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REPORT
EMERGENCY AND FIRE SERVICES
Meeting:
GENERAL PURPOSE AND ADMINISTRATION COMMITTEE
Date:
May 24, 2005
Report #: ESD-007-05
File #
10,12,6
By-law #
Subject:
FIRE SERVICES EMERGENCY MEDICAL RESPONSE
Recommendations:
It is respectfully recommended that the General Purpose and Administration Committee
recommend to Council the following:
1. THAT Report ESD-007-05 be received;
2, THAT the City of Oshawa's resolution regarding Fire Services Emergency Medical
Response be endorsed; and
3. THAT the Region of Durham and the City of Oshawa be advised of Council's decision.
Sohm;.,' by . dccL J~.
Gordon Weir, AMCT, CMMIII
Director of Emergency & Fire Services
RevieWedbY:O~~.
Franklin Wu,
Chief Administrative Officer
GW:sr
Attachment I: City of Oshawa Correspondence dated March 22, 2005-05-13
Attachment 2: City of Os haw a Report OS-05-37-CM dated March 8, 2005
CORPORATION OF THE MUNICIPALITY OF CLARINGTON
40 TEMPERANCE STREET, BOWMANVILLE, ONTARIO L 1C 3A6 T(905)623-3379 F (905)623-6506
REPORT NO. ESD 007-05
PAGE 2
COMMENTS
After reviewing The City of Oshawa's Report OS-05-37-CM dated March 8, 2005 (copy
attached) staff agrees that there is a need to address the reimbursement of costs for Fire Services
to respond to medical emergencies. Medical responses in this Municipality have become
approximately 42% of our call volume.
Staff also agrees, with a view to achieving greater efficiencies and possibly response times, that
the Region of Durham in its development plans for new emergency medical service facilities
should ensure comprehensive location analyses are completed which include local fire station
locations as possible locations for ambulance facilities,
RECOMMENDATIONS
Staff requests that Committee recommend to Council that we endorse the City of Oshawa's
Report OS-03-297-CM and that Council notify the Region of Durham of its support of the
recommendations set out in the City of Oshawa's report.
0-/0
'05APROl PM 3:49:57
ATTACHMENT # TO
REPORT # 65D -fY,n-rf;
Department of Corporate Services
File F-5000
March 22, 2005
P.M. Madill
Regional Clerk
The Regional Muni . ality of Durham
605 Rossland R E.
P,O, Box 62
Whitby, UN 6A3
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Re: Fire Services Emergency Medical Response
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City Council considered the matter at a meeting held March 21, 2005 and adopted the following
recommendation of the Operational Services Committee:
"1. That the Region of Durham respectfully be:
(a) requested to reimburse all costs associated with the provision of EMS service
provided by municipal Fire Services, as per Option 2 outlined in Section 3.2.3
of Report OS-05-37-CM dated March 8, 2005; and
(b) continue to comply with established response criteria protocols for the dispatch
of municipal Fire Services.
2. That Report OS-05-37-CM be forwarded to Durham Region municipalities, the
Association of Municipalities of Ontario, area MPP's, the Association of Municipal
Emergency Medical Services of Ontario, the Ontario Association of Fire Chiefs, the
Ontario Fire Marshal's Office, and the Ministry of Community Safety and Correctional
Services requesting a letter of support be forwarded to the Minister of Health and Long
Term Care for increased funding for the Regional provision of Emergency Medical
Services, Regional reimbursement of costs for municipal Fire Services EMS support,
and the transfer of the Central Ambulance Communications Centre to Regional EMS.
3. That the Ministry of Health and Long Term Care arrange a meeting with the Ministry
of Community Safety and Correctional Services, and the Ontario Association of Fire
Chiefs to address improvements in the EMS model including increased funding for the
provision of emergency medical services.
The Corporation of the City of Oshawa
City Clerk Services
50 Centre Street South, Oshawa, Ontario L 1 H 3Z7
TEL: 905-436-5639, FAX: 905-436-5697
Webslte: www.oshawa.ca
-2-
4. That the Ministry of Health and Long Term Care be requested to establish up-to-date
response time standards for Regional EMS.
5. That the City of Oshawa request the support of other Durham Region municipalities to
have Durham Region in its development plans for new emergency medical service
facilities ensure comprehensive location analyses are completed which include local
fIre station locations as possible locations for ambulance facilities."
Consideration of this matter by Regional Cotmcil is appreciated. Enclosed is a copy of Report OS-05-37-CM
dated March 8, 2005.
