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HomeMy WebLinkAboutESD-003-13 SERVICES Cladiwn REPORT EMERGENCY AND FIRE Meeting: GENERAL PURPOSE AND ADMINISTRATION COMMITTEE Date: April 22, 2013 Resolution#: / ° -1 By-lava#: Report#: ESD-003-13 File#: Subject: OPTIONS FOR RESPONDING TO MEDICAL AND RESCUE CALLS RECOMMENDATIONS: It is respectfully recommended that the General Purpose and Administration Committee recommend to Council the following: 1. THAT Report ESD-003-13 be received for information. Submitted by: �� Reviewed by: `—J � c�,'�, ., Gor Weir, Franklin Wu, Director of Emergency Chief Administrative Officer Services GW/mb CORPORATION OF THE MUNICIPALITY OF CLARINGTON 40 TEMPERANCE STREET, BOWMANVILLE, ONTARIO L1C 3A6 T 905-623-3379 REPORT NO.: ESD-003-13 PAGE 2 1.0 BACKGROUND 1.1 Medical and rescue calls are provided through a Tiered Response Program. 1.2 Clarington Emergency and Fire Services (CEFS) have participated in the tiered response program for approximately 23 years. Tiered response was set up to dispatch police, fire and ambulance services to what is determined to be a life threatening situation. At that time, the following criteria would prompt a tiered response: • Absence of breathing/difficulty breathing • Unconsciousness • Severe bleeding • Motor vehicle accident with ambulance responding • Real or apparent heart attack 1.3 With the purchase of two Pumper/Rescue trucks in 1994, the Department began the move from single function trucks to multi-purpose trucks capable of responding to a variety of calls with the same crew. Today, these Pumper/Rescue trucks and/or a Rescue truck (when staffed) respond to medical calls and rescue calls throughout the Municipality. 1.4 Clarington Emergency & Fire Services respond from five stations strategically located in Bowmanville — Station 1, Newcastle — Station 2, Orono — Station 3, Courtice — Station 4 and Enniskillen — Station 5. Ambulance bases are located in Bowmanville and Courtice. Green dots denote the location of EMS (ambulance) stations in Clarington. F- ti I I� 4 r � I:;7k � - 1 REPORT NO.: ESD-003-13 PAGE 3 1.5 Fulltime firefighters are scheduled to staff three trucks as follows: At Station 1 — Bowmanville: Pumper/Rescue truck, 3-5 firefighters; and Rescue truck 2-3 firefighters (when staffing permits) At Station 4 — Courtice: Pumper/Rescue truck, 3-5 firefighters 2.0 COMMENTS 2.1 For patients seriously injured in a traumatic event, time is of the essence. The direct relationship between definitive (surgical) treatment and the survival of a trauma patient increases if the trauma patient is in an operating room within 1 hour of the injury, also known as the golden hour. Every action taken must have a life saving purpose, as minutes of the golden hour are being traded for the time taken for every action carried out before transport. 2.2 The ultimate goal of"Tiered Response" is to provide a timely first response as seconds count when dealing with medical emergencies. The criteria for a medical emergency were established provincially by the Emergency Medical Service (EMS). 2.3 Tiered Response 2.3.1 Medical and rescue calls are responded to in Clarington by CEFS and EMS using the Level C Tiered Response agreement. 2.3.2 A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with the response reference chart, for the following emergency requests for service: 1. Respiratory Arrest (Absence of Breathing) 2. Cardiac Arrest (Absence of Pulse) 3. Unconsciousness 4. Motor Vehicle Collision with EMS attending 5. Profuse and Uncontrolled Bleeding 6. Acute Chest Pain and/or Shortness of Breath/Difficulty Breathing These criteria for medical tiered response are in addition to the usual incidents requiring Fire Services response under their fire suppression, rescue and/or HAZMAT mandate where Central Ambulance Communications Centre (CACC) notification of the fire departments is automatic. REPORT NO.: ESD-003-13 PAGE 4 2.3.3 Once a tiered response has been initiated, it shall only be cancelled if the request for service is cancelled by the call originator and/or EMS resource(s) have arrived on scene and made patient contact. Refer to Attachment 1 to ESD-003-13 for a full list of Tiered Response Levels. 