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Fact Sheet 1 – Tiered Response

Fact Sheet 1 – Tiered Response

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Let’s look at what this means.

Here is the explanation from the Ontario Association of Fire Chiefs, Ministry of Health and Long Term Care – Emergency Health Services, Ministry of Community Safety and Correctional Services, Office of the Fire Marshal in the fall of 2005:

“Tiered Response Agreements are formal written documents negotiated between two or more public and/or private sector safety agencies. They establish local protocols for a multi-agency response to a life threatening or public safety incident. A tiered response agreement outlines the capabilities, expectations and limitations of each agency and defines the criteria for participation.

“The intention of tiered response is to provide a clear response time advantage in scene arrival by one of the other partners, over the primary responding agency 

“Criteria for activating tiered response may include:

  • Life threatening medical emergencies (i.e. cardiac arrest, unconsciousness);
  • Multi-casualty incidents;
  • Hazardous materials incidents (CBRNE: Chemical, Biological, Radiological, Nuclear, Explosion) involving casualties and/or potential for casualties;
  • Large fires involving casualties and/or potential for casualties;
  • Natural disasters resulting in such occurrences as building collapse.
  • Vehicle collisions

‘Tiered Response is a voluntary program built on the principles of teamwork and cooperation between the public and/or private safety agencies. Each participant in a local emergency response program has a specific role to play in the community, and by working together, they are better equipped to meet the specific emergency needs of the constituents they serve.”

Tiered response has its place, but it isn’t the whole answer by a long shot.

Performance Concepts Consulting did a report in 2011 called INFORMING THE PUBLIC DIALOGUE AROUND MEDICAL TIERED RESPONSE IN ONTARIO, An Independent Evidence-Based Review. They found this:

“Good evidence does exist for fire department and other first responders (police, volunteer first responders in rural areas, and the general public) to be activated to a small sub-set of critical “time sensitive” calls only. Due to declining structure fire workloads, fire departments have surplus resource capacity and can respond quickly to the subset of time sensitive calls typically comprising 1-2 percent of EMS call volumes.”

The cardiac arrest calls where fire department involvement is statistically helpful constitute only about two per cent of total EMS calls. Again from Performance Concepts Consulting in 2011:

“The landmark OPALS (Ontario Prehospital Advanced Life Support) research project has documented the statistically significant benefit of Fire participation in prehospital emergency medical tiered response for a distinct subset of EMS Code 4 calls dealing with life threatening cardiac events. These OPALS related cardiac calls typically represent approximately two per cent of EMS dispatched Code 4 emergency service requests. It is this two per cent of total EMS call volume that the Fire community references when discussing their time sensitive contribution to Ontario’s pre-hospital emergency medical system.”

And finally the consultants conclude that there is a better way to deal with cardiac arrest. The fire department comes out third best after EMS and community/citizenresources:

“According to OPALS research, fire department defibrillation/CPR ranks third behind EMS and community defibrillation/CPR in terms of life saving benefits. As noted in the OPALS report, expanded community CPR represents the optimal tactic for improving cardiac arrest survivability in urban Ontario:

“Resources for the management of out-of-hospital cardiac arrest should be preferentially allocated to early defibrillation and citizen CPR, where the greatest impact can be realized.”
– OPALS”

OPSEU recognizes and supports an appropriate tiered response agreement for a distinct subset of prehospital emergency medical calls. The agreement must be locally developed, meet the needs of the community and have statistically significant benefits. 

On behalf of the paramedics proudly serving your community

Jamie Ramage
Ambulance Division Chair
ramagerider@sympatico.ca

Sources:

Ontario Association of Fire Chiefs, Ministry of Health and Long Term Care – Emergency Health Services, Ministry of Community Safety and Correctional Services –Office of the Fire Marshal. Fall 2005

Performance Concepts Consulting. (2011). INFORMING THE PUBLIC DIALOGUE AROUND MEDICAL TIERED RESPONSE IN ONTARIO, An Independent Evidence-Based Review, pg xi