3 YORK REGION EMS AND FIRE SERVICES TRAINING OPPORTUNITIES

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1 3 YORK REGION EMS AND FIRE SERVICES TRAINING OPPORTUNITIES The Health and Emergency Medical Services Committee recommends the adoption of the recommendations contained in the following report, May , from the Commissioner of Health Services, with the following amendment to Recommendation No. 2: 2. That this report be circulated by the Regional Clerk to all area municipalities requesting comments. 1. RECOMMENDATIONS It is recommended that: 1. Health and Emergency Medical Services Committee and Regional Council receive this report for information. 2. This report be circulated by the Regional Clerk to all area municipalities for information purposes. 2. PURPOSE The purpose of this report is to provide Health and Emergency Medical Services Committee with information regarding opportunities for integration of services provided by York Region paramedics and area municipal firefighters in response to inquiries made by members of Regional Council. This report focuses on one aspect of integration, the provision of additional emergency response training for municipal firefighters in York Region. 3. BACKGROUND York Region Emergency Medical Services (EMS) and area municipal fire services respond to emergency calls throughout The Region, and both services require stations, vehicles and staff. These relationships suggest that some combination of these services would result in cost efficiencies and synergies for both regional and municipal levels of government. Different degrees of integration include fully integrated services; shared EMS/ fire stations and resources; shared administrative services; and enhanced training. 3.1 York Region EMS and Municipal Fire Services York Region EMS is a regionally-operated land ambulance and paramedic service which currently employs 201 full-time paramedics of which are 56 Advanced Care Paramedics (ACPs). York Region EMS has 17 EMS stations and operates up to 31 EMS vehicles during peak periods of call activity. In 2003, York Region EMS responded to

2 approximately 94,000 calls. Dispatch is provided by two Ministry of Health and Long-Term Care Communication Centres located in Barrie and Mississauga. York Region EMS primarily provides stabilization and emergency medical procedures to patients, and land ambulance transportation of the sick and injured. Comparatively, fire services in York Region are an area municipal responsibility. There are approximately 516 full-time firefighters and 317 volunteers, 29 fire stations and 63 fire trucks combined across all nine area municipalities. In 2003, York Region firefighters responded to approximately 26,000 calls, of which approximately 8% involved a fire and approximately 36% were health-related. The remainder of calls are miscellaneous in nature but include false alarms, motor vehicle collisions requiring extraction, public hazards (such as broken water pipes and downed wires), and hazardous materials calls. Dispatch is conducted from three municipal centres located in Markham, Richmond Hill and Vaughan. The primary mission of fire services is fire suppression and the extraction of patients. To date, York Region EMS and fire services have co-located in a number of stations including Keswick, Queensville, Aurora, Stouffville, Ballantrae, Thornhill, Unionville, Maple and Vaughan. These sites have provided both York Region EMS and fire services with efficiencies such as lower capital, construction and operational costs, and assisted in relationship building between EMS and fire services staff. Opportunities to co-locate continue with new stations planned for Markham, Mount Albert and Vaughan. 4. ANALYSIS AND OPTIONS 4.1 Challenges to Creating a Fully Integrated York Region EMS/Fire Emergency Service In the United States, a few cities have integrated paramedic and fire responses successfully including Pittsburgh, Tennessee, and New York. However, in Canada there are no examples of fully-integrated regional EMS and municipal fire services. In Alberta, some smaller area municipalities have integrated municipal paramedic and municipal fire services successfully and provide emergency services from shared locations with shared personnel. In Ontario, however, there are no examples of full integration, even in those areas where EMS and fire services function under the same level of government. In a press release dated September 3, 2003, the City of Owen Sound attempted integration and failed largely due to union objections. There are a number of barriers to successful integration in York Region including: Cultural differences between paramedics and firefighters and the representation of these workforces by two separate labour unions. Costs the savings from consolidating services and minimizing duplication can be minimal when compared to the cost of cross certifying existing personnel.

