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Flashpoint

July 2, 2013, Toronto – In a blog from September 2010, I made up a
small-town fire department that had merged operations with solid-waste
management. I am sometimes accused of not taking things seriously. In
this case, all I was doing was taking three essential municipal services
and playing a little game of organizational three-card Monte to
reiterate a point. That point had come from a previous Flashpoint
column, in which I had noted that;

“there are many support functions that are common to fire and EMS. We
train and equip staff, purchase and maintain vehicles, operate
communications and dispatch centres in order to provide emergency and
non-emergency service to the public. But the same can be said about the
solid waste, water/waste-water, roads or public health departments. How
come I don’t remember anyone talking about fire-based waste management?”

Of course, nobody is talking about fire-based waste management, but the
debate over fire-based EMS continues. Last week, the City of Toronto
released the executive summary of a consultant’s report, A Service and
Organizational Study of Toronto's Emergency Medical Services and Fire
Services. I am certain that several of the key recommendations contained
in that summary came as a surprise to some of the luminaries who
commissioned the study. Among the recommendations is this very clear
statement: “Do not consolidate TFS and TEMS.”

How about that? The consultant, Pomax Consulting Inc., determined that
there was little advantage to be gained financially or otherwise in the
consolidation of fire and EMS services, which are each organizationally
mature and operationally competent. Across Canada, of the 10 largest
cities, just four – Montreal, Ottawa, Winnipeg and Hamilton – have EMS
and fire services under the same operational umbrella. The rest operate
fire services that interface with provincially operated EMS (Calgary,
Edmonton, Vancouver) or municipal/regional EMS operating within a
provincial system (Toronto, Mississauga, Brampton). There would have to
be a marked difference in operational cost or performance between these
models to make a compelling case for major structural change.
Apparently, there is no such deficit, so if it ain’t broke . . .

Pomax also recommends increases in TEMS staffing by 223,451 staffed
ambulance-unit hours, the equivalent of about 25.5 additional ambulances
staffed 24/7, but no net reduction in TFS staffing (I will look in more
depth at the recommendations Pomax makes for TFS in my August
Flashpoint column). This is where I think the surprise came in, since
the terms of the study as tendered by the city in 2012 was to “Consider
integrating EMS and fire organizationally and developing new models to
shift more resources to EMS response and less to fire response over
time.” The tacit assumption built into the project was that fire
apparatus could be magically transmogrified into ambulances with no
operational deficit to fire services. Instead, the final recommendations
include a note that, “By working closely together and with other
divisions and community partners, TFS and TEMS can create synergies,
reduce costs, and improve operational performance.”

I couldn’t have said it better myself, except that I already did, five
years ago. I will finish this blog with the closing paragraph from my
original column, since nothing about this debate has changed in the
intervening years, and Toronto’s recent study backs me up:

“The bottom line is, if a patient can receive fast and appropriate
first-responder care, including defibrillation if needed, and be handed
off to advanced life support within the established time frames – then
why would that patient care what shoulder flashes are worn by the
medics? And if all of this can be accomplished by separate services in a
cost-effective manner, then why would the taxpayer care? The model that
can most efficiently and consistently deliver excellent, seamless care
is the one that should be chosen.”

Retired District Chief Peter Sells writes, speaks and consults on
fire service management and professional development across North
America and internationally. He holds a B.Sc. from the University of
Toronto and an MBA from the University of Windsor. He sits on the
advisory council of the Institution of Fire Engineers, Canada branch.
Peter is president of NivoNuvo Consulting, Inc, specializing in
fire-service management. Contact him at peter.nivonuvo@gmail.com and
follow him on Twitter at @NivoNuvo.