# "Smitherman: Firefighters should swallow EMS"



## mariomike (22 Jun 2010)

In today's National Post:
"proposed a friendly takeover of Toronto Emergency Medical Service by Toronto Fire":
http://news.nationalpost.com/2010/06/22/smitherman-firefighters-should-swallow-ems/

One more reason I am thankful to be retired.
Come back, Mel. All is forgiven!

It happened to New York City:
http://www.fdnyemswebsite.com/


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## medicineman (22 Jun 2010)

Winnipeg too.

MM


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## PMedMoe (23 Jun 2010)

When I was doing my ambulance ride-along in TO, most times, the fire department was at the scene before EMT.


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## McD (23 Jun 2010)

Pretty much the entire United States requires all Firefighters to be at least have their EMT-Basic, if not their EMT - Paramedic. Quite often the EMT - Paramedic must be completed after being hired on anyway. 

In fact EMT-Basic is a requisite ticket to have in order to start some Firefighter Academies. Although useless in the eyes of Ontario I took my Basic just to be a more compotent First Responder just incase things changed, like this proposal for example , and just incase I got hired on. Glad I've stepped away from it now, my life is this new path with the CF, but I agree with guy. 

Most of the calls are medical. It makes sense. FDNY & FDNY EMS (minus their ridiculous wages) have a good system from what I saw all the times Ive been there but the city has more private or FDNY sponsored buses out on the road than actual FDNY EMS. As long as their pay scales are not looking to be adopted this is a good thing in my mind. 

However The City of Houston, Texas balances it best. You either hire on and work only EMS for a set amount of years straight or spend your time rotating from Fire to EMS, and you must attain Paramedic level with HFD. 

 :2c:

PS im sure some 'Old Hat' (and thats said with respect) will boot my *** for sayin all that...but its the business of saving lives why not equip them with that knowledge?


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## SeanNewman (23 Jun 2010)

mariomike said:
			
		

> One more reason I am thankful to be retired.



MM,

I am a complete outsider-looking-in on this one, but out of curiosity why would one of either (EMS / Firefighter) be against it?

If it's just a matter of Firefighters taking on more tasks without more resources and EMS guys losing their jobs then of course it's a bad idea, but what if it could be done like a merger?  

Shared residences?  Shares resources (general purpose vehicles, etc)?  Shared training?  Shared chains of command / human resources?

Would you be for it if they each kept their own identity but got rid of redundancies?

Purely for discussion sake.


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## mariomike (23 Jun 2010)

Petamocto. 
I appreciate that you ask these questions. We really are just a small fish in a big political pond.
Thankfully, the Toronto Paramedic Association, and the president of the union ( even though I am no longer a member of either ) have already issued statements to condemn this, this....thing:

"The paramedics’ resistance to a merger is no surprise. Mr. Smitherman based his policy on a 2008 discussion paper by *the Ontario Association of Fire Chiefs and the Ontario Professional Fire Fighters Association*, which advocated integrating the departments and simultaneously dispatching paramedics and firefighters to life-threatening medical emergencies."
"Smitherman has the support of the Ontario Association of Fire Chiefs and the Ontario Professional Fire Fighters’ Association."
Big Surprise.

"Toronto has five to six fire stations for every ambulance station. Retraining firefighters would be difficult, since paramedics must spend two full years at community college."
Roberta Scott, Toronto Paramedic Association

"While the president of the Toronto Professional Fire Fighters’ Association is open to working more closely with paramedics, representatives of *the city’s paramedics would fight it tooth and nail*.":
http://www.theglobeandmail.com/news/national/toronto/smitherman-would-blend-paramedic-firefighting-services/article1614098/
http://www.newswire.ca/en/releases/archive/June2010/23/c7785.html

“I think it’s a rather clumsy way of admitting that we don’t have enough paramedics on the road,” said Mark Ferguson, a paramedic and president of the Canadian Union of Public Employees Local 416." 
“Why would George Smitherman commit to sending four firefighters and a half-a-million dollar pumper to a medical call when in fact he could achieve the same thing by sending two fully qualified paramedics to the call?”:
http://www.thestar.com/news/gta/article/827127--smitherman-combine-fire-and-ems

It is the international fire union that started the push:
"Our next frontier is Canada." And, their General President spells out why:
http://www.iaff.org/03News/061203has.html

But, when I read the news yesterday, "swallowing" being the word used, as a pensioner, it was the intangibles that came to my mind. 
Even though decades younger than myself, I suspect that you, as a young serving officer of a proud regiment, might feel the same way. It's the *history* of your organization,
http://www.torontoems.ca/main-site/about/history.html
and *the guys *
http://www.torontoems.ca/main-site/about/history-files/tree.html
you had the pleasure of working with, not the political B.S. that you remember at times such as this.


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## SeanNewman (23 Jun 2010)

Okay thank you for that detailed reply.  There is somewhat of a parallel discussion going on with our reserve regiments because people in the upper offices on the outside have all these good "common sense" ways to save money (that actually do make practical sense), but when you mention things like history and pride I understand it more.  Reserve regiments fight it the same way to save their history because even though they may parade 10 people on a Tuesday night, they had a former member earn a Victoria Cross and they are fanatical about not losing that link.

My next question though is whether or not the Paramedics actually have anyone significantly powerful (other than Unions that a lot of people don't like) enough to do anything about it?  Some generic Reserve regiment facing amalgamation might have all sorts of former mayors and prominent local business owners in their pocket as honourary members of their mess and can deploy them as necessary.

