The other day, I had a chance to read an article about Toronto EMS, and their relationship with the fire department, or more specifically, the fire department’s union. In a recent study done by a third party, it was recommended that paramedic unit hours be increased, and that a fire station on the city’s west side be closed down. Ever since then, it seems like in Toronto, the fight has been on, and boy is it an ugly one. With headlines like the one on a 2010 article reading “We’re in a War with the Fire Department” do nothing but draw unnecessary lines in the sand.
Dispatch protocols were reviewed, and fire first response was removed from 50 of those protocols, but added to 22 others. In the year since the revamping, they have been added back onto less than ten of those they were removed from. It is the position of the Toronto Paramedic Association that what the citizens of Toronto need is exactly what last year’s study calls for: more paramedics. Ed Kennedy, president of the Toronto Professional Fire Fighters’ Association disagrees. He feels that care being provided to the citizens of Toronto suffers without the fire department’s first response, and even says that Toronto should scrap their third service paramedic system in favor of a fire-based EMS service.
My question to Mr. Kennedy is a simple one: where is the evidence? What does he have to hang his hat on that says not only that fire fighters should be added back as first responders but should, in fact, take over the ambulance service? The study, which provides evidence to the contrary, recommends against consolidation and advocates for the addition of 25 ambulances per day, a jaw dropping number regardless of the current size of the service. It is time to cut through the B.S. and let the evidence speak for itself.
Toronto EMS, however, is not without their problems. Their response goal of under 9 minutes 90% of the time is not even close to being achieved, and currently sits at an abysmal 65%. Does that mean that the system needs first response, or does that say that the need for the system is actually more paramedics? While the fire department first responding to additional calls might allow someone to get there more quickly, it does not actually get the more critical patients what they need: a Toronto paramedic with the ALS equipment necessary to care for them. It does not even get them an ambulance to at least start the transport to the hospital.
If you want evidence against consolidation, look no further than Kansas City, who dissolved MAST two years ago, or any of the other currently struggling US based Fire/EMS models such as Washington DC, Detroit, or Philadelphia. Or even take a look across the border to Canada, and check out Winnipeg, who has struggled for the past 15 years since consolidating their EMS system to overcome many of the financial and personnel challenges they faced. If you want to see another study that was recently done, check out the Santa Clara County Grand Jury Report from 2011.
In an urban setting, the fire suppression units certainly have their place in EMS response. Time sensitive calls like cardiac arrests, and incidents where staffing levels might be low due to other units tied up on runs certainly warrant response from the closest unit. Rescue operations, HAZMAT situations, and motor vehicle crashes also immediately come to mind, and there are plenty of others that I could potentially site as well. Problems like the response time issues being experienced in Toronto, much like the ones we have here in the state (most recently publicized in Washington DC) are ones that need to be addressed by the addition of ambulances, not more first response. You need the right tool for the right job, and in this case the right tool is a paramedic level ambulance, not someone who can sit and wait longer with the patient.
The old adage of “if it ain’t broke, don’t fix it” does not apply here. Toronto EMS is not perfect, and they certainly have their issues. The answer to these problems though, is not to dissolve the system but to grow it to a size where it can support the volume they face in Toronto. The study supports it. The evidence supports it.