"Smitherman: Firefighters should swallow EMS"

[Sheerin]

I have folks who'd disagree but the demographics we're speaking about are like comparing apples to bowling balls and I'll concede that you know what you're speaking of for your geographic area.

What specifically would they disagree with?  I'm just curious to find out how different regions operate.

I think that is a little unfair. My buddies moan about the "blood box" because it's busier than the engines. Being that they are professional and dedicated I do not think it takes away from their level of service.

I imagine your friends joined the fire department to be firefighters, not paramedics.  I would imagine that they do not have a vested interested in paramedicine and as such only spend the absolutely minimum amount of time maintaining skills, and have zero interest in expanding their role as paramedics. 

Also the quality of care you receive from someone who isn't 100% interested in being there is less than from the person who wants to be a paramedic.  Same is true for paramedics who want out by aren't able to pull away from a 80k+/year  job. 

 

[Scott]

EHSNS has invested heavily in the MFR program here which should be a strong indicator of what they believe. ALL first responders are trained to their standard and the program is now quite intense (I do not participate save to drive them there) Equipment is supplied by them on a rolling basis as are the ongoing modules one must attend to keep their certification.

It's not the same everywhere, I know, and in larger centers it's harder to run and maintain. But we have a good thing going here that EHS and the medics seem happy with as well as the firefighters - to a point that we now have "first responder only" members in the vollie halls.

About my buddies running dual: they all attended Vernillion's program so they are all EMT/Firefighter's out of school. Their vested interest is in their employment contract and there's no getting cheeky about it - you might love what you do but you also have to pay the bills.

I look at it this way: I will never begrudge anyone in this line of work one single frigging penny provided that they go out of their way to earn it and also make the community a better place (part of which IS covered merely by showing up to work) In ways we are all on the same team - I say that with no union behind me.

Cheers

 

[SeanNewman]

...I imagine your friends joined the fire department to be firefighters, not paramedics...

I don't think the answer is that simple.  Saying a person only wants to fight fires is like saying a soldier joined because they want to kill people.

I think there is a lot of overlap, actually.  If you think about the end and not the means, both EMS and Firefighters are there to serve, protect, and help citizens.

My best man was a firefighter so this is a bit anecdotal and not a scientific survey, but when we talk about these sorts of things it's all about getting as many qualifications as you can in order to help save people.

A soldier doesn't only focus on killing and a firefighter doesn't only focus on fighting fires.  Both of them can benefit greatly from any sort of life-saving training, and I don't think it's stepping on a Paramedic's toes for the others to study casualty care because they can still be the experts.

So to get back to the core of what I quoted of your post, I think people join any career for a lot of reasons and there are many factors, but a firefighter who would refuse EMS-type training would be pretty stupid and I don't think many would say "I don't need that training, my job is only to fight fires".

 

[SeanNewman]

Oh for sure, don't get me wrong of course their primary job is still to fight fires, but that's just the means.  The end is still saving people, regardless of how it's done. 

While of course nobody can state why every single person joins that career, I don't think the only single answer would be "Because I hate fires and I want to extinguish every goddam one of'em" (which is how I took the post I quoted).

First Aid (and more advanced life-saving skills) are a benefit to everyone, be they soldiers, firefighters, police, lifeguards, etc.

 

[Sheerin]

I don't think the answer is that simple.  Saying a person only wants to fight fires is like saying a soldier joined because they want to kill people.

I think there is a lot of overlap, actually.  If you think about the end and not the means, both EMS and Firefighters are there to serve, protect, and help citizens.

My best man was a firefighter so this is a bit anecdotal and not a scientific survey, but when we talk about these sorts of things it's all about getting as many qualifications as you can in order to help save people.

A soldier doesn't only focus on killing and a firefighter doesn't only focus on fighting fires.  Both of them can benefit greatly from any sort of life-saving training, and I don't think it's stepping on a Paramedic's toes for the others to study casualty care because they can still be the experts.

So to get back to the core of what I quoted of your post, I think people join any career for a lot of reasons and there are many factors, but a firefighter who would refuse EMS-type training would be pretty stupid and I don't think many would say "I don't need that training, my job is only to fight fires".

