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Home My WebLink AboutOES 15-05PICKERING REPORT TO EXECUTIVE COMMITTEE Report Number: OES 15-05 Date: May 3, 2005 From: Everett Buntsma Director, Operations & Emergency Services Subject: Fire Services - Emergency Medical Response (EMS) File: A-2130 Recommendation: 1. That the Region of Durham reimburse all costs associated with the purchase of all medical equipment and training to Municipal Fire Services; and That the City support the recommendation that existing and future fire station locations be strongly considered as joint Emergency Medical Response / Fire facilities; and That the City support the establishment of a local stakeholder committee mandated to review our present Regional tiered response system and implement improvement where possible and practical. Executive Summary: The purpose of this report is to outliine concerns, that the Fire Services administration has regarding the tiered response to emergency medical calls (EMS) and to recommend changes to the current EMS protocol established by the Province. Financial Implications: Not applicable Background: This report is in response to a similar initiative and Council recommendation from the City of Oshawa. Oshawa has requested the support of other Durham Region Municipalities. In the early 1990's the current 9-1-1 System was introduced in Durham Region. This system requires Police, Fire and EMS to become part of a "tiered response" system. The following table indicates the number of EMS alarms Pickering Fire Services have responded to and the proportional percentage of EMS alarms. Report OES 15-05 Subject: Fire Services Emergency Medical Response Date: May 3, 2005 Page 2 TOTAL # OF ALARMS MEDICAL ALARMS (%) 2001 3159 1205 (38.14%) 2002 3142 1270 (40.4%) 2003 3379 1421 (42.05%) 2004 3545 1501 (42.34%) Current EMS Operation The Central Ambulance Communication Centre (CACC) presently located in Oshawa is under Provincial authority. Therefore, the Province of Ontario controls the communications system, which tiers Durham EMS and Municipal Fire Services. CACC determines the severity of calls and dispatches Fire Services according to set criteria. Fire Services will respond at the request of CACC where a person is believed to be suffering from: 1. Absence of breathing / difficulty breathing 2. Unconsciousness 3. Severe Trauma 4. Motor Vehicle crash 5. Cardiac Arrest Municipal Fire Services are the second level of response. 9-1-1 operators receive the alarm from the resident and transfer it to CACC. CACC dispatchers notify EMS then determine if Fire Services should be dispatched (see above criteria) and if so notifies our Fire Dispatcher of the alarm. Fire Apparatus is then dispatched by Pickering Fire Services. It is important to note that CACC, being the agency responsible for emergency medical dispatch is in control of notifying Fire Services. These have been concerns in the past by Fire Services in reference to delays in notification of our personnel from CACC. CORP0227-07/01 Report OES 15-05 Subject: Fire Services Emergency Medical Response Date: May 3, 2005 Page 3 2004 Response Times Pickering Fire Services response items are as follows: Within Under $ Under 6 Over Ambulance on the scene 4 min. min. min. 6 min. Total Before Fire after Fire Total # of EMS alarms responded to 684 410 212 166 '1472 876 596 % of EMS alarms responded to 46.5% 27.9% 14.4% 11.3% 100% 59.5% 40.5% *29 cancelled and assist calls (not included) "Stopping the Clock" The term "Stopping the Clock" is a measure of the time necessary for a primary care provider to arrive on scene with appropriate equipment to provide emergency patient care. Fire Services personnel arriving at a medical emergency does not "stop-the- clock" and are not included in provincially targeted timelines. The issues for Fire Services is that we spend a lot of money and training time so that Fire Services personnel can provide competent professional medical aid to our residents, but Ministry of Health do not even recognize the standard of care we provide. Regional EMS The Region of Durham provides medical emergency services. This downloading from the Province to the Region has provided a better EMS system, i.e., better coverage by moving about ambulances and strategically locating or building new ambulance stations. There is a consistent training program and equipment purchasing. Fire Services Pickering Fire Services have always responded to medical emergencies. In the 1970s & 1980s we had basic medical supplies and resuscitators on our fire apparatus. Most medical alarms at that time were related to motor vehicle accidents were most of what we did was trauma medical aid. Today the number of medical responses has dramatically increased. In 2004, we responded to 1501 medical emergencies and 579 motor vehicle accidents. CORP0227-07/01 Report OES 15-05 Date: May 3, 2005 Subject: