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Last spring, a council committee in Peterborough, Ont., on the advice of the city’s fire and EMS chiefs, agreed to stop sending firefighters to non-life-threatening medical emergencies. Like most Canadian municipalities, Peterborough was looking for ways to cut costs and best use resources. The two chiefs did what they were told to do by their employer, the municipality: they worked together, considered options, and came up with a plan.

Some regions of the country, such as Lethbridge, have combined fire and EMS services, but there is tension between firefighters and paramedics in Ontario over responses to certain medical calls. Both sides have created websites to promote their positions – www.sendfirefighters.ca and www.sendthepros.ca

On May 30, Fire Chief Trent Gervais and Emergency Medical Services Chief Bob English told the committee that in more than 50 per cent of non-life-threatening calls, the fire department arrives on scene after EMS, and firefighters’ services are not required.

The policy change would have reduced the number of medicals to which the fire department responds by between 500 and 700 calls a year. Peterborough Fire & Rescue responds to about 1,800 medical calls annually.

Under the proposal, the fire department would still respond to medical calls for life-threatening situations. And dispatchers would send fire to medical calls in non-life-threatening situations if an ambulance couldn’t respond within 10 minutes.
A week later, after hearing from the firefighters association, council voted against the change.

“The reduction of response services to the public . . . is morally and ethically wrong,” Robert Lloyd, president of the Peterborough Professional Fire Fighters Association, told council. “This proposal will cost lives.”
Or would it? That depends on perspective and the politics at play.

The two chiefs said the policy change wouldn’t put lives at risk because fire would respond if paramedics couldn’t.

Peterborough Mayor Daryl Bennett said the proposal offered a workable solution to having both ambulances and fire trucks respond to non-life-threatening medical calls. “It’s not going to endanger lives,” he said.

And Chief Gervais argued that the changes would reduce the risk to the public and to firefighters by not having half-million-dollar apparatuses rush through town to calls that paramedics usually get to first.

But the firefighters association noted that there had not been a single accident causing serious injury in the last 25 years involving a fire-department response.

“They do their job well. Let them do it,” Lloyd said of the firefighters. “It’s not about who gets there first, it’s about somebody getting there as quick as possible.”

While councillors debated the cost and benefits of what they called a duplication of services, Lloyd indicated that the union might have a grievance against the city if council were to approve the proposed change.
At about 1 a.m. on June 7, councillors decided against the policy change.

* * *

The tension between the grassroots of the fire and paramedic services in Ontario over emergency response to medical calls is palpable.

Both sides have built websites to promote their points of view – www.sendthepros.ca (the paramedics) and www.sendfirefighters.ca (the firefighters association). Both claim that patient care is the priority and both say their response to a medical emergency is in the public interest.

As Fred LeBlanc, president of the Ontario Professional Fire Fighters Association (OPFFA) noted in an August column in Fire Fighting in Canada, “ . . . for municipal councils to play the budget card as justification for reducing this type of service is laughable: taking trained emergency responders out of the mix for minimal savings on fuel and wear and tear on vehicles just doesn’t make sense and, ultimately, the taxpayer will pay more dearly through longer response times.”

The issue – emergency response to medical calls – will be resolved by municipal or regional councils rather than unions or fire and EMS chiefs. Local governments set response levels for their communities but to do so, politicians need to understand the ins and outs of tiered response and simultaneous dispatch and absorb the research on response times and effectiveness.

“Councils need to decide what level of service they want in a community and what level of service they want for their residents,” Chief Gervais said in an interview. But to some degree, the issue goes beyond municipal boundaries to the provincial Central Ambulance Communication Centres (CACCs) that dispatch EMS services.

“The other concern is that we’re going to race a 40-tonne truck across the city and get there and find out the patient is gone,” Gervais said. “Simultaneous dispatch is the answer. And that’s the provincial CAC Centres – that’s what it comes back to. There is a project on the go to fix that, but I think the answer has to be to download the CAC Centres to municipalities, but we can’t even get an EMS radio in our dispatch centre. If we could get that, we would hear where they’re going and communicate with them. That’s how silly it is.”

Gervais, who has been the fire chief in Peterborough since 2008, says the issue of how best to deploy fire and EMS resources is multi-faceted and frustrating.

“If it were me having problems I’d just want the quickest person there,” he said.

Emergency response has been a hot-button issue in Ontario for years. Studies on pre-hospital care in 2005 and 2008 showed that getting to a scene quickly and starting CPR, then administering rapid defibrillation, improves survival rates for those who suffer cardiac arrest.

The quagmire resurfaced in early 2011 as talk of municipal budget cuts surfaced and the Ontario Professional Fire Fighters Association (OPFFA) wanted to get the response issue in front of provincal politicians in the runup to the Oct. 6 election.

The OPFFA supported incumbent Dalton McGuinty and his Liberal government in the election campaign. The Liberals had introduced presumptive legislation for volunteer firefighters and mandatory retirement for suppression firefighters, and backed a pilot project in simultaneous response that will be rolled out in 2012.