As noted in Parts I (a) (b) and 5, the City of Os haw a respectfully requests the Region of Durham to reimburse
all costs associated with the provision of EMS service provided by municipal Fire Services (as per Option 2);
and that the Region, in its development plans for new emergency medical service facilities, ensure
comprehensive location analyses are completed which include fire station locations as possible locations for
ambulance facilities.
By copy of this letter, I am advising area Municipalities of Council's decision and requesting their support to
request the Region consider fire station locations as possible locations for ambulance facilities in
development plans for new emergency medical service facilities.
If you need further assistance, please contact Steve Meringer, Fire Chief at the address listed below, or by
telephone at 905-433-1238.
~C-
Sandra Kranc
City Clerk
SK/mm
Enclosure
c. City Manager's Office
Fire Services
City of Pickering
Town of Ajax
Town of Whitby
Municipality of Clarington /'
Township of Brock
Township ofScugog
Township ofUxbridge
Oshawa (y)0/\. I t6 to Report .ESD-O
CncfL NOn. QVo5 Report
fll, ellr '" Moll'H'
To: Operational Services Committee Item: Date of Report:
OS-05-37-CM March 8, 2005
From: Bob Duignan, City Manager File: Date of Meeting:
A-2100 March 14, 2005
Subject: Fire Services Emergency Medical Response Ward:
All
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Attachment //2
07-05
1.0 BACKGROUND
Since the inception of the tiered response agreement between the Province, the Region of Durham
and the City of Os haw a, introduced as part of the 911 program in the early 1990's, medical
responses by Oshawa Fire Services have increased considerably. Statistics for 2004 confirm that
medical responses account for more than 50% of Oshawa Fire Services total responses, as shown
in the following table:
Fire Services Emergency Responses
Year Total Number of Calls Medical Calls (%)
2000 6,519 2,877 (44%)
2001 7,308 3,554 (49%)
2002 7,445 3,619 (49%)
2003 8,231 4,293 (52%)
2004 8,249 4,319 (52%)
Council was previously provided with Report OS-03-297 dated July 23, 2003 (Attachment No, I)
with respect to Fire Services emergency medical responses. The report provided Council with an
explanation of the increase in emergency medical responses at that time, as well as
recommendations for facilitating service delivery improvements. Staff have since followed
through on Council's recommendations,
The purpose ofthis report is to outline outstanding concerns regarding the three-tiered response to
emergency medical calls and to recommend to Council proposed changes to the current EMS
model to improve the efficiency and effectiveness of emergency medical services.
2,0 INPUT FROM OTHER SOURCES
Fire Services has received feedback on concerns related to the three-tiered response from the
following:
· Durham Region Fire Chiefs;
· Durham Emergency Medical Service;
· Durham Regional Police/911 Centre;
· Ministry of Health and Long Term Care;
· Region of Durham;
45
Report to the Operational
Services Committee (Continued)
-2.
Item: OS.o5-37-CM
Meeting Date: March 14, 2005
· Lakeridge Health Base Hospital; and
· Oshawa Central Ambulance Communications Centre (CACe) presently managed by the
Ministry of Health and Long Term Care,
3.0 ANALYSIS
3.1 Current EMS Model
Emergency medical services are delivered via a three-tier response model involving the Province,
the Region and local municipal Fire Services. The Province is responsible for the.CACC, which
currently controls communications to Durham Region EMS and municipal Fire Services. The
CACC determines the severity of the calls and dispatches accordingly.
The Region operates the EMS through the provision of land ambulances with base funding from
the Province. The Province is responsible for setting guidelines and protocols regarding response
times and level of service that the Region must follow. The Ministry of Health and Long Term
Care currently has no standard with respect to response times but the best practice is to target
1996 EMS performance levels which were on average a 9 to 10 minute response time. The Region
meets a 7 minute 55 second response time for 90% of its caUs in the City ofOshawa.
Fire Services at the municipal level are the second level of response. Fire Services currently
receives calls from the CACC, although because the Pro,ince's system is not automated, calls to
the Region and Fire Services are not delivered simultaneously. Fire Services response times are
as follows:
. 49,5% of calls are responded to within 4 minutes;
. 27.3% under 5 minutes;
. 13.1% under 6 minutes; and
. 10.2% over 6 minutes.
CaU response by Oshawa Fire Services is under 6 minutes 90% of the time compared with the
EMS time of7 minute 55 seconds. Although EMS response times have improved, Fire Services
is stiU first on the scene in many cases, although it is the second level of response. In all cases,
EMS is dispatched before Fire Services to tiered response caUs. Fire Services response times do
not "stop the clock" upon their arrival and are not included in the provincially targeted timelines.
