HomeMy WebLinkAboutESD-007-14 Unfinished
Business (b)
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EMERGENCY AND FIRE SERVICES DEPARTMENT
Meeting: GENERAL PURPOSE AND ADMINISTRATION COMMITTEE
Date: June 9, 2014 Resolution#:Gppt_yyk,_`L, By-law#:
Report#: ESD-007-14 File#:
Subject: TIERED RESPONSE
RECOMMENDATIONS:
It is respectfully recommended that the General Purpose and Administration Committee
recommend to Council the following:
1. THAT Report ESD-007-14 be received;
2. THAT the Director of Emergency and Fire Services be provided direction with
respect to the level of tiered response Emergency and Fire Services is to deliver;
and
3. THAT all interested parties listed in Report ESD-007-14 be advised of Council's
decision.
Submitted by:� Reviewed by:
Gord Weir, Franklin Wu,
Director of Emergency Chief Administrative Officer
Services
GW/mb
CORPORATION OF THE MUNICIPALITY OF CLARINGTON
40 TEMPERANCE STREET, BOWMANVILLE, ONTARIO L1 C 3A6 T 905-623-3379
REPORT NO.: ESD- 007 -14
1.0 BACKGROUND
PAGE 2
1.1 Council Resolution C- 155 -14 requires the Director of Emergency and Fire
Services to report back to Council on extended dispatch times, full -time turnout
times, and strategies to address tiered response and how to implement more
volunteer fire fighters to avoid overtime costs.
This report addresses tiered response strategies.
1.2 Tiered response levels approved by Emergency Medical Services (EMS)
provincially include:
Level A Tiered Response:
A tiered response will be requested within one (1) minute of EMS dispatch, 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, 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, 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
REPORT NO.: ESD- 007 -14
PAGE 3
A tiered response will be requested within one (1) minute of EMS dispatch, 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)
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, 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
1.3 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 department is automatic.
1.4 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.
1.5 Clarington Emergency and Fire Services (CEFS) and Durham EMS currently
exercise a Level C Tiered Response Agreement.
2.0 COMMENTS
2.1 The ultimate goal of tiered response is to provide timely and comprehensive
emergency response resources and skills to out of hospital medical emergencies.
2.2 Under a Tiered Response Agreement, a number of agencies have responsibilities
including:
REPORT NO.: ESD- 007 -14
PAGE 4
Central Ambulance Communications Centre Responsibilities
• Activation of the tiered response, to provide first response resources and
skills to out of hospital medical emergencies in accordance with the
applicable tiered response agreement
• Provide all necessary call details /information during the initial and /or follow -
up notifications(s) to ensure the details provided to emergency first
response resources are consistent with details provided to EMS
Fire Service Responsibilities
Emergency care and priority management (primary assessment and critical
intervention, oxygen administration, early CPR, early automated
defibrillation, assisted ventilations, assist and support EMS with overall call
management and clinical care)
Fire prevention and suppression
Coordinate rescue and /or HAZMAT operations in cooperation with EMS
resources to ensure patient clinical care requirements are addressed
EMS Responsibilities
Coordinate all out of hospital medical care and transportation
Work cooperatively with Fire Services during rescue and /or HAZMAT
operations to ensure patient clinical care requirements are addressed
2.3 CEFS's medical call data analyzed for this report is from January 1, 2009 through
to December 31, 2013.
Volume of medical calls — 8,615
1850
N 1800
m
U
@ 1750
U
0
1700
0
-0 1650
E
Z 1600
1550
2009 2010 2011 2012 2013
Year
Over the period analyzed, medical calls averaged 50.8% of the CEFS total call
volume.
REPORT NO.: ESD- 007 -14
PAGE 5
For comparison, the most recent Provincial data is for the years 2008 — 2012 and
shows the Provincial medical call average being 42.7 %, with Pickering 41.9 %,
Ajax 39.4 %, Whitby 35.2 %, Oshawa 27.7% and Toronto 53.1 %.
