Council eyeing 'firemedic' option

Link to article: Council eyeing 'firemedic' option
Sudbury Star

Council will consider this week a provincial pilot project to introduce firemedics into the city’s emergency response landscape.

“The province’s plan involves combining the skills and experiences of a firefighter and that of a paramedic into a single role known as a firemedic,” a staff report notes. “In June 2017, the Ontario government announced that the province will ‘provide funding for two pilots in interested municipalities that will enable firefighters certified as paramedics to respond to low acuity calls to treat and release or treat and refer a patient, and provide symptom relief to high acuity calls’.”

But staff is recommending council turn down the project.

“The City of Greater Sudbury did not request changes to the current service delivery model. It has a paramedic service that meets or exceeds council-approved response time standards and is among the top performers in the province,” the report states. “Fire services has a variety of opportunities for change within its current service portfolio that could strengthen its performance. Considering the different legislative and labour relations agreements in the fire and ambulance sectors, it is reasonable the proposed pilot will lead to labour disputes and litigation. There is no objective data to demonstrate this proposed service model will improve patient outcome or response times.”

The province is intending to launch the pilot project in two municipalities in Ontario, for a period of anywhere from six months to two years. They intend to announce which cities will host before the June election. 

Currently in Sudbury, paramedics and firefighters have similar response times.

“When fire services responds to medical tiered calls, paramedic services arrives prior to, or at about the same time as, fire services approximately 90 per cent of the time,” the report states. “This is partly due to the fact that both services are often responding from the same station in all career and some volunteer response areas, and is also due to the service model used by paramedic services, where ambulances are routinely traveling throughout the city during a shift and not always responding to a call from their home station.”

Firemedics are used in other jurisdictions, mostly in the United States. As the report points out, the Ontario Professional Fire Fighters Association is the driving force behind the pilot.

The OPFFA commissioned a poll last July, which reached 4,600 Ontario residents via telephone. They found the majority of Ontario residents favoured the use of firemedics.

According to a release issued by the OPFFA last November, "when asked about changing regulations to allow firefighters who are trained paramedics to administer care at the scene of an emergency, almost nine in 10 Ontarians (88 per cent) said they would support allowing them to use their medical training. Included in that number is almost two thirds of Ontarians who strongly agree with making the necessary changes."

CUPE, which represents about 5,500 of the province’s 8,000 paramedics, also conducted a poll in late 2017. Their results disputed those of the OPFFA.

"If they had to call for medical assistance for themselves or a family member, nearly 88 per cent of Sudburians who responded to a poll about provincial changes to 911 delivery said they prefer a response by an ambulance service," CUPE said in a March release. "Only eight per cent said they preferred a response by a fire department."

Provincially, more than 83 per cent of the 2,500 Ontarians surveyed in the CUPE poll said they prefer a response by an ambulance service. Only 6.8 per cent said they would prefer the fire department respond.

“Many provincial and municipal stakeholders and paramedic labour unions publicly opposed the firemedic proposal on the basis that there is no evidence demonstrating that firemedics will improve patient outcomes,” the staff report indicates.

One of the reasons staff are encouraging council to vote down the pilot project is because the city only pays half for its paramedics.

“If firemedics were to become a recognized delivery mechanism, it is unknown what, if any funding, would continue or if these costs would be downloaded entirely to the municipality; fire services are funded 100 per cent through the municipal levy while paramedic services operate under a 50/50 cost-sharing agreement with the province,” the report notes. “Implementation of the proposed model could divert financial and physical resources from the paramedic services division impacting service delivery and efficiency as costs for wages and equipment are higher in the fire service. Expensive fire vehicles would incur additional wear and tear through the increased call volume. For example, paramedics respond to approximately 7,000 calls per year in the downtown area.”

According to CUPE, it costs significantly more to use firemedics. An hour of fire service costs 55 per cent more than an hour of ambulance service.

There are also questions about the efficacy of using firefighters to respond to medical distress calls, as well as the working relationship between the two services.

“The firemedic model is a first response model that would duplicate current service delivery with no demonstrated improvement in patient care outcomes,” the report notes. “Fire service vehicles do not have transport capability and thus would still require ambulances to carry patients to facilities as needed. … Labour relation dynamics between firefighters and paramedics have led to conflict in municipalities across the province, including Greater Sudbury, affecting the day-to-day relationships. This is already being seen in relationship to the proposed pilot through recent media statements and ‘dueling’ surveys. The introduction of a firemedic role would result in significant legal costs resulting from labour disputes and have the potential to impact labour costs through future rounds of negotiations.”

Staff is also concerned about how the 24-hour shifts adopted by the firefighters would influence the work environment.

“Current legislation prohibits paramedics from working shifts longer than 12 hours, whereas firefighters work 24-hour shifts,” the report notes. “There is a growing body of evidence showing that moderate sleep deprivation produces impairments equivalent to those of alcohol intoxication.”

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