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Saved by the bell

The firefighter’s job is changing as ever more medical calls come in


 

Every pump truck in Winnipeg has a cross-trained firefighter-paramedic

“Maisie,” an elderly Toronto woman whose chain smoking often leaves her gasping for air, is so well-known to the firefighters at the nearby station that when her address is announced on the loudspeaker, they all bellow her name. They lumber up the dark stairwell to her squalid apartment as often as three or four times a night. On this particular occasion, they listen to her breathing and give her oxygen. After the paramedics arrive, her colour improves. She signs a waiver, refusing to allow EMS to take her to hospital. On his way out, the fire hall captain empties an ashtray, and places a few dirty dishes in the sink.

While firefighters may be known more for their courage than caregiving, the reality, says Susan Braedley, a post-doctoral fellow at York University’s Institute for Health Research, is “they’re doing more emergency medical care than anything else.” In 2006, 52 per cent of calls to the Toronto Fire Service were medical in nature—a statistic that prompted Braedley to spend 10 months observing the city’s firefighters. Her research, which includes the visit to Maisie’s home, is slated for publication by the McGill Queens University Press next spring in a book entitled Neoliberalism and Everyday Life. According to Braedley, the “accidental assignment of some health care provision” to firefighters has been brought on by several factors: better fire prevention, which has freed up firefighters for other tasks; aging baby boomers; a dearth of family doctors, which has forced marginalized populations to use 911 as a way into the system. It’s a shift that has been subtle and the source of conflict. The result, however, is clear: in municipalities across Canada, what it means to be a firefighter is changing significantly.

Firefighters have long played an informal role in health care delivery. Until the ’70s, when formalized paramedicine became an integral component of emergency health care, they were often called upon to administer oxygen and deliver CPR. Though paramedics eventually assumed, and dramatically improved upon, pre-hospital care, firefighters continued to assist, particularly on calls where lives are at risk. (In some smaller centres, like Brandon, Man., and Lethbridge, Alta., the paramedic service grew out of the fire departments; today, members are cross-trained to perform all emergency rescue tasks.) With the push to improve survival rates for cardiac arrests—brain function begins to deteriorate after just six minutes—firefighters were called upon more often, in large part due to the speed at which they can arrive on scene. Due to pressure from home insurers, in urban areas, a pump truck is rarely more than five minutes away.

Today, the Toronto experience is hardly unique. In Prince George, B.C., where, according to fire captain and union president John Iverson, two-thirds of calls to fire departments are medical, “Everybody that gets into this business now fully understands it’s a huge part of their job.” To Iverson, increasing their medical capabilities just makes sense. So, last year, the Prince George fire service became the first in the province to increase the medical training of most of its members to Emergency Medical Responder (EMR) level. But because of provincial regulations limiting the degree of medical attention firefighters can provide, they’ve not been able to put their new skills to use. “We didn’t anticipate there would be such a bottleneck trying to get through the system,” he says. “From my members’ point of view, it’s extremely frustrating.”

According to Jim Lee, a former firefighter and the Ottawa-based assistant to the general president of the International Association of Fire Fighters (IAFF), “We’ve been trying, on an ongoing basis, to educate the politicians that we’re a resource that they should be using.” In 2002, the IAFF made a presentation to the Romanow commission, arguing that “the true potential [of firefighters] in the realm of EMS remains largely untapped.” But despite emergency room delays, which, in some municipalities, tie up ambulances to the point where not a single EMS vehicle is available for hours at a time, Lee says that, since 2002, not much has changed. “The political will is still not there.”

Though the specific guidelines that regulate the provision of emergency medical care vary, in both Ontario and B.C. firefighters are limited to basic assistance in life-threatening situations, such as providing oxygen to an asthmatic or applying a defibrillator to someone in cardiac arrest. But in B.C., change could be on the horizon: the province is reviewing regulations that govern what firefighters can and can’t do in emergencies, and, as a pilot project, Prince George firefighters will soon be allowed to practice some EMR-level skills under the supervision of a medical director.

But as they inch further into the realm of emergency medicine, firefighters also find themselves at odds with those whose reason for existence is pre-hospital care: paramedics. Darryl Wilton, president of Ottawa’s Professional Paramedic Association, decries the push by fire departments to take on more medical responsibility as partly “hard-core unionism” in the face of a “diminished primary function.” Some paramedics express concerns about medical oversight and training of firefighters: would-be paramedics must beat out fierce competition to gain acceptance into difficult college programs, which take years to complete. But beyond that, Ottawa paramedic chief Anthony Di Monte says he worries that summoning firefighters to a wider range of medical calls would detract from what they were trained to do. “I would be diminishing the suppression capacity in my city. What if there was a major fire?” Cardiac arrests, he says, make up a mere one per cent of the total EMS call volume.

Though the turf war does not play out on the ground, where, by all accounts, the interaction between emergency responders is good, it has caused some animosity behind the scenes. Dispatch times are a major sticking point for firefighters: in life-threatening situations, they say they are sometimes alerted after EMS, despite the fact that they can often arrive faster. EMS, meanwhile, says that fire is alerted the moment it is determined that lives are at risk. (The process varies, but generally a 911 call is answered by an attendant in a central location, who transfers it to fire, police or ambulance. In life-threatening situations, such as a heart attack, the ambulance dispatch forwards the call to police and fire. Likewise, in the case of a burning building, fire summons police and ambulance.)

Still, in pleading their case for a more formal medical role, firefighters often cite Winnipeg as an example of their services being maximized. There, after a decade-long attempt to amalgamate EMS and fire, the services reached an agreement in 2007. Though two separate streams, they are headed by a single chief, and dispatch is coordinated from one centre. Significantly, there is a cross-trained firefighter-paramedic on every pump truck: if firefighters find that EMS is not needed, they can tell ambulances, which are often in short supply, to turn back.

The new arrangement seems to be working. Last year, the fire trucks handled some 10,000 medical calls on their own. But the partnership didn’t come easy. The attempted merger saw relations between the firefighters and paramedics degrade to the point where, by the time a deal was reached, three unions had become embroiled in formal labour disputes with the city. According to Fire and Paramedic Chief Jim Brennan, the difficulty came from trying to homogenize two distinct workplace cultures, with different seniority structures, uniforms and senses of identity. Brennan, who in the 1960s worked for Frank Pantridge, the Belfast cardiologist who pioneered paramedicine, says he has a unique understanding of changing something as simple as a rank insignia: “When you do that, someone appears to have lost, and that causes conflict.”

But even informally, the cultural divide between fighting fires and tending to the sick runs deep. Of the 37 firefighters Braedley interviewed, “all but four expressed sentiments ranging from discomfort to outright rejection of their work in the health care provision,” which, she says, has “shaken the hyper-masculine core of fire services and firefighting culture.” As a firefighter in her study explains: “The things they’re asking us to do are so far outside the realm of what we anticipated, that you almost feel like ‘I’m losing some of what I was really meant to be.’ ”

But regardless of any apprehension they may have, firefighters understand that, for better or worse, their role evolves according to the public need. This need, it seems, is the reason Toronto firefighters continue to bound up Maisie’s stairs. As one member told Braedley, “Some people would say she’s a nuisance, but she needs help. There is no one else. So we do it.”


 

Saved by the bell

  1. I think we need to focus Firefighters on fighting fires ,specialized rescue and building safety issues, and Paramedics on emergency patient care, special paramedic operations , and community medicine/public health initiatives. Analyse and resource them as required to meet their primary mandates.

    • As a recently retired Paramedic in Winnipeg I have seen the "benefits" of firefighter/paramedics. I watched as funding for EMS was funnelled to a Fire Service that only managed to "stop the clock" on a citizens medical emergency. It does nothing to provide definitive care or get the patient to the hospital any sooner. The citizens of Winnipeg are getting a false sense of security when they see a fire truck arrive at their front door.

      • Its typycal reaction of Paramedics thinking that funding is being taken away from Paramedics and given to Fire Depts. No matter whether Fire trucks respond to medicals are not, the same amount of trucks are needed due to pressure from insurance companies. Paramedics seem to always want to blame Firefighters for all their percieved problems. Why not look at the true problems, like for example extended off load delays at hospitals. As for experience, the Firefighter/Paramedic has taken the exact same courses, passed the exact same exams, precepted the exact same way as every Paramedic that rides on an ambulance. In fact a lot of the Firefighter/Paramedics that ride on fire trucks have transfered over from the Ambulances so have a lot more experience than the average PCP on an ambulance. Of course most aren't as trained as some of the ICP's or ACP's but then again some are and practise on the firetruck at a lower level. I am really disappointed the so many Paramedics STILL think this way. I thought we had finally gotten over this petty petty crap.

      • Con't
        This is NOT a new problem. It has been going on for 30 years now that I know of when the first group of firefighters were trained as EMT 100's. Exactly the same as Paramedics of the day. MY suggesttion for all of this is to quit trying to compare jobs because you are still comparing apples and oranges. Promote Paramedicine as a great and growing career and stop the whining!

      • First of all, I am not employed as a fire fighter or paramedic, however I have a number of close friends working in both fields so I have exposure to both sides of the issue. From what I have seen and heard, the number one problem – by far – is the confrontational attitude between the two groups and it makes absolutely no sense to me. The comment by “Jeff” proves this. Why would you want to give the impression that fire fighters are not providing any benefit or serving the patient? The only thing this does is make the SYSTEM look bad, paramedics included. Your comment that the Fire Service only manages to “stop the clock” on the emergency…. correct me if I’m wrong, but isn’t the moto of paramedics “do no harm”? How is this any different? You are not doctors. You cannot fix the problem, only treat them and transport them to the appropriate facility. Unfortunately the system requires paramedics to spend too much time with paper work and other non-medical duties (waiting in emergency rooms) so allowing fire fighters to arrive quickly and assess the situation is certainly a benefit. Would you rather the patient wait precious extra minutes waiting for the ambulance unattended?

    • . In Winnipeg's situation, make no mistake, while paramedics were amenable to the full amalgation of services, the IAFF local never was and what they wanted , and still wants, is to provide the Advanced Life Support from the fire apparatus, essentially being the heroes with all the specialized prehospital tools, while not having to transport anyone to hospital unless in critical conditionwith the support of the Basic Life Support paramedics in ambulances. All the "unglamourous" calls, like Maisie in this article, would be left for the ambulance paramedics, essentially a non-emergent check up and taxi service. Unfortunately what the IAFF, especially in Winnipeg, have never really come to terms with is that good pre-hospital services require paramedics from the basic to advanced provider to be continually exposed to patients of all sorts, as the ambulance based paramedics are, and actually spend more time than the 5 or so minutes that the Firefighter-Primary Care Paramedic spends while on a call in Winnipeg. Barely having the time to get a pt name, and a blood pressure doesn't constitute true paramedicine in my book. Any health clinician worth their salt would say the same.

      • Agreed !

  2. The slight delay in notifiying the firedepartment comes from the fact it takes time to determine the problem the caller is calling for. Keep in mind that eventhough Toronto Fire Services (and others) have a 50-70% medical call volume, it only makes up for usually less than 30% of the total EMS calls. I also question the authors statistic that a commnity goes without an ambulance for hours. I know here in Ontario there is a seamless system, so if one community gets stripped, the other communities send trucks in. The time without an ambulance is minutes at best. (although response will be delayed). And lastly, if I'm not mistaken, the firedepartment only started going to medical calls once tiered response started which was in the 80's. Many small communities with volunteer fire departments don't even respond to medical calls now.
    The fire department does a great job, but I think if enhancements are made to the EMS system, it only makes sense to put more Paramedics on ambulances since the patient still needs to get to the hospital. Most communities have already taken great strides to enhance the ambulance counts.

