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Fourth Emergency Service
- Thread starter mariomike
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I suspect there is a very detailed set of guidelines to be used by the 911 call taker, and a whole of guidelines for the responders to follow if call is not as reported or goes south.
From what I have read (which isn't much), they would have no authority to transport to a medical facility nor any particular authority to take a person to a MH facility for an involuntary assessment.
Overall, I think there are all sorts of calls where somebody is simply having a very bad day that hasn't escalated beyond perhaps a non-assaultive disturbance.
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As a user of streets and other public spaces the question I would be asking is which service is going to be most efficient at containing the disruption and getting the miscreant into the back of a vehicle.
Will the TCCS talk the individual into custody?
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I doubt TCCS has a Staging / Delay Service SOP / Guideline.
T-EMS defined Staging as, "the decision making process to withhold patient care".
The Staging / Delay Service SOP was pretty simple,
wait for police assistance if,
a. there is an active shooter scenario, or
b. there is direct evidence of ongoing violence;
The City of Toronto could have assigned a social worker to a Paramedic crew, as they do at FDNY-EMS.
That way TCCS would be operating under the T-EMS SOP.
But then, the average time on scene for the Paramedics would increase from 24 minutes to 53 minutes.
It would also come with a pay raise for Paramedics.
America’s largest city pays their Paramedics a 6% differential on their base pay, including OT and pension on their B-HEARD program.
So, Canada's largest city would also have to ante up.
The so called Fourth Emergency Service is likely the most cost effective option for city taxpayers
In most cases of someone with mental health issues, using legal authorities to force them into the back of a vehicle isn’t going to be the best bet. Normally with a bit of patience they can be talked down. For every one wild scene you might see or here or there are many dozens of lesser ones that you never notice.
If someone is disordered or disruptive to the point where there really isn’t another good option, fine- and that’ll probably be police. But now you’re taking a couple cops or an ambulance off the road from a few hours and unavailable for other calls. That needs to be balanced.
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I concede that if a miscreant is effectively verbally engaged then the situation is contained and the public disruption is minimized if not nullified.
I suspect, though, that TCCS will require police escort, that the police will still be the first responder, that they will still be the last to leave the scene and that the TCCS, like paramedics and firemen, will still limit their operations to "secured" scenes.
I don't see the copper's burden being reduced.
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Most of the talking was done by the Call Originator. Seldom the "miscreant ".
Like, "Just go with these guys and get checked out. It's free!" ( Its not. )
The best hook was usually the promise of a clean, warm bed, a shower,and hot food. Maybe some soothing medication to take the edge off.
The nurses hated you for bringing them in. Fortunately for us, we had a choice of hospitals to deliver them to.
If it was a long haul, easier to hold a steering wheel , than breaking your back with another LIFT.
"As long as they walk", was the way we looked at it.
According to The City of Toronto, from March 31, 2022 to April 30, 2023,
If TCCS is allowed to spend an average of 53 minute On Scene, I expect the City's PR machine will generate those heart-warming "do gooder" stories the public loves.
Time On Scene was a luxury we could not afford. Unit Hour Utilization.
I think it will. This will reduce cops on scene and clear them earlier.
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We've had two plus decades of care in the community being handled by police, and EMS whose focus is physical injury.
It should not be a surprise that using mental health professionals to deal with mental health issues works.
In army terms it's like using a cougar as a tank. Or actually a tank as a HLVW.
Medicine Hat has a PACT organisation where mental health professionals are available to go with police.
We have a small downtown area where the usual suspects have incidents/breakdowns so between police foot patrols, OD/needle cleanup response foot patrols, and PACT things are dealt with fairly efficiently.
Locals still think that downtown is dangerous despite there being no assaults outside of drunk bar fights and between people who know each other. One random attack in the last 10 years or so. But someone yelling at a window is dangerous I guess.