Two things I really don't understand about the situation being discussed:

1 - The ratio they give of fire stations to EMS halls is completely out of whack of what I would think it would be (and more than likely explains why the common perception is that a fire truck always gets there first.  I would think that people require EMS far more than fire fighting services, so as an outsider one could think that the ratio should be the other way and there should be 5-6 Ambulance ports for every fire hall.

2 - If they were co-located, why would one of each get sent to every call?

Historic affiliations aside, if they were merged/co-located, why wouldn't they just send the assets that are likely required?  If there was an ambulance parked at every fire hall, and one got a call for a kid found in a pool, what sense at all does it make to deploy an expensive fire truck to that location?

I'm now going back to read all of your links in more depth.

Added - From what I'm seeing, I am only seeing drama when there is talk about the two services being merged, but not so much of an argument being put up against the co-location idea.  I don't see what would be wrong logistically with putting them in the same buildings, and nobody would have to lose their identity but now you have one set of hydro bills to pay, etc.  The Reserves could do the same thing by parading in the same buildings, but in that case it results in troops having to drive farther instead of this case where in theory you could get the EMS pers closer to where they may be needed.


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## Scott (23 Jun 2010)

Just medics getting the shaft as per normal. 

MM, I am one firefighter who has *never* enjoyed the idea of integration.

For those that already serve in integrated departments, fine, have fun, I know several guys who do this and all are happy with it (even if they spend their time trying to get OFF the ambulance) But I see those trying to do so now just trying to bolster union numbers and cut budgets. Somewhere a level of service will be lowered, not heightened.

When the band-aids went on strike here years ago EHS asked the vollies to run the ambulances for them. In all cases but one (one where the ambulance was actually needed) EHS was told to pound sand into several orifices. Solidarity means something even across the services.

In Nova Scotia we co-respond with the medics mostly to provide muscle when it's a bigger patient or someone combative. We enjoy a wonderful relationship with them during calls, training sessions and public education events that I would never want to see compromised. I tease the medics all the time becase, for 20 bucks an hour, it hardly seems worth it to me. I know, I know, they love it, I just do not understand the lack of parity - and I likely never will.


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## larry Strong (23 Jun 2010)

Red Deer, Alta has been using Fire=medics for quite a few years with no problems

http://www.reddeer.ca/City+Government/City+Services+and+Departments/Emergency+Services/Become+a+FireMedic/Firemedic+Requirements.htm


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## mariomike (23 Jun 2010)

Petamocto said:
			
		

> My next question though is whether or not the Paramedics actually have anyone significantly powerful (other than Unions that a lot of people don't like) enough to do anything about it?



Major-General Richard Rohmer is Honourary Chief of Toronto EMS:
http://www.torontoems.ca/main-site/about/history-files/heraldic-grant.html

But, nobody with any political muscle. That's expensive. Certainly we have nothing to compete with FIREPAC - Canada ( Fire - Political Action Committee ):
http://www.iaff.org/canada/firepac/index.htm

Police, Fire and Paramedics in Toronto all belong to unions. Police and Fire call their's associations.
Paramedics belong to the "Outside Workers Union" ( Welders, Garbagemen, etc. ). We are no use to them as a strike weapon since the Essential Service Agreement ( ESA ) of 2001:
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_01a10_e.htm
Unlike Police and Fire, Paramedics are not considered an Essential Service. 
Ambulance ESA is what lead to the great garbage strike in Toronto last summer. 
But, from 1972-2002 ( ESA came in 2001 ) Metro Ambulance was their "Atomic Bomb". Garbage trucks used to pull over ambulances to remind us of that fact- not too sublety either. Said so in the papers. They used us to scare the public into giving in to their demands. We were just used as pawns by the union until the next contract negotiations. Metro was spared an outside workers strike for those three decades. Then, with ESA, came a small strike in 2002, followed by a big one in 2009.
In 1972, Local 43 ( Metro ) voted 97% to take ambulance out on strike with them. First time that ever happened ( as far as I know ) And they did too!. The bitterness from the public over that lasted for years. For almost 40 years now, we have been trying, without sucess, to be declared an Essential Service. Just like police and fire. 



			
				Petamocto said:
			
		

> 1 - The ratio they give of fire stations to EMS halls is completely out of whack of what I would think it would be (and more than likely explains why the common perception is that a fire truck always gets there first.


 
That was Roberta.  
There are about 80 firehouses and 40 ambulance stations in Toronto.
The ratio of Firefighters to Paramedics in Toronto is about 3100 : 850.

But, the point to remember is that it is very unlikely the ambulance will respond from station. Mobile Deployment is the method used in High-Performance EMS. That is, the ambulance will standby at "walk and don't walk" until sent, which usually is not long. It's all about Unit Hour Utilization UHU. Toronto, like many other cities, will likley have Central Book on Stations CBOS in the future. That means, instead of 40 ambulance stations, the city will have four CBOS. Best way to describe the idea is like terminals for bus drivers.
It is also known as System Status Management SSM. Mobile Deployment eliminates "Chute ( not shoot ) Time. Chute Time is the time taken for Paramedics to leave the ambulance station after being notified of a
call. Also referred to as "reaction time". ie: Just drop it into gear, and put the pedal on the metal.
I've seen some funny things happen at at 0400 with that!  ;D ( Don't park near water! )



			
				Petamocto said:
			
		

> I would think that people require EMS far more than fire fighting services, so as an outsider one could think that the ratio should be the other way and there should be 5-6 Ambulance ports for every fire hall.


   
:worms:



			
				Petamocto said:
			
		

> 2 - If they were co-located, why would one of each get sent to every call?