    • Not everywhere. My dept has been running a full ambulance service (ALS since the 80's) since the 1910's. We do both jobs

  3. People of Canada, don't let the IAFF destroy EMS in your country like it's destroyed EMS in the US!!

    • Wow, is this a blanket statement to bash unions. If you could elaborate on this with an educated and supported argument I think people would actually take the time to debate this.

    • privatization destroyed EMS in the US – make no mistake about it.
      The FD's in the US are now trying to save the sinking ship!

  4. Ambulances are great for transport, but in Winnipeg fire trucks arrive first 70% of the time with an average response time of 4 minutes compared to the ambulance's average of 9 minutes. I'm sure the person who's heart muscle is in the process of dying is MORE than happy that fire truck has a paramedic riding on it who can give them the care they need. That extra five minutes is without question a life or death time for the person whose heart isn't beating effectively and needs to be defibrillated with a shock, or for the person whose throat is swelling closed due to an allergic reaction.

    • Put that funding into more Ambulances and they could be there even faster than a giant gas waster! The reason they can respond fast is that they are lying down with nothing better to do while the Paramedics are run off their feet and often respond right from hospital after dropping off the last patient. The cost becomes astronomical, which makes Fire Dep.'s happy but the patients still need the Ambulance to get to hospital. Just put money to good use and deploy more Ambulances! Here where I live, the number of Fire Stations outnumber the number of Ambulances?

      • "BULLY" you are embarrassing yourself. The pathetic notion that the fire service is over-funded and that using that money for more ambulances on the road would be better for the public is absurd, and quite frankly ignorant. It would be like saying that we should stop repairing pot holes because the health care system is under-funded; this is not an either or decision. Paramedics need proper funding just like all other emergency services – fire and police – because they all provide different services.

      • CONT'D…
        The fire stations – which coincidentally house ambulances as well in many cases – outnumber ambulances because in case of a fire the truck must be within minutes of the emergency in order to effectively respond. You have this infrastructure in place for fires, so why not take advantage of the same resources for medical emergencies as well? If these fire fighters are "lying down with nothing better to do" then why not make them do something? Or would you rather fire half of them and hire paramedics only? I'll let you do that in your community, then you can explain to your neighbour why his house burnt down completely because the fire fighters were too far away to respond in time. Hopefully there was no one in the house at the time.

      • Bully – Have you ever had a fire in your house or required the assistance of the FD?
        It takes about 2 people to handle most medical calls — It can take dozens of firefighters to handle a structure fire. Do you really just want 1 or 2 guys to show up to your house thats on fire after 20 mins to save your loved ones and property?

    • The cost of placing Paramedics on fire apparatus in Winnipeg in terms of manpower is significant…to the tune of 180 fire/medics. Using a very basic staffing formula (9.3 paramedics to staff one ambulance 24/7), that means Winnipeg could have used those 180 paramedics to staff an additional 20 ambulances around the clock…without doubt more than would be required to improve ambulance response times drastically. First response plays a vital role in Manitoba's EMS system, but for a system to rely so heavily on first response to "stop the clock" is inappropriate.

      • I'd like to apologise for some of the other paramedics on here who, quite frankly, are embarassing us. It is not only that the fire trucks are often closer to the pt, it is also partially the attitudes of the paramedics that are to blame for the incredibly slow response times. The fire trucks are not usualy FIVE MINUTES closer to a pt. Try to keep the politics out of the discussion and stick with the facts. Where I work, in downtown Winnipeg, Station No.1 is one of the 3 busiest fire halls in North America. Those firefighters are not just laying around. They drop what they're doing and RUN to the truck no matter what the call is for. They are constantly studying maps so they know their streets well and can get there extremely quickly. My fellow paramedics often disgust me as they sit around and finish eating long after they've been dispatched and then saunter over to the ambulance, flip to the map page and try to make sense of where they're going. Why put money towards this? Ask any Winnipeg dispatcher and they will tell you that firefighters LEAVE THE STATION twice as fast as we do. It's sad.

        • I am sorry to agree with you Winnipeg Paramedic. Unfortunately because of a few, Paramedics are quicky becoming known as a profesion of whiners. Thankfully the quiet majority do a FANTASTIC job.

      • Eric, you're missing the entire point of why this system is so effective. You can't just take away those 180 firefighter/paramedics and make them paramedics because they are still FIREFIGHTERS as well. They are going to be on those fire trucks anyway. The fact that they're paramedics who arrive on scene 5 minutes before an ambulance is pure bonus. The writing is on the wall, and the wave of the future is for fire trucks to have one highly trained medical professional on each…and for ambulances to be there strictly for transport. Future ambulance drivers will wipe the windows, check the oil, and drive the pt to the hospital.

        • I'm not sure I am missing the point. As stated by IAFF President Harold Schaitberger in addressing the need for fire services to embrace EMS…"we could either work to control it and make it ours, or ignore it and let somebody else reap the benefits.” He goes on to say “This means we have more work to do to grow our profession and protect our members' work.” That suggest to me that perhaps you could take away those 180 firefighter/paramedics…
          Your remarks about the professionalism of firefighters and paramedics is well taken. I'd suggest there are underlying issues related to the behaviors you observe, a discussion for another day perhaps. And I'm not suggesting for one minute that paramedics should only work in ambulances…on the contrary there are a number of excellent examples of paramedics working in rapid response units, hospital settings, community and clinic sites, industrial facilities etc. Changing the face of paramedicine to meet the needs of our patients is appropriate and responsible. Driving change to protect funding and jobs…maybe not so much.

        • So following that then very twisted logic (besides disrespectful of the EMS side) then in a critical patient is transported with the FF/ACP, just where does that put Pumper or Fire Rescue status at … thats right OUT OF SERVICE.

          Hence your effective model cost effectiveness is escalated and requiring other hall's to cover and hence increase your response time to a real fire.

          Heres another Idea for your plasure why not train the PCP ACP on EMS side to 1001 ? then when you do have a big wreck or fire not only do you have more medical resources on scene but more people to pull hose ?

          • Yea that would be great train PCP-ACP´s on EMS side to 1001! So we can have Paramedics help ¨pull the hose¨ That will fix evrything. I really hope that never happends Id rather be up all night doing medical calss thanks!

          • So ironically one can go from Fire to provide medical services but not EMS to Fire services when the need arises ? Perhaps a double standard exists ? Tell me it isn't so. MEH.

  5. Paramedics and firefighters don't save lives by being "highly trained medically Professionals" as much as they save lives with basic life support. Spraying nitro to open up closed heart arteries, administering epinepherine for allergic reactions, shocking a fibrillating heart or even clearing an airway are all things that Winnipeg firefighter/paramedics do…and do well. Do these patients have an extra five minutes to wait for an ambulance? NO.
    Until ambulances can start arriving on scene as fast as the fire trucks do I feel VERY strongly that having firefighter/paramedics on the fire trucks is the ONLY way to go.

    • The fact you state nitro opens up closed heart arteries tells us that you have no idea what that drug does to the human body. Exactly my point below, minimal education and NO medical oversight. Unless you understand the benefits and the dangers of administering a drug, you have no business touching it.

    • You bring up an excellent point. I would imagine Winnipeg has similar stats to Toronto. The article states 52% of TFD responses are medical in nature.

      Perhaps it is time for budget dollars to be reallocated to ambulances and full paramedic crews who work all day everyday, instead of fire suppression crews who don't see a fire for weeks on end.

    • I would seem obvious to invest in more paramedics and ambulances. Why invest a significant amount of dollars and time to train a fire-medic whose primary fuction is to fight fires and does not have the ability to transport the person to a hospital. If response times are the issue…invest in more paramedics

      • the idea of having a medic on every pump truck in Winnipeg is so if they arrive on scene first, and they usually do, they can determine if a paramedic crew is needed or not. If not, then the crew is free to respond to calls of a more serious nature. The medics should appreciate not having to respond to the call if they are not needed.

    • Then Sir we should be focused in on the best ROSC as in Seattle model where over 50% closely of the population is trained to do CPR and clearly reflects the to-door-discharge, followed by Vancover where estimates are 25% of population are trained, ROSC from flat line is abysmal in the field (look to evidence based medicine PLEASE)

      Are YOU teaching CPR out of your HALL?

      My quote: "We do not 'SAVE LIVES' but rather, we make positive influences on outcomes, with brains, experience, and instinct, Life Savers are just CANDY" nuff said ?

      Is that clearer for you positively affecting outcomes is a far different mentality than "

      Your NTG, OK right then first off your talking PCP not ACP, so without a 12 lead and rule out a right sided infarct you could actually kill that patient ! Defib OK so what if its SVT unstable ? and your Epi ? btw acute Anaphlaxis can occur in less than 90 seconds and are your FF/PCP prepared to do a Crike? These are just baby steps in passing and just one part of the health care process.

      You clearly state that BLS is required within the 4 minute window, but you have omtted the ALS closely followed in under 8 minutes (as IF you could actually present evidence based medicine to prove your statement's )

      cheers

    • Winnipeg firefighter states that a fire truck can arrive much sooner than an ambulance… maybe we should seek fewer firetrucks and more ambulances as a solution.. Fire gets their sooner because they are sitting idly, while EMS (which typically has fewer cars running) has more calls and less staff.
      I'm no opposed to fire responding to medical calls, but lets not forget what our primary functions is. First response has it's place, it should not be viewed as a solution to a bigger problem!

    • To Winnipeg Firefighter: If any ambulance service was funded even half as lavishly as any fire department, there would be absolutely no question who arrives first. I imagine the stats in Surrey BC where I worked for many years tells the tale. There were 19 fire halls serving the population of Surrey each running 3 manned trucks. In contrast there were a total of 6 ambulances. That's right, 6 ambulances in total for the same population base. Surrey fire departments budget was approximately one quarter of the entire ambulance budget for the Province of BC. Is it any wonder the fire department arrived first in about half the calls? The statistics and the budget seems to say you have about a 20 times more likelihood of catching fire than you do of getting sick. Seems skewed to me.

    • Well of course that's 'cause we are spending way too much money on too large equipment on to many people that don't do anything. What is their productivity rate…6-8% including false alarms!!!! Time to get the money to the two services that really do something!!!

  6. What ever happened to unbiased media? This is written so pro-fire. We know for a fact Darryl Wilton tried to get balanced information into the hands of the author, yet the only message she heard was union fighting. The fact remains, that with only a couple of exceptions, fire departments has absolutely NO medical oversight. There is no one ensuring firefighters are competent in what they are doing to my patient.

    I will not be renewing my subscription to Macleans.

    • Once again has anyone outside of Ontario heard or care of what people do in the west for example Winnipeg and majority of Alberta integrated fire departments. We pass and maintain the same license as the EMS personnel do. We don't go out of our way to bash those individuals on their skills and qualifications as we respect them for what they do. So before making a blanket statement try to look outside the borders of ontario and educate yourself on what the rest of Canada is doing.

