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Fire-based EMS

mariomike

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HTFUAlberta said:
But in all seriousness I know that the days of Johnny and Roy won't appear in TO anytime soon.

The City decided:

1) "Do not consolidate TFS and TEMS."

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."

3) "Increase TEMS response capacity by 223,451 staffed vehicle hours to meet demand."

4) "Continue the Community Paramedicine program as part of a strategy to provide the most appropriate patient treatment and reduce emergency medical response call volume demand."







 

Sheerin

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HTFUAlberta said:
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! :eek:

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

The two bolded lines above are exactly the reason why fire based EMS doesn't make sense.  It is a massive waste of resources to send a pumper with 4 or 5 firefighters to a medical call, each of which are earning nearly 100k a year.  If you shift that money to EMS it's far more efficient.  For that one pumper you could get 2 transports and possibly a response unit. 

Also what happens when there (albeit rare) fire, what happens to medical response times?  What calls would take priority?  Would an ALS pumper be diverted from a paediatric VSA for a smoke condition call?  I really, REALLY hope that it wouldn't but I suspect that it would. 

Municipalities need to get away from the mindset that fire needs to have as many resources as they current have.  The simple question is, if fire is having such great difficulty making use of their man hours, then why do they have so many man hours to begin with? 
 

PuckChaser

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Code5 said:
The simple question is, if fire is having such great difficulty making use of their man hours, then why do they have so many man hours to begin with?

Unions, and our fire prevention methods have moved into the 21st century in most cities.
 

mariomike

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Code5 said:
The two bolded lines above are exactly the reason why fire based EMS doesn't make sense.  It is a massive waste of resources to send a pumper with 4 or 5 firefighters to a medical call, each of which are earning nearly 100k a year.  If you shift that money to EMS it's far more efficient.  For that one pumper you could get 2 transports and possibly a response unit. 

This came out two days ago on that subject.

"As ‘emergency’ changes its meaning, some critics are arguing it’s time to revisit a century-old system. Is there such a thing as too many heroes?":
http://www.bostonglobe.com/ideas/2013/09/07/plenty-firefighters-but-where-are-fires/isCPrIPauX078UKHdixu0K/story.html?s_campaign=sm_tw

"Whether or not this shift in purpose is a good thing has lately been the subject of intense debate in Toronto, where a third-party review of the fire department in 2012 led the city to stop dispatching firefighters to 40-some types of medical emergencies that they used to respond to alongside ambulances. While firefighters there argue that the move has jeopardized people’s safety, EMS workers contend that there are only a handful of situations when the firefighters’ presence actually helps victims."
 

mariomike

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Update.

Fraser Institute
May 7, 2015
"Number of firefighters in Ontario balloons while number of fires drops dramatically"
https://www.fraserinstitute.org/research-news/news/news-releases/Number-of-firefighters-in-Ontario-balloons-while-number-of-fires-drops-dramatically/

"from 1997 to 2012, the number of reported fires in Ontario fell by 41.4 per cent while the number of firefighters increased by 36.3 per cent."


Globe and Mail  May 19, 2015
http://www.theglobeandmail.com/globe-debate/why-firefighters-are-underworked-and-overpaid/article24459593/

"Municipalities that resist the union’s demands can go to arbitration. But they virtually never win. Arbitrators simply hand the union whatever the last guys got. “When the municipalities lose 100 to zero, there’s something wrong,” the mayor argues. “The arbitration system has to change.”

"In big cities, only a small number of the calls to the fire service are for actual fires. (In Toronto, only 9.9 per cent of calls to the fire service in 2013 were about fires; in Calgary it was just 3.4 per cent.)"


‘Fire-Medic’ proposal
Star Jul 07 2015
http://www.thestar.com/news/gta/2015/07/07/fire-medic-proposal-pits-firefighters-against-paramedics.html

"According to van Pelt, 20 hours of training is not enough to equip firefighters with the skills they need to make life-saving decisions."

I've been retired for over six years, so operational decisions no longer affect me.  But, as a civilian who may need help one day,  Paramedics are worth the investment ( in my opinion ).
To apply, candidates must first must graduate the mandatory two-year Paramedic Diploma program, followed by 500 hours of on-the-job training. If hired, for the rest of their career they must recertify their skills annually.

That is just for PCP. ACP involves more training. As does HUSAR, Marine SAR, Emergency Task Force (ETF - Tactical ), PSU, ESU-MPU, CBRNE, CCTU, etc. 
 