Duplication never used to happen. People have become used to it, but they used to ask us, "I called the Paramedics, why did they send a fire engine?"
Do the benefits of sending a fire apparatus in tandem with an ambulance outweigh increased risk a collision, or a "wake accident"? 
Also, as I said, the ambulance is not likely to be in station. Of course, the Emergency Medical Dispatchers EMDs know where they are at all times. 



			
				Petamocto said:
			
		

> I don't see what would be wrong logistically with putting them in the same buildings, and nobody would have to lose their identity but now you have one set of hydro bills to pay, etc.



There is no great need for ambulance stations, because, like I said, they are little more than places to park your PMV and a locker. Your office is the street.
Funny thing, they are better now, but if I were to tell you of the places that we called "ambulance stations" you would never believe me. Not in a million years. But, we had a lot of fun anyway. 

Toronto Fire and EMS share the same HQ at 4330 Dufferin St., as well as some station properties. But, in all cases ( administration, communication and operations, fleet Maintenance, planning and operational support, and materials management/logistics ) they are separated physically by brick walls. Same thing at the Academy. Both services operate independently.
For example, there are combined fire and EMS stations. The crews are literally segregated separated by brick walls. Each department has their own truck drivers who deliver necessities such as toilet paper and soap etc. 

"FDNY was also hoping that EMS (which has a large number of women and minorities) would solve FDNY's racial problem (The New York City Fire Department was about 94% white male at the time, and the Federal Government was looking into why it was that way.)":
http://www.fdnyemswebsite.com/


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## Braver.Stronger.Smarter. (23 Jun 2010)

Larry Strong said:
			
		

> Red Deer, Alta has been using Fire=medics for quite a few years with no problems
> 
> http://www.reddeer.ca/City+Government/City+Services+and+Departments/Emergency+Services/Become+a+FireMedic/Firemedic+Requirements.htm



A lot of rural services do that and it works for them because it gives them the combined manpower to get the job done. Not all firefighters and EMS personnel want to work in a rural area so it can be tougher to get people to work out there. In the larger metropolitan areas, it's just redundant. Yes, all fire has medically trained members, but why send a firefighter to do what a paramedic/EMT has to come and do anyways?

IMO, EMS doesn't get the funding that it needs to properly accomplish what it needs to do. I don't think that integrating Fire and EMS will make that better.


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## mariomike (23 Jun 2010)

Scott said:
			
		

> I tease the medics all the time becase, for 20 bucks an hour, it hardly seems worth it to me. I know, I know, they love it, I just do not understand the lack of parity - and I likely never will.



Hi Scott-
Paramedics do ok here. 
The Sunshine List shows one ( a Supervisor ) made $225,218.36 with Taxable Benefits of $723.84 last year.
http://www.fin.gov.on.ca/en/publications/salarydisclosure/2010/munic10b.html

( The rank structure is Paramedic > Supervisor > Manager > Deputy Chief > Chief )


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## Scott (24 Jun 2010)

Sure, I recall you posting that another time. But that would be a rather large exception rather than the rule, yeah?

And that is Toronto.

There is not much in the way of parity elsewhere...which makes an interesting argument for amalgamation of the services. A fire/medic is paid what a fire/medic is and that's just it.


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## readytogo (24 Jun 2010)

The EMS world is one that i used to be involved in and would love to be again one day, but here in Alberta (specifically in St. Albert which is just north west of Edmonton) EMS integration has been a way of life for quite some time. Granted it is a much smaller service than TO, if a call comes in that needs medics than they are dispatched, if a  call comes in that is fire or extracation based than fire is dispatched, and if they need both then off they go. When the scene changes(as they can often tend to do) than any EMT of MEdic can throw on a jacket and grab a hose or vice versa.  Moral of the story is that the people who do it here have no issues.  I believe it is a much harder topic to sell to larger services(Edmonton has been fighting it tooth and nail for some time as  i understand) if some one in edmonton EMS or fire feels im wrong please put me back in lane.  Like i said im no longer involved in the work but that was the prevailing attitude when i left!!

RTG

 :2c:


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## mariomike (24 Jun 2010)

readytogo said:
			
		

> I believe it is a much harder topic to sell to larger services(Edmonton has been fighting it tooth and nail for some time as  i understand) if some one in edmonton EMS or fire feels im wrong please put me back in lane.  Like i said im no longer involved in the work but that was the prevailing attitude when i left!!



"Both Calgary and Edmonton amalgamated their EMS and Fire Services and ended up going back to separate services because it did not benefit their citizens, no more lives were saved and the move resulted in a much higher cost to the tax payers.":
http://www.newswire.ca/en/releases/archive/June2010/23/c7785.html

"It took Winnipeg a decade of bitter fighting with both unions to integrate the departments.":
http://www.theglobeandmail.com/news/national/toronto/smitherman-would-blend-paramedic-firefighting-services/article1614098/

If the government is sincere about helping the people of Toronto, they will make their Paramedics an Essential Service.  When Mr. Smitherman was Minister of Health, I don't recall him saying anything on that subject.



			
				Scott said:
			
		

> Sure, I recall you posting that another time. But that would be a rather large exception rather than the rule, yeah?
> 
> And that is Toronto.
> 
> There is not much in the way of parity elsewhere...which makes an interesting argument for amalgamation of the services. A fire/medic is paid what a fire/medic is and that's just it.



He put in an exceptional amout of overtime to achieve that. He does most every year. But, it goes to show what you can achieve if you are willing to work the overtime. And, voluntary O.T. is not offerred by seniority. Overtme is one of the few things on the job not affected by seniority. So, even if you have only been on the job since coffee-break, O.T. is divided equitably between yourself and the most senior Paramedics. In fact, the senior people are most likely to refuse O.T. because we got old and tired.