In a perfect world that wouldn't happen, but you would find that once EMS was totally integrated in with fire, you'll have people trying to use paramedicine as a backdoor to firefighting.  Just look to the US where the fire/medic model is used extensively. 
Yes we're here to serve the population, but we're not interchangeable.  As a paramedic, my job differs dramatically from a cop which differs dramatically from a firefighter.  There is some overlap, but its only on the very superficial level. 

Fire will always have a place, assisting on medical calls.  They're the ones who know how to take a car apart after a bad MVC, they're the ones who know how do angle access, etc.  And on VSA's it's always nice to have an extra set of hands on scene.  If it were up to me, we wouldn't need fire to attend most calls as EMS would have a response time that is comparable to fire.  But that's not going to happen as politicians have been told that a fire company on a medical call is almost as good as having a paramedic.   

 

[SeanNewman]

Very good points, especially the one about the firefighters having the access kit.

Sorry if I worded my post in a way that made it seem like I was saying they were interchangeable; I certainly know they are not.

 

[mariomike]

Dr. Martin McNamara is an Ontario ER physician. He wrote a thesis on this topic:
"Conclusion: There is little evidence for current fire staffing levels in certain cities such as Toronto, and excess money would be better chanelled into improving EMS services."

The most authoritative study on the problems with Fire-Based EMS, "The McNamara Report":
http://nycemsauthority.com/?q=node/8
http://nycemsauthority.mayfirst.org/files/McNamara1.pdf
http://nycemsauthority.mayfirst.org/files/McNamara2.pdf
http://nycemsauthority.mayfirst.org/files/McNamara3.pdf
http://nycemsauthority.mayfirst.org/files/McNamara4.pdf
http://nycemsauthority.mayfirst.org/files/McNamara5.pdf
http://nycemsauthority.mayfirst.org/files/McNamara6.pdf
http://nycemsauthority.mayfirst.org/files/McNamara7.pdf
http://nycemsauthority.mayfirst.org/files/McNamara8.pdf

"Dr. McNamara was employed as a paramedic in Orillia and Midland from 1977 to 1992 and completed a Bachelors in Anthropology/Geography in 1992. He finished McMaster Medical School in 1995 and Residency in Family Medicine and Emergency Medicine in 1998.
He is qualified CCFP/EM, working at RVH ER from 1998-2000 and Huronia District Hospital, 1998 to present. His posts include Medical Director of the Community Paramedic Program on Christian Island, Medical Director of the Humber College Paramedic program and Chief of ER at HDH from 2000 to 2003. Has has been President of Medical Staff HDH, 2006 to present.":
http://www.socpc.ca/pdf/Patch%20Drs%20Oct%2009.pdf

Ottawa Sun:
"Rushing to the Rescue: examines the tensions between medics and firefighters"
http://www.ottawaparamedics.ca/news.asp?id=230

 

[Sheerin]

Sent this to Smitherman, not that I expect a response lol

Mr. Smitherman,

I would like to comment on your recent proposal of merging Toronto EMS and Toronto Fire.  Right off the bat I'd like to tell you that this is an absolutely atrocious idea.  The only way it will work is if you force it, and I can guarantee you that the level of prehospital emergency medical care would drop dramatically in this city. 
You accurately pointed out that Toronto fire has, on average, a significantly shorter response time for calls than Toronto EMS does.  If you looked more closely at the numbers, you would see that the reason why they are able to do this is that their annual call volume is SIGNIFICANTLY less than Toronto EMS, they also have significantly more stations than T-EMS.  The idea shouldn't be, 'hey, TFS is able to do calls, lets use them', it should be 'why are we funding a service to the point where they can literally sit around and do nothing, while earning a large amount of money?'