      I don't think Macleans will miss the money.

      • The majority of Alberta are not integrated. The largest cities and most of rural operate with ALS paramedic ambulances, unassociated with any fire dept. With AHS now in charge fire dept paramedics will only decrease. A bit of a shame because they do quite a good job, even if their primary job in desire and title are fire based.

    • Uh..try a base hospital as medical oversight.

  7. I would like two present two key points for you to judge any type of Fire Credibility in this article

    A – Toronto Fire Department is in bargaining right now – Things that make you go hummm.

    B – A Toronto Fire Fighter does not even stock needles let alone use an expensive stethoscope as shown in this picture. All the medics in Toronto are laughing at the picture because it is almost as good as the Tiger Woods jokes going around right now.

    Talk about a staged article. Hey Rachel curious if joining the Fire 911 club biased you that much or is it something else like self promotion. This article is so red machine glam and promotion, the lack of objectivity only lets people draw other conclusions.

    • Correct me if I am wrong but to judge your credibility:

      1: isn't the picture of a Winnipeg Firefighter/Paramedic and
      2: Everything doesn't revolve around Toronto

    • Look a little closer and you will see that the fire fighter in the picture is from Winnipeg where they have cross trained fire fighter/paramedics. That is NOT a Toronto fire fighter in the picture and any Toronto paramedic would know that!

  8. As a Fire Fighter in Toronto I want NO PART OF EMS! My union does not know what we want if they are advocating for us to do more EMS work which we are tottally lost at anyways. They should be protecting our 24 hours shift so we can get the rest we need in case of a big fire.

  9. Station 44 you are so right – our union needs to make sure they keep our 24 hour shift. if they keep pulling stuff like this Scott Marks can kiss his presidency good bye

    • There has to be meaningful discussion and dialogue between all the stakeholders to determine how to serve the public better in EMS without just throwing more money into the system. Paramedics and fire fighters have to take a step back and work on what makes sense, not turf protection.

      And for writers, "Station 44" and "Poker Fire Fighter" I say, come to the union meeting on December 16th and have your voice heard and have the facts explained to you, instead of hiding behind your anonymity in here and taking shots.

      Scott Marks,
      President, Local 3888

    • Scott Marks is not afraid to address important issues on behalf of the fire fighters of Toronto. Fire fighters that want no part of EMS or believe that it is somehow related to the 24 hour shift need to spend less time complaining and more time educating themselves on what their own membership has endorsed.

      Toronto Fire Fighters endorsed pursuing a more effective involvement in EMS over three years ago. That does not mean taking jobs from paramedics, but it does mean making more effective use of fire fighters who arrive on scene first. The studies out of the U.S. have shown that quick triage and "scoop and go" has been far more effective in saving lives than the movement towards full ALS EMS departments. Fire fighters (once properly trained) being first on scene would be the logical ones to determine the need for an ambulance. This would free up more ambulances and at the same time not impact fire responses to other incidents or even impact the number of EMS calls fire responds to.

    • And don't forget that a Paramedic can not legally work a 24hour shift. So all those firedepartments that are looking at getting Paramedic's on a firetruck might want to consider the ramifications to their 24hour shift.

      • Bob – many paramedics work 24 or even 48hr shifts

  10. Station 44, I totally agree. If we are constantly up all night doing ems work, how are we expected to respond to the big call?? My union dues should not be used to pay for this crazy ideology.

    • Jimmyff,

      So if you are up all night (24 hours) responding to house fires and traffic accidents, "How would you be expected to respond to the big call (just using your own words)" at the end of your 24 hour shif that you love so much.

      Give your head a shake and look at the facts. Be thankfull YOU still have a job. Just a few months ago, the IAFF put out a report talking of all the fire cut backs across to US, but not one single job was lost in a Fire Department that provided both fire/rescue and paramedicine

  11. Love the open sharp too!! Dark Ages of health and safety – Don't let that guy near my family. oh ya and Susan Braedley "10 months with fire" there is objectivity for you .

    • I'm pretty sure that's a blunt-fill needle in the picture and not plutonium….. They do have to be handled at some point for administration don't they?

  12. Yes Fire Depts and EMS are very important to their communities; most often EMS is often overlooked at funding time. The IAFF is a big lobby group as well as one well run propaganda machine. The IAFF is not in it for patient care but to keep firefighters employed and well paid.
    As for response times; its apples and oranges, fire response times start when their wheels start rolling as EMS’s response times start when 911 answers the phone.
    If the government ever realizes that people are more important than property, they would properly fund EMS, but as it is; not enough paramedics on ambulances to keep response times down and lots of firefighters hanging out in stations not fighting fires so why not send them along to stop the clock.
    As a paramedic in Toronto, I appreciate the help of firefighters, but they are not a replacement for highly trained paramedics

    • Thank you. Finally a paramedic who is not caught up in the pathetic turf war.

      No one wants fire fighters to REPLACE paramedics. Far from it. They are there to SUPPLEMENT the work of paramedics and provide more effective response and care to the patient. Do doctors hate nurses? Of course not, because the nurses assist doctors and allow them to do their job more effectively.

      The public doesn't care about your personal B-S. They want more effective care. Period.

    • I like what you have to say but also consider that just because I don't work for an EMS service (I work for a fire service) doesn't mean that I'm not a "highly trained paramedic". I've taken the same programs that you have and am just as responsible for running an ambulance as a fire truck.

    • You are wrong…Firefighter/Paramedics and the IAFF are there for pt care and here in Winnipeg the response times begin at the same time. Firefighters also rush to he scene..out the door in less than 30 secs, the EMS Paramedics finish their coffee first, then head out at a much slower pace.

  13. Why on earth would the fireguy in the picture be holding an open sharp in a firehall? Obviously he hasn’t had the proper training to know enough to not open the sharp just for a photo-op!

  14. As a Winnipeg Paramedic I can tell you there is a very large difference between a WEMS PCP vs. UFFW PCP… experience also plays a large part. UFFW PCPs lack exposure to calls… and patients. Yes they do arrive before EMS the majority of the time however by the time the make patient contact the WEMS Paramedics are arriving on scenes and the majority of time Fire is cleared to return to quarters.

    Several weeks ago a Fire crew was sent to assess a patient… they called a Paramedic unit to transport the intoxicated patient. Once the patient was placed in the back of the unit and assessed properly… the patient wasn't intoxicated rather very far from it… the patient is now in ICU recovering…

    • Silly argument. I was at a call where the paramedics forgot to bring a baby along! Unattended. Mistakes can be made and you can't blame all for the mistake of one. PLUS it can be very hard to tell the difference between a sick pt and an intoxicated one. It's not like he called for the police. He must have called for ambulance to transport to hosital for a reason.

    • I am a 17 year vet firefighter/paramedic/tech rescue trainer and I can also give you plenty of stories of EMS ACPs making big mistakes at calls. Do you want to go there? We are at the same calls and a lot of the time we are NOT returned to station but go with the ambulance to the hospital because our help is needed. What about when we are at a medical call for 2 hour s waiting for the EMS guys to finish "lunch"? We are not given that luxury! You sound like a very inexperience medic.

    • Your an idiot. There is absolutely no difference between the 2 and you should know better. In fact many, many have more time spent working as a WEMS PCP than probably you have. The fact that fire crews are cleared is because the majority of calls are minor in nature. True emergencies are few. If you want to get into people making mistakes it would be a big mistake because i have kept a book of People making mistakes.

  15. Lets face it. This article is just another attempt for the Fire Dept. at justifying their inflated budgets and protecting their jobs. Eventually a politician will raise an eyebrow to where they are allocating the public's money. (Pop into a hall unexpectedly someday and you will know what I mean) If this was truely about patient care, they would be looking at more
    ACP ambulances on the streets of your community, and leave the Firefighters to fight the fires. If you are looking to interrupt their down times to justify their employment, check with Public Works. I am sure they will have some work for them.

    • Fire based ems does exactly that. Fully trained Firefighter Paramedics attend to ems calls and that frees up more ACP ambulances. It is working in Winnipeg and you can't deny that.

      • Define "working". Patient care should not simply be defined as a good response time. Research based on patient outcome is no where in these aurguments.

  16. Its a shame that Rachael Armstrong did not do her research properly and instead relied solely on the IAFF opinion. Firefighter call times are based when their wheels are rolling, not when the call comes in. With ambulance dispatch, as soon as the call comes in the clock is ticking, funny how Rachael Armstrong did not present this. Firefighters are concerned as their calls are diminishing and are needed less and less. They see medical calls on the rise and are trying to jump on the bad wagon. Fire , if you guys want to be medics, go to school for 2-4 years. Firefighters are a vital necessity, but they are trained to fight fires. Let the fire fighters fight fires and let the medics take care of all medical calls.

    • In my part of the world, a PCP paramedic gets the same amount of training as a PCP Fire fighter. I don't know where you go to school. If someone is a trained paramedic, it doesn't matter wether he works on an ambulance or on a firetruck

    • Geoff – some of us DID go to medic school for 2-4 years. I wanted to be a medic AND a firefighter. I'm fully trained to do both jobs AND I do do both jobs under the same roof

  17. As a Winnipeg firefighter I was skeptical years when the cganges started to come in. I can now honestly say I believe this "new way" of doing things is a tremendous asset to the people of Winnipeg. I've seen it first hand countless times where our arrival on scene has saved lives. Be it delivering epi to the patient that was about to have her throat seal shut or the gentleman in the back yard who still had a shockable cardiac rhythm that ended up with a second go around. We have better outcomes because we're on scene faster and can provide earlier intervention.

  18. All political posturing aside, I'm glad to have this system on place. I've lived in communities without firefighter-paramedics and 2 with them. Having needed them for my parents on two cooasions, I'm greatful those guys were there to respond because they were there in only a few minutes to provide medical assistance.

  19. As an observer and participant in the EMS system.
    The question becomes a simply one do need you EMS within a timely fashion. Medical science proves that having caregivers to assess and adminster required treatment as earky as possible save lives.
    As a 20 year firefighter and witnessing the this additional service delivered by firefighters not only to assess, but can stabilize and deliver certain drugsdone on scene thus saving precious time and having the success rate of survival increased.

    • Ok what ? Your statements contradict;

      1- You state Quote: "The question becomes a simply one do need you EMS within a timely fashion"
      2- Then you state Quote: "Medical science proves that having caregivers to assess and adminster required treatment as earky as possible save lives."

      Have any Evidence to Prove that Fire based EMS is superior to survival outcomes ?
      Your suffering from Cranial Rectal Inversion and need treatment.

  20. So if we can put this all in layman terms. There are Electricians, Plumbers and Carpenters. Which would you call when you need help with your heart wiring ? You would call the electrician as they are the expert. If there is only a plumber around yes they may be able to help out as they work in the building trades. If your a company that needs more electricians would you train the pulmbers to do basic electrical work ? No youv would perhaps change your budget streams to get more Electricians on staff. Each has a specialty. To put in a wall plug many people could do this. To work on the main panel you really want the pro the electrician. The skills that a paramedic does are easy to teach. The training is in the clinical assessment and the complicated human body interdependancies that can be associated by disease procsses. When you go see your Dr. you go for the assessment and knowledge of how many different factors, signs and symtoms, drug interacctions, drug complications etc etc etc. This can be trained through 2-3 years of Paramedic College courses and associated hospital clinical time and field paramedic supervised patient care. If the Fire service wants to do Paramedic Leve Care then please go to school and tsake the requred courses. Don’t pretend a EMR course is going to offer the public what an Advanced Care Parameidc has to offer. Most urban centers around the world are reducing response times to Patients by stafffing Paramedic Response Car programs. One Paramedic in a response Car can quciky assess, start treatment and decide if more or less resources are needed. Why send a 600,000 dollar pump with 4 members to a medical call when the way others are improving medical response is to send 1 paramedic in a police style car. Best of luck uncovering the facts as the IAFF is a powerful lobby group that paramedics can rarely compete with. We focus our efforts on our patients.