3 Disparate workloads between paramedics and fire departments medical emergencies can be largely predicted based on the movement patterns of people, and therefore flexible deployment and peak load staffing is utilized for EMS. However, fires cannot be easily predicted, and therefore fire services are station-based and operate at full service levels 24 hours a day, seven days a week. Lack of integration of paramedic and firefighter training at Ontario colleges. Given the system conditions in York Region and the current regulatory framework, a combined fire and paramedic model would be a considerable challenge. If significant interest on behalf of the Regional Council exists in further investigating the impacts and possibilities of a fully integrated EMS/fire model, an independent consultant should be retained to provide this analysis. 4.2 Integration of Paramedic and Fire Training Courses In order to become a paramedic, an individual must first complete a two-year program at a community college. To become an Advanced Care Paramedic, an experienced paramedic requires an additional 960 hours of courses under strict entry criteria, which results in certification and the ability to perform delegated acts. In order to become a firefighter, an individual must complete a one-year program at a community college. Some graduates receive additional medical training; however the curriculum is different from college to college. Durham College is an example of an Ontario college that offers both paramedic and firefighting courses. The curriculum for these courses is largely determined by set criteria established by the Province. Institutions such as this will not attempt to integrate paramedic and fire courses until there is legislation in place supporting this model, and until there is support from the individual labour union associations. An example of integrated paramedic/fire training is found in Vermilion, Alberta where the Northern Alberta Institute of Technology (NAIT) partnered with Fire etc., a training school, to provide Canada s first integrated paramedic/fire training college in Currently, this institution has approximately 7,000 firefighter graduates per year, and 52 yearly graduates from the integrated Emergency Services Technology (EST) Program. The integrated EST program contains three components: a firefighting component (approximately 400 hours), an emergency medical technician component (approximately 400 hours), and an employability skills training component (approximately 600 hours) which includes technical writing, computer literacy, public relations and public speaking. The EST program boasts a 90% employability rate of its EST program graduates. 4.3 Emergency Medical Responder Training The most successful examples of cooperative EMS/fire service delivery are those which keep the two services separated, but offer further emergency response training to fire departments for first response. As outlined earlier, fire services have more staff, more trucks and more stations than York Region EMS. Therefore, fire services are often the

4 first responders to arrive on the scene of an emergency. This first response capability of the fire service is extremely valuable, especially if fire services are capable of offering some degree of medical assistance beyond basic CPR and first aid while awaiting the arrival of EMS. Emergency Medical Responder (EMR) training is considered a baseline training program for first responders and is recognized as a standard across Canada. EMR training is designed to complement the care provided by EMS. The training involves 120 to 130 hours of training courses set out into modules. EMR functions typically include supporting the airway of a patient, stopping bleeding and using an automated external defibrillator, when indicated, prior to the ambulance s arrival. All of these activities can positively impact on patient outcomes. EMS paramedics reassess a patient s status and repeat procedures when transferring care from fire services personnel. EMR training would improve this coordination of service and ensure a smoother interaction between fire first responders and more highly trained paramedics. Both groups would be operating under common protocols and would work towards common quality improvement mechanisms. This can improve patient outcomes by reducing the amount of time necessary to transfer the patient from the first responder to the paramedic or ACP through continuity of care. However, EMR training does not necessarily increase nor decrease the number or types of medical calls to which fire departments respond, and does not increase the fire departments required staffing levels. Implementation of an EMR program would not mitigate the required staffing levels for York Region EMS, nor the need to maintain sufficient EMS resources to respond within the legislated response time EMR Impact on Response Times Only certified paramedics employed by a certified ambulance service can be utilized to meet The Region s legislated response time obligations. Even if EMR response were to be recognized under the regulations, as with any first response component in the EMS system, medical best practices would still require that the transport ambulance system maintain sufficient resources to respond within medically acceptable response times. Therefore, EMR training for fire services staff will not reduce the need for adequate transport ambulance resources in order to meet ambulance response times EMR Impact on Dispatch Currently, a call placed in York Region is answered at the York Region Police Communications Centre. Once call screening has been conducted, the call is forwarded to either EMS or fire services dispatch. York Region Police dispatch stay on the line until the call information has been transferred, and then EMS or fire services dispatch has responsibility over the call. In situations where EMS has been transferred a call and fire services are also required, EMS dispatch will contact the services dispatch directly. The same process occurs in situations where fire dispatch services are transferred responsibility of a call.