"Fire-medics": 
I have read of "Fire-medics" on here, but I have never heard it mentioned in Toronto, except in jest. It has an exciting ring to it but, but...
You can train train 800 Paramedics as Firefighters. It only takes 12 to 16 weeks.
"Training tends to vary between approximately 12 and 16 weeks":
http://www.toronto.ca/fire/recruitment/faq.htm#a12

It would probably take less time because they could skip the first-aid, and already being City employees, could skip all the Corporate Policy lectures, administrative processing etc.

There is also the Class-F licence. It doesn't sould like a big thing, and usually is not, but I have heard of a lot of hassles involving getting, and keeping, that particular class of licence than any other. 

But, why put an ambulance out of service to upstaff a fire truck?
Training 3100 Firefighters as Paramedics would be different. It's a two-year full-time program at the college level. How many would have the education required for entrance? 
Also, their union fought for an won 24-hour tours. That's fine for Firefighters, but, as a matter of public safety, would be impossible for Paramedics.

P.S.
I should like to add for the benefit of younger readers that the "Mel" I referred to was, of course, none other than our first Megamesscity Mayor Mel Lastman, ( please see attached pic ) It was too late to add his last name to the post.


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## Sheerin (24 Jun 2010)

If the IAFF and the Fire Union are for it then you know it's a bad idea.  These bodies have done an exceptional job of making the public believe that firefighters are absolutely necessary and that in order to be safe you need to have a fire station, filled with firefighters on every block.  The whole reason why fire wants this is becuase their call numbers are falling, dramatically.  And they know that numbers look good to municipal politicians who sign their cheques.  They've done a brilliant job of this, and have been doing so for years.  Just go into any children's clothing store and I guarantee that you'll find at least one piece of clothing that looks like  stylized bunker gear with the words "Mommy's little hero" written on it.  

Does having fire attend calls actually make a difference?  In the majority of calls, no.  They have no medical training, they don't know how to do proper assessments and they don't know how to treat the patient.  And this is not a slag against them.  They're firefighters, not paramedics, they should be expected to do my job, just like I shouldn't be expected to grab a hose and run in a burning building.  

The fire-medic model is quite possibly one of the dumbest models ever proposed for emergency medical care.  All it does is stop a clock, Paramedic Response Units (single medic SUVs/fly cars) do that just as well and for significantly less, and I dislike PRUs, particularly when i'm working it. 

Here's a brilliant idea, how about  increasing the funding of EMS so services can hire the right number of medics and have enough trucks on the road so there isn't a 12 minute response time.   You can take the money from fire... Unfortunately this won't happen becuase you have morons who are at the top who've chugged the kool-aid that the IAFF has offered. 

Smitherman, you sir are a total moron. 

   
edited to fix a couple grammatical errors and typos (ie: should have proof read)


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## Scott (24 Jun 2010)

Sheerin said:
			
		

> If the IAFF and the Fire Union are for it then you know it's a bad idea.  These bodies have done an exceptional job of making the public believe that firefighters are absolutely necessary and that in order to be safe you need to have a fire station, filled with firefighters on every block.  *The whole reason why fire wants this is becuase their call numbers are falling, dramatically.  And they know that numbers look good to municipal politicians who sign their cheques. * They've done a brilliant job of this, and have been doing so for years.  Just go into any children's clothing store and I guarantee that you'll find at least one piece of clothing that looks like  stylized bunker gear with the words "Mommy's little hero" written on it.



This started happening years ago. Agreed, by the way.



> Does having fire attend calls actually make a difference?  In the majority of calls, it's not in the least.  They have no medical training, they don't know how to do proper assessments and they don't know how to treat the patient.  And this is not a slag against them.  They're firefighters, not paramedics, they should be expected to do my job, just like I shouldn't be expected to grab a hose and run in a burning building.



Care to fill us in on what/where you are basing this broad statement on? Because where I come from the opposite is true. Fire attends, normally beats EMS, and provides care that they are trained to and are mandated to provide, by EMS, in a tiered system. I am not trying to start a bunfight here but you've made a pretty brash statement that I feel is not 100% true. Perhaps in major centers but we all do not live in the center of the universe.



> The fire-medic model is quite possibly one of the dumbest models ever proposed for emergency medical care.  All it does is stop a clock, Paramedic Response Units (single medic SUVs/fly cars) do that just as well and for significantly less, and I dislike PRUs, particularly when i'm working it.



As mentioned before, there are places where it does work well. Now, as I have stated, my buddies who are EMT/Firefighters, do their elvel best to get out of any shift on the waaaambulance to stay on the engine but that's neither here nor there. Perhaps the difference is that I am speaking about places with rather large tax bases.



> Here's a brilliant idea, how increasing the funding of EMS so services can hire the right number of medics and have enough trucks on the road so there isn't a 12 minute response time.   You can take the money from fire... Unfortunately this won't happen becuase you'll have morons who are at the top who've chugged the kool-aid that the IAFF has offered.



Agreed on both

And this is a fireman saying it.

Edited to add: anyone else being driven completely batty by the buggered up post box? Mike has been chasing it but I still get it and it almost drives me to fits when it starts


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## Sheerin (24 Jun 2010)

> Care to fill us in on what/where you are basing this broad statement on? Because where I come from the opposite is true. Fire attends, normally beats EMS, and provides care that they are trained to and are mandated to provide, by EMS, in a tiered system. I am not trying to start a bunfight here but you've made a pretty brash statement that I feel is not 100% true. Perhaps in major centers but we all do not live in the center of the universe.