    • Get your facts straight. Firefighters in Winnipeg are now PCP's not EMR's Typical of most misinformed Paramedics. Again quit trying to compare jobs. I guess the same comparison could be used and saying why see an undertrained Paramedic when you could be seeing a highly trained ER Doctor. Comparisons don't work.

      • The scope of Practice for PCP vs ACP is rather different is it not?

        Call yourself a PARAMEDIC in any other country in the WORLD and you can be dealing with charges, only Canada fell into that trap.

        • I thought we were talking about Canada. Guess you weren't

        • So you're saying that all PCP's are not paramedics. I guess that means that more than half the paramedics who are employed by WEMS and a vast majority of paramedics in rural areas are not in fact worthy of the title. I guess only when you become an ACP (ie. "one test away from being a doctor") you are worthy of the title. Quite arrogant!

          • No not arrogant if you actually understanding the scope of practice for each level the Primitive Care Paramedic is limited at best and in addition to EMR skills set is Ventolin, Epi (prelods), Glucagon or D50W (D10W) in BC thats IF those PCP are IV endorsed, maybe a Combi tube and NTG (if the patient is prescribed it) and oh yes aspirin.

            This is called the EMT I level in the USA.

            And here in lies the problem that the expectation of the general public is when they see a Patch saying Paramedic the actually expect Advanced Life Support and this is what they duped into believing the are receiving.

            The arrogance finger should be pointed back at yourself , just how long is your CMA approved program 6 months and the ACP level is 2 years get off YOUR high Horse you may fall off and need pain medications and something only an ACP can do.

          • You' re right, every call in Winnipeg requires a "Paramedic" with ALS skills. And every patient expects the person who shows up at their door to intubate them as soon as they get there, my mistake. Sorry the Paramedic title isn't entirely yours to wrap yourself in, make sure you tell your patient the difference between you and your "EMT" partner, I'm sure they'll feel better that they are not being duped and will make sure the "EMT" gets in the driver seat so you can provide all those ALS skills.

          • Well besides being overly sarcastic the fact if the matter is that realistically ~ 10 % are requiring ALS intervention, that said I have yet to have an EMT partner that enjoys working with an ACP. And driving to ER is dependent on the call, only fair in a good partnership that all responsibilities be shared . In fact there is never been a discussion over levels of care on scene as that would be taking away from the patient care focus and quite unprofessional.

          • Primitive Care Paramedic…Geez, with your attitude I can't imagine why an EMT wouldn't want to work with you. In fact I would say much less than 10 % require ALS skills. In fact even at 10%, you are arguing that EMT's are capable of doing 90% of the EMS workload. So wouldn't it be reasonable to assume the general public is expecting EMS to be able to provide BLS skills 90% of the time. There is no doubt that ACP's are a valuable and essential asset to emergency services but respect goes both ways. You might want to look in the mirror and ask yourself if EMT's don't like working with ACP's or maybe it's your attitude towards them that is the problem. By the way I've worked with lots of great ACP's who have been more than happy to share their knowledge and training-you work with people, not titles!

          • Well because the ~10 % I refer to are true life threatening situations where "EARLY" ALS interventions do make a difference to positive outcomes, on the other hand BLS the scoop and run in the "Canadian EMS experience" can not be statistically evaluated because there is not enough ALS providers ….. Nationally.

            Then theres the capability of Pain relief, that is rather one of my personal goals as a Paramedic, the PCP is limited to entonox (thats if medical director allows) so you are truly barking up the wrong tree !

            Comparing a 6 month program EMT/PCP to a ACP is just pompus (the prerequisite being (PCP/EMT) and then additional 2000 hours of didactic clinical time under the wing of MDs (specialists) and experienced RNs and then field endorsements by proven field evaluator and you suggest that the title should be synonymous is a huge folly and confuses the public at large (ps your government loves it btw) Do as they have done in BC and call everyone a "Paramedic" and see if the purse strings held bu bean counters open up to provide an improved level of care ….

            It "Primitive" gets your goat perhaps go back to school and give it a go yourself ? I dare to throw a gauntlet at your feet to educate and improve yourself … or you could just continue to believe that EMTs do not "like" to work with me EPIC FAIL.

            If the term being called "Primitive Life Support" is upsetting then working the street will send you crying back to your Moma … Field Medics are one of the highest "statistically" physically assaulted group's of all occupations in health care let alone cursed out for no tangible reason … just saying a thicker skin may assist you in your long term goals. Good Luck.

          • Blah, Blah Blah. you're the one that said EMTs don't like ACPs. I 'm not crying to my "Moma" (whatever that is). I'm just saying that you are obviously incredibly self important and suffer greatly from illusions of grandeur. I know it hurts that the general public thinks of you as an ambulance driver but we both know you're more than that. By the way, anyone can become an ACP, you're living proof! It's just a matter if you want to be bitter, insecure and miserable for a career. Obviously you are. Good luck with the pending MI.

          • Blah Blah Blah ?… I believe you missed the entire point of my post, but a most clever response and quite articulate.

            < edit correction > "that said, I have yet to have an EMT partner that does NOT enjoy working with an ACP" (my bad?) It opens doors, minds and keeps both partners sharp.

            <edit> Mummy or Mama , insert the term of endearment as you would wish, your continued sarcasm speaks volumes.

            As an ACP …. well, I have been called FAR worse that an Ambulance Driver and got to love those little old gals that could care less what level of training is because they know that one cares for them. In fact at parties, I go for the shrimp and those little tasty wieners and when asked what I do for a living my response "I am Delivery Truck Driver" nuff said ?

            Your comment anyone can become an ACP well we need more out there whats stopping YOU ?

    • What about the Carpenters?

    • I've been an ACP medic for 12yrs (emt for many yrsbefore that). I have just as much skills and experience as any other medic at my level.
      The badge I wear says FD.
      Sometimes I take my skills on an ambulance, sometimes a fire truck to back up our own guys.
      The point is, we can respond to EMS or fire and we can do either job fully and are equipped and ready to do so. While Ems is waiting for 4hrs in the hallway I'm doing more calls – EMS and fire

      • And then you check out your retirement fund as many EMS providers have NONE .. sour grapes no, Same Scene Sam Pay as they say in BC. then legislation allowing for FF early retirement and pull CPP at age 55 … tell me again why FF/ALS is superior ?

        If your not waiting in the hall with that patient you treated in the field then your seriously lacking the medical legal responsibility to your patient and the continuity of care that YOU learned in school, one cannot pass of responsibility to a subordinate level of care UNLESS to invasive treatment was NOT provided.

        • I don't know what you're trying to say here but assume its negative (based on your other remarks). What do you want me to say? If you guys want a voice get a decent COLLECTIVE union and stand together and then you'll begin to get the same things – for some reason EMS people tend to stand alone in their own communities and don't want to band together (don't know why that is).
          BTW – we don't retire early. Of the dept that do many can only do so because they've contributed into a supplemental pension – basically they're svaing more than you and I so that they can. You can negotiate this with your employer too. What's stopping you?
          We obviously know about continuity of care. Again, I don't know what you're trying to say
          Don't cry, apply – as we say…. (we are hiring right now BTW)

    • We have the same training as firefighter/paramedics as most of the EMS dept does here in Winnipeg PLUS haz mat, tech rescue, auto ex, confined space, trench, suppression, arson, etc,etc

      • Jack of all trades, master of none! You should focus your efforts on only a few specialties. You've mentioned a half dozen or more. Leave paramedicine to paramedics!

  21. How about a highly trained Fire-Medic

    • Unless your Superman you cant do both.

  22. Brandon Firefighter / Paramedic

    The firefighter / Paramedics have been providing EMS and fire fighting to the citizens of Brandon and surrounding area for over 100 years. We are a fully integrated system with ambulance transport. The Firefighter/Paramedics in Brandon are very highly trained in all aspects of firefighting and EMS including medical ACLS ( advanced cardiac life support). Quite frankly, what this allows us to do is save lives.

    It is unfortunate that we have to speak about money when it comes to emergency services, but we all know that cities look at efficiencies, but that's the world that we live in, and the fact that Brandon has Firefighter / Paramedics providing both of these important services at a very high level of care to the citizens under one department is a huge savings for the city, not to mention more efficient.

    When we look at caridac arrests which are the most serious calls our department will respond to we see that in Brandon almost all cardiac calls have 5 Firefighter / Paramedics attending the scene, this allows the patient to receive compressions, ventilations, defibrilation, admistering heart start drugs, and finally a scribe to document the call. This is done all at the same time due to the fact that we respond quickly and we respond at the same time. Putting all the rhetoric aside all our department does with the our firefighter / Paramedics is give the patient a strong chance of survival and save lives and isn't that what its all about.

    I can't speak for any other departments, all I can say is that our system has worked for over a hundred years, and over that time we have probably saved as many lives if not more than some paramedic services. The only difference is that we have saved these lives in a more cost effective way, and that's not a bad thing is it?

    • I am glad your system workes. Historicaly, were fire has stated the ems it seems to have worked better. However, in places were they try to amalgamate 2 different cultures it has not gone so well. Look at Calgary, Edmonton, and New York City to highlight failures in amalgamation. Yes, New York is still a combined service, but look at the overt hostility between the medics and hte firefighters. That cannot translate to good patient care. Also, Brandon is a city of 40,000 people and you have 56 staff (http://www.city.brandon.mb.ca/Main.nsf/Pages+By+I… Where I work we did 85,000 calls last year. There are literaly, hundreds of medics and firefighters. Can you imagine the expense of crosstraining that many people. Also, we have 48 hours of mandated in-service training for ems; huge costs if you try to cross train this many people.

      • Madmedic – When did Calgary/Edmonton try to amalgamate? Medicine hat is the only place I know of that really gave it an effort in Alberta. The rest was all just talk/rumour/speculation.

        You're right in that it will cost a lot to cross train but look at what the Alberta government is spending now (needlessly) so that the province can run the EMS service here. Integration does work. Its not easy to implement but it makes more sense than copying a model that is already proven to fail.
        In the past, our community taxpayers paid for 1 department to handle fire AND EMS. The future is uncertain but to invest in cross-trained personnel only makes sense. My wage is no higher than either of my counter parts in other cities yet I can perform the role of 2 jobs.
        The cost of a carreer is 100X more than the cost of cross training

        Brandon might be a smaller center (as is Lethbridge – my city) but if you compare calls per unit/ambulance we're busier than Calgary. Maybe Brandon is just as busy?

  23. As with all other forms of health care, paramedicine is evolving to suit the needs of the population, and fire fighters have now been included in that. No one asked them to carry this burden but they have done so with great skill and dedication. These proud men and women perform difficult work “so far outside the realm of what we (they) anticipated” and they deserve our support and respect.