2.4 Medical Calls 2.4.1 Medical calls are a core service provided as defined in Emergency & Fire Service Governing By-Law# 2007-134, whereas emergency pre-hospital care responses and medical acts such as defibrillation, standard first aid, and CPR are performed as required. 2.4.2 CEFS responds to medical calls in following manner: Calls in Station 1 Area — Fulltime firefighters (3-5) in a Pumper/Rescue truck or if staff permits, fulltime firefighters in the Rescue truck (2). When fulltime firefighters are not available volunteer firefighters in a Pumper/Rescue truck (3-5) are dispatched. Fulltime firefighters in a Pumper/Rescue truck from Station 4 also initiate a response clearing after volunteer firefighters from Station 1 begin to respond. Calls in Station 2 Area —Volunteer firefighters in a Pumper/Rescue truck (3-5). A fulltime Pumper/Rescue truck or Rescue truck also initiates a response clearing after volunteer firefighters begin to respond. Calls in Station3 Area —Volunteer firefighters in a Pumper/Rescue truck (3-5). A fulltime Pumper/Rescue truck or Rescue truck also initiates a response clearing after volunteer firefighters begin to respond. Calls in Station 4 Area — Fulltime firefighters (3-5) in a Pumper/Rescue truck. When fulltime firefighters are not available volunteer firefighters in a Pumper/Rescue truck (3-5) are dispatched. Fulltime firefighters in a Pumper/Rescue truck or Rescue truck from Station 1 also initiate a response clearing after volunteer firefighters begin to respond. Calls in Station 5 Area — Volunteer firefighters in a Pumper/Rescue truck (3-5). A fulltime Pumper/Rescue truck or Rescue truck also initiates a response clearing after volunteer firefighters from Station 4 begin to respond. Note: One of the intents of Rescue 11 from the Master Fire Plan was to staff this truck 24/7 and to respond to medical calls, check calls, CO calls etc. REPORT NO.: ESD-003-13 PAGE 5 2.4.3 Over the past 3 years the crews were dispatched to 5,177 medical calls, 162 of which the response was cancelled prior to arrival. The following chart illustrates the breakdown of medical calls responded to from 2010 - 2012. 0 Vital Signs Absent, DOA - 141, 2.7% 141 6, 0.1% 15 5, 3.0% ■ Traumatic Shock- 6 237, 4.6% 119, 2.3% ❑ Seizure - 155 837, 16.2% El Oxygen Administered - 837 1545, 29.8% ■ Other Medical Resuscitator Call- 574 ❑ Medical/Resuscitator Call No Action Required - 833 ■ Medical/Resuscitator Call No False Alarm - 31 ❑ Medical Aid Not Required On Arrival- 131 ■ Defibrillator Used - 19 574, 11 .1% 01 CPR Administered -40 2, 0.0% ❑ Chest Pains or Suspected Heart Attack- 507 507, 9.8% 833, 16.1% ■ Burns -2 40, 0.8% ■ Asphyxia, Respiratory 31, 0.6% Condition- 1545 19, 0.4% ■Alcohol or Drug Related - 119 131, 2.5% ■Accident or Illness Related - 237 REPORT NO.: ESD-003-13 PAGE 6 2.4.4 Firefighters are trained to the Emergency Medical Responder Program and deliver Base Hospital protocols, as agreed. The following graph illustrates the number of medical calls responded to from 2010 —2012 per station and the number of calls patient care was administered by firefighters for chest pains or suspected heart attack, by administering oxygen, administering CPR or applying defibrillation. 3000 2794 2500 2261 2000 1500 1372 1000 ' 920 500 554 468 293 255 164 141 0 Station 1 Station 2 Station 3 Station 4 Station 5 1#of Calls ® Care Provided 2.4.5 Although providing emergency pre-hospital care and medical acts such as defibrillation, standard first aid, and CPR are core services provided by CEFS, these services support Durham Emergency Medical Services. At any time firefighters in a pumper/rescue truck could be re-routed to perform other core services such as fire extinguishment, rescue, defensive hazardous material response, etc. requiring the resources carried on a pumper/rescue truck and a compliment of firefighters greater than what may be required to perform at a medical call. 2.5 Rescue Calls 2.5.1 Rescue calls are a core service provided as defined in the Emergency & Fire Service Governing By-Law# 2007-134 whereas special rescue services shall include performing extrication using hand tools, air bags and heavy hydraulic tools, as required. Fulltime firefighters will be trained in basic rope rescue techniques as determined by the Fire Chief. Water/Ice rescue services shall be provided by those firefighters who are competently trained to perform the requested level of service as determined by the Fire Chief(up to level III if so trained). 