I'm a PCP with a large urban service in Southern Ontario (not Toronto EMS). Where I work fire is tiered on all SOB, unconscious/ decrease consciousness, chest pain, major trauma, VSA, and any other call the dispatchers at CACC think fire might be useful.  They typically beat us to calls as they have many bases and a (significantly) lower call volume.  
They do not have medical training, rather what they have is advanced fire aid training.  There is a significant difference, at least from my perspective.  When they arrive before us they typically do a good job, but they are significantly limited in what they can do, particualrly when they're there without EMS.  There's also different crews that do different jobs.  Some fire guys are great, they'll have gotten the patients medications, and OHIP card and get a basic history.  Others aren't so great.
I've done major trauma's where it was nice having a few extra pairs of hands available so I could focus on other things.  So please don't take my comments as me trying to disparage fire.  
Overall I'd say my interactions with fire have been positive, but that doesn't change the fact that their presence on medical calls is usually unnecessary.  



> As mentioned before, there are places where it does work well. Now, as I have stated, my buddies who are EMT/Firefighters, do their elvel best to get out of any shift on the waaaambulance to stay on the engine but that's neither here nor there. Perhaps the difference is that I am speaking about places with rather large tax bases.



I would suggest that it doesn't work well if the firefighters view being put on the ambulance as being less desirable than being on an engine.  I would imagine the efforts they go to to get off the ambulance surpass the efforts put into patient care and staying current on the science of paramedicine.


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## mariomike (24 Jun 2010)

Sheerin said:
			
		

> Unfortunately this won't happen becuase you'll have morons who are at the top who've chugged the kool-aid that the IAFF has offered.



The Kool-Aid is sweet, Sheerin.
The International Association of Firefighters IAFF is number 10 on Washington's Top 20 PAC Contributors to Candidates, 2009-2010:
http://www.opensecrets.org/pacs/toppacs.php
http://www.opensecrets.org/pacs/lookup2.php?strID=C00029447

"What is a PAC?":
http://www.opensecrets.org/pacs/pacfaq.php

( For discussion of IAFF FIRE-PAC Canada, please see Reply #9 )


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## Scott (24 Jun 2010)

Sheerin said:
			
		

> I'm a PCP with a large urban service in Southern Ontario (not Toronto EMS). Where I work fire is tiered on all SOB, unconscious/ decrease consciousness, chest pain, major trauma, VSA, and any other call the dispatchers at CACC think fire might be useful.  They typically beat us to calls as they have many bases and a (significantly) lower call volume.
> They do not have medical training, rather what they have is advanced fire aid training.  There is a significant difference, at least from my perspective.  When they arrive before us they typically do a good job, but they are significantly limited in what they can do, particualrly when they're there without EMS.  There's also different crews that do different jobs.  Some fire guys are great, they'll have gotten the patients medications, and OHIP card and get a basic history.  Others aren't so great.
> I've done major trauma's where it was nice having a few extra pairs of hands available so I could focus on other things.  So please don't take my comments as me trying to disparage fire.
> Overall I'd say my interactions with fire have been positive, but that doesn't change the fact that their presence on medical calls is usually unnecessary.



I have folks who'd disagree but the demographics we're speaking about are like comparing apples to bowling balls and I'll concede that you know what you're speaking of for your geographic area.



> I would suggest that it doesn't work well if the firefighters view being put on the ambulance as being less desirable than being on an engine.  I would imagine the efforts they go to to get off the ambulance surpass the efforts put into patient care and staying current on the science of paramedicine.



I think that is a little unfair. My buddies moan about the "blood box" because it's busier than the engines. Being that they are professional and dedicated I do not think it takes away from their level of service.


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## Sheerin (24 Jun 2010)

> I have folks who'd disagree but the demographics we're speaking about are like comparing apples to bowling balls and I'll concede that you know what you're speaking of for your geographic area.


What specifically would they disagree with?  I'm just curious to find out how different regions operate.



> I think that is a little unfair. My buddies moan about the "blood box" because it's busier than the engines. Being that they are professional and dedicated I do not think it takes away from their level of service.



I imagine your friends joined the fire department to be firefighters, not paramedics.  I would imagine that they do not have a vested interested in paramedicine and as such only spend the absolutely minimum amount of time maintaining skills, and have zero interest in expanding their role as paramedics.  

Also the quality of care you receive from someone who isn't 100% interested in being there is less than from the person who wants to be a paramedic.  Same is true for paramedics who want out by aren't able to pull away from a 80k+/year  job.


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## Scott (24 Jun 2010)

EHSNS has invested heavily in the MFR program here which should be a strong indicator of what they believe. ALL first responders are trained to their standard and the program is now quite intense (I do not participate save to drive them there) Equipment is supplied by them on a rolling basis as are the ongoing modules one must attend to keep their certification.

It's not the same everywhere, I know, and in larger centers it's harder to run and maintain. But we have a good thing going here that EHS and the medics seem happy with as well as the firefighters - to a point that we now have "first responder only" members in the vollie halls.

About my buddies running dual: they all attended Vernillion's program so they are all EMT/Firefighter's out of school. Their vested interest is in their employment contract  and there's no getting cheeky about it - you might love what you do but you also have to pay the bills.

I look at it this way: I will never begrudge anyone in this line of work one single frigging penny provided that they go out of their way to earn it and also make the community a better place (part of which IS covered merely by showing up to work) In ways we are all on the same team - I say that with no union behind me.

Cheers


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## SeanNewman (24 Jun 2010)

Sheerin said:
			
		

> ...I imagine your friends joined the fire department to be firefighters, not paramedics...



I don't think the answer is that simple.  Saying a person only wants to fight fires is like saying a soldier joined because they want to kill people.

