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Guest Column: August 2011

There has been a lot of focus lately in Canada on the role of the fire service in emergency medical responses. It is interesting that the focus has been so great lately in Ontario, given that the fire service has historically played a significant role in responses to life-and-limb threatening emergencies. While the level of response has varied, the Ontario Pre-hospital Advance Life Support (OPALS) study conducted in the mid-1990s set the course for the involvement of Ontario’s fire service in emergency medical responses. 

Today, it is common for professional firefighters to be trained in advance emergency first aid, CPR, and defibrillation. This training, combined with the ability to respond quickly to emergencies, makes the fire service a logical choice to augment paramedics in the delivery of EMS.

In Ontario, the fire service has played largely a supportive role in the pre-hospital emergency-response system. During the OPALS study (and since that time) many fire services adopted defibrillation as part of their service delivery; this works well and supplements the response of advanced-life paramedics to these life-threatening emergencies. Recently, there has been a lot of focus in Ontario on EMS response time – this has nothing to do with the front-line paramedics, rather the concern relates more to a larger, systemic problem. But with more ambulances and EMS personnel spending more time waiting in emergency rooms, the fire service has been relied upon to an even greater extent to respond to life-threatening emergencies. For the OPFFA, it seems like a natural fit for the fire service to be involved in the broader delivery of emergency medical response.

So why all the fuss from the EMS community? The OPFFA has for years sought the simultaneous dispatch of fire and EMS to medical emergencies to ensure the best of the system can be delivered to the patient. Three years ago, the Ontario Association of Fire Chiefs (OAFC) approached the OPFFA to work jointly on this initiative. As I write this column, the McGuinty government has supported simultaneous notification and a pilot project is in the final planning stages. The simultaneous-notification technology could be a turning point for the way emergency medical services are delivered and the role of the fire service in this type of response. It is disappointing that when the fire service is finally receiving critical government support for simultaneous-notification technology, there are still some in the fire service and in municipal administrations who are pushing back. 

Both the OPFFA and the OAFC expected some turf protection from the EMS community, which may view simultaneous response as a potential encroachment on its territory. However, both associations have advocated sending fire to the life-and-limb threatening calls to which it already responds, but doing so simultaneously. To have some fire chiefs support a reduction in the type of life-threatening medical emergencies to which their fire services respond (which has happened in a number of Ontario municipalities, and which the OPFFA equates to a reduction in public service) is disappointing. And, 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.

EMS chiefs have been very good to convince some Ontario fire chiefs to amend local tiered-response agreements based on new ambulance dispatch protocols and patient outcome – a term I have heard more recently than during my entire career. Essentially, their argument is that there are many responses to which the fire service simply doesn’t make a difference to patient outcome. But the fire service does make a difference to patient care, whether it is with hands-on medical intervention, assisting the advance-life paramedics, or by dealing with distraught family members. If it is determined by paramedics on scene, after a patient assessment, that firefighters are not required, then so be it – we clear that scene and are immediately put back into the system, ready to respond to the next call. Does it not make more sense to send firefighters? We are trained and the cost of fuel is negligible.

To clarify, this is about life-and-limb threatening emergencies only. Ontario’s paramedics respond to a variety of calls and the OPFFA is not suggesting that the fire service needs to respond to everything that the paramedics do. With the advent of simultaneous notification, now is the time to establish common, tiered-response agreements wherever there are full-time firefighters responding. Many who are working on the simultaneous-notification project see the wisdom in this approach, but without the support of the OAFC, it becomes difficult to achieve. The OAFC believes that doing so will override local decision making. Therefore, municipal politicians, who set local service levels, need to understand the role the fire service can play in emergency medical response and the value that the fire service brings to their constituents.

We don’t have to look far outside of Ontario to see the advantages of an EMS system in which fire plays an increased role. In Winnipeg, for example, they have introduced firemedics (firefighters trained as primary care paramedics) as an additional element within their EMS system. The difference between Ontario and Winnipeg is that ownership of the EMS service remains with the province (or at least the upper-tier municipality – where the fire service is at the lower tier), as do the dispatch centres. Without the ability to locally control the resources through one dispatch centre, the efficiencies can be found only as they have been described here – through simultaneous notification and expansive tiered-response agreements.

We need to attempt to remove the turf-war mentality at the upper levels of management and the union and focus on the front-line response. After all it is about the patient – it’s that simple.

Fred LeBlanc is president of Ontario Professional Fire Fighters Association and a captain in Kingston, Ont. Contact him at fleblanc@opffa.org