(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.)
3.2 Evaluation of Current Model
3.2.1 Mandate of Regional EMS
Regional EMS is the principle service provider of medical emergency services. Some efficiencies
were gained when the service was downloaded to the Region in lieu ofa mix of provincial and
private ambulance services. With the Regional EMS system, there is an ability to provide better
coverage throughout the Region by moving ambulance units around the Region and strategicaUy
46
Report to the Operational
Services Committee (Continued)
-3-
Item: OS-05-37-CM
Meeting Date: March 14, 2005
locating ambulance stations. As well, there is consistency in the training of staff and purchasing of
equipment. However, it is also recognized that the downloading of the service was incomplete
with the CACC remaining at the Province. Regional EMS is the agency that the public holds
accountable for the service yet Regional EMS is not accountable for all facets of service delivery.
3.2,2 Role of Fire Services
Fire Services have traditionally responded to EMS calls and generally arrives first on the scene in
many cases. As such, Fire Services provides a significant role in the provision of emergency
medical services. Both the Region and the public rely on Fire Services for quick response and to
maintain high life save rates. It must"berecognized, however, that fire prevention; education and
suppression are Fire Services principle mandate.
In order to meet National Fire Protection Association (NFPA) standards, Fire Services must
deploy a minimum number of staff. There is capacity within this system to allow Fire Services to
respond to other calls such as medical incidents while still meeting NFP A standards. This is
consistent throughout most fire departments and during multiple event instances mutual aid
support is provided by neighbouring departments, if necessary. Although rare, if resources are
limited, fire calls take priority and the CACC is notified that Fire is unable to respond.
If the current model af shared responsibility for emergency medical service is to continue, there is
a need to address the reimbursement of costs for Fire Services to respond to medical emergencies.
3,2.3 Model Options
Several models can and should be considered. The question is which is the most efficient model
for EMS delivery. The options are:
1. Status quo;
2. Status quo with cost reimbursement to municipal Fire Services;
3, Self-sustaining Regional EMS; and
4. Transfer of EMS to lower tier for integration with Fire Services.
Each option is discussed below.
Status Quo
Inefficiencies are present in the status quo model. It is inadequately funded by the Province, target
performance levels have not been updated and, because provincial standards do not recognize Fire
Services responses, "stopping-the-cIock" response times are not optimum, As explained above,
current EMS dispatch functions are the responsibility of the Province, Fire Services receive calls
from the CACC, although because the Province's system is not automated, calls to the Region and
Fire Services are not delivered simultaneously. In addition, the involvement of the Province in the
CACC means the dispatch function is through a third party. On many occasions, messages to
EMS and Fire are not consistent with respect to important information regarding the patient or
47
Report to the Operational
Services Committee (Continued)
-4-
Item: OS-05-37-CM
Meeting Date: March 14, 2005
potential hazards upon arrival. Also, there have been significant delays in notification noted from
time to time between EMS and Fire, which increases response times.
The accountability for the dispatch service could be improved through a direct reporting
relationship to the Region EMS. Durham Region EMS has expressed interest in taking over
responsibility ofthe Durham area CACC, The Ministry of Health and Long Term Care has
confirmed that a five-year pilot project is underway for the delivery of dispatch services in
Niagara Region where the Regional EMS was the successful bidder. The Province has put a
moratorium on further pilot projects until the pilot initiative is completed and results reviewed.
Downloading the CACC responsibilities with supporting financial resources would assist with
communication issues currently facing Regional EMS and Fire Services. In the rii'eantime, the
CACC representatives have agreed to continue to review issues brought forward to them in an
effort to improve current communications. .
The Ontario Association of Fire Chiefs, the Ontario Fire Marshal's Office and Emergency Health
Services have also struck a committee to develop a Project Management Action Plan with respect
to the delivery of emergency medical services, The intent of the project is to reduce and
harmonize the number of protocols for tiered response within the cammunities of Ontario for
EMS providers. The committee anticipates a revision to the 1997 Tiered Response Guideline by
the spring of2005. This will include clearly defined response guidelines for the CACC. It is
expected that this initiative will minimize delayed response notification and provide better
updates for Fire Services.
On February 25, 2005, the Large Urban Mayors' Caucus of Ontario recognized that EMS service
is under-resourced and passed a resolution calling for the Province to be engaged as an active
partner in seeking a solution to the ambulance funding formula,
If the status quo is maintained, the Province needs to assess the funding provided for Regional
EMS (including the cost for municipal Fire Services support), update response times and ensure
efficiencies are achieved in the current delivery model.