2.4 Volume of medical calls, by type
700
600
500
400
300
200
100
0
6 6 6 � to `� 5 a a 5 a� oc
eye ete 5e \° \tiJ °c a` a \c otc` . \" e� se e`' \o
�r J� �Q Co �5 eXb \�N ea Pc Pa
L `�t`° eta rey ��e
\a o5P �p�Q et`�\
��et�PaOQQ -P &� �e O
—2009 2010 - -2011 —2012 —2013
2.5 Percentage of medical call types
Defibrillator Used
0.4%
CPRAdministered
0.8%
Oxygen
Administered
16.4%
False Alarm
0.6%
Respiratory
Condition
30.2%
No Action
15.2%
Burns
0.0%
Traumatic
0.2%
Seizure
3.2%
Electric Shock
0.0%
Chest Pains
9.2%
Not Required
2.9%
Vital Signs Absent
2.7%
Alcohol/Drug
Related
2.3%
Accident/Illness
4.6%
Other Medical
11.4%
REPORT NO.: ESD- 007 -14
2.6 Percentage of medical calls, by station
Station 1
54%
Station 2
1 n%
2.7 Volume of calls, by time of day
1450
1200
950
700
450
M.
752
on 3
/o
station 4
27%
Station 5
3%
1437
1349
1221
1236
1020
617
24:00 - 3:00- 6:00 - 9:00 - 12:00- 15:00 - 18:00- 21:00 -
3:00 6:00 9:00 12:00 15:00 18:00 21:00 24:00
PAGE 6
2.8 The average response times, by station to a medical call over the study period
was:
• Station 1 — 7 minutes, 6 seconds
• Station 2 — 8 minutes, 5 seconds
• Station 3 — 8 minutes, 57 seconds
• Station 4 — 6 minutes, 18 seconds
• Station 5 — 10 minutes, 49 seconds
REPORT NO.: ESD- 007 -14
2.9 Percentage of medical call, by type and by station
False Alarm
No Action
Other Medical
Accident /Illness.
6
Alcohol /Drug Related
r
Vital Signs Absent
r
Not Required
Burns
Chest Pains
Traumatic
I
Electric Shock
PAGE 7
Seizure
Respiratory Condition
Defibrillator Used ■
1
CPR Administered
1
Oxygen Administered - -
0 10 20 30 40 50 60
Percentage
■ Station 1 - Station 2 - Station 3 ■ Station 4 ■ Station 5
3.101CONCURRENCE: None
REPORT NO.: ESD- 007 -14
4.0 CONCLUSION
PAGE 8
4.1 CEFS presently provides Level C tiered response service to medical calls. Over the
study period of January 1, 2009 through December 31, 2013, CEFS arrived at 8,615
medical calls, 50.8% of the total call volume.
4.2 Firefighter skills in managing a medical call include providing emergency care and
priority management (primary assessment and critical intervention, oxygen
administration, early CPR, early automated defibrillation, assisted ventilations, assist
and support EMS with overall call management and clinical care). Additional,
firefighters in some cases have brought order to chaotic situations allowing
paramedics to focus on the patient.
4.3 There are two strategies for Council to debate in establishing the level of tiered
response to medical calls CEFS will provide.
1. Remain status quo - Emergency Services continues to provide timely and
comprehensive emergency response resources and skills (Level C) to out of
hospital medical emergencies for the following:
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
2. Change the tiered response level to either Level A or Level B.
Such a change over the study period would result in:
a) Reduced call volume by as much as 4,807 across the Department
• Station 1 — 2,588
• Station 2 — 589
• Station 3 — 334
• Station 4 —1,113
• Station 5 — 185
b) Reduced expenses through fewer volunteer firefighter calls, lower fuel
consumption and reduced wear /tear on vehicles
c) Reduced level of service presently provided by not responding to calls
for:
• Profuse and Uncontrolled Bleeding
• Acute Chest Pain and /or Shortness of Breath /Difficulty Breathing
REPORT NO.: ESD- 007 -14 PAGE 9
4.4 A final consideration not to be overlooked in determining what level of tiered
response CEFS will provide is what is termed "crew resource management ",
although its importance may be difficult to specifically quantify. The Municipality
already has 5 fire stations that are strategically positioned across the Municipality
to deliver emergency response; firefighters are already trained by Central East
Pre - Hospital Care Program to deliver Provincial Healthcare Provider protocols
and firefighters are the first element in a well- designed system. Being as
residents have provided significant investment in this infrastructure and it is
already in place, it is staff's opinion that this service does have a positive impact
on patient care and should be continued.
CONFORMITY WITH STRATEGIC PLAN
The recommendations contained in this report conform to the general intent of the
following priorities of the Strategic Plan:
_ Promoting economic development
X_ Maintaining financial stability
_ Connecting Clarington
Promoting green initiatives
_ Investing in infrastructure
Showcasing our community
Not in conformity with Strategic Plan
Staff Contact: Mark Berney, Deputy Fire Chief
List of interested parties to be advised of Council's decision:
Rick Armstrong, Director, Durham Region Emergency Medical Service