5 Operating multiple dispatch centres is expensive and requires a great amount of coordination in order to achieve seamless, integrated service and consistency. If a more cooperative and efficient relationship were established between EMS and fire through an EMR program, the justification for a centralized dispatch servicing both EMS and fire in York Region would be strengthened. A central dispatch model would offer system efficiencies, provide accountability, improve response times and decrease costs. 4.4 Other Regions, Municipalities and Single Tier Cities Peel Region On January 12, 2004, Peel Regional Council endorsed the adoption of an EMR system for area municipal fire services. Although costs for training have not yet been established, the Region of Peel has entered into a cost-shared agreement with the municipalities for the additional training for firefighters. The Fire and Emergency Services departments of all three area municipalities in Peel Region have indicated their desire to take EMR training. The Peel Region base hospital is providing a Train the Trainer program to a number of firefighters in Peel Region. These firefighters will in turn train the other members of their fire departments on EMR. The medical oversight for this program is also being supplied by the Peel Region base hospital Durham Region In Durham Region, the EMR program was initiated by the Durham Region base hospital in 1999/2000. In April 2004, the first local municipal fire department, Pickering, celebrated the EMR graduation of their firefighters. Within the next twelve months, approximately 450 firefighters will have completed the EMR training in five of the eight local municipalities in Durham Region. These programs are joint initiatives between the Durham Region base hospital and the local municipalities Town of Markham Markham is currently in Phase 1 of 10 modules to train 172 front-line Markham firefighters to the EMR standard. Last fall, nine trainers were trained by the York Region Base Hospital. These trainers will be providing the EMR program to the existing fire services staff which will be completed by Medical oversight is being undertaken by Dr. Austin, Medical Director, York Region Base Hospital. The Markham decision to pursue the EMR model was driven by statistics showing that approximately 55% of all the calls Markham fire services were responding to were medical in nature City of Ottawa The City of Ottawa trains their Fire Services staff for first response to emergency medical scenes. Their training program is slightly more in-depth than EMR training. However, the City of Ottawa is currently considering cutting back on the level of training to coincide with standard EMR training. Their experience has been that Fire Services staff

6 were not utilizing the extra medical training provided, and only required enough medical training to stabilize a patient before the arrival of EMS paramedics City of Hamilton The City of Hamilton provides emergency medical training to their Fire Services staff based on a fire-focussed model from the United States. This model focuses solely on the stabilization of a patient until the arrival of EMS paramedics. The Fire Chief oversees both Fire Services and EMS programs. 4.5 Relationship to Vision 2026 Additional training and coordination of EMS paramedics and firefighters represent a significant commitment to York Region s Vision 2026 Goals of Responding to the Needs of Our Residents through Supporting Safe and Secure Communities, and Quality Communities for a Diverse Region through the provision of Safe Neighbourhoods. 5. FINANCIAL IMPLICATIONS The EMR program can add value in the overall land ambulance system. This program may assist EMS and fire services in working together to achieve overall system performance and efficiencies for York Region tax payers. Further analysis of opportunities for integration of fire and ambulance services could be more fully explored by an independent consultant. 6. LOCAL MUNICIPAL IMPACT EMR trained personnel will improve the first response capabilities of municipal fire departments across The Region. This higher level of training would allow EMS paramedics and firefighters to work more efficiently together on EMS calls, reducing some of the duplication in patient assessments and providing greater assistance to paramedics. Implementation of this program may reduce the overall time required on the scene for both services and benefit patient outcomes in all local municipalities. 7. CONCLUSION Fully integrating York Region EMS and municipal fire services poses significant challenges. However, the upgrading of fire services training to EMR levels would assist in making the fire services first response more effective in the case of medical emergencies and provide significant value to the overall EMS system. The implementation of this program would also encourage more efficient methods of caring for patients and exchanging information necessary for patient care. The Senior Management Group has reviewed this report.

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