I think there is a lot of overlap, actually.  If you think about the end and not the means, both EMS and Firefighters are there to serve, protect, and help citizens.

My best man was a firefighter so this is a bit anecdotal and not a scientific survey, but when we talk about these sorts of things it's all about getting as many qualifications as you can in order to help save people.

A soldier doesn't only focus on killing and a firefighter doesn't only focus on fighting fires.  Both of them can benefit greatly from any sort of life-saving training, and I don't think it's stepping on a Paramedic's toes for the others to study casualty care because they can still be the experts.

So to get back to the core of what I quoted of your post, I think people join any career for a lot of reasons and there are many factors, but a firefighter who would refuse EMS-type training would be pretty stupid and I don't think many would say "I don't need that training, my job is only to fight fires".


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## SeanNewman (24 Jun 2010)

Oh for sure, don't get me wrong of course their _*primary*_ job is still to fight fires, but that's just the means.  The end is still saving people, regardless of how it's done.  

While of course nobody can state why every single person joins that career, I don't think the only single answer would be "Because I hate fires and I want to extinguish every goddam one of'em" (which is how I took the post I quoted).

First Aid (and more advanced life-saving skills) are a benefit to everyone, be they soldiers, firefighters, police, lifeguards, etc.


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## Sheerin (24 Jun 2010)

Petamocto said:
			
		

> I don't think the answer is that simple.  Saying a person only wants to fight fires is like saying a soldier joined because they want to kill people.
> 
> I think there is a lot of overlap, actually.  If you think about the end and not the means, both EMS and Firefighters are there to serve, protect, and help citizens.
> 
> ...



In a perfect world that wouldn't happen, but you would find that once EMS was totally integrated in with fire, you'll have people trying to use paramedicine as a backdoor to firefighting.  Just look to the US where the fire/medic model is used extensively.  
Yes we're here to serve the population, but we're not interchangeable.  As a paramedic, my job differs dramatically from a cop which differs dramatically from a firefighter.  There is some overlap, but its only on the very superficial level.  

Fire will always have a place, assisting on medical calls.  They're the ones who know how to take a car apart after a bad MVC, they're the ones who know how do angle access, etc.  And on VSA's it's always nice to have an extra set of hands on scene.  If it were up to me, we wouldn't need fire to attend most calls as EMS would have a response time that is comparable to fire.  But that's not going to happen as politicians have been told that a fire company on a medical call is almost as good as having a paramedic.


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## SeanNewman (24 Jun 2010)

Very good points, especially the one about the firefighters having the access kit.

Sorry if I worded my post in a way that made it seem like I was saying they were interchangeable; I certainly know they are not.


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## mariomike (24 Jun 2010)

Dr. Martin McNamara is an Ontario ER physician. He wrote a thesis on this topic:
"Conclusion: There is little evidence for current fire staffing levels in certain cities such as Toronto, and excess money would be better chanelled into improving EMS services."

The most authoritative study on the problems with Fire-Based EMS, "The McNamara Report":
http://nycemsauthority.com/?q=node/8
http://nycemsauthority.mayfirst.org/files/McNamara1.pdf
http://nycemsauthority.mayfirst.org/files/McNamara2.pdf
http://nycemsauthority.mayfirst.org/files/McNamara3.pdf
http://nycemsauthority.mayfirst.org/files/McNamara4.pdf
http://nycemsauthority.mayfirst.org/files/McNamara5.pdf
http://nycemsauthority.mayfirst.org/files/McNamara6.pdf
http://nycemsauthority.mayfirst.org/files/McNamara7.pdf
http://nycemsauthority.mayfirst.org/files/McNamara8.pdf

"Dr. McNamara was employed as a paramedic in Orillia and Midland from 1977 to 1992 and completed a Bachelors in Anthropology/Geography in 1992. He finished McMaster Medical School in 1995 and Residency in Family Medicine and Emergency Medicine in 1998.
He is qualified CCFP/EM, working at RVH ER from 1998-2000 and Huronia District Hospital, 1998 to present. His posts include Medical Director of the Community Paramedic Program on Christian Island, Medical Director of the Humber College Paramedic program and Chief of ER at HDH from 2000 to 2003. Has has been President of Medical Staff HDH, 2006 to present.":
http://www.socpc.ca/pdf/Patch%20Drs%20Oct%2009.pdf

Ottawa Sun:
"Rushing to the Rescue: examines the tensions between medics and firefighters"
http://www.ottawaparamedics.ca/news.asp?id=230


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## Sheerin (25 Jun 2010)

Sent this to Smitherman, not that I expect a response lol



> Mr. Smitherman,
> 
> I would like to comment on your recent proposal of merging Toronto EMS and Toronto Fire.  Right off the bat I'd like to tell you that this is an absolutely atrocious idea.  The only way it will work is if you force it, and I can guarantee you that the level of prehospital emergency medical care would drop dramatically in this city.
> You accurately pointed out that Toronto fire has, on average, a significantly shorter response time for calls than Toronto EMS does.  If you looked more closely at the numbers, you would see that the reason why they are able to do this is that their annual call volume is SIGNIFICANTLY less than Toronto EMS, they also have significantly more stations than T-EMS.  The idea shouldn't be, 'hey, TFS is able to do calls, lets use them', it should be 'why are we funding a service to the point where they can literally sit around and do nothing, while earning a large amount of money?'
> ...


