margaret Wente article: Emergency Services are like insurance. Don't ask if you can afford it, ask if you can afford NOT to!