    • OMG rounds of Ipecac and I will buy first round !

      BTW whats the demographic breakdown of these proud Men vs Women in Fire Departments ?

  24. Wow! Looks like we need a teacher in the sandbox. This article was intended to inform the general public about how Fire based EMS systems are starting to show improvements in service. As a vocation (EMS/Fire) we see deeper and are ready to attack and protect our own . This is not the response we should be showing to the public on a open forum. I think we need to work together and stop the bickering between us. I will admit if money was not an issue I too would love to have a full ACP staffed unit arive on scene everytime. And don`t tell me to cut fire staffing to do it , either. That is an ignorant point of view that needs to be changed. I will not apologize for the strenght of my union, the bed in my dorm or the lack of fires that apparently bother you so much. I do need to learn more about Paramedic issues and respect your points of view. Winnipeg is trying and we are not perfect but our system is helping to reduce strain on over worked paramedic units in our city. We have a long way to go and budget dollars are not flowing freely. How about coming up with positive solutions , instead of bashing the fire service. And if you stand behind your negative comments then put your name to them.

    • Hey Jay:
      Your right we do need educated informed individuals to teach, please open your mind to include many other of the options presented, Fly cars, increased funding to EMS, and perhaps look across a few borders and ponds to se whats happening outside "Planet Winnipeg"

      Paramedics did not start this controversy the IAFF did !

      • See this is yet another example of trying to fight with IAFF members instead of working to better the system

      • Again, your comments seem to be geared at soliciting a negative response from the fire service. I feel that your views are valid in many ways but your delivery is poor. You need to to stop the bashing and offer positives instead of the current dish you are serving. Try writing an educated well thought out response for publication that highlights EMS and your issues. I think with your knowledge and experience you might be able to get it published in a EMS trade magaizine or better yet Firefighting in Canada has a second magazine called Canadian Firefighte and EMS quarterly. I would love to here about Fly cars!
        regards,
        Jay Shaw

        • Open your mind Jay Shaw if you truely want to have Prehospital delivery of care improve in Winterpeg.

          Fly cars supervisors units with ACLS Paramedics have been in operation for may years in many areas, try Calgary or Edmonton to start with, well over 15 years Alberta or perhaps in the UK or Australia don't look to old paradigms

          Point being an initial responder a Paramedic "Practitioner" and the Initial responder based on Dispatch Information one that has enough experience and Education to determine what level of care is required and then summon the most cost effective means to transport if even required to be transported (fact of the matter realistically is that 90% of patients visit to ER do NOT required admission) then summon an ambulance, by personal family member, by MICU or additional resources or even throw in a few sutures or consult with MD or Social services, and then of course treatment and release by increasing the scope of practice in legislation and/or cancellation of transport as this could be a huge step forward in delivery of health care, heck many patients need not to go to ER and sit in a chair for 8 hours only to receive a script for antibiotics or a pat on the head. Tell me this isn't so and I will go back to loading chairlifts in a Ski Area or flipping burgers.

          In the UK in London for example Steven Hines Paramedic Director of Clinical Support Manager London England to start with http://en.wikipedia.org/wiki/Emergency_Care_Pract… an interesting concept and very cost effective.

          Perhaps look to other publications other than Firehouse as the a means of information and goggle is your friend btw.

  25. Wow, Rachel Mendelson how much money were you paid to write this article in such a biased fashion? You had plenty of factual information provided from a paramedic standpoint to, at the very least, balance your article and let readers make up their own minds about the validity of fire responses to medical calls. Too bad you chose to ignore it.

    When it comes to my family, I'll take the 2+ years of college educated Paramedic advanced assessment and care arriving a few minutes later over the fire department's few hours of first aid training any day.

    • Again you are showing how misinformed you are. Before you show your ignorance maybe you should find out what training actually takes place. You will find that in Winnipeg, the Firefighter/Paramedics have the same training. Go to the same school and take the same exams and have the same Provincial license as all Paramedics in this province. And many of them are trained to much higher levels but are only allowed to practise at the PCP level. The days of someone with simple first aid have been gone for 30 years.

      • Same in Alberta integrated fire departments. Not only do we arrive quickly we provide the ALS care and personnel to get the job done safely, quickly and in the pt's best interest. Check your facts about firefighters before you make a blanket statement.

        • So where per say, Calgary and Edmonton does NOT … only Strathcona, Leduc, FMM, Red Deer and Lethbridge and soon to go the way of the dinosaur, watch AHS EMS and you will soon have to make a choice .

      • Whoopee a 6 month course "max" and why are they only allowed to practice to PCP level, bah hum bug, a true waste of resources.

    • Actually "Jules", if I'm involved in a medical emergency I would much rather have a medical doctor with 8+ years of college education over you. I say we should fire you and hire a doctor to do your job… good logic, don't you think?

      Stop with your petty, selfish rangling over turf. This is about the patients, not you. Fire fighters are already in the community, ready to respond. Why not train 25% of them properly (i.e. as a PCP) to supplement the paramedic service. That was we can save more lives.

      • Who being petty Sergio, if your roof is leaking do you call a plumber? The same applies to Medical Emergencies and Fire emergencies. If my house is on fire I want the best trained people at my door to put the fire out, the same if my family member is choling I want the peole with the training and expertise at my house to remove the obstruction. I do not want to have any firefighters lose their jobs or have their budgets slashed but if I am spending millions of dollars on a service who has 30% fire and 70% medical then why not reallocate resources and scale back the the one side and bring up the medical response side? In additon to this are you going to pay the $10000.00 dollars and take unapaid leave to become a PCP and then another $15000.00 to become an advanced care??? If so step up and go for it because I am not spending my tax dollars to educate you when I had to pay for all of mine.

        • First of all, your analogy for a roof leak is completely flawed. My roof leak is not an emergency and can wait for someone to respond, unlike many medical emergencies where minutes are precious. Moreover, many roofers are carpenters or other trades who have simply worked in the business (i.e. not a skilled trade). Stick to the issue instead of these ill-conceived analogies.

          Secondly, your argument that you want the best trained people there is fair, but unrealistic. Paramedics (PCP or ACP) are not the best trained medical professionals. There are doctors and specialists who are better trained, but they serve a different role. Paramedics are needed just as much as doctors and nurses are needed; no one is arguing that, nor is anyone looking to replace paramedics. In fact, we are trying to add more paramedics to the system by putting one on every fire truck.

          • Do one Medivac from a "rural" facility and your opinion would change markedly , I like the leaky roof scenario its simplistic and is very realistic.

        • CONT'D

          Let's be clear here; we are not talking about taking Joe Firefighter who has worked on the truck for 20 years and making him a PCP. We are talking about well-trained PCP's – many of which have experience working on an ambulance – who have cross-trained to fight fire as well. These individuals are hired with these skills and training already, BEFORE they get hired with the department. There are no tax payer dollars going into this training, at least not in Winnipeg where I live.

          • So why are there not "EMS/Fire" system (always see "Fire EMS," in that order….property over lives?) simple semantics show true intentions. Same goes for "fire based EMS" Would we be having the same discussions if the Paramedic Chief started to run the fire department? Agree, its easier to train a Paramedic to become a firefighter vs a Firefighter to become a Paramedic (and less costly). As a simple taxpayer reading through this I am wondering why we have not seen an EMS system "take over" a fire department. Happened in any any other country Europe?

          • Actually, the Chief of the Winnipeg Fire Paramedic Service is a Paramedic brought up through the Winnipeg system. He is well respected,both by Firefighters and Paramedics who appreciate his leadership in the changes that have been implemented here.

    • When it comes to my family, I'd like someone there in 4 to 6 minutes with the proper training to provide first aid, oxygen therapy, defibrilation, and medical assist with some basic drugs. Pretty basic stuff for firefighters who have doing it for years while waiting for an ambulance with a crew that typically takes their time and is never in a hurry to get to the patient. As the studies show, you can have all the advanced assessment you want, getting the patient to the hospital quickly is what saves lives and the more ambulances that are attending to non-emergencies the greater the delay in their response. Ontario has the lowest survival rate in North America based on a significant cardiac event. Things have got to change.

  26. To: Editor of Mcleans
    From: Concerned Paramedic

    Please do a cost comparison between Toronto FD and Toronto EMS. Add up the cost of the two departments. Show this to the people of Canada. Then ask the question, why is it mandated that when a residential area is planned that a Fire station has to be placed in this new community, and not so for an ambulance station. Also, look into the offload problem in the GTA. Hours and hours waiting in the hospital trying to unload a patient. Paramedics stuck in hospital limbo while the community gets less and less EMS coverage. The firefighters are needed to fight fires and the paramedics are needed for patient care. Look into what happened in Edmonton when the Fire Department took over ambulance coverage. I will give you a hint, it wasn't pretty. Please release this information to the public, they deserve to know where their tax dollars are going. Pumping millions into fire departments across Canada is crazy. Just add paramedics and make sure they can get out of the hospitals in a timely manner, problem solved. I bet the cost would be 100 times less. Cut through the Fire Fighter PR and get to the facts. Do you relies that with every tragic event that hits the news stands, such as a murder, a house fire, a horrible multi-car pile up on the 401, SARS, Swine Flu, paramedics are there and get no recognition. And One more thing. When paramedics arrive on a medical call guess who steps aside, everyone. We take over care of the shot gang banger, the asthmatic teenager, the fifty year old heart attach patient. Police, firefighters, off duty ER nurses and even doctors stand aside. We have the training and the gear to save lives, in the out of hospital setting. Ride along with some paramedics in Toronto and have your eyes opened.

    • Cchris – Respectfully, you cannot do a comparison this easily between FD's and EMS. They are totally different jobs requiring different training, manpower, equipment etc.

      Neither emergency is more important than the other and resorces need to be available for BOTH. Some things cost more than others but the cost does not reflect the need – ie, just because a fully staffed fire truck costs more than an ambulance does not make it less important

      As an EMS worker (as I assume you are) you should know this

  27. Fire fighters that want no part of EMS or believe that it is somehow related to the 24 hour shift need to spend less time complaining and more time educating themselves on what their own membership has endorsed.

    Toronto Fire Fighters endorsed pursuing a more effective involvement in EMS over three years ago. That does not mean taking jobs from paramedics, but it does mean making more effective use of fire fighters who arrive on scene first. The studies out of the U.S. have shown that quick triage and "scoop and go" has been far more effective in saving lives than the movement towards full ALS EMS departments. Fire fighters (once properly trained) being first on scene would be the logical ones to determine the need for an ambulance. This would free up more ambulances and at the same time not impact fire responses to other incidents or even impact the number of EMS calls fire responds to.

    There has to be meaningful discussion and dialogue between all the stakeholders to determine how to serve the public better in EMS without just throwing more money into the system. Paramedics and fire fighters have to take a step back and work on what makes sense, not turf protection.

    • I have read this "first on scene" buisiness in many postings here. Really? Working in a large urban EMS system responding out of the same halls (and halls much further) to the same calls the fire dept certainly does not "beat" us most of the time, in fact me and my peers often cancel them prior to their arrival.
      If, in your service community the fire dept "beats" EMS to calls that sends up a red flag indicating there needs to be more ambulances.
      Chris, your comment was well put

  28. I am all for saving lives. As a medic for 28 years I don't care who gets to the cardiac arrest first as long as the patients gets shocked. Where I work you are more likely to be defibrillated by a rink worker or life guard; our public access defib. is second to none. I would not like to fight fires and most firefighters I know do not like going to medical calls. Each profession trains very hard to be the best in their field. I do not know how someone can be expert at both. There is far too much turf protectionism in both fields. However, I too am concerned about the title picture that depicts a Toronto Fire Fighter perfoming a skill that would not happen there.