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## mariomike (25 Jun 2010)

December 11, 2009:
"Scott Marks, *president of the Toronto Professional Fire Fighters’ Association*, and Damien Walsh, the group’s executive officer, also* paid to attend*. “It was a great speech,” said Mr. Marks. “*His best asset is that he’s coming from outside council*.”:
http://network.nationalpost.com/np/blogs/toronto/archive/2009/12/11/board-of-trade-gives-george-smitherman-an-ovation.aspx
http://twitter.com/TorontoFIREPAC/status/16863465524

Toronto Budget ( 2008 ):
Fire Services: $234.58
EMS:                 $41.72 
http://www.toronto.ca/toronto-budget/your-property-taxes.html

"Be wary of Fire Departments who tell your ambulance service and your citizens that they will help streamline your EMS system. These Fire Departments who want to come riding to the rescue of your EMS service should be viewed with the utmost suspicion. Before we were taken over by FDNY we had some members of EMS who viewed FDNY riding to our "rescue" as a white night on a horse. However those of us who were smart realized the Grim Reaper also rode a horse. It turns out FDNY was the Grim Reaper and the "merger" was our Waterloo. FDNY EMS died on March 17, 1996.
If you do not listen to our story and heed our words you may suffer our fate.
Former Mayor Giuliani decided that he could use EMS as a money maker in order to save Firefighter jobs. FDNY was also hoping that EMS (which has a large number of women and minorities) would solve FDNY's racial problem (The New York City Fire Department was about 94% white male at the time, and the Federal Government was looking into why it was that way.) One other factor that led to the takeover was a FDNY productivity issue (Too much down time for the Firefighters)."

"Our next frontier is Canada."
IAFF General President Harold A. Schaitberger 

"EMS Anthem":
http://www.youtube.com/watch?v=gi4Imbhr5uc

"History of Modern EMS":
http://www.youtube.com/watch?v=AqD_w4gFa0E


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## SeanNewman (25 Jun 2010)

MarioMike,

You are the most prolific researcher I have ever seen, so kudos to you.

If I ever run for office, can I please hire you on my staff to dig up the goods on my competitors?


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## mariomike (29 Jun 2010)

Posted with permission of Dr. MacNamara.

June 26, 2010
Dr. Martin McNamara,

Dear Mr. Smitherman;

I was somewhat surprised as I read your recent comments with regards to a “Fire/ems” model of prehospital care.  I must say that, in your previous role as Minister of Health, you won my respect.   I admired the manner in which you arrived at difficult decisions using evidence and facts from a variety of sources.  To read that you have based this service altering decision on an opinion piece developed by a special interest group such as the IAFC ( International Association of Fire Chiefs ), without input from all participants, was disheartening, to say the least.

I would respectfully offer the following facts for you to consider:. 

The EMS average response time to high priority calls is 7 minutes and 32 seconds, not 12 minutes as you stated.  More than half of all cardiac arrest have the EMS team apply their defibrillator first, before other first responders. In 50% of high priority calls, EMS arrives before or at the same time as Fire.  5.6% of all cardiac arrests in Toronto survive to discharge not 2.5% as you were quoted.  

In 26.7% of arrests in Toronto, the paramedics are able to restore a heartbeat before arrival at the hospital.

One of the difficulties in determining response times is that various agencies record  their times in a variety of ways, making comparisons difficult.  Fire starts the clock when the pumper leaves the station; EMS starts the clock when the call is received. 

If you are truly concerned with improving outcomes, there are other avenues.  In some European countries, ALL licensed drivers are legislated to be current in CPR, effectively making their entire population First Responders, not being wholly dependent on allied agencies such as Fire and Police.

If the purpose of the exercise is truly to get an Advanced Care Paramedic to the patient in a minimum of time, there are much faster and safer methods than on the back of a pumper with four Fire fighters.

Less than 5% of emergency calls require Advanced Life Support.  The most effective method of providing this service is to place the ALS medics in rapid, small, first response vehicles.  Some jurisdictions use motorcycles, others, small, agile cars. In this manner, an ALS medic can arrive within the shortest time frame and begin care while assessing the scene and determining the type of support needed.  

Research has shown that brain death occurs in 4-6 minutes.  We know that we must get a responder to the scene within this time frame to be effective.  We also know that the fire department strives for a 4 minute response time and have their halls conveniently placed appropriate distances to achieve this.  The question is why? Insurance actuaries have calculated that a 4 minute response time is as effective as a 7 minute response time and does not result in more property loss. This is reflected in the premiums calculated for both homes and businesses.   Accordingly, one can conservatively estimate that 1/3 of fire halls could be decommissioned with no resultant loss of property.  Imagine the savings here.                         

Consider further, if you will, the fact that Fire Departments run at a staff to:management ratio of 4:1 whereas EMS averages 9:1. Which system is more cost effective?

Consider that Fire deployment is based on a static model simply because businesses and property don’t move.  EMS is based on a dynamic model, vehicles and staff moving hourly with the population they serve as commuters flow into and out of the city.  

Consider that Fire has effectively bargained that each fire truck MUST have four Fire fighters around the clock, regardless of call volume.  EMS upstaffs for peak hours and downstaffs during slower times, again presenting a savings to the tax payer.   
Fire fighters in Toronto are allowed to work 7 twenty four hour shifts per 28 days, with a built in 8 hour “rest” period and get the rest of the month off. 

I have attempted to highlight for you some of the more obvious problems with a U.S. styled, Fire/EMS system.  An entire tome could be written describing the differences between the two cultures, the differences in training, education, liasing with Base Hospitals, differences in their respective approaches to patient confidentiality, approaches to treatment of patients, medical directives, continuing medical education, etc.  

I would be pleased to meet with you and discuss some of these at your convenience.

