Editor's blog

June 14, 2016
Written by
June 14, 2016, Toronto – The news out of the Ontario Professional Fire Fighters Association (OPFFA) conference in Collingwood yesterday – that the province will review the union’s firefighter/primary-care paramedic proposal – is not surprising to those who’ve been paying attention. But it sure hit a nerve.

“Premier @Kathleen_Wynne at #OPFFACon2016 announces OPFFA firefighter/primary care paramedic concept consultation,” the union tweeted Monday afternoon.

There’s no press release on the government website to explain the consultation process or which groups will be involved. And, oddly, no Tweets or retweets from Wynne’s office about the announcement.

There is, however, considerable frustration among paramedics. One tweet: “. . . such a waste of tax $ for a duplicate service.” Another: “@OPFFA @Kathleen_Wynne is this what $165, 912 liberal campaign donation buys you!” And: “Why pay more to create a redundant system? Sounds foolish and based on political pressure rather than wisdom.”

That the premier spoke at the conference 90 minutes north of Toronto – with Labour Minister Kevin Flynn and brand new Public Safety Minister David Michael Orazetti in tow – having announced a cabinet shuffle earlier in the day, says plenty about the OPFFA-liberal party relationship. (At the urging of the OPFFA, the government passed presumptive legislation for PTSD in April, a move the Association of Municipalities of Ontario says is likely to cost tens of millions of dollars.)

The timing of Wynne’s announcement is interesting given the situation in Chatham-Kent, where the third-party EMS provider’s contract expires at the end of the year and Fire Chief Ken Stuebing has proposed to council a blended fire/EMS service, which he says is the most cost effective and sustainable service model.

Council, of course, sets the level of service. Ambulance service, however, is regional, funded by the upper tier of government. Potentially changing the level of service provided by firefighters would likely prove to be an interesting exercise, and to what end? In a cash-strapped province in which the government has experienced myriad financial fumbles, giving firefighters the ability to administer certain patient-care procedures may help patients on scene but doing so gets no one to hospital faster.

Back in February, shortly after the PTSD legislation was introduced, OPFFA president Carmen Santoro (past-president as of yesterday) told me in an interview that the union was launching a campaign to promote its idea to expand the response capabilities of firefighters who are also paramedics. The union estimates that about 1,000 of its members – 10 per cent – are or were paramedics; some would have to upgrade their skills or re-certify.

“We will be aggressively lobbying all the relevant ministries and the premier’s office,” Santoro said. “The same committee that was working on fire-medic is now switching gears and looking into this model. PTSD is now out of the way but we’re going to be very aggressive in the coming months, with or without AMO and the fire chiefs.”

The original fire-medic proposal, which would have allowed firefighters with 20 hours of new training to administer certain symptom-relief medications, was sent to government in March 2015; it was revised after push back from paramedics and the province’s base hospital doctors, and lack of support from AMO. The Ontario Association of Fire Chiefs says it has never officially been consulted on the matter.

While details were sparse when we chatted, Santoro said the proposed firefighter/primary-care paramedic system would be based on the Winnipeg Fire Paramedic Service structure.

Back in February, the ministry of health hadn’t requested a costing out of the proposal, Santoro said, but the province would be asked to cover the training required to get firefighters back up to a certain standard.

“[The cost] will be a lot less than the fire medic, that’s for sure,” Santoro said. “Even the fire-medic costs, they called that nominal. As a matter of fact, it should reflect huge cost savings for the ministry.”

It also wasn’t clear how such a system would be rolled out – through pilot sites perhaps, as was proposed in the original fire-medic plan – or if it would eventually be province-wide or in select communities.

“It’s an underutilized service to help with an overburdened service,” Santoro said.

Santoro acknowledged that while some firefighters who were formerly paramedics left the job because of frustration over hospital wait times, it’s equally as frustrating for a firefighter with paramedic training to stand around and wait for an ambulance to show up while watching patients suffer.

“Our goal is to have a paramedic on every fire truck at all times – eventually, when everyone realizes that this is the way of the future.”

The paramedics, I suspect – at least those in Ontario’s overburdened municipalities – have a different vision.