Also, have you thought about what would happen to Fire crews if they became paramedic response units?  They'd get dispatched, and would be tied up on scene taking care of patients (many of whom are not having true medical emergencies) waiting for a transport (ie: an ambulance) to take them to the hospital.  When you sit down and do the math, it screams at you that it would be a horrendous mismanagement of resources.  Why, you ask?  The simple answer is you've just wasted a $500,000 vehicle that is designed to fight fires, and 4 or 5 firefighters on a call.  When you could have shifted the money into EMS and added additional ambulances and Paramedic Response Units (SUVs).  The math is relatively simple, for the price of one fire apparatus, and 4 firefighters, you could have purchased at least 2 ambulances and staffed them with two qualified paramedics, or 4 PRU SUVs, with 4 qualified paramedics.  All of which would be more desirable than having a fire crew on a medical call. 

If you want to reduce response times in the City of Toronto, you have to look at the core problem.  The demand for EMS is significantly higher than the current resources can handle.  The solution isn't cross training firefighters to be paramedics; the solution is adding more paramedics and ambulances to the fleet.  You can always take money away from the fire department as they really don't need the inflated budget that they have. 

 

[mariomike]

December 11, 2009:
"Scott Marks, president of the Toronto Professional Fire Fighters’ Association, and Damien Walsh, the group’s executive officer, also paid to attend. “It was a great speech,” said Mr. Marks. “His best asset is that he’s coming from outside council.”:
http://network.nationalpost.com/np/blogs/toronto/archive/2009/12/11/board-of-trade-gives-george-smitherman-an-ovation.aspx
http://twitter.com/TorontoFIREPAC/status/16863465524

Toronto Budget ( 2008 ):
Fire Services: $234.58
EMS:                $41.72
http://www.toronto.ca/toronto-budget/your-property-taxes.html

"Be wary of Fire Departments who tell your ambulance service and your citizens that they will help streamline your EMS system. These Fire Departments who want to come riding to the rescue of your EMS service should be viewed with the utmost suspicion. Before we were taken over by FDNY we had some members of EMS who viewed FDNY riding to our "rescue" as a white night on a horse. However those of us who were smart realized the Grim Reaper also rode a horse. It turns out FDNY was the Grim Reaper and the "merger" was our Waterloo. FDNY EMS died on March 17, 1996.
If you do not listen to our story and heed our words you may suffer our fate.
Former Mayor Giuliani decided that he could use EMS as a money maker in order to save Firefighter jobs. FDNY was also hoping that EMS (which has a large number of women and minorities) would solve FDNY's racial problem (The New York City Fire Department was about 94% white male at the time, and the Federal Government was looking into why it was that way.) One other factor that led to the takeover was a FDNY productivity issue (Too much down time for the Firefighters)."

"Our next frontier is Canada."
IAFF General President Harold A. Schaitberger

"EMS Anthem":
http://www.youtube.com/watch?v=gi4Imbhr5uc

"History of Modern EMS":
http://www.youtube.com/watch?v=AqD_w4gFa0E

 

[SeanNewman]

MarioMike,

You are the most prolific researcher I have ever seen, so kudos to you.

If I ever run for office, can I please hire you on my staff to dig up the goods on my competitors?

 

[mariomike]

Posted with permission of Dr. MacNamara.

June 26, 2010
Dr. Martin McNamara,

Dear Mr. Smitherman;

I was somewhat surprised as I read your recent comments with regards to a “Fire/ems” model of prehospital care.  I must say that, in your previous role as Minister of Health, you won my respect.  I admired the manner in which you arrived at difficult decisions using evidence and facts from a variety of sources.  To read that you have based this service altering decision on an opinion piece developed by a special interest group such as the IAFC ( International Association of Fire Chiefs ), without input from all participants, was disheartening, to say the least.

I would respectfully offer the following facts for you to consider:.

The EMS average response time to high priority calls is 7 minutes and 32 seconds, not 12 minutes as you stated.  More than half of all cardiac arrest have the EMS team apply their defibrillator first, before other first responders. In 50% of high priority calls, EMS arrives before or at the same time as Fire.  5.6% of all cardiac arrests in Toronto survive to discharge not 2.5% as you were quoted. 

In 26.7% of arrests in Toronto, the paramedics are able to restore a heartbeat before arrival at the hospital.

