Questions and answers about “expanded medical responses” from the OPSEU Ambulance sector
Q1. What are “expanded medical responses”?
Ontario’s Ministry of Health and Long-Term Care is considering adopting a model to expand medical interventions by firefighters in what has been termed the “fire-medic” model.
While OPSEU is committed to improving pre-hospital care for patients, there exists no sound evidence that expanding the role of fire-medics (firefighters that are also trained as paramedics) will achieve this goal. The model would put increased cost pressures on already-overstretched municipalities who bear the full cost of fire services – without guaranteeing positive outcomes for Ontarians.
Q2. Is this model safe?
A: OPSEU is concerned about the safety implications of the fire-medic model for both patients and staff. One Ontario study suggests that increasing the use of firetrucks for emergency response may actually put citizens at greater risk as more large vehicles are on the roads.
Many fire departments operate on a 24-hour shift schedule. As primary care paramedics working for a land ambulance service, these employees would be accustomed to 12-hour shifts, with eight to 11 hours off in between. Under the proposed model, as fire-medics, they would be required to work 24-hour shifts, at the same level of responsibility and accountability.
OPSEU questions the ability of an employee working 24 hours to be able to make split-second decisions and conduct assessments and drug calculations that are accurate and safe. The union is opposed to putting employees – and patients – in such high-risk situations.
Q3. Will this model lighten the workload of paramedics?
A: The simple answer is no. Increased fire involvement does not negate the need for timely patient transport and treatment at appropriate facilities.
Q4. Will it cost more money?
A: Where an ambulance is required, it is a waste of resources and a duplication of costs to send both paramedics and firefighters. The cost of expanded fire response is an increased cost placed on already-overstretched municipalities who bear 100 per cent of the cost of providing fire services. In the fire-medic model, municipalities also pay an extra cost for the additional wear and tear on firefighting equipment.
Q5. Would this model impact employment standards?
A: Paramedics are not exempt from the hours of work, daily rest period, time off between shifts, and weekly/bi-weekly rest period provisions of the Employment Standards Act. Firefighters are exempt from all of the above. Where the Act sets minimum standards and rules for land ambulance service, these standards and rules cannot be ignored or exempted.
Q6. Will it improve patient outcomes?
A: There is no Ontario-relevant evidence to support fire as first response for any CTAS 1 (highest urgency) patient other than sudden cardiac arrest (which comprises approximately one to two per cent of all EMS calls). No Ontario studies provide medical evidence that fire response makes a significant difference in patient morbidity and mortality.
It is important to note that expanded fire involvement does not fix any of the issues that exist with the current dispatch system, hospital offload delays, or current community demands. The province should focus its attention on addressing these issues.
Q7. How can we improve pre-hospital care?
A: OPSEU is committed to improving pre-hospital care for the citizens of Ontario and strongly advocates for:
- Changing the current dispatch process to the Medical Priority Dispatch System (MPDS) to reduce the urgency of approximately 10 per cent of calls, thereby reducing stresses on the system.
- An Automated External Defibrillator (AED) registry allowing Ambulance Communications Officers to identify the location of AEDs at the time of 911 calls.
- Expansion of the Public Access Defibrillator Program (PAD) and citizen CPR.
Sample Tweets @OPSEU @OPSEUAmbDiv
Fire-medic model = disaster for ON patients @drerichoskins @OPSEU #onpoli
Want to improve pre-hospital care @drerichoskins? Avoid dangerous & costly fire-medic model #onpoli
@drerichoskins @premierwynne Fire-medic model: costs more, benefits no one @OPSEU #onpoli
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Ontario Public Service Employees Union (OPSEU)
Send a letter to Minister Hoskins
You can copy and paste the letter below or write your own letter to Eric Hoskins, Ontario’s Minister of Health and Long-Term Care.
Hon. Eric Hoskins
Minister of Health and Long-Term Care
10th Floor, Hepburn Block
80 Grosvenor St., Toronto, ON, M7A 2C4
Dear Minister Hoskins,
I am writing to express my concern about the proposed “fire-medic” model that would increase medical interventions by firefighters.
There is no medical evidence to suggest that fire response makes a significant difference in patient outcomes; expanded fire involvement does not fix the issues that exist with the current dispatch system, hospital offload delays, or current community needs.
The model, which would see fire-medics working 24 hour shifts, is not safe for patients or staff. You should focus on these issues.
Increased fire involvement does not negate the need for timely patient transport and treatment. Where an ambulance is required, it is a duplicate cost to send both paramedics and firefighters. On all fronts – patient outcomes, employment standards and use of resources – the fire-medic model is flawed.
Minister, please focus on practical improvements.