2.5.2 Defensive hazardous material emergency response shall be conducted to the operations level by the fulltime firefighters and awareness level by the part-time firefighters. In addition to operations level response, the capability for rescue and emergency decontamination shall be maintained where resources permit. REPORT NO.: ESD-003-13 PAGE 7 2.5.3 Rescue is defined as persons in danger due to their proximity to the occurrence who are unable to self evacuate and are assisted to safety by fire department personnel (excludes persons evacuated for precautionary reasons). Included in this definition are persons rescued from elevators or other circumstances where they could not extricate themselves and fire department assisted in the extrication, e.g. vehicle extrication, collision, collapse, trapped in elevator, water rescue and water/ice rescue. 2.5.4 Rescue Calls are responded to in the following manner: Calls in Station 1 area — On-duty fulltime firefighters (6-10) on two Pumper/ Rescue trucks, Pump 11 and Pump 14 Calls in Station 2 area —Volunteer firefighters (3-5) on a Pumper/Rescue truck and on-duty fulltime firefighters (3-5) on a Pumper/Rescue truck, Pump 12 and Pump 11 Calls in Station 3 area —Volunteer firefighters (3-5) on a Pumper/Rescue truck and on-duty fulltime firefighters (3-5) on a Pumper/Rescue truck, Pump 12 and Pump 11 Calls in Station 4 area — On-duty fulltime firefighters (6-10) on two Pumper/ Rescue trucks, Pump 14 and Pump 11 Calls in Station 5 area —Volunteer firefighters (3-5) on a Pumper/Rescue truck and on-duty fulltime firefighters (3-5) on a Pumper/Rescue truck, Pump 12 and Pump 11 Additional resources that may be required for a rescue call i.e. Rescue truck for water or ice rescue; Tanker truck to act as a blocking vehicle on highways; All Terrain Vehicle (ATV) vehicle for remote rescue; and additional Pumper/Rescue trucks. REPORT NO.: ESD-003-13 PAGE 8 2.5.5 Over the past 3 years the crews were dispatched to 1,256 rescue calls. The following chart illustrates the breakdown of rescue calls responded to from 2010 -2012. 3, 0.2% 13, 1.0% 4, 0.3% 19, 1.5% 19, 1.5% 1123, 89.4% 9, 07% 2, 0.2% 3, 0.2% 61, 4.9% o High Angle Rescue -2 ■ Animal Rescue -3 ❑Vehicle Extrication- 61 ❑ Vehicle Collision- 1123 • Home/Residential - 3 ❑ Persons Trapped in Elevator- 13 •Water Rescue -4 ❑ Other Rescue - 19 • Rescue No Action Required - 19 ® Rescue False Alarm - 9 2.5.6 The following graph illustrates the number of rescue calls responded to from 2010 — 2012 per station and the number of vehicle collisions where fire prevention and or patient care was performed by firefighters; the number of vehicle collisions where vehicle extrication was performed by firefighters; the number of other rescues performed by firefighters including animal rescues, persons trapped in elevators, water rescues, and other rescues; and the number of rescue calls where no action was required or the call was a false alarm. 500 471w 400 300 263 200 100 32 131 99 28 9 5 1 1 8 2 4 14 7 14 6 2 0 0 Station 1 Station 2 Station 3 Station 4 Station 5 91 Vehicle Collisions ■Automobile Extrication Performed ■ Other Rescue Performed ❑ No Action Required/False Alarm REPORT NO.: ESD-003-13 PAGE 9 2.57 Responding to rescue calls is a core service provided by CEFS. A single vehicle collision requiring the extrication of one trauma patient can require several firefighters to perform tasks simultaneously so that the trauma patient can be transported and arrive to hospital within the golden hour. After performing their duties at the rescue call, firefighters in a pumper/rescue truck could be re-routed to perform other core services such as fire extinguishment, defensive hazardous material response, medical calls, etc. requiring the resources carried on a pumper/rescue truck including a full complement of firefighters. 