Yet another article about a big city fire department, not having enough work to do trying to “merge” with EMS. Only this one is from Canada and the person making the comment is not a beleaguered EMT or paramedic, but a police officer lamenting the insistence of the Toronto Fire Department that they must respond to calls even when they have been directed not to.
You really should read the entire article because it raises some valid points. It’s actually better balanced than most of the other “fire EMS merger” articles I’ve read. Which isn’t going to stop me from selecting a few quotes and commenting on them.
“Fire has twice the budget, but the largest majority of calls for service are for EMS,” notes the KPMG report, which contains a series of potential cost-saving measures to help fill Toronto’s $774-million budget hole. A merger, it suggests, could save up to 20% on the city’s budget for fire and EMS.
Yes, they always say that it will save money, but then again no one ever does any follow up to find out if that’s actually true so we don’t know.
The report also recommends reducing the range of medical calls to which the fire department responds. Currently, firefighters are dispatched for all serious medical calls as well as some less serious incidents.
So, they want to merge fire and EMS to reduce the work load on the fire? No mention of shifting resources to EMS by closing fire stations, hiring more paramedics, and buying more ambulances.
The city’s recent KPMG report says the current dispatch process is designed to err on the side of “over-response” and could benefit from a more “risk-based approach.”
As I’ve opined before, all of the card systems are designed to reduce liability, not improve medical care, despite what the proponents may say to the contrary. They ALL over triage and result in needless (and dangerous) responses to what are often minor problems.
No article on fire ems mergers would be complete without a quote from an “expert”.
Brian Schwartz, senior advisor to the Sunnybrook Osler Centre for Prehospital Care and a member of the city’s tiered response committee, says the body has no figures to show how many fire service responses are unnecessary. It is gathering data, however, with results expected in the fall.
Dr. Schwartz points out that even when firefighters cannot perform the necessary medical intervention, they can assist in other ways, from gaining entry to buildings to holding elevators for paramedics.
Only a doctor would think it makes sense to send a $250.000.00 piece of fire apparatus, along with four fighters to hold an elevator for paramedics. Because we don’t know how to push that call button and at least around here the fire service jealously guards the special keys which allow them to take control of the elevator. Yeah, only a doctor would think that’s a valid reason to have the fire department respond.
The idea of a full-fledged merger of Toronto’s fire and ambulance services is controversial but not new. During the mayoral campaign last summer, candidate and former health minister George Smitherman proposed a friendly takeover of Toronto EMS by Toronto Fire, suggesting it could save both lives and money.
Like the Jackalope and Unicorn, there is no such thing as a “friendly takeover” of EMS by a fire department. The culture of the fire department, some would call it arrogance, just doesn’t allow it to happen. The article goes on to cite Winnipeg and Edmonton. As noted Edmonton was a complete failure and despite what the article says, a friend of mine who worked in Winnipeg before and after the merger, it was not a very smooth transition. It’s still not a very smoother operation. Oh, and in New York City it’s not a “full merger”. EMS is very much a second class operation, with lower pay, fewer benefits, dilapidated stations, and a far higher per unit call load. FDNY administers a “promotional” exam for EMS personnel who want to become real firefighters. Not what I’d call a full merger.
Because of fire’s extensive coverage area — stations were historically situated close enough together that a horse and carriage could dash to any scene without running out of breath — ambulance services have increasingly housed their services out of local fire stations. In addition to possibly boosting response times, the measure saves operational costs. In Toronto, 11 EMS stations are colocated with fire stations, and two in police stations; in Mississauga, four of 20 fire stations are co-located or being considered for co-location.
To the best of my knowledge, fire apparatus in Toronto is not drawn by horses any longer. Still, their siting plan, if they have one, is based on something not done for 80 or so years. That’s why we talk about the fire service having 150 years of tradition unimpeded by progress.
Colocating fire and EMS stations doesn’t require a merger. Austin, TX EMS has been doing it since it’s inception. Even though the stations are colocated with the fire, they are separate facilities, often separated by a wall. That seems to work for them, so it might work in other places as well.
Once again the obvious seems to escape the experts. If you don’t have enough EMS personnel and ambulances, then get more EMS personnel and ambulances. Putting forth the fantasy that using the fire department as stand ins is effective is counter productive at best. At worst, it’s a lie meant to deceive the public about the services they are receiving.
What would make more sense is a friendly takeover of Toronto Fire by Toronto EMS. And then they could absorb about 80% of their budget for EMS calls, and save the rest of fighting fires every now and then.
Sauce for the goose…
Ye Gods… they just don’t have a clue… sigh
The phenomenon of situating stations within horse running distance is one that you can blame on the ISO, the agency that rates fire departments. The ISO, owned and run by insurance companies, demands that fire stations must be situated within 1.5 miles of any given location. Since a large part of a fire department’s reason for existence is the reduction of insurance costs, departments do what they can to keep the ISO happy.
EMS has similar issues, as many things that are done by EMS are more driven by insurance companies and lawyers than they are by doctors. Frustrating when lawyers and accountants run your profession.
Municipalities are going to care less and less about the ISO ratings since that effects homeowner’s insurance rates and not the budget of the municipality. EMS response times are driven primarily by politics because when someone calls 9-1-1 for an ambulance they want one fast, no matter how trivial their problem. Our biggest headaches are calls to city hall that an ambulance didn’t come fast enough for someone’s ingrown toenail. Most people don’t much care who gets there or what they do as long as someone gets there. Thus the fire service gets lauded for administering the “stare of life” while EMS, who actually treats the patient gets lambasted for “being too slow”. It’s a farce.