One of the difficulties in determining response times is that various agencies record  their times in a variety of ways, making comparisons difficult.  Fire starts the clock when the pumper leaves the station; EMS starts the clock when the call is received.

If you are truly concerned with improving outcomes, there are other avenues.  In some European countries, ALL licensed drivers are legislated to be current in CPR, effectively making their entire population First Responders, not being wholly dependent on allied agencies such as Fire and Police.

If the purpose of the exercise is truly to get an Advanced Care Paramedic to the patient in a minimum of time, there are much faster and safer methods than on the back of a pumper with four Fire fighters.

Less than 5% of emergency calls require Advanced Life Support.  The most effective method of providing this service is to place the ALS medics in rapid, small, first response vehicles.  Some jurisdictions use motorcycles, others, small, agile cars. In this manner, an ALS medic can arrive within the shortest time frame and begin care while assessing the scene and determining the type of support needed. 

Research has shown that brain death occurs in 4-6 minutes.  We know that we must get a responder to the scene within this time frame to be effective.  We also know that the fire department strives for a 4 minute response time and have their halls conveniently placed appropriate distances to achieve this.  The question is why? Insurance actuaries have calculated that a 4 minute response time is as effective as a 7 minute response time and does not result in more property loss. This is reflected in the premiums calculated for both homes and businesses.  Accordingly, one can conservatively estimate that 1/3 of fire halls could be decommissioned with no resultant loss of property.  Imagine the savings here.                       

Consider further, if you will, the fact that Fire Departments run at a staff to:management ratio of 4:1 whereas EMS averages 9:1. Which system is more cost effective?

Consider that Fire deployment is based on a static model simply because businesses and property don’t move.  EMS is based on a dynamic model, vehicles and staff moving hourly with the population they serve as commuters flow into and out of the city. 

Consider that Fire has effectively bargained that each fire truck MUST have four Fire fighters around the clock, regardless of call volume.  EMS upstaffs for peak hours and downstaffs during slower times, again presenting a savings to the tax payer. 
Fire fighters in Toronto are allowed to work 7 twenty four hour shifts per 28 days, with a built in 8 hour “rest” period and get the rest of the month off.

I have attempted to highlight for you some of the more obvious problems with a U.S. styled, Fire/EMS system.  An entire tome could be written describing the differences between the two cultures, the differences in training, education, liasing with Base Hospitals, differences in their respective approaches to patient confidentiality, approaches to treatment of patients, medical directives, continuing medical education, etc. 

I would be pleased to meet with you and discuss some of these at your convenience.

Once again, know that I have long admired your approach to medical problems in your previous role as Minister of Health and certainly appreciate the fine work you completed in that role.  I find these latest comments poorly researched and certainly out of character for you.  I must express my disappointment in your presentation.

Respectfully,

Dr. Martin McNamara.  CCFP/EM

 

[mariomike]

June 30, 2010:
"Toronto Fire is taking too long to answer calls, process the information and dispatch firefighters. Details on how slow they are have been blacked out in the report."
"The Star, which exposed tardy response time to some blazes last year, obtained the $150,000 report under municipal freedom of information legislation. Key portions are blacked out – 53 of 157 pages and numerous other pages are censored.":
http://www.thestar.com/news/gta/article/830351--secret-report-reveals-fire-response-problems?bn=1

June 6, 2009:
"When the Sunrise Propane explosion rocked the city last summer, it was more than nine minutes before the first Toronto Fire Services pumper truck made it to the blast site, just over two kilometres from the station house.":
http://www.thestar.com/news/gta/article/646628

One more reason, in my opinion, why mayoral wannabes and Toronto Fire should keep their hands off T-EMS.

 

[Sheerin]

Go figure that their response times aren't as rosy as they'd like us to believe. 

 

[mariomike]

Go figure that their response times aren't as rosy as they'd like us to believe.

Response Time must be recorded from the time a 9-1-1 line starts ringing at 4330 Dufferin, to when the patient receives the shock delivered by the difibrillator.
Even if Paramedics have to get to the 20th floor of a highrise, the clock does not stop recording.
That is how T-EMS measures Response Time. 