3.0 CONCURRENCE Not applicable 4.0 SUMMARY 4.1 CEFS is a composite fire department. Response to medical and rescue calls will always include on-duty fulltime firefighters and at times volunteer firefighters being called in when applicable. 4.2 Firefighters utilize .a variety of vehicles and equipment to provide services including pumper/rescue trucks, rescue truck, tanker trucks, an ATV, trauma equipment, defibrillators, ventilators, specialized stretchers, hand tools, heavy hydraulic tools and air bags. 4.3 Firefighters are trained to provide emergency patient care to the standards of Central East Prehospital Care Program as an Emergency Medical Responder (EMR). The education curriculum is based on the National Occupational Competency Profile for prehospital providers for Canada. This program is based on basic life support knowledge and skill performance. 4.4 CEFS responds on average to 1,700 medical calls annually. EMS stations are located in Bowmanville and Courtice. Fire stations are located in Bowmanville, Courtice, Newcastle, Orono and Enniskillen. A tiered response within one minute of EMS dispatch, in addition to the time for Fire to dispatch, assemble and respond would suggest EMS should make patient contact in Bowmanville and Courtice prior to Fire Services arrival. Statistics indicate firefighters have been required to provide patient care on average 76% of the time in Bowmaville and Courtice. Firefighters responding from Newcastle, Orono, and Enniskillen provide patient care 85% of the time. REPORT NO.: ESD-003-13 PAGE 10 4.5 Firefighters are trained in fire prevention and suppression techniques, special rescue services including extrication using hand tools, air bags and heavy hydraulic tools, basic rope rescue, water/ice rescue, defensive hazardous material emergency response. 4.6 For seriously injured patients, time is of the essence. The direct relationship between definitive (surgical) treatment and the survival of trauma patients increase if the trauma patient is in an operating room within one hour of the injury, also known as the golden hour. Every action taken must have a life saving purpose, as minutes of the golden hour are being traded for the time taken for every action carried out before transport. 4.7 CEFS responds on average to 419 rescue calls annually. On average, 98% of the time firefighters carried out tasks that preserved life, property and the environment. 4.8 Depending on the type of emergency and established protocols, CEFS sends an adequate amount of resources to each call. Often the response requires a combination of fulltime firefighters and volunteer firefighters. These members using their experiences and department policy to provide a high level of service to Clarington's residents and visitors alike. 4.9 Options are limited with respect to how the department responds. CEFS is a Composite Department comprised of full-time and volunteers. If the intent of looking at our medical and rescue responses is to reduce our overall costs, the tiered response agreement would have to be changed to either a Level A or B tiered response level as seen on Attachment 1. This would reduce the number of medical responses overall. 4.10 With regards to how trucks are staffed and number of firefighters on these trucks, we are somewhat restricted. Pumper trucks may respond with a minimum of 3 and a maximum of 6 depending on the truck. All responses with a pumper truck require a driver, officer and a crew which could range from 1 firefighter to 3. The Rescue truck at Station 1, when in service, usually runs with 2 staff, a driver and an officer. 