Towards_the_gap

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The Fraser Institute report has been debunked as using incorrect data on the actual number of firefighters.

Margaret Wente only seems to post articles like those in election years. Never mind her journalistic credibility is junk anyways.

*Retracted*


Just my 2c.
 

mariomike

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Towards_the_gap said:
As for the Fire-Medic proposal, it's a shame no one has asked the base hospitals or MOHLTC for comment. Not surprisingly, they are all behind it.

That's interesting. Would you mind sharing any ( non Firefighter union or Paramedic union ) sources you may have that support "fire-medics" in Ontario? I have never seen any ( except from the Firefighter union ). But, would like to read them, if they exist.

If you don't mind me asking, are you now in the firefighters union? I'm no longer a member of any union. My opinions are ( now ) only those of a potential future patient of the "fire-medics".

"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."

"Most people expect to need EMS some time in their lives while they don't necessarily expect their homes to catch fire. Local municipal officials know the public criticism and fallout from fire department cuts will be much more severe when EMS is involved in the equation. And they know that EMS operations certainly increase the clout of our local unions in their campaigns to fight those cuts."

"Our next frontier is Canada. That is why we have more than three dozen of our Canadian brothers and sisters here at this conference. Although most of Canada is still locked into a third-service EMS system with workers represented by Canada's largest public employee union, our Winnipeg local's success in integrating EMS into its fire department has shown that fire-based EMS can and, if I have my way, will work in Canada, too."
http://www.iaff.org/03News/061203has.html

Remarks by International Association of Firefighters ( IAFF ) General President Harold A. Schaitberger
June 12, 2003
 

Towards_the_gap

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mariomike - I retracted my statement about the MOHLTC/Base Hospitals being on board. It was told to me secondhand by someone and when called out by you, couldn't find any statements (from a third party) that confirmed it.

First off, yes I am in the IAFF/OPFFA, HOWEVER.... I pay the dues, and that is it. I'm not a big fan of labour organisations, and to be quite honest, I think the OPFFA has picked the wrong fight on this issue.

But, I do see some merit in the proposal, if you remember that no one in the IAFF/OPFFA is advocating replacing EMS with firefighters with 20 hours of training. Far from it. It is only seeking to train FF's to administer ventolin/nitro/epinephrin/aspirin and glucose, IF IT IS INDICATED in accordance with medical direction, as a stop gap until EMS is on scene.

A perfect example is this - ''Dave'', a middle aged, severe diabetic in my district. We typically receive 2-3 calls per week for him coming in as uncon-seizure. He goes into a full blow diabetic seizure and his wife calls 911, due to the threat of violence (unintended from him I might add) police are tiered as well. We arrived on scene over half the time before paramedics and all we can do is monitor and take vitals until the paramedics arrive. If we had the symptom relief training we could administer the glucose gel  and start levelling out his blood sugars, and thus freeing up the ACP/PCP crew and bus who have been dispatched to the call, seeing as 'Dave' always refuses to go to the hospital.

I want to reiterate that I personnally am not advocating this fire-medic idea. As I said, I think it's pissing off the wrong people and I only hope it won't affect the great working relationship I have with the professional medics in this city. I just hate how it has already, in less than a month, descended into alot of mutual ill-feeling and s**t slinging...on both sides I'd like to emphasize. My side of the table has been no better, that's for sure.
 

mariomike

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Thanks TTG.

The three attachments below ( click to enlarge ) are from the Base Hospital Physicians of Ontario. Dated 8 July, 2015.

"Base Hospitals have not been involved in the ( OPFFA ) proposal, yet explicit references to the role of Base Hospitals and their Medical Directors occur throughout the  ( OPFFA  ) document."

"In our opinion, in order to achieve the most benefit for the patient, while balancing the risk of treatment, these skills should only be provided by fully certified and current paramedics."

Thanks again for your post!





 

mariomike

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I saw an interactive map of Toronto Fire Service recruiting, 2000-14:
http://globalnews.ca/news/1872085/slowly-toronto-firefighters-become-more-diverse/

I'll post it here in case anyone is interested in joining.

The report says, that 72 per cent of those hired by TFS are from out-of-town.

I'm not sure about now, but in the past, I believe the ratio was similar at Toronto Police and Paramedic Services.