Status Ouo with Cost Reimbursement to Municipal Fire Services
Overall financial implications involved with the delivery of medical responses are substantial. Fire
Services is not being given financial support for providing its vital emergency response service.
As a result, funding for medical response by Fire Services is a major concern.
As noted above, the Province currently provides partial funding to the Region for the provision of
emergency medical services, The remainder of the cost, other than a fee collected for ambulance
transport from users, is currently the responsibility of the Region, offset by lower-tier
municipalities absorbing their costs. Currently, there is no cost reimbursement for emergency
medical services provided by local municipalities although EMS calls represent more than 50% of
total Fire Services responses. Without the response by Fire Services to emergency calls, EMS
could not maintain the response times currently being provided or provide the same level of
patient care without a significant expansion of their staffing and equipment inventory.
48
Report to the Operational
Services Committee (Continued)
-5-
Item: OS-05-37-CM
Meeting Date: March 14, 2005
A proposed cost recovery would see the Region reimburse the lower-tier municipalities for
emergency medical services. Transferring the cost of municipal emergency medical Fire support
services to the Region is appropriate given the Region has primary responsibility for the provision
of the service. The impact on the Oshawa taxpayer would remain the same given the tax impact
of the service would be transferred from the City to the Region, thereby reducing the City's budget
requirement. The level of service including response protocols, training by Lakeridge Base
Hospital and equipment provided by municipal fire departments are consistent throughout the
Region. The northern municipalities have modified agreements due to the fact they do not have
full-time staff. Centralizing and coordinating resources through one agency would therefore
provide greater continuity and administrative cost savings,
Currently all consumable medical equipment such as oxygen, protective apparel and first aid
supplies is provided by Durham EMS to the local municipal fire departments. Items such as
defibrillators and ongoing training and certification are currently paid for by Fire Services. New
defibrillators have just been purchased by Oshawa Fire Services for all vehicles at a total cost of
$80,000, Current medical training costs for Oshawa Fire Services staff are approximately
$32,000 per year. It is difficult to specifically identify vehicle costs associated with medical
responses. A fee per call could be negotiated to cover vehicle maintenance and other costs
associated with the emergency response.
It should be noted that 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
including the recognition of Fire Services as a competent, qualified responder. Funding concerns
will also be addressed at that time. The City, along with other municipalities, should provide
support to the Region when lobbying the Province either directly or through the Association of
Municipalities of Ontario for increased funding for service providers.
Self-Sustaining Regional EMS Service
This model, although desirable from an accountability perspective, is costly given it would be
necessary for the Regional EMS to increase staff, resources and equipment to meet the required
response times without the assistance of Fire Services. This would further burden the taxpayer,
This model would also require the Province to pay its full share of the cost-shared program.
Transfer of EMS to Lower Tier for Integration with Fire Services
This model reflects the fact that Fire Services are first on the scene on many occasions. It is also
efficient and cost effective for ambulance and fire services to be located together. Durham Region
Fire Chiefs have confirmed that when new fire stations were planned and constructed over the
past number of years. Regional EMS has been provided with an offer of shared use of space. For
example, a letter was sent June 15, 2004 to Durham EMS offering space in the proposed new fire
station in north Oshawa. The Region, through the EMS, has confirmed that it is committed to
shared resources, wherever possible, and is interested in the ability to have ambulances stationed
in Fire Halls. Ambulance station locations are based on historical data relating to both response
times, as well as incident occurrence locations. If fire stations are located in the vicinity of the
49
Report to the Operational
Services Committee (Continued)
-6-
Item: OS-D5-37-CM
Meeting Date: March 14,2005
Region's target areas they will negotiate the sharing of space. To date, no sharing of space has
occurred or is planned.
The Report of the Task Force on the Future of the Greater Toronto Area (Golden Report)
specifically spoke to ambulance service, as follows:
"The Province should review the appropriate scale for coordination of ambulance services, and the
possible amalgamation of ambulance and fire services, with a view to achieving greater
efficiencies and improving response times. . ."
4,0 FINANCIAL IMPLICATIONS
There are no financial implications as a result of this report.
5.0 CONCLUSION
Oshawa residents, as well as other municipalities within Durham Region, currently enjoy a very
professional, well-trained level of emergency medical care provided in a very timely manner.