    • I forgot this part. " As one member told Braedley, “Some people would say she's a nuisance, but she needs help. There is no one else. So we do it.”" "There is no one else", give me a break. What fire forgets is that they roll on about a quarter of our calls. We do this kind of call all the time. When an elderly person falls from their bed, who puts them back? When a disabled person needs help back into their wheelchair who is there? The medics are and we do it because we like to help.

    • My Friend – the picture shows a Winnipeg Fire/Fighter Paramedic – not Toronto.

      • Apologies, I stand corrected.

    • MadMedic – Come down to Lethbridge. It is possible to be experts at both – we've been doing it here for years (as has Red Deer, Fort McMurray, Strathcona and host of other smaller Alberta depts).
      I'm sure for the years I have in (less than you) I've seen just as many sick people as you have over the same period and I would also assure the other firefighters that I've seen just as many fire responses (the fire is just as hot here as other places)

  29. Yes I would like a highly trained medical professional, but unfortunately the doctors are busy in the hospitals saving the people that are there. I want to get to the hospital where the top medical professionals and equipment are located, but in the meantime I need someone to assess and treat me as quickly as possible. So I look forward to seeing a paramedic at my door as quickly as possible, but if a fire fighter – paramedic can get there quicker then I'm glad to see them as well.

    • Well thats all well and good although somewhat sarcastic but not everyone in "Canada" has those options for example to door angioplasty or a Trauma center now with the increasing scope of practice of the ACP/ CCP ie thromolytics delivered in the field (as London UK) the clot busters are on CAR, how about a Diabetic needing D50 W, a Hypertensive Crisis, or a the Asthmatic needing Ventolin or CPAP . These interventions do save lives unfortunately property is has a higher priority than life in many cases. Get there more quickly due the funding and call volume but just how does one actually transport to that facility hence your point becomes mute.

  30. Having called upon this service, I have nothing but positive things to say about these hard working firefighter paramedics. Totally awesome!

  31. The only reason the IAFF has been pushing for literally overtaking EMS provision is an ever declining call volume for actual fires. They have known this for years, and as a stagnating workforce are looking for something to do

  32. Most reasonable people understand that having Firefighter Paramedics in a Fire based EMS system is highly efficient in that it enables them to cancel ambulances when they are not needed. These ambulances are then freed up to attend calls where transport is required. This has happened more than 10,000 times in Winnipeg last year alone. This saves tax dollars and delivers a more efficient service. The only complaints are from disgruntled ambulance personnel who insist on tilting at windmills.

  33. If advances in technology are aiding in the realm of fire prevention, it’s only logical that fire fighters diversify their skills. If paramedics are not available to respond because they are “in short supply” then by all means, cross train the firefighters.

    As a taxpayer, I expect a certain level of service. If I’m in a dire situation and require immediate medical assistance, I want someone who is qualified to respond. I don’t care what uniform they’re wearing.

    • So many points, so little room…First, it is not cost efficient to send a $600,000 fire truck with 4 FF's (approx. salary total ~$350,000/yr) to attempt to cancel ambulances when they are not needed. In some municipalities, an experienced BLS or ALS paramedic in a single small vehicle is sent to do the same thing for far less.
      Secondly, it gauls me when FF's say they should be doing all the ems anyway as they often get there first and faster. As a paramedic, I am sure if my department had the same amount of ambulances as there are fire apparatus, they would rarely be first. And if they actually had fires, high angle rescues, trench rescues, water rescue calls, HAZMAT all day, every day, the fire departments would NEVER have the time to do ems. Apparently their job functions do not encompass enough for them to keep busy doing firefighting duties.
      see next…

      • Our FD does run the ambulance service and has quite well for nearly 100 years.

        I cannot believe you're telling "taxpayer" that the life of his or his loved ones is not worth the response of an engine crew because the ambulance crew has been in the hallway for 4+ hours.
        Why not sell the small vehicle that the medic has, put him on an engine. That way he can be further utilized to do fire? (also, 1 less FF) – its the exact same arguement.

        I think you're overplaying the amount of EMS calls that you do as well. Most of the time the EMS crews are sitting in the hallways. I do at least as many responses on the fire truck than many other EMS crews – especially the larger centers… just sayin'

  34. Part One;

    I have never read such a biased article, oh wait, yes I have, anything written to do with the Fire Department.
    First off, this is nothing more than another example of Fire Services and the IAAF trying to justify thier existance and thier over inflated budgets. Perhaps the author should take 10 months and ride with Paramedics and the write another article after she spends 12 hours on the road per shift without a meal break or down time, being spit on, verbally abused and not getting a theraputic hug from the Captain when a child dies.
    To Be Continued!

  35. Part two;

    In the mid '80's the Government realised that there weren't enough Ambulances to serve the public need so, in order to save money and face, they approached the Fire Departments and said "hey, we don't want to pay for more Paramedics and Ambulances so, we are going to have you respond to a select type of call, hold the patients hand, put oxygen on and do a circle of healing until we can get an over worked and under funded Ambulance to them" thus, the invention of "Tiered Response", and putting the onus of funding in the hands of Municipalities to send 1, sometimes 2, half million dollar fire trucks and 8 people to a cut finger.
    To be continued

  36. Part 3

    When it is mandated that there be a fire-hall for every (and I'm guessing here) 50,000 people but one ambulance for every 150,000 people (fact) what does that tell you about where our politicians put thier priorities (property, not life!!) Where I work and live, we have a population of 160,000 – five fire-halls with 2 fully staffed 24 hour trucks = 10 fire trucks but,only 2 Ambulance stations with 3 fully staffed 24 hour trucks and 2 fully staffed 12 hour trucks.
    I'ts time that government's realize that human life is more important than property and put the funding where it is needed – more Advanced Life Support Ambulances and Paramedics.

    To be continued, again!

    • I've already said this but…
      How many guys does it take to fight a house fire? How much equipment?
      How many guys does it take to get someone to the hospital? How much equipment?

      How much does each cost?
      One will always be A LOT more than the other. Why? They are different jobs and you cannot compare them this way.

      What's more important? The severe asthmatic 6yr old or another 6yr old trapped in a burning building?

      • Good argument, so as a paramedic and firefighter and no other apparatus available which call for the 6 year old would you go to?

  37. Finally, and this one took some research through public records: the City of Oshawa, Ontario's (population 135,000) fire budget last year was over 25 million dollars and they don't do EMS calls, Durham Region, Ontario's (population 800,000) EMS budget was 17 million. Imagine what Durham could do for it's residents with 8 million extra dollars in it's EMS budget. Durham by the way, has the highest save percentage of out of hospital Cardiac Arrest in the Country even when Tired Response is taken out of the picture.
    It's time to stop the biased reporting and state the facts, EMS needs more funding not the IAAF!

    • If you're going to speak against the fire service you need to get some idea about it.
      The IAFF is a union – the public does not fund a union…

      • going out on a limb, the point is allocation of funding. 8 million dollars could possibly put , 5 ALS providers in an ambulance and 5 ALS rapid response units for a year (employing 15-20 people) dedicated to pre-hospital care, or 3 pumps (employing 12-15) for fire supression and "first" response….it's all about allocation of funding.

  38. Thirdly, there is a deficit of truly experienced fire-based paramedics (esp. in Winnipeg) as this program generally hires new individuals, places them as the primary team leader amongst a fire crew that have less training, and more senority than them, and then expect them to lead that team, in an environment where senority and Captains rule. Generally, the fire-pcp is left, under supported in his clinical assessments and decision making by his crew, all prior to ambulance and ALS arrival. This is unequivocably unlike any medical response, either prehospital or in hospital.
    Fourth, if you believe ALS provision should come off a fire truck, read my third issue and add a massive amount of training, clinical, and in field experience all usually found by working on an ambulance, and think about that fire pcp . Nope.

    • I dunno, Pete. This applies to EMS services as well where the average experience level of the crew is 2-3 yrs. Some major centers are hiring entry level trained people (only a 2 weeks course). Theres first aiders out there with more than this!
      Although you MAY be right – it cuts both ways

  39. Everyone is entitled to their opinion and we're all entitled to voice that opinion. Before you do voice it though, think of how it sounds. Think especially how it sounds to the non emergency worker who is reading your post. Both PRO and ANTI firefighter comments on here sound ridiculous. We all have a purpose. Stop publicly debating on behalf of one side or the other while using personal experiences as dogmatic examples for your chosen cause. It's embarrassing to the rest of your co-workers. Not a fan of this article.

  40. At least half the Fire/PCP come from the EMS side and those Captains have been doing the job for 30 yrs and most likely been been trained as a EMT 100 plus they also have 30 yrs of EMS experience going to calls. Also aren't the Medical Supervisors supposed to be attending each fire hall within his district at least once a week to check with fire/pcp's? Quit bashing Firefighters and doing your job. I am truly getting sick of the whining going on by a few paramedics that actually think they know whats going on. Get your facts straight.

  41. Pete
    Whether or not you are aware, the majority of FF/PCP's in Winnipeg have many years of experience on the ambulance before crossing over. Alot of the cross-overs have very few positive things to say about their time spent in WEMS.
    Complaints range from having burnt-out partners with no passion left for the profession, to long of hours without breaks, to having to precept poorly trained students from nearby colleges.

    If EMS members spent half the time working and fighting on their own issues and rights, as they do on fighting and talking down to their fellow firefighter co-workers, some action might get done.

    • Really? Burned out paramedics. I don't suppose it has anything to do with the ems doing 10 times the calls with a fraction of the resources. How many firefighters sleep their night shift and then go off to their day jobs? What do medics do after a night shift? We go to bed. The only reason you are interested in doing patient care is the you have done such a good job at fire prevention you are putting yoursleves out of a job. I have nothing but respect for firefighters and my job would be alot more difficult without their assistance, but I am tired of hearing about how you can do it better.

      • Again you are showing your ignorance. You cannot compare jobs or call volumes because the jobs are not the same. Once Paramedics understand that we will be way better off. No one said we can do it better. We are a cog in the wheel that hopefully makes the system better. If you would direct your anger at bettering the system rather than always bashing the fire service maybe you wouldn't be so burned out. If you really want to compare jobs maybe you should compare your self to an ER nurse but then they have a 4 yr University degree.

        • Nope You just did there Reg tell me MadMedic is not totally on the money with his post, theres no anger just realistic facts.

  42. I am close to retirement after 30 years in the Fire Service, and frankly, looking forward to it. I tire of comments from those who continually attempt to fan the flames of a 'turf' war between fire fighters and paramedics. The fundamental driver of pre-hospital emergency care for citizens that I was taught, and ascribe to, is "the highest level of care as fast as possible". Trained BLS and ALS paramedics, no question, have superior training and qualifications than fire fighters. I have the greatest amount of respect for what they do. Can and do fire fighters make a difference in positive patient outcomes? Absolutely. I've seen it multiple hundreds of times in my career. If a Girl Guide trained properly in current CPR protocols is first on scene at a cardiac arrest, then she is the highest level of care until relieved by someone with higher qualifications and better training & resources. The principle is really quite that simple. No fire fighter that I know wants to take away paramedic jobs. No fire fighter that I know wants to transport patients to the hospital. All most of them want to do is make a positive contribution to the community and a difference in the lives of its citizens…and they do.