When I hired on, there was a Residency Requirement. But, that ended years ago. It has been a hot topic ever since.   
 

mariomike

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Make sure you have travel insurance. Know what it does, and does not, cover.
Even in Canada, the fee for ambulance service varies from one province to another.

If you've seen one service you've seen one service — because no two are alike.

12 Aug 2016

City of Gloucester, MA

What does it cost to be transported via Gloucester Fire Department ambulance?
All rates are per trip:

Basic life support: $1,513.84

Advanced life support: $1,797.44

Advanced life support, Level 2: $2,601.58

Mileage rate (applies to all): $46.08/mile

Supplies (oxygen, IV fluid etc.): $425

Extra EMT aboard: $600

Schultz conceded some patients are stunned when they get a bill for ambulance services.

What a ride will cost you,

Schultz’s memo outlines the city’s transport policies and fee schedules, with no proposal to alter the charges. The city’s ambulance rates, in general, range from a base of $1,513.84 per trip for basic life support services, plus $46.08 per mile, to a rate of $2,601.58 per trip for advanced life support with added costs for the use of supplies such as oxygen, or an additional EMT if needed.

Some people think that, because it’s out of the Fire Department, it’s free,” Schultz said. “Also, people are surprised at the costs.” He noted that an ambulance transport is not a ride, but more akin to treatment in a mobile emergency room, with medical personnel on board.
http://www.gloucestertimes.com/news/local_news/city-owed-k-in-fees-for-ambulance-services/article_99181b0f-2280-563b-823a-7b1c03f06969.html

They even charge extra ( $425 ) for oxygen.

 

mariomike

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One of the reasons I wish the GTA had been allowed to separate from Ontario years ago,

Ontario firefighters slam paramedics in bid to take on medical emergencies
http://www.cbc.ca/news/canada/windsor/paramedics-fire-fighters-response-times-1.3867522
Video criticizes slow response times and rising costs of Ontario paramedics
In a campaign that criticizes the province's paramedics, Ontario firefighters say they have a plan to improve response times for medical emergencies.

Ontario Professional Fire Fighters' Association released a video this week that slams the province's paramedic system, saying response times are too slow, while costs continue to rise.

Not enough fires! Prevent layoffs!



 

mariomike

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A NSFW graphic video of a jumper down - not a traumatic arrest, he is still alive - in New York City, but it's not about that. It's about patient care. Some say ...it's not so good.

Warning - Man jumping from Brooklyn Bridge possible suicide attempt might contain content that is not suitable for all ages.
https://www.liveleak.com/view?i=3ba_1506035907
He was alive. They tossed him onto the stretcher like a sack of potatoes. The c-collar was useless in this case.

I bet their Bureau of Investigations and Trials ( BITS ) are licking their chops over this one.

Doing a call like that would have been career suicide where I used to work.

Speaking of career suicide,

Firefighter ripped down U.S. flags put up for the 16th anniversary of 9/11.
http://www.wfaa.com/news/local/denton-county/fw-firefighter-accused-of-ripping-down-flags-that-had-been-raised-for-911-rememberance/482067823



 

mariomike

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Saw this in another thread.
I remember the media coverage of that policy debate. As I recall, the FD union was concerned that each truck would have to give up a (union) crew member to accommodate the EMS and argued for funding to raise the qualifications of its members. I don't know enough of the pros and cons to have much of an opinion. While it might improve initial care, you still need an ambulance if you have to transport.
Fortunately, they dodged the bullet.

If you really want to do a deep dive into the subject,
A Service and Organizational Study of Toronto's Emergency Medical Services and Fire Services
320 pages.

Yes, I understand that is only one municipality among many others, and each province / territory does things differently.

Amalgamation may, or may not, be a fantastic idea in some of those other municipalities, and provinces.
 

Colin Parkinson

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With the high level of OD's here in the Lower Mainland, it was overwhelming the combined response by EHS/Police/Fire/Social workers and volunteers. Some of the Fire halls despatch a Pickup truck with two guys to medical calls and the remainder stay with the pumper. This cuts down on wear and tear on the main appliances and would allow the pumper to respond to a fire and get setup while the other team is enroute. I think that is the way to go for halls with high medical call outs.
 

lenaitch

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Saw this in another thread.

Fortunately, they dodged the bullet.

If you really want to do a deep dive into the subject,

320 pages.

Yes, I understand that is only one municipality among many others, and each province / territory does things differently.

Amalgamation may, or may not, be a fantastic idea in some of those other municipalities, and provinces.