Statistics have shown that this high level of response is indicative of the success rates for a variety
of treatments such as ventricular fibrillation. Oshawa and Durham Region's life save rate for
ventricular fibrillation is amongst the highest in the country. Without Fire Services, this same
success rate could only be realized with the substantial expansion of the Regional EMS system.
This would include a large increase in staff, as well as capital items such as vehicles, facilities and
specialized equipment.
The present tiered delivery of emergency medical response by municipal Fire Services and the
Regional EMS is very successful in terms of overall customer service. Patients receive a much
better level of service both from a time of response perspective as well as professional care
provided by the multi-agency approach. In a serious situation such as a heart attack, fire crews
provide CPR and ventilation, which allows E~S crews to provide specialized treatment such as
intravenous, medication and advanced defibrillation.
Fire Services currently plays an important role in emergency medical responses, however, it is
recommended that the total cost of the service be borne by the Region with increased funding
support from the Province, and that Durham Region EMS should assume responsibility for the
CACC.
6.0 RECOMMENDED ACTION
That the Operatianal Services Committee recommend to City Council:
I. That the Region of Durham be:
a) requested to reimburse all costs associated with the provision of EMS service provided
by municipal Fire Services, as per Option 2 outlined in Section 3.2.3 of Report OS-05-
37-CM dated March 8, 2005; and
50
Report to the Operational
Services Committee (Continued)
-7-
Item: OS-05-37-CM
Meeting Date: March 14, 2005
b) continue to comply with established response criteria protocols for the dispatch of
municipal Fire Services.
2. That Report OS-05-37-CM be forwarded to Durham Region municipalities, the Association of
Municipalities of Ontario, area MPP's, the Association of Municipal Emergency Medical
Services of Ontario, the Ontario Association of Fire Chiefs, the Ontario Fire Marshal's Office,
and the Ministry of Community Safety and Correctional Services requesting a letter of support
be forwarded to the Minister of Health and Long Term Care for increased funding for the
Regional provision of Emergency Medical Services, Regional reimbursement of costs for
municipal FireServices EMS sUl'port, and the transfer of the Central Ambulance
Communications Centre to Regional EMS.
3. That the Ministry of Health and Long Term Care arrange a meeting with the Ministry of
Community Safety and Correctional Services, and the Ontario Association of Fire Chiefs to
address improvements in the EMS model including increased funding for the provision of
emergency medical services.
4, That the Ministry of Health and Long Term Care be requested to establish up-to-date response
time standards for Regional EMS.
5. That the City of Os haw a request the support of other Durham Region municipalities to have
Durham Region in its development plans for new emergency medical service facilities ensure
comprehensive location analyses are completed which include local fire station locations as
possible locations for ambulance facilities.
/7 //
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Steve Meringer, Fire Chief
Bob Duignan, City Manager
Attachment
51
Oshawa
rh. CU, III Mott..
Attachment No. 1
Report
To:
Operational Services Committee
Item:
Date of Report:
OS-03-297
July 23 2003
Date of Meeting:
From:
Commissioner
Department of Corporate Services.
File:
Subject:
FIRE SERVICES EMERGENCY MEDICAL
RESPONSE
September 2, 2003
Ward:
1.0 BACKGROUND
Through the City's participation in the 911 tiered response emergency system, the number of
emergency medical responses by Oshawa Fire Services has increased significantly over the past few
years. As requested by Council, this report outlines the reasons for the increase in medical responses
as a result of present emergency response practices and procedures and provides recommendations to
improve the present system.
2.0 INPUT FROM OTHER SOURCES
Durham Region Fire Chiefs
Durham Emergency Medical Service
Oshawa Fire Services Tiered Response Guideline
3,0 ANALYSIS
The emergency 911 system was introduced in Durham Region in the early 1990s. A basic
requirement of initiating the 911 system was for the emergency service providers (police, fire and
ambulance) to agree to a system of "tiered response" where all emergency services would respond
to specific emergencies to ensure the response time to the incident was as quick as possible.
In the late 1970s and early 1980s Oshawa constructed new fire stations that were strategically
located to provide an average response time offour minutes within the urban area. Because of the
location of the City's fire stations, Fire Services is usually the first service on the scene of most
emergency medical calls.
Over the years, this tiered response agreement has evolved so that Durham Regional Police, having
minimal emergency medical equipment in vehicles, does not respond to emergency medical cal1s.