There is petty theft if you leave your car open and bikes out on the front lawn. There was petty theft like that in Ottawa's shishi Rockcliffe neighborhood in the 80s.
There were no good old days. There were only old days where problems were ignored or locked up instead of being dealt with.
It should not be a surprise that using mental health professionals to deal with mental health issues works.
In army terms it's like using a cougar as a tank. Or actually a tank as a HLVW.
Medicine Hat has a PACT organisation where mental health professionals are available to go with police.
We have a small downtown area where the usual suspects have incidents/breakdowns so between police foot patrols, OD/needle cleanup response foot patrols, and PACT things are dealt with fairly efficiently.
Locals still think that downtown is dangerous despite there being no assaults outside of drunk bar fights and between people who know each other. One random attack in the last 10 years or so. But someone yelling at a window is dangerous I guess.
There is petty theft if you leave your car open and bikes out on the front lawn. There was petty theft like that in Ottawa's shishi Rockcliffe neighborhood in the 80s.
There were no good old days. There were only old days where problems were ignored or locked up instead of being dealt with.
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Not to suggest Medicine Hat PACT ( Police and Crisis Team ) is any better, or worse, than TCCS. Just different.
Similar to B-HEARD in America’s largest city. Only difference being mental health professionals go with Paramedics.
Again, not to suggest one method is better, or worse, than another. Opinions may vary.
Just three different ways of doing things.
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I don't really care about Toronto, New York, or Toronto.
I was just pointing that municipalities are realizing that police and EMS are not mental health responders.
It is all the same thing. Mental health professionals get out of the office and off the ward and respond to the site of the crisis.
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Never really got used to them.
The good news is, they send professionals now.
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Like CAF units sending 'Sentinels' with their 4 or 7 hours training to deal with MH and suicidal soldiers.
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The end goal is to deescalate and resolve a situation, not putting someone in the back of a vehicle. Trained MH workers have a better tool kit than most coppers, firefighters or paramedics to do that. What they don't have is the authority to place somebody in custody beyond exiting civilian powers (which, if exercised, have to be turned over to the police).
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I don't think TCCS talks "miscreants" "into the back of a vehicle".
But, if there is a possible medical problem, TCCS will call paramedics.
We tried to talk them into the back of our vehicle, if that is what the Call Originator wanted. All in the name of customer service.
Call Originators interested in "getting the miscreant into the back of a vehicle." might have more success if they indicate a possible medical problem when they call 9-11.
TCCS, on the other hand, "will talk with you to understand what supports you need."
Nothing about talking anyone into the back of a vehicle,
Supports & Services
- Crisis intervention: Counselling and de-escalation for you and those around you.
- Case Management: Working with you to achieve your goals and improve the quality of your life.
- System Navigation & Referrals: Supporting you to access other social service programs including food, shelter, health care and employment.
- Harm reduction: Providing substance use support, supplies, and counselling.
- Essential Living Supplies: Providing food, clothing, and hygiene supplies.
- Traditional Indigenous Supports: Supporting those who identify as Indigenous wholistically, with access to Elders, ceremony, medicines, and culture.
- Afrocentric Supports: Supporting those who identify as Black through culturally meaningful approaches grounded in the lived experiences of Black communities.
daftandbarmy
Army.ca Fossil
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I must admit I agree in principle with this concept but, in practice, it feels like 'malpractice' and more of a threat to each party than a help for both...
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In the news yesterday,
Data from America’s largest city shows 43% of involuntary removals failed to meet the requirements for admission .
"( NYC ) Mayor Adams’ plan has clearly resulted in far too many people being transported to hospitals even when they do not meet the criteria for removal."
We could attempt to talk the individual into voluntary removal , if that is what the customer wanted.
As for involuntary removals, the standard doctors used for a psychiatric hold was often higher than the Call Originator.
Hospitals did not admit patients removed for a determination of untreated psychosis , as it often turned out to be a drug-induced state that wore off as the individual sobered up.