Fire Services Emergency Medical Response Page 4 This increase in medical responses has led to fire service operational staff having to enhance their medical training and expertise. Firefighters are now trained by Base Hospital to a national standard, "Emergency Medical Responder", and carry defibrillators on our apparatus. So Fire Services make a significant contribution to the provision of emergency medical services in our community. Costs Fire Services personnel are now highly trained to respond to emergency medical alarms. Defibrillators, bag valve masks and other medical supplies are carried on our fire apparatus. Although some costs for this equipment used is reimbursed to us (i.e., oxygen bottle refills), and some everyday equipment are replaced by EMS as required, costs for sophisticated equipment and training are not. For example, in 2005 the "Defibrillator Program" and Emergency Medical Response training have a budget of $40,000.00. This pays for annual recertification, annual updates and physician licensing costs related to the delegated act of defibrillation. There are also the costs associated with responding apparatus. ~ssues Tiered response has led, in some instances, to a duplication of services as well as delayed notification from CACC to Fire Dispatch. Although guidelines have been established by CACC, either Fire Dispatch should receive notification of EMS alarms from 9-1-1 Centre Operator at the same time as the CACC or more stringent supervision should occur at CACC to ensure Fire Dispatch is notified without delay. Costs are increasing to maintain currency of training. Most of the medical equipment is paid for or replaced by EMS, but Fire Services have to purchase defibrillators and pay for Medical Response Training from Municipal operating budgets. We are also aware that there is the issue of the costs associated with responding our apparatus, i.e., fuel costs and repair costs. Because we are assisting another emergency service to meet their mandate of responding to Medical Response Training alarms then all or a large proportion of Fire Services costs for defibrillators and training should be paid out of Regional budgets. The Province administers the communications system for ambulance. We believe that Durham Region EMS should take over the responsibility of the CACC located in Whitby. CORP0227~07/01 Report OES 15-05 Date: May 3, 2005 Subject: Fire Services Emergency Medical Response Page 5 EMS and Fire Services should consider "Consolidated Facilities" when opportunities arrive to do so. This would ensure duplicate responses would not occur. EMS cars are currently staffed by two EMS personnel. Currently, if a patient has to be "worked-on" during the EMS transport to hospital a firefighter assists with patient care on route. We then have to pick up our own firefighter from the hospital. I believe EMS should consider minimum staffing of vehicles to be 3 personnel. Currently Ministry of Health does not "stop-the-clock" when fire services arrive at the scene. EMS does not recognize, within their own protocols that our trained fire service personnel arriving at an emergency medical scene ensures appropriate medical care is being provided. This leads to EMS purchasing more emergency vehicles to meet established response time criteria when Fire Services is already on the scene providing advanced medical services. We see this as EMS saying we need your help, but we are not officially going to recognize it. Conclusion There are many issues mentioned in this report that are very complex. Financial implications for both the Region and Municipalities are substantial. Response issues need to be addressed as they lead to frustration for Fire Personnel responding to EMS alarms. There seems to be a lack of commitment on behalf of EMS to look seriously at sharing facilities with Municipal Fire Services at a generate cost to taxpayers. The Ontario Association of Fire Chiefs is working with the Ontario Fire Marshal's Office to lobby the Provincial government for improvements to the EMS system. Durham Regional Fire Chiefs are attempting to meet more regularly with EMS management to address concerns. Our City, along with other municipalities, should support any initiative to have the Province increase funding for all EMS service providers. The Ministry of Health should review their CACC guidelines to ensure fire services are dispatched immediately to appropriate EMS alarms. Attachments: None CORP0227-07/01 Report OES 15-05 Subject: Fire Services Emergency Medical Response Date: May 3,2005 Page 6 Prepared By: Mark Dio~ (Acting) Fire Chief Approved / Endorsed B.y,~ Everett~ntsma Director, Operations & Emergency Services MD:mid Copy: Chief Administrative Officer Recommended for the consideration of Pickering City Council .-' / ,,,-?.-., ~z~ ,,/ J / I z.i ~ t ' / ' Them'.a-',~ j: Ouin~Chi~/Admin,~str~tti~ Offer CORP0227-07/01