Fire Services only responds to calls that are determined to be "Code 4". (The rate of Code 4 call-
outs has increased significantly.) These calls involve:
1. Absence ofbreathingldifficulty breathing;
2. Unconsciousness;
3, Severe uncontrolled bleeding;
4. Motor vehicle accident with ambulance responding;
5. Real or apprehended heart attack where I or 2 above has not occurred.
52
Report to Operational Services Committee
(Continued)
-2-
Item No: OS-03-297
Meeting Date: September 2, 2003
At the time of the Fire Marshal's Review of Os haw a Fire Services in 1996, it was noted that
Oshawa Fire Services responded to over 6,000 calls with over half being for emergency medical
incidents. While the number and severity of fire calls has decreased significantly because of
effective fire prevention, education and early warning by-laws, the total number of calls has still
increased substantially from 2,710 in the early 1990s, when the 911 system was introduced, to 7,445
in 2002. Although the City has grown over the years, the primary cause for the number of calls is
the dramatic increase in emergency medical calls which have escalated from 297 in 1993 to 3,619 in
2002 - a 1,200% increase.
Fire Services Emerl!:encv ResDoDses_ .
Year
Total
Medical
Motor Vehicle
Accidents
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2,503
2,716
4,447
5,731
5,847
6,036
6,137
6,215
6,519
7,308
7445
172
297
1,575
2,121
2,456
2,747
2,661
2,661
2,877
3,554
3619
161
201
426
620
655
622
663
677
764
879
866
In 1999 when Durham Region assumed responsibility for ambulance services, it inherited a system
that was previously operated by the Province and private operators. The Province tended to work
from, or close to, hospitals. The private operators sometimes worked out of funeral homes. Both
the Province and the private operators obviously had an interest in keeping costs as low as possible,
therefore, the addition of more ambulances and staff did not increase in response to demand factors
such as population growth and an aging populatian demographic. Because ambulance service was
not adequate, local fire departments began to fill the service gap and even now, regardless of the
major investment into the ambulance service by Durham Region, the ambulance service cannot
provide the proper response levels without depending on local fire services to do so.
Until Durham Region acquired the ambulance service, there had been no plan to significantly
increase the number of ambulances or to work with the other emergency medical providers, such as
local fire departments, to ensure that ambulances were located in facilities that provide the best
response times. The Region's Emergency Medical Service has contacted area fire departments
about the possibility of shared facilities, but there is still no coordinated planning for shared
facilities to minimize response times by all emergency medical service stakeholders. As the Region
53
Report to Operational Services Committee
(Continued)
-3-
Item No: 05-03.297
Meeting Date: September 2,2003
approves funding to construct new ambulance facilities, it is important that they consider all service
delivery opportunities to ensure a comprehensive long-range strategic approach.
Until the Durham Region ambulance service strategically locates its facilities in areas to meet
provincial response time requirements, there will be a duplication of service between municipal fire
services and Durham Region Ambulance Service. Presently the Region's emergency medical
system cannot meet the Province's response time requirements without depending on municipal fire
services. Durham Region and area municipalities need to develop long-range plans to ensure the
emergency service is managed in a more effective and cost-efficient manner.
Former Oshawa Fire Chief, Milt \vilSclli brought the Durham Region emergency medical service
stakeholders together from across Durham Region to discuss the current tiered response situation.
A number of issues were identified that need to be addressed if changes in the tiered response
system are to take place. The following summarizes the issues identified.
Multiple Jurisdictions
· The Province through the Ministry of Health is setting standards and policies for emergency pre-
hospital care, ambulance response times and communication procedures. However, the
Province is not assisting with the financial resources required to meet their imposed standards.
· Durham Region is the jurisdiction responsible for managing and providing emergency medical
services and is taking steps to meet provincial standards; however, is doing so unilaterally
without involving other emergency medical service stakeholders.
· Local municipalities are providing emergency medical services through their individual fire
departments. In most cases, emergency medical calls are more than 50% of the fire service
emergency responses which significantly impacts municipal budgets for staffmg, training and
equipment.
· In addition to public emergency medical services, there are also a number of private providers
who focus on profitable areas of emergency medical service such as non-emergent patient
transfers.
· There is no discussion taking place involving the Province, the Region and local municipalities
to improve service delivery.
· Fire trucks are very expensive and inappropriate alternatives to ambulances.
Whv Is It Necessarv That Fire Services Emerl!encv Medical Service Responses Continue?
· Ambulances are spending more time in hospitals processing patients.
· Ambulances are re-routed to other municipalities and are therefore away from their base
municipalities.
· Ambulance training standards are higher now than years ago so ambulance paramedics take
more time stabilizing patients at the scene of an incident.