  43. Pete seems to be another unhappy Paramedic without the facts. If you had stuck with your union President 10 years ago Winnipeg Fire and Paramedics would be amalgamated but no you chose to dump him and go in another direction.

  44. Richard you make a good point except for one. The average firefighter is not interested in taking paramedic jobs away, unfortunately, that is not the case with your union.

  45. I like how you refer to fire fighter EMR. Have you heard of Alberta where there is as mentioned in the reply of fire medic. A very highly trained professional in both the fire suppression side and emergency medical calls. We've competed for those positions in both streams of emergency response and accomplished and completed the education required, passed the stringent ACP testing process and continue to provide one of the highest levels of medical care in the country to this date. Our response times are proven to be far greater than EMS stand alone systems without a degradation in the level of service to either emergency medical calls and or fire emergency. I would like to add in these firefighters have also gained a passing grade in Hazmat, high angle rescue, CBRN and a host of other courses. So yes I would rather have the fire medic show up to my emergency.

    • Yes I have heard of that Province and if you live there with new guidelines from Alberta Health Services you should feel very threatened, I say give it 3 years and Fire Based EMS will be a thing of the past thanks to Druckman, to assume that because one is an ACP in AB and does not have Hazmat, High Angle, SAR, maybe helicopter long line and a few other degrees besides, well makes this your point mute as well.

      BTW have you completed the most enjoyable CIMS Practitioner Module assuring the highest of standards … right then.

      If you are an ACP/ REMT-P in AB then you would know ACoP has yet to establish the CCP level and the arrogance to believe that AB remains cutting edge with all the "health care restructuring" your sadly in error, btw the only CMA approved CCT program is ONT.

  46. I work in possibly the oldest integrated Fire/EMS service in Canada (since early part of 20th century, nearly 100 years). We currently have over 90 crossed trained Fire Paramedics and Fire EMTs and another group of former EMTs and advanced first aiders bringing our total complement to 123 who respond with ALS equipped ambulances, engines, and quints to every medical, fire, hazmat, and rescue emergency in our Community. It is the most cost efficient and customer oriented service possible. It would be a huge mistake to change that. Communities all over North America are realizing that what we do makes sense and Firefighters are the most compassionate people in the world. Good article and anyone who looks at the whole picture will realize this is the only way to go.

  47. As a newer member of the emergency services in Brandon I consider myself very fortunate to belong to a department that provides EMS and Firefighting duties.

    I have read many comments about the level of care a firefighter / Paramedic can provide a patient. I cannot speak about other departments, but the men and women that I work with provide an extremely high level of care for firefighting and medical care.

    I have taken training with other departments in the past and have been forced to listen to paramedics complain about firefighters constantly instead of focusing on their own job. When I came to Brandon I thought I would hear similar comments, but instead I have been surrounded by highly trained Firefighter / Paramedics that put the patient care before everything and continually train year round to insure that the patient care never deminishes. In Brandon everyone plays a vital role in patient care and it's that teamwork that allows us to do a great job.

    As a young man I believe that the choice I made to become a firefighter / Paramedic was the best choice I have ever made.

  48. mike- 25 years on the ambulance!. Paramedics are the key to the health care system. FFs have their place-to assist EMS on selected calls. At best, about 10% of all 911 calls need immediate intervention. the other 90% don't. But they do need assessment and disposition within the health care system. So… mostly, timely arrival is irrelevant when you look at seconds and minutes. For the ones that do count, those calls ocurring LESS than one percent of the time? Decommision a few aerial trucks and park more ambulances at the ubiquitous fire halls we have and increase EMS coverage that way

  49. wow! You are one bitter paramedic wannabe! Your facts are all wrong..I am a 17 year Firefighter/ Paramedic/Tech Rescue Instructor on shift. We are not first aiders but PARAMEDICS as the article states. In case you are not informed, Firefighters and even Captains are Advanced Care Paramedics in many states. We all want to see more Ambulances but you have to solve the problem of off-loading at the hospitals first, otherwise the ambulances just sit there and wait for hours…which brings me to the down time! The down time is both in the station and at the hospital for EMS crews. Our machines get up to 6000 calls a year in the busy stations, what service do you work for which gives you this opinion? You need to have some experience before you start spewing out false ideas. Also, the elderly woman is our Grandmothers, Mothers, Sisters, friends, etc who need help. You have no compassion therefore you are entering the wrong career.

  50. Another example of a Paramedic that thinks that the Fire depts are the problem. Listen up!! Its been said over and over again. No matter if Firefighters go to medical or not we still need the same amount of Firefighters. The reason we have lots of fire stations and firefighters is because if we don't arrive in a timely manner its not just your house that burns but its your neighbours and that neighbours. We deal with the potential of multiple casualties and millions of $$$ of damage instead of 1 patient at a time. Deal with real problems like off load delays, etc.

    • Mike is quite correct and accurate while you remain very defensive, if offloads are a system problem is because there is a lack of clinics and family practice MDs (perhaps re read the article) and remember the sooner you realize Wayne that your attitude is far more of an problem, the ERs are filled for numerous reasons beyond field triage and this is EXACTLY why Paramedic's should be part and parcel of that HC system and why Fire Men should not, Let the true educated experts take it from here …Thanks.

  51. Its becoming a boring and tiring argument you put forward. The sooner you realize that, the better for the whole system. Instead of trying always to bash Firefighters maybe you should look for solutions such as maybe a Triage car to sort out what calls really need an ambualnce. Hospital ER's are full of people that would be better served elswhere such as a Dr's office or a walk in clinic. Firefighters are NOT your enemy.

  52. Firefighters have been providing first aid forever. If they can get there sooner then why not enhance the service and have a paramedic, who can come from any emergency response unit not just ambulance, on a truck that responds within 4 to 6 minutes. They could determine the need to transport and keep ambulances on the road for more important calls. Not enough ambulances???…problem solved!

  53. Mark
    I believe we are on the same page here. The two professions are different. That is why I find it hard to believe this Mcleans article was even written. The expense of up grading fire fighters to the level a paramedic, even primary paramedic is asinine. The job could be done by one paramedic in a rapid response vehicle. To have a 4 to 5 man fire truck racing around the streets doing medical calls would be extremely expensive. Let alone dangerous. I wrote the comment because I have seen first hand the lack of funding for ambulance and its negative results. The FD and EMS draw their funds from the same pool, the tax payer. I honestly believe it would be a more cost effective way to manage medical calls with paramedics rather than firefighters. I have been a paramedic for 12 years and know first hand the importance of the fire department and what they do. I believe we should do more cross training with the FD, in order to clearly define our rolls and to improve patient care. I have brought this up multiple time with my management and their response is always " we lack the funds''. I also know that paramedics have a PR problem. They can not compete with the FD in this area. This obviously reflects their budget problems.
    On a personal note, I know of paramedics that couldn't even go to post tramadic debriefing, due to the cost. Do you recall the poor family that was hacked up in Oshawa last year. Children diced up by some wacko. Well the police, the firefighters, the nurses, the doctors and even the hospital secretaries could go to their debriefing while some of the medics couldn't, due to funding. We get awards for saving peoples lives or being good at our jobs, but can we get time off to get said awards, nope, due to funding.
    Thanks for reading
    Chris

  54. I am not going to sit here and argue who has seen more sick people, but I doubt you have seen more that me. What I am arguing is that firefighting is a difficult profession, as is paramedicine. You say it yourself, … "Strathcona and host of other smaller Alberta depts."__Emphasis on smaller. We could never afford to cross train the hundreds of firefighters and paramedics here. I cannot speak to Alberta, but here in Ontario as an ACP it takes 3 years in college to get to this level. That does not take into account the untold hours we spend with other medics analysing 12/15 lead ECG and pulling out equipment or reviewing standing orders that we do not often use. Being an ACP is a full time job, I cannot imagine trying to to stay current with both paramedicine and firefighting. I work in a service that if we see the station for 2 hours a shift we are having a quiet day. Finaly, why is it that 33 of 37 firefighters interview were either uncomfortable with, or wanted nothing to do with ems?

    • – which is why I tried to say in the same time period (or within 12 yrs). I'm not saying who's seen more either but I'd suggest that its the same given the same amount of time. Our ambulance typically sees 8-10 patients in a 12hr period so I think it'd be just as busy as yours.
      just because a city is smaller doesn't mean a SINGLE ambulance is less busy. ie – Toronto may have 100 ambulances while Kenora has 1. Sure, Toronto itself will be busier but the 1 Kenora ambulance might be just as busy as any 1 of the Toronto Ambulances
      I understand that you have not seen how a real integrated service works. Just because you haven't seen it does not mean it doesn't exist.
      About the same time to train here in Alberta. I'm pretty sure that we know the same stuff (in fact I checked it out about a dozen years ago).
      I don't know what to tell you about 33 of 37 stat. I can tell you that ALL of the guys on my job (210) came on BECAUSE it is integrated.

      • Quote" About the same time to train here in Alberta. I'm pretty sure that we know the same stuff (in fact I checked it out about a dozen years ago).

        Comparing Kenora (rural) and town, the urban sprawl or downtown TO .. quite a difference in volume, demographics and ALS vs BLS cars … please your making yourself look very uninformed.

        12 years ago? best check again my friend your very incorrect please "refresh your memory" try Paramedics of Canada AIT TOOL and or College of Paramedics AB reciprocity tools to compare one province to another.

        I think you may be a very shocked in fact!

        • Maybe I'm not explaining myself clearly. Out of 10,000 people (with all other things being equal) you should have roughly the same amount of calls per year. If there's more people, than there's more ambs – just because its a larger center doesn't mean that the crews are busier.
          As far as Ontario medics being better than Alberta medics. I'll take your word for it, I have no desire to ever be there so don't really care. Perhaps the incidence of ALS calls are a lot higher out there? Albertans are a lot tougher of people after all and "sub-par" EMS is probably OK for us, right?
          This argument isn't very productive if you guys all nit-pic at minor points and don't discuss the actual issue itself

  55. This is a response to a reply I recieved on my above comment. I think it might help clear things up.

    Mark
    I believe we are on the same page here. The two professions are different. That is why I find it hard to believe this Mcleans article was even written. The expense of up grading fire fighters to the level a paramedic, even primary paramedic is asinine. The job could be done by one paramedic in a rapid response vehicle. To have a 4 to 5 man fire truck racing around the streets doing medical calls would be extremely expensive. Let alone dangerous. I wrote the comment because I have seen first hand the lack of funding for ambulance and its negative results. The FD and EMS draw their funds from the same pool, the tax payer. I honestly believe it would be a more cost effective way to manage medical calls with paramedics rather than firefighters. I have been a paramedic for 12 years and know first hand the importance of the fire department and what they do. I believe we should do more cross training with the FD, in order to clearly define our rolls and to improve patient care. I have brought this up multiple time with my management and their response is always " we lack the funds''. I also know that paramedics have a PR problem. They can not compete with the FD in this area. This obviously reflects their budget problems.
    On a personal note, I know of paramedics that couldn't even go to post tramadic debriefing, due to the cost. Do you recall the poor family that was hacked up in Oshawa last year. Children diced up by some wacko. Well the police, the firefighters, the nurses, the doctors and even the hospital secretaries could go to their debriefing while some of the medics couldn't, due to funding. We get awards for saving peoples lives or being good at our jobs, but can we get time off to get said awards, nope, due to funding.
    Thanks for reading
    Chris

  56. Having worked in an integrated system that has been around for over 100 years, I can say that only time will be the answer to all the discord between the two disciplines. Plain and simple, why wouldn't you want someone that can seamlessly switch from one role to another? Accident scenes, fires, cardiac arrests with extrication?….I've seen it and been part of it many many times in my career…..there are no egos to deal with and in the end the patient is ultimately the one who wins in this. 80 – 90% of the personnel on my dept are firefighter / paramedics, and at any one time anyone of them can move from a pumper truck or engine, to an ambulance and perform any advanced intervention on the way to the hospital….. A win win situation I'd say…..