+1 #11 Mike 2016-06-21 09:19
There is absolutely no evidence, no documentation, no study, no research that proves fire depts get to medicals first enough times to support their crusade - NONE! More services are going to rapid response vehicles that are far more effective for first response and a far more appropriate use of taxpayer dollars. Times, they are a changin" and those responsible to the public are realizing that fact all over the province.
+1 #10 A Madguy 2016-06-20 19:10
This is a waste of taxpayer's money. A concept that Santoro and his OPFFA, friends created as an effort to save fire jobs and budgets, when the city of Toronto, had a firm do an audit that suggested adding more ambulances and decreasing the fire budget. This has nothing to do with improving patient care. The OPFFA's magazine, the intrepid, in summer 2015, quoted how the provincial average for medical calls had decreased between 2009 and 2013. The OAFC, released a paper, citing how part of the hope was to divert provincial funding from EMS to FD.
The odd occasions in areas where fire may arrive first, the time difference between FD arrival and ambulance arrival, isn't enough for the fire medic to do an accurate assessment of scene safety, assess the patient, take vitals and gather enough information to make a safe proper treatment decision. The bottom line is a patient needs a hospital, they need an ambulance, with Paramedics, not fire trucks.
+2 #9 Bob 2016-06-20 06:57
Lets go the other way with this proposal. There is alot of FF that are working as Paramedics these days and I can speak from experience. FD arrives on scene with a paramedic on a crew now and has to wait and watch the PT suffer while waiting for EMS to arrive. There is lots of times working in rural areas where all FF are volunteer, and responding from home, work, etc.so now EMS has to wait and watch PT. Suffer because they are needing extrication. Lets put jaws, rams, cribbing and a few hours of training in place and start doing rescue. Less red trucks and more ambulances with trained Paramedics would up our response time dont need a University degree to figure that out. EMS needs to pull away from the title first responders that title is FD. EMS is pre hospital care we diagnose and treat and if not done correctly we can be de-certified.
+1 #8 A different Kyle 2016-06-17 13:33
Looking at post #4 by Kyle 6/16/16 10:18... "paramedics are the one trick pony as you only deal with medical situations". That's actually the point and thank you for making it, we only deal medical/trauma. Do you go to a General Practitioner (GP) for a cardiac condition? No, you go to a cardiologist, a specialist who deals with only heart problems. Who would you rather install an electrical panel in your home, a general contractor who has some knowledge or an electrician who is a "one trick pony"?
FYI - the minimal education for entry to practise for ON paramedics is rapidly moving towards a four year degree.
+1 #7 Peter 2016-06-17 12:08
Has anyone considered the fact that all our calls go through 911 operators and many time the fire department is dispatched first. There is also many documented times when the police have been dispatched to an mvc and waited until they got on scene to determin what resourses are required. Pretty much puts the who responds first in the hands of a call receiver. Interesting.
+2 #6 Mike 2016-06-16 22:08
Kyle, look around on all those scenes you talk about. You will see paramedics right there. But we won;t see you on ETF, marine and other calls. You talk about being professional yet OPFFA says they can do the job I spent two years in college, continuing medical education and years of actual experience developing my skills with a 20 hour course. If you follow that logic, I can learn to do your job in about 15 minutes. If there is truly a concern for the public, the fire department would be lobbying for more ambulances and paramedics, not trying to mislead the public with a solution to a problem that does not exist.
+6 #5 Ivan 2016-06-16 17:50
Kyle, with all due respect you took the words out of my mouth. The FD are very good at Fire Suppression and Prevention and all things associated with it ( I would make a generalized statment saying that extrication and Hazmat could be grouped in there).

Paramedics are, as you say, a "one trick pony" - but I would suggest that makes paramedics experts in pre hospital care and patient management.

I am always appreciative of FD assistance when required on certain medical calls. However as we move forward into a world of evidence based medicine these requirements will change profusely.

At the end of day, medical professionals like MDs and RNs have specialties such as ER, ICU, NEPHRO, etc... and paramedics and fire fighters are no different. Paramedics are pre hospital and transport medicine experts. At the end of the day medicine does not need a jack of all trades but rather a master of one. Cheers.
-11 #4 Kyle 2016-06-16 10:18
Hey Mike, paramedics are the one trick pony as you only deal with medical situations. Fire Departments deal with a lot more than just fires. Auto ex, Hazmat, structural collapses, trench rescues, confined space rescues, gas leaks, and any number of other unsafe situations that come up.

As much as I am opposed to the fire medic proposal I am even more opposed and disappointed in the unprofessional and crybully response from medics and their unions on this issue.

I have noticed that medics on medical calls that I am going to have gone back to completely ignoring out initial assessment reports when we have gotten their first. Medics have also gone back to clearing us when they could have utilized us to help them and not clearing us when they have no use for us.

I understand your opposition to this but there is something to be said for remaining professional.
0 #3 David 2016-06-15 19:24
If the public and city leaders only knew how many countless shift fire fighters went without a peep, or call, sleeping and cooking up gourmet meals.....there would be a revolt. Their call volume of actual working structural fires is almost non existent now a days with concrete building. Their budget is absolutely crazy!! Fire dept if they are lucky saves 1-5 lives a year per fire house. Each and every ambulance saves that per rotation of 1-2 weeks!
Paramedics go to school a LONG time to get certified to properly administer medication. If a fire fighter can take a course with only 20 hours of training is absolutely crazy. IF ANY Base Hospital Physician lets a Fire Fighter work under their Doctor license after a public insulting 20 hours, I'd be absolutely shocked. But when push comes to shove, who do you want showing up at your door? A fire fighter with 20 hours of training or a paramedic with minimum or 2 years?
+4 #2 Steve 2016-06-15 13:42
1. Fire Medics will not change hospital wait times one bit.. so that is a red herring.

2. Stunning that cost is the main push without mention to quality. As a tax payer, the nominal cost increase to me is well founded in having a paramedic with soon to be a 3 year degree responding to my life threatening health situation and not a Firefighter with 20 hours training. Today, the ambulance is an mini emergency room on wheels and the paramedics are performing doctor procedures in the initial 20 minutes, as trained and delegated by a doctor.

As I saw posted somewhere, emergency services are three distinct services and skill sets. Crime fighters, fire fighters, and death fighters!

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