Features Leadership
Challenges and changes

As the City of Toronto EMS chief, Bruce Farr has led the charge in
emergency responses to crises such as the SARS epidemic in 2003, the
G20 riots last summer and many others.

Retiring Toronto EMS Chief Bruce Farr says fire and EMS personnel have a solid and professional working relationship that he hopes will continue to improve. (Photo courtesy Damon Schreiber for Toronto EMS)

But the 63-year-old chief is
retiring in February after a long and distinguished 39-year tenure
providing – and advancing – emergency services in Canada’s largest and
most challenging city.

Toronto EMS is a huge, complex beast. The service responds to more than
700 emergency medical calls a day  – 24 hours a day, seven days a week
– and employs more than 850 paramedics and 150 dispatchers, who are
supported by a fleet of 150 ambulances.

Farr has been a leader in shaping the emerging profession of
paramedicine and emergency medical dispatch. He joined the service in
1972 as an ambulance driver and attendant. He later became a trainer,
and in 1980 he worked in the commissioner’s office to improve paramedic
training programs and transform them into community college programs.
In the midst of the SARS epidemic, Farr became chief.

Farr has played a significant role over the years in introducing
standards that have transformed Toronto EMS into a sophisticated,
modern service. He oversaw the implementation of a program that allows
paramedics to bypass the usual procedures for patients suffering heart
attacks and rush them straight to cardio centres, as well as a system
that allows paramedics to refer low-priority patients to community
health specialists instead of taking them to hospitals.

Today, paramedics save lives by performing many emergency procedures at
the scene that were once the preserve of hospital emergency rooms. But
it was not always so. When Farr first began working as an ambulance
attendant in 1972, staff were given a mere month of training before
they were sent out into the field. “Compared to the service we provide
today, it was just first aid then,” he says.

The concept of a paramedic as we know it today – someone who is not a
doctor but can independently perform emergency medical procedures –
didn’t exist then, even in life-threatening situations, says Farr.
“Although we were trained to provide CPR, we couldn’t legally perform
it unless we were directed to do so by a physician. The provision of
CPR outside a hospital didn’t take shape in Ontario until 1975.”

Over the years, attitudes and training have changed significantly. The
initial one-month course Farr took has grown into a formal two-year
community college program for primary care paramedics. Farr was
involved in developing a more intensive three-year program for advanced
care paramedics.

Communications technology has also evolved over the years to facilitate
faster, more targeted responses. Today, 911 call centres can handle
sudden spikes in calls; GPS and other advanced technology is used to
get an exact fix on the caller’s location, and field staff are equipped
with mobile communications.

“The 911 service didn’t start in Toronto until 1982,” Farr says.
“Before then, there was one seven-digit emergency phone number for the
city. If a bad accident happened in a highrise apartment and 30 people
called about it, this surge in calls would completely jam emergency
communications for that section of the city. That can’t happen today –
switching to 911 was a very good thing for the city.”

The roles of EMS and firefighters, and the processes they use to
respond to calls, have also evolved into a well-oiled system that works
with maximum efficiency to save precious time and lives. Back in the
’70s, EMS staff were typically dispatched to incidents first, and they,
in turn, would call the fire service if the situation required more
resources.

“We didn’t have a sophisticated method of tiered response, like we do
today, to pre-alert a fire truck and a paramedic unit simultaneously to
life-threatening emergency calls,” Farr says.

An advanced system of triage that separates low-priority calls from
high-priority calls has been developed over the years, initiating a
series of responses while the caller is still on the line.

“We use a medical algorithm approved by our medical directors that
determines under which circumstances EMS and fire need to respond
together. In the past, we would respond with lights and sirens to a
greater number of calls than we do today.”

The fire service’s assistance handling medical emergencies in many tough situations has been invaluable, says Farr.

“If you think about all the highrise apartments in Toronto that we have
to get into and all the different types of access issues we might have,
it makes sense to have a tiered response with the fire service.”

Firefighters are also better trained to assist in medical emergencies
than they were in the past, and they’re a critical component of
emergency medical resourcing.

“They’re well trained in first-responder programs, so they’re able to
provide support to the community in medical emergencies. When EMS take
a patient to the hospital, they may often get trapped there because
there are always so many things to do – sometimes it’s difficult to get
EMS resources back to the point where they can fully respond to new
calls.”

Any major disaster that hits Toronto is a challenge, but Farr says the
SARS crisis was the toughest roadblock he faced in his career.

“Never before in my career have I had to communicate to my staff that
many of their colleagues were in intensive care at the hospital, and we
didn’t know what outcome to expect because we didn’t know what we were
dealing with. It was all new ground because there was no blueprint to
follow, and we had no specific information about the cause of the
disease,” Farr says. “As SARS evolved, we learned to protect ourselves,
and the firefighters and police who were working with us.”

Farr says he will still be available to provide guidance after he
retires, and will be back as a pioneer (EMS alumni) to attend events.
He looks forward to EMS and the fire service working closely together
to help each other during future crises, as they have in the past.

“We work as a team, each with its own specialty. For example, in a
recent highrise fire, firefighters were there to put out the fire and
help the residents to safety, while EMS was right there with them to
treat victims and also to treat firefighters who were affected by the
heat and strain of fighting the fire.”

Rosie Lombardi is a Toronto-based freelance writer and regular contributor to Canadian Firefighter and EMS Quarterly.