Once again, know that I have long admired your approach to medical problems in your previous role as Minister of Health and certainly appreciate the fine work you completed in that role.  I find these latest comments poorly researched and certainly out of character for you.  I must express my disappointment in your presentation.

Respectfully,

Dr. Martin McNamara.  CCFP/EM


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## mariomike (30 Jun 2010)

June 30, 2010:
"Toronto Fire is taking too long to answer calls, process the information and dispatch firefighters. Details on how slow they are have been blacked out in the report."
"The Star, which exposed tardy response time to some blazes last year, obtained the $150,000 report under municipal freedom of information legislation. Key portions are blacked out – 53 of 157 pages and numerous other pages are censored.":
http://www.thestar.com/news/gta/article/830351--secret-report-reveals-fire-response-problems?bn=1

June 6, 2009:
"When the Sunrise Propane explosion rocked the city last summer, it was more than nine minutes before the first Toronto Fire Services pumper truck made it to the blast site, just over two kilometres from the station house.":
http://www.thestar.com/news/gta/article/646628

One more reason, in my opinion, why mayoral wannabes and Toronto Fire should keep their hands off T-EMS.


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## Sheerin (30 Jun 2010)

Go figure that their response times aren't as rosy as they'd like us to believe.


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## mariomike (30 Jun 2010)

Sheerin said:
			
		

> Go figure that their response times aren't as rosy as they'd like us to believe.



Response Time must be recorded from the time a 9-1-1 line starts ringing at 4330 Dufferin, to when the patient receives the shock delivered by the difibrillator. 
Even if Paramedics have to get to the 20th floor of a highrise, the clock does not stop recording.
That is how T-EMS measures Response Time.  

I never really enjoyed being parked at Spadina and Bloor, Union Station etc at 0400. We seldom saw a station, except to book-on/off. They issued us coolers for mobile lunches. Forget about beds. 
That is not meant as a complaint. I knew that when I hired on.
We understood why it had to be done. Operational neccessity. Same way as the police. Call comes over the radio, toss your cigarette out the window, throw the stick into Drive, turn on the lights ( we tried to keep the siren to a minimum ), and hit the gas/diesel pedal.  ( That could be funny if you, or the guy you were with, was half-asleep behind the wheel.   )

It was the only way to keep Response Time respectable. Ambulances were always staffed to an absolute minimum. Car counts were dynamic and determined by the hour. ie: after 2300 Hrs, they dropped considerably. ( Fewer calls. Less traffic. = less Paramedics ) At 0200, the count took another big drop. 

We also understood that slowly driving around our standby area, and keeping an eye on the streets at night between calls gave the public some degree of confidence. To be able to walk their streets safely at night. They could see we were out there to help them, and radio the police, if necessary. This was especially important before 9-1-1 and cell phones came along.

I have followed the TFS website on "Active Incidents" for a long time. It is updated every five minutes. Never, ever been shut down. Last time I checked was during the recent earthquake. Obviously, it triggered a lot of automatic alarms. 
Today - for the first tiime ever - it gives this message:

"Active Incidents:
The following active incidents are dispatched from Toronto Fire Services Communication Centre. The contents are updated at five minute intervals from the CAD (Computer Aided Dispatch) system. 
Sorry! The active incidents list is not available right now. Please try again later."
http://www.toronto.ca/fire/cadinfo/livecad.htm


"Fire services report still a mystery to councillors. Why the slow response times? Politicians want to know what a consultant learned: City councillors say it’s time they saw a $150,000 report that found the Toronto fire service is behind the times technologically and responds too slowly to emergency calls.":
http://www.thestar.com/news/gta/article/830695--fire-services-report-still-a-mystery-to-councillors


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## mariomike (13 Oct 2010)

Update
Sun
October 12, 2010

"Jim Brennan, a long-time Winnipeg paramedic, witnessed the devastation first-hand when that city’s politicians directed its EMS and fire departments to amalgamate in 1998."

http://www.torontosun.com/news/torontoandgta/2010/10/11/15655576.html

"The fire department also took over EMS in New York City, but paramedics were left disgruntled as the traditions of their service virtually disappeared and they were left feeling like outsiders.
“From what I understand, there was almost blood in the streets,” Alex Pierson, president of the Toronto Paramedic Association, said of New York’s experience.
Things were eventually smoothed over when paramedics were allowed more of a say in their day-to-day operations.
Pierson said if the city wants to improve response times, it should open more EMS stations, buy more ambulances and hire more paramedics."


( Interesting comments. )


"Waiting For Definitive Care: Smitherman, in his bid for Mayor of Toronto has publicly stated that he wants to combine fire and EMS services.  Smtherman mistakenly thinks this will improve the level of patient care.":
http://ontariomedic.ca/2010/10/03/waiting-for-definitive-care/

"Any municipality that attempts to try this constantly touts “Look to Winnipeg” as they have a combined fire/EMS service. 
Well lets look to Winnipeg.  Winnipeg spends 3 times as much as neighbouring municipalities for their EMS service and has the poorest times in getting patients to the hospital.":
http://www.winnipegfreepress.com/opinion/editorials/paramedic-apples-and-oranges-103509039.html

9/21/2010 
"Smitherman Wants EMS and Fire to Work Together, Not Merge":
http://www.newstalk1010.com/News/localnews/blogentry.aspx?BlogEntryID=10142033

Far-sighted ambulancemen saw this mess coming years ago. 

At this point, Pantalone, Ford, Rossi are all both opposed to the idea and Smitherman has since toned down his position.
Apparently, the Paramedics asked that the next mayor and council to reduce FF first response by 80% and apply the savings to the EMS budget so that we can put more ambulances and paramedics on the road.


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