· Ambulance facilities are not strategically located in accordance with response times.
· Population growth continues to increase response requirements.
54
Report to Operational Services Committee
(Continued)
-4-
Item No: OS.{J3.297
Meeting Date: September 2,2003
. Population demographics are changing and are increasing responses.
. Vehicle traffic continues to increase therefore vehicle accidents continue to increase. A future
Highway 407 will increase vehicle traffic and population growth tremendously.
The Province Sets Dispatch Protocols
. Regardless of Durham Region's responsibility to provide emergency medical service, the
. Province maintains the ambulance dispatch and communications system. The current provincial
radio system does not allow contact between local emergency service stakeholders (police, fire,
ambulance) which leads to increased routing of calls, delays and duplicati9n of service.
. The Province sets response standards but fire service intervention does not "stop the clock" of
meeting the response standard. This leads to the requirement for more ambulance{ to meet
response times when in many cases a fire service vehicle with defibrillation equipment was at
the scene within the specified time.
Facilities
. Ambulance facilities are not strategically located with regard to response times. There are
provincial response time standards that must be met so Durham Region is building new
facilities, but doing so without involving other emergency medical service providers.
. Additional ambulances are purchased in an attempt to meet response standards with no regard to
fire service intervention from strategically located stations with trained fire personnel.
. There is no long-range plan to strategically locate ambulance stations with future fire stations.
. Municipal fire service facilities are usually located to provide a quicker response time than
ambulance facilities.
Traininl!
. Until recently there has been no attempt by the Province to include firefighter emergency
medical service training into the Ministry of Health emergency health care training system.
. At the street level, fire services is an intricate part of the pre-hospital care process but it is not
recognized by the Province, which leads to the requirement for more ambulances to meet
provincial response time standards.
Obviously, from the issues identified by local emergency medical service stakeholders, if changes
are going to take place in the tiered response system, a significant commitment by all levels of
government is necessary, and the provincial government in particular.
There is no doubt that the introduction of fire services into the emergency medical service system
has been beneficial to the citizens of our community. There are statistics that clearly shaw that many
lives have been saved and injuries minimized because of fire services' quick response times and the
use of defibrillation units. The current "save rate" for Oshawa patients suffering from ventricular
fibrillation is 20.2% compared to Durham Region at 6.7% and a provincial average of 4-5%.
Taxpayers can depend on a highly trained fire service that can intervene between fire and rescue
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Report to Operational Services Committee
(Continued)
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Item No: OS-03-297
Meeting Date: September 2, 2003
duties to provide emergency medical service. This is a valuable benefit to all citizens; however, if
nothing is done to change the present system, the cost of providing emergency medical service will
continue to increase for the taxpayers of Os haw a and indeed all Durham Region taxpayers.
Present emergency medical response procedures have created a system of expensive duplication.
The ambulance system cannot respond quick enough to meet response time standards, therefore
local fire services are depended on. However, the present level of fire personnel training is not
recognized by the Province as sufficient enough to not require ambulance paramedics to still
respond and to transport individuals. The tiered response system needs to fundamentally change to
use either the ambulance response infrastructure or the fire response infrastructure efficiently and
properly. The Province needs to"decidewhether or not municipal fire services. are integral or not to
emergency medical responses. The Province also has to understand that establishing c:mergency
medical response standards requires a commitment to efficiency rather than allowing this costly
"hybrid" system involving ambulance and fire personnel to continue and no doubt expand further.
If there are to be changes in the tiered response process to provide a more cost-effective system,
then the changes have to begin at the provincial level. The Province has to initiate changes in its
standards and policies. It is not possible for Durham Region and local municipalities to discuss
tiered response efficiencies and procedural changes if the Province does not participate and agree to
change its dispatch procedures, response time requirements, and begin to recognize the involvement
of fire personnel in the emergency medical system. The present tiered response situation is not just
a Durham Region situation; the situation is the same throughout the Province.
Tiered response is part of the pre-hospital care process and in many cases minimizes the amount of
time a victim spends in hospital and enhances their chances ofleaving the hospital with the
expectation ofa good quality of life. Ifmunicipal fire services are to be included as part of this pre-
hospital care process, they must be recognized as part of the overall emergency health system by the
Ministry of Health. The provincial recognition of fully trained municipal fire personnel would
reduce duplication of fire and ambulance response to emergency situations. When fire service
training is recognized by the Province then fire service intervention in the response process could
stop the clock on response time thereby reducing the need for additional ambulance resources.