4.11 Volunteer firefighters respond primarily with the pumper truck with a crew of 3 as a minimum. One important note to mention is that we respond to all medical calls when requested by EMS, however should a more serious call come in such as a house fire, the truck would be redirected in most instances and another vehicle would be dispatched to assist EMS._When the department is tasked with a major emergency, EMS is advised we will not be able to assist with medical responses at that time. REPORT NO.: ESD-003-13 PAGE 11 4.12 Our last version of the Master Fire Plan identified staffing the Rescue truck with full-time staff. This has not been done. This would allow Rescue 1, a smaller truck with less staff, to respond on a regular basis to most medical calls. The option of splitting up the full-time staff to run medical calls and depleting the minimum staff required for a pumper response is not an option. 5.0 CONCLUSION 5.1 In closing, staff suggests their current response structure and tiered response levels remain unchanged and are therefore recommending this report be received for information. CONFORMITY WITH STRATEGIC PLAN Not Applicable Staff Contact: Gord Weir, Director of Emergency Services Attachments: Attachment 1 - Tiered Response Levels Approved by EMS Provincially Attachment 1 to ESD-003-13 TIERED RESPONSE LEVELS APPROVED BY EMS PROVINCIALLY Level A Tiered Response: A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with the response reference chart, for the following emergency requests for service: 1. Respiratory Arrest (Absence of Breathing) 2. Cardiac Arrest (Absence of Pulse) 3. Unconsciousness 4. Motor Vehicle Collision with EMS attending 5. Profuse and Uncontrolled Bleeding (not nose, vaginal, rectal, or catheter site bleeds and not on calls originating from Long Term Care facility (LTC), medical facility and/or other location with an available on-site EFR program or higher level of care) A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with the response reference chart, when the EMS response time is anticipated to be greater than ten (10) minutes for the following emergency requests for service: 1. Acute Chest Pain and/or Shortness of Breath/Difficulty Breathing (not on calls originating from LTC, medical facility and/or other location with an available on- site EFR program or higher level of care Level B Tiered Response: A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with the response reference chart, for the following emergency requests for service: 1. Respiratory Arrest (Absence of Breathing) 2. Cardiac Arrest (Absence of Pulse) 3. Unconsciousness 4. Motor Vehicle Collision with EMS attending A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with the response reference chart, when the EMS response time is anticipated to be greater than twelve (12) minutes for the following emergency requests for service: 1. Acute Chest Pain and/or Shortness of Breath/Difficulty Breathing (not on calls originating from LTC, medical facility and/or other location with an available on- site EFR program or higher level of care Attachment 1 to ESD-003-13 2. Profuse and Uncontrolled Bleeding (not nose, vaginal, rectal, or catheter site bleeds and not on calls originating from LTC, medical facility and/or other location with an available on-site EFR program or higher level of care) Level C Tiered Response: A tiered response will be requested within one (1) minute of EMS dispatch, and in conjunction with the response reference chart, for the following emergency requests for service: 1. Respiratory Arrest (Absence of Breathing) 2. Cardiac Arrest (Absence of Pulse) 3. Unconsciousness 4. Motor Vehicle Collision with EMS attending 5. Profuse and Uncontrolled Bleeding 6. Acute Chest Pain and/or Shortness of Breath/Difficulty Breathing These criteria for medical tiered response are in addition to the usual incidents requiring Fire Services response under their fire suppression, rescue and/or HAZMAT mandate where Central Ambulance Communications Centre (CACC) notification of the fire departments is automatic. Once a tiered response has been initiated, it shall only be cancelled if the request for service is cancelled by the call originator and/or EMS resource(s) have arrived on scene and made patient contact.