As you are probably aware, Ontario went through a lot of municipal amalgamations in the '90s under the Harris government. One problem with any amalgamation that involves a larger centre with more rural surroundings is the larger centre can become a bit of a money pit with the rural areas seeing their taxes go up with little to show for it; seemingly more chronic with wider density spreads. I hear little about it now but I don't know if the growing pains have been sorted out or rural politicians have simply given up tilting at the windmills.

In my area, EMS is run by the county. More locally, there was some talk of amalgamating the fire services of several municipaliites (3 volunteer and one hybrid). While there seemed to be some positives financially, many volunteers stated a lack of interest in serving the larger entity (less 'community-based) and the concern that equipment and resources would be drawn to the centre. Law enforcement has already seen that with the OPP closing or downgrading many smaller detachments. Having said that, the prairie provinces have geographically large 'rural municipalities' that seem to work (if 'Hellfire Heroes' is any indication - my sole source of information) so might be worth further study. The size and shape of many Ontario counties don't seem to favour county-wide fire services. The municipal governance structure in Ontario is a bit of a dog's breakfast.
 

Booter

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Anytime government tries to “merge” anything it doesn’t do it well.
It amazing to me how EMS is neglected- it’s a constant shell game of units and geographic areas.

in Alberta last year when I was still there they merged, amalgamated, and “shifted” some EMS stations and the result was actually quite scary.

the patch work coverage and constant who’s paying the bill, has created a really unwieldy beast as soon as you leave any major centre.

and in major centres, EMS is still the “have not” service.

it’s always boggled my mind
 

mariomike

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They say, "If you know one Paramedic service, you know one Paramedic service."

We had something like 50 in Ontario, last time I looked.

And, in the rest of Canada, Paramedics are regulated by their provinces.

What I know of Ontario is that in 1968, the Ministry of Health began to take an interest in how ambulance service was provided. In addition to the establishment of regulations and standards, the MoH began to operate ambulance services in Ontario, either directly, or under contract.
Ontario was under the direction of Dr. N.H. McNally.

In Metro, the Goldenberg Report of 1966 led to the creation of The Department of Emergency Services on 1 Jan., 1967, under the direction of Commissioner John Pollard, a retired army colonel.

The "differences of opinion and philosophies" between Ontario's Dr. McNally ( a medical doctor ) and Metro's Commissioner Pollard ( a retired army colonel ) were highlighted in a Toronto Star article on 5 July, 1973.

Not to say which of them was right. But, their "differences of opinion and philosophies" were profound.

Among other things, Metro ambulance were of a different type and color than the provincial units.

I worked for "the Colonel", so naturally, I was influenced by his opinions and philosophies. I guess being fresh out of high school, and a young reservist, I was pretty "moldable"

Those who worked in the rest of the province under Dr. McNally I am sure must have their own opinions.

The community colleges were not involved in training back then.

Ontario recruits were sent to CFB Borden, to be trained by provincial instructors.
Metro recruits were trained in Metro, by our own instructors.
Not to suggest one school was better or worse than the other. Just different.

One thing back then, Metro had a Residency Requirement to join. There were no "lateral transfers."

So, you never really learned of any other way of doing things.

For us probies, under the watchful eyes of the '46'ers ( WW2 vets like Colonel Pollard ) it was, "Do it our way, or the highway.) :)
 

CBH99

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It amazing to me how EMS is neglected- it’s a constant shell game of units and geographic areas.

in Alberta last year when I was still there they merged, amalgamated, and “shifted” some EMS stations and the result was actually quite scary.

the patch work coverage and constant who’s paying the bill, has created a really unwieldy beast as soon as you leave any major centre.

and in major centres, EMS is still the “have not” service.

it’s always boggled my mind
Genuinely curious. Would you mind expanding?

It boggles my mind also that (here in Alberta anyway) EMS is considered the have-not service, along with retention issues. Seems like there are always job postings for EMS even in major centres, and members seem to pack up and leave at a decent rate also.

I was privy to a ‘meeting’ (for lack of a better word) about a year and a half ago in which a 15 year member resigned, due to the constant petty nonsense coming from the top. (In this case he had backed up an ambulance about 8ft without using a spotter - was disciplined, and summoned to a disciplinary board also, which is where he just decided to walk away from the job)

Not a Thank You. No conversation about having him stay. No effort to ‘be a team’. Just a very insincere ‘cool, turn your stuff in by friday, thanks for coming out.’
 
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