The potential outcome in Durham Region of provincial recognition of fire personnel training could
be ambulance service provided by municipal fire services in appropriate response vehicles rather
than "fire trucks". Conversely, if the Province does not want to recognize medically trained fire
personnel then local municipalities, including Oshawa, should determine whether or not they will
continue to respond to emergency medical responses at all. If municipalities decided to not respond
to emergency medical calls, Durham Region would be required to significantly increase its
emergency medical service investment because the Region could no longer expect the support and
investment made by municipalities in medical training and equipment.
To accomplish changes to present provincial standards, the Ontario Association of Fire Chiefs and
the Ontario Fire Marshal are now meeting with senior staff at the Ministry of Health to analyze fire
service emergency medical service standards to detennine how they compare to the Ministry of
Health basic life support training. Once this process is completed and accepted by the Province,
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Report to Operational Services Committee
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Item No; 05-03-297
Meeting Date; September 2,2003
there should be no reason that the intervention of fire personnel with defibrillation capabilities does
not "stop the clock" to meet Ministry of Health response standards.
The Province has to also agree to cooperate with local 911 communication providers to develop
protocols that use all communication systems efficiently. Oshawa, together with the other southern
Durham Region fire departments are currently working with Durham Emergency Medical Service
and Durham Regional Police to develop a radio interoperability system. Although this is principally
designed for senior level communication at this time, it may offer the ability for expansion to suit
the needs outlined within this report.
There is one area of immediate cooperation possible between Durham Region and local
municipalities that would lead to efficiencies. A coordinated long-range plan for placement of
ambulance facilities and fire stations in the context of the geographical area of Durham Region is
necessary. A practical strategy in responding to medical emergencies in the future is to plan and
build facilities that accommodate ambulance, fire and possibly police. The City's current fire station
location study is examining medical response options as part ofthe overall study; however, if all
options are to be considered participation by all stakeholders is necessary.
4.0 CONCLUSION
The City of Oshawa, alone, is not going to change the present tiered response system. Regardless of
the present duplication of service between Durham Region emergency medical services and local fire
services, the present system does work although at operating costs that are greater than they should
be. The present emergency medical service stakeholders (province, police, fire and ambulance) are
all entrenched in the present system and there is tremendous reluctance to change the system.
Therefore, ifOshawa is committed to changing the present system, the City needs to understand it
will be a long-term process requiring the cooperation of the Province, other municipalities and
emergency medical service stakeholders.
The following recommendations outline a course of action the City could follow to acquire support
for change to the tiered response system and to have the issue of tiered response become not only an
Oshawa priority but a priority for other stakeholders including the Province of Ontario, other local
municipalities including Durham Region itself, as well as the Association of Ontario Municipalities
(A.\10).
5.0 FIl'iANCIAL IMPLICATIONS
The opportunity of significant savings exist if we could initiate a better system as referenced within
this report.
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. Report to Operational Services Committee
(Continued)
Item No: 05.03-297
Meeting Date: September 2, 2003
.7.
. 6.0 RECOMMENDED ACTION
.
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The Operational Services Committee recommends to City Council that:
I. The City of Oshawa outline the City's concerns regarding the present emergency medical tiered
response system to the Minister of Health and Area MPP's;
2. The City of Oshawa forward this report to other Durham Region municipalities and request their
support by also outlining their own concerns with the present emergency medical tiered
response system to the Ministry of Health and Area MPP's;
3. The City of Oshawa request the suPPOrt of other Durham Region municipalities to have Durham
Region in its development plans for new emergency medical service facilities ensure
comprehensive location analyses are completed which include local fire station locations as
possible locations for ambulance facilities;
4. The City of Oshawa request the support of other Durham Region municipalities including
Durham Region and Durham Region Police Service to establish a local emergency stakeholder
committee with a mandate to review the present local tiered response system and implement
improvements wherever possible and make recommendations to local Council's when
necessary;
5. The City of Oshawa, given the support of other Durham Region municipalities, establish a local
emergency stakeholder committee and request through the Minister of Health that a provincial
representative participate in discussions to improve the tiered response system throughout
Durham Region; and
6. The City of Oshawa request the support of other Durham Region municipalities in a resolution
to the Association of Ontario Municipalities (AMO) requesting AMO complete a
comprehensive province-wide analysis of emergency medical response systems and that AMO
complete a policy position supporting a more efficient and effective system for presentation to
the Minister of Health.
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Steve Meringer
Fire Chief
n f\.
U'fN'.-V
Don O'Leary
Commissioner
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