I never really enjoyed being parked at Spadina and Bloor, Union Station etc at 0400. We seldom saw a station, except to book-on/off. They issued us coolers for mobile lunches. Forget about beds.
That is not meant as a complaint. I knew that when I hired on.
We understood why it had to be done. Operational neccessity. Same way as the police. Call comes over the radio, toss your cigarette out the window, throw the stick into Drive, turn on the lights ( we tried to keep the siren to a minimum ), and hit the gas/diesel pedal.  ( That could be funny if you, or the guy you were with, was half-asleep behind the wheel.  )

It was the only way to keep Response Time respectable. Ambulances were always staffed to an absolute minimum. Car counts were dynamic and determined by the hour. ie: after 2300 Hrs, they dropped considerably. ( Fewer calls. Less traffic. = less Paramedics ) At 0200, the count took another big drop.

We also understood that slowly driving around our standby area, and keeping an eye on the streets at night between calls gave the public some degree of confidence. To be able to walk their streets safely at night. They could see we were out there to help them, and radio the police, if necessary. This was especially important before 9-1-1 and cell phones came along.

I have followed the TFS website on "Active Incidents" for a long time. It is updated every five minutes. Never, ever been shut down. Last time I checked was during the recent earthquake. Obviously, it triggered a lot of automatic alarms.
Today - for the first tiime ever - it gives this message:

"Active Incidents:
The following active incidents are dispatched from Toronto Fire Services Communication Centre. The contents are updated at five minute intervals from the CAD (Computer Aided Dispatch) system.
Sorry! The active incidents list is not available right now. Please try again later."
http://www.toronto.ca/fire/cadinfo/livecad.htm


"Fire services report still a mystery to councillors. Why the slow response times? Politicians want to know what a consultant learned: City councillors say it’s time they saw a $150,000 report that found the Toronto fire service is behind the times technologically and responds too slowly to emergency calls.":
http://www.thestar.com/news/gta/article/830695--fire-services-report-still-a-mystery-to-councillors

 

[mariomike]

Update
Sun
October 12, 2010

"Jim Brennan, a long-time Winnipeg paramedic, witnessed the devastation first-hand when that city’s politicians directed its EMS and fire departments to amalgamate in 1998."

http://www.torontosun.com/news/torontoandgta/2010/10/11/15655576.html

"The fire department also took over EMS in New York City, but paramedics were left disgruntled as the traditions of their service virtually disappeared and they were left feeling like outsiders.
“From what I understand, there was almost blood in the streets,” Alex Pierson, president of the Toronto Paramedic Association, said of New York’s experience.
Things were eventually smoothed over when paramedics were allowed more of a say in their day-to-day operations.
Pierson said if the city wants to improve response times, it should open more EMS stations, buy more ambulances and hire more paramedics."


( Interesting comments. )


"Waiting For Definitive Care: Smitherman, in his bid for Mayor of Toronto has publicly stated that he wants to combine fire and EMS services.  Smtherman mistakenly thinks this will improve the level of patient care.":
http://ontariomedic.ca/2010/10/03/waiting-for-definitive-care/

"Any municipality that attempts to try this constantly touts “Look to Winnipeg” as they have a combined fire/EMS service.
Well lets look to Winnipeg.  Winnipeg spends 3 times as much as neighbouring municipalities for their EMS service and has the poorest times in getting patients to the hospital.":
http://www.winnipegfreepress.com/opinion/editorials/paramedic-apples-and-oranges-103509039.html

9/21/2010
"Smitherman Wants EMS and Fire to Work Together, Not Merge":
http://www.newstalk1010.com/News/localnews/blogentry.aspx?BlogEntryID=10142033

Far-sighted ambulancemen saw this mess coming years ago.

At this point, Pantalone, Ford, Rossi are all both opposed to the idea and Smitherman has since toned down his position.
Apparently, the Paramedics asked that the next mayor and council to reduce FF first response by 80% and apply the savings to the EMS budget so that we can put more ambulances and paramedics on the road.