Actually, the trend in this area is for “priority dispatching.” This is resulting in longer response times. Our city manager once said that “EMS and Fire are like the Sanitation Department. No one notices them until the trash doesn’t get picked up.”
Excellent observations TOTW! Lest someone think that only in Texas can separate agencies be co-located; here are some other examples from my neck of the woods:
Hennepin EMS (Minneapolis): We have 4 stations co-located with Minneapolis Fire. 3 have separate office areas for our staff and we share the dayroom/kitchen with one station. All work pretty well. We also co-locate with Eden Praire, Minnetonka and Excelsior Fire stations. A couple with separate offices, and a couple with shared spaces (admittedly those are often staffed with volunteer or paid-on-call personnel, but I digress). We also have one station located in a suburban community center (office space next to the police substation).
The neighboring private services also have similar arrangements with some of their local fire departments.
Many of the areas, it’s truly cooperative with just some shared expenses. Others involve a more formal leasing agreement. In the end, it works well as an alternative to capital real estate purchases or leases for substations.
Here’s something I never understood: If you merge Fire and EMS, and Fire only constitutes 20% of the combined operational workload, and EMS brings in all the extra money from billing, then why is Fire always in charge of the merged agency and why is it still called the Fire Department?
Yeah, me neither.
The comments when it comes to Fire Services never cease to amaze me. Fire Services don’t staff for medical calls, they staff for fire related calls. Even if you took away the medical calls from the Fire Service, their staffing and budget will not decrease.
Toronto EMS is more concerned with image and getting respect than they are with patient care and the well being of the public. They twist everything to try to make themselves look better. The comment from an “OPP officer” (who isn’t man enough to give his name) about Fire Responding when “told not to” is just nonsense. Who called the Fire Service in the first place? Dispatch. Cops are as medically trained as, wait, they aren’t, and he has no power, even as a peace officer, to cancel a response that he did not initiate. How many times have you arrived on scene and the cops say the person is ok, and you run in on a CTAS 1? Funny how many say how useless cops are at a medical scenes, yet now one annonymous cop “is god”
As for some of my out of shape co-workers, which, unfortunately, are most, you’ll be off on workers compensation within weeks of the Firefighters not assisting with the stretcher and equipment.
Firefighters are not in competition with medics , why are so many medics in competition with them? If you joined this professional for fame and fortune, get out now, you made a mistake.
I’d find your comments laughable if they weren’t so, well laughable. If buildings are burning less frequently, then governments might want to start reconsidering how they staff fire departments. It’s happened in a couple of places and will happen in more. Modern building codes, smoke detectors, sprinkler systems have changed the wire buildings catch fire and how fire departments have to respond. Around here police are required to be first responders which is what the fire is required to be. That the fire decides to have EMTs is their decision. They still can’t do more than any other first responder, nor should they. The first five minutes of any EMS call are BLS, or they should be. Paul Pepe did one of the first studies demonstrating that and started the ball rolling for first responders to have AEDs because that is the only real proven benefit to have fire departments respond to medical calls. We’re finding more and more that throwing oxygen on every patient isn’t beneficial and might be harmful.
How many times have I arrived on scene to find a patient with a non rebreather and the FD administering the “stare of life” to a cardiac arrest patient?
Sorry to say but in my system, unless it’s a morbidly obese patient we don’t let the fire touch the stair chair or stretcher any more than we touch hoses, ladders, or axes. Since I’ve been operating that way for over 30 years without going out on comp, I’m not worried about it.
No, the fire isn’t in competition with medics. That’s why they try to supplant non fire fighter EMS personnel when ever they can. That’s what happened in LA City, what they tried to do in San Francisco, did in St. Louis, and are trying to do in Kansas City, and a couple of other cities. Nope, no competition there.
are you even in Canada?
No, although I don’t know that anatomy, physiology, or medicine are all that much different.
Then you know nothing about the sitation in Toronto. I’m going to guess you’ve never even been here. I would suggest you put your energy to fixing the problems in your country, rather than giving your ill-informed opinions on topics you know nothing about.
The situation in Toronto is the same as in any other city in North America. The fire department doesn’t have enough to do to justify it’s budget and sees EMS as easy pickings. EMS, which knows what it’s doing doesn’t have enough resources, but is also one of the first agencies on the block at budget cut time. Clueless politicians are sweet talked by clueless and dishonest fire and union officials who tell them “We can do that because all that EMS does is drive patients to the hospital, we do the real treatment before they even arrive.” The politicians don’t know any better, and even the few that do are willing to go along with the fantasy because it’s an easy way to cut the budget. Then, when they realize that having the FD do it doesn’t increase save rates, reduce real response times, or save money, it’s usually too late to revert back. Except for in Louisville, Kentucky where they undid the merger a few years back.
Our country will solve it’s problems fine, once of which is the sociallist medical system we recently adopted, which like yours is already harming the economy. As I recall, Canada is rethinking that whole issue with an eye towards moving some aspects to a free market system.
Like all too many fire fighters you have no clue about EMS and like a dog chasing are car you’d not know what to do with it if you caught it. Other than bite the tires and piss on the hubcaps, that is.
I have no clue about EMS? I AM EMS you dolt ! Have been for 29 years.
My guess would be that you have one year of experience, repeated 29 times over as opposed to 29 years of experience.