The OPFFA explains its stance on its website:

We (the OPFFA) want to ensure that our direction, our legislative agenda as it relates to EMS and the fire service is clear, not only to our membership, but the public, decision makers and those in the EMS field that we work with. Our AGENDA is based on the following fundamental principles;

• Whenever someone in medical distress dials 911, they expect the closest trained emergency responder to be sent as soon as possible, regardless of whether that responder arrives in an ambulance or fire truck.
• The fire service is already strategically placed to respond rapidly to fires or other emergency situations and studies have proven that firefighters can positively affect the outcome of medical emergencies.

We believe and continue to strive to achieve recognition and implementation of the following;

• Firefighters, in urban centres, should be dispatched simultaneously with EMS to emergency medical responses that meet local tiered response agreement criteria.
• Firefighters, in urban centres, should be dispatched to all calls for emergency medical help that involve life and limb threatening medical emergencies, i.e. those that meet EMS Code 4 dispatch criteria. We will continue to work with local associations, fire chiefs, and municipal councils to ensure tiered response agreements reflect this goal.

Ontario’s paramedics are highly skilled emergency responders who save Ontarians’ lives every day. However, we believe the fire service is positioned to play an increased role in pre-hospital care . . .

Paramedics group president Norm Gale waded into the fray in October, perhaps a tad unawares. Gale was quoted in the Toronto Sun by a columnist who has been critical of Toronto firefighters. The Association of Municipal Emergency Medical Services of Ontario (AMEMSO) had commissioned a study that showed firefighters are needed on just two per cent of medical calls. (As Gervais noted, two per cent of medical calls in Peterborough means firefighters are helping 50 or 60 people, so the number is not insignificant.)

A couple of days later, Gale was quoted by the CBC saying that firefighters can be a valuable resource at medical calls and that the Sun story had an anti-firefighter tone.

“He noted the idea behind the study was to gather information about the best patient care possible, for the best price,” the CBC said.

“Gale said some fire departments in southern Ontario want to expand their role in medical calls. Now, a tug of war is developing between firefighters and paramedics in some Ontario cities, as each group tries to prove its value and head off possible budget cuts.”

As the CBC noted in a September story, “ . . . this duel arises as a result of cost-cutting measures at the municipal level.”

The report, out of Ottawa, said firefighters were worried that their services may be deemed more expensive than EMS, and may be cut. The story noted that fire services cost almost two times more annually than emergency medical services, according to City of Ottawa numbers.

A few months earlier, at the OPFFA’s annual convention in Ottawa in June, LeBlanc noted in a speech to delegates that enhancing medical response would increase the value of fire departments to the community.

“Make no mistake; the EMS community is not in agreement with us,” LeBlanc said. “They are fighting back and they want the fire service out of what they consider ‘their business.’ However, removing the fire service from EMS responses will only cost the municipalities and the provincial government more. Therefore, we must take advantage of this opportunity to position ourselves as a logical use of tight budget dollars.”

LeBlanc urged delegates to work on the issue with local councils to ensure long-term success of simultaneous response.

“Now, at the completion of this pilot and upon full rollout of the simultaneous notification technology the issue becomes local, and it is up to you. We will set the stage for a strong tiered-response agreement, but you need to commit to the concept and strongly advocate with your council to ensure your place – our place ­– in EMS response is entrenched.”

LeBlanc also noted the role of the Ontario Association of Fire Chiefs (OAFC) in the debate.

“Unfortunately we cannot rely upon the OAFC to stand with us on this issue. They have retreated from this issue and are partnering with the EMS chiefs under the guise of duplication and cost savings.”

The OAFC says it is staying out of the discussion but supports simultaneous notification and is compiling data to pass on to municipal councils to help them understand the issues.

“The fire service has an important strategic role in the delivery of emergency patient care,” OAFC President Tim Beckett said in an e-mail.

“Through the evaluation of fact-based data the OAFC, in consultation with the Association of Municipal Emergency Medical Services of Ontario, is committed to investigating and further clarifying the role of the fire service in emergency pre-hospital patient care. Through these discussions, we are ensuring that together we provide each municipality with information to assist them in optimizing their services to provide the best possible delivery to the citizens in their communities.

“We also remain committed to the dispatch simultaneous notification project, which will assist in enhancing the current tiered-response plans that are in place in municipalities throughout Ontario.”

Others are less enamoured with simultaneous notification. An Aug. 9 letter to Peel regional chair Emil Kolb from Caledon, Ont., Mayor Marolyn Morrison – after Morrison read LeBlanc’s speech – was blunt.

“Simultaneous notification will only heighten the cost of emergency response to the taxpayers,” Morrison said. “We should seriously review the use of this response in Ontario. Simultaneous notification has failed in Grand Valley, Owen Sound and Hamilton, to name a few.”

A quagmire indeed.