  57. If firefighters have so much spare time perhaps they should mount a snowplow on their pumper and clear roads, instead of sleeping through half of their 24hr shift. More realistically, they should take a pay cut so the city could fund the hiring of more paramedics.

  58. Seems to be 1 side that is always comparing EMS to fire (nothing new, this has been going on forever). As someone who has worked both (and now a fully integrated one) — You cannot compare them equally. They are 2 different jobs requiring different manpower, equipment and training. To suggest that fire service budgets should supplement an EMS service and STILL be expected to perform at a high level is unrealistic for stand alone systems. We're undermanned for both services.

  59. CONT
    2nd. there is a difference between firefighter 1st responders and a fully capable ALS engine. As I think the article suggests, a fire/medic has all the experience and training as any EMS worker.
    To all the naysayers that claim its not possible – it is if you do your homework
    Also, this is NOT taking away jobs (there's not enough skilled workers for all the jobs anyway!) but enhancing them and providing a better service for everyone. Who can complain about that?
    Having worked at a FULLY integrated service I KNOW that this works first hand. Our department is the envy of many municipalities across North America – maybe boastful but I'm every bit as proud to be a paramedic as a firefighter and I can/have done BOTH jobs with equal skill and experience. (we do all the transports too)

  60. We started a one medic first response system about 6 years ago. Fire beats us almost never and even less time by over a minute. One fire large service, in our area, has even quit doing any medical response except confirmed cardiac arrest and car accidents.

  61. Having worked some of my 15 yrs in 2 of Alberta's largest EMS systems, I am of aware of the negativity between Fire and EMS. It is more disturbing to see it on a public forum. I am now in a duel service department and see how effective providing advanced life support and fire services to a community is. Advanced life support pump as well as transport services is by far the best way to go. Assigning percentages to the acute calls will appear to the public as 'heartless' when it is their child/parent/friend who has an acute emergency needing EITHER service, it should not be done. I know from my experience that my paramedic skills and fire skills together best serve the surrounding community. Wait times and apparatus expense are factors out of hand for providers, why use it in argument. Turf protection? Why waste the energy.

  62. With AHS taking over EMS, just which side will you be choosing, tick tick tick only 3 years to go and there will be a divorce.

    • no divorce here in Lethbridge – A1 service ! the province is aware of that. Good luck and best wishes to all the AHS medics.

  63. I think this is just another attempt by the fire departments to justify their enormous budget. Why if everyone knows the situation EMS continues to be ignored. EMS budgets need to be increased to help meet the demand of annual call volume that rises 8 to 10%. You mentioned in your article that fire is seeing a decrease in fire calls and you see the problem? Maybe redirect some of the fire budget to EMS so it can be put to better use. If I suggested we put some extrication equipment on Fire thinks they have the answer to everything, so Fire Chiefs how would you clear your crews from offload delays. The point hear is you put wet stuff on hot stuff and paramedics have 2 to 4 years post secondary training vs your 250 hour traing in EMR so stick to what you do best FIRE PREVENTION. Maybe EMS should make a move to take over Fire. Oh right we wouldn't want to destroy your public brian washing of people will die if the heros are not there! Once again EMS is forgtten by the media, politicians and overall public. Everyone can always do better but try walkind in our shoes and maybe you will open your eyes.

  64. Quote: Advanced life support pump as well as transport services is by far the best way to go.

    Really ? So run a ACP on a Pumper … and EMT or EMR or FF on the Ambulance ?

    So we should disregard all of the other systems that are actually more cost effective ? I do believe that you have blinders on your glasses and do not speak for vast rural areas, of Alberta. So what about rural Alberta where dedicated volunteers staff Fire departments, brother look at the bigger picture and that of Pre-Hospital Health care delivery system thats effective in all areas.

    1-So lets just forget about increasing budget to the real needs of EMS that is clearly identified with the "heartless" statistics.
    2- So lets forget (for a minute) that your FF/Medic position just may change with takeover of EMS by AHS.
    3-So lets forget about the Hospital based model (and a MORE more effective use of medical resourses)
    4-So lets forget that IAFF is one of the Largest Unions in North America.(and the pretty picture that misleading)
    5- So lets forget about PRU (or fly cars) or let a lower level triage a patient ?
    6- So lets forget that many other options are viable, as in the UK, OZ or NZ ? Heck NS has a great outreach Clinic model.
    7- So lets assume the Public actually knows the difference between Levels of EMR/PCP/ACP/CCP.
    7- So lets forget that one person can be in 2 places at one time.<cough> or enough ACP out there.
    8- So lets forget that this article is biased one side with a more than a very obvious agenda.
    10-So why waste energy ? … because we have a lot further to go to tangibly improve viable Pre Hospital Health Care, look beyond the "turf" wars to address the real issue not just a bandaid fix, short term.

    There will NOT be a group Hug until the Divorce is complete.

  65. Get with the program. There will be no divorce. Either get with the program or get another job!!

  66. Who's program ? YOURS … you must be from Winnipeg !

    Look to "suggested" Guidelines for AB AHS and what they have in store for FF/ Paramedic services the divorce is going to happen within 3 years.

    If your working in AB you will be either a FF or a Medic whether you like it or not, BC is not Fire based, SASK multiple delivery most sub contracted,Toba is so far behind, its pitiful, Ontario is not Fire base it is Hospital, would you like me to continue … best not you wil just become upset and don't shoot the messenger for laying the some viable options on the table, they are all being evaluated. You must not be from AB as there are very few remaining Fire based services and btw I have a great job I DO work for government ;>)

    That comment could be perceived as a Threat … best watch your tenor .

  67. I think you are missing the point, really. More ambulances on the road means more delayed in the ER, so goes the thinking of some municipalities. It takes more than 1.1 million to purchase, staff and equip one ambulance, no assuming. The suggestion is not to take away patient transport, but to modify existing resources. Unions aside, this makes the most sense. I did not need two 7's to make my point, which is to provide shorter response time with the highest level of pre-hospital care possible makes the most sense. FACT.

  68. I am tired of this whole pile of crap. I have been involved for almost 30 yrs. We the rank and file have nothing to do with what happens. What bugs me is that some Paramedics continue to think that the rank and file Firefighter is the enemy but we aren`t. Period

  69. I agree the Hospital off load is a huge issue, the ever decreasing bed capacity in most "provinces" is the biggest challenge. But best reevaluate your statistics first the proven need is more ACP and more Ambulances to get response times down and include the response the capability for transport and/ or newer intuitive to treat and release or ACP placement in rural areas in hospital/ clinics) This has worked exceptional well in NS with teaming up with NPs when no MDs are available for rural Canada, T&R works very well in UK as well (btw in London UK 4000 calls is a slow day) and the Australia and NZ models that are completely separate entries EMS vs Fire Side, and do not deplete the Public Safety Officers ie FF.

    On a personal note assuming I am not informed and a wannabe well and lack compation just a personal attack but for your reading pleasure add 10 more years to your 17 (ACP Registered) add Flight, NICU, PICU, Multisystems Failure AICU . Forest Fires, Close Protection Support, Movies, Industry (high risk events) and Remote deployments for Humanitarian relief .

    cheers

    But when you put " in many states" in your cover is busted your not from Canada are YOU ?

    • You say :personal attack..the rant you have written is personal to Firefighter/Paramedics and I quote " Captain should have washed the dishes he put in the sink and got a rookie to take out the trash " !! Paramedics have more idle time as they are in the halls resting or at the hospitals having coffee and a nice chat with the other Paramedics! I do not think you want to compare resumes with me either. Both Fire and EMS are important to our society, so bashing Fire does nothing but diminish your opinion as a disgruntled EMS wishing you had done enough push-ups to be a firefighter.

      • So I offer some minor insight into my background and now you wish to in the tradition of macho FF mentality, so next did you want to pull out Mr. Willy next ? Well it has just come out so strong it is laughable.

        It certainly sounds like it, in passing does it sound from the personal information provided that I need more push ups … besides the fact that your not even living in this country, a huge "DGA" that is "dead give away"

        There is a marked difference between satire, literary licence, making jest and bashing but in a personal attack, so dear Dustin best read terms of engagement first, Whats so wrong with the Capitan doing the dishes or someone to take out the garbage in the first place EH?

        Please remember this heart throb senario of rushing to a the frequent flyer and the kindness shown by FF treating the COPD with a little O2 is fiction to start with as is the rest of the poorly researched article from a very biased reporter.

        • Squint you sound like the same old tired unhappy Paramedic that thinks the fire service is the cause of all your problems. Maybe you should quit trying to degrade what firefighters do and try and work for solutions to the real problems like off load delays, politicians that don't fund enough, Medical diretors that dictate what and how you do things. I don't care home much experience you have, you sound foolish using the same stupid argument thats unfounded.

          • What stupid argument are you speaking of per say ? Alternative and truly innovative ideas and cost effective alternatives to provide health care and expand the scope of Paramedicine ?

            Fire Departments have never threatened any of my position(s) what does bother me is that some how in the highly populated urban areas were we see "professional firemen attitude" is this attitude that they are Supermen and Hero's (in there own eyes) were as in Rural areas and remote deployments theres no time to nor enough resources to have turf wars in the first place.

            Perhaps you sir should review the topic at hand, promotion of IAFF and the “accidental assignment of some health care provision” hell your own membership of Firemen cant get on the same page.

  70. What is interesting is that the Fire Service EMS is only found in North America. This not an issue in other countries, EMS is EMS, Fire is Fire. Why is this??? Would it have to do with the IAFF????

  71. I agree with you mark. I think the problem here in Winnipeg is that Paramedics are afraid that they will lose their jobs. They have been told this by their managers for almost 30 yrs that I know of. Plus the Richardson report wants all medical calls come from a fire truck and Ambulances would just be used for transport. Unless the Paramedics work toward some positive changes this may become a reality. Not something either of us wants.

    • Care to read the Romanow Commission on HEALTH care ?

      And the your department is the envy of WHOM, oh man thats the funniest thing I have heard in quite some time !

      http://www.healthcoalition.ca/romanow.html

  72. Has anyone asked what FF's would be doing if they were not called to "assist" on medical calls? Wow 52% of calls were medical, which means that 52% of the time they show up to carry bags for actual Paramedics? I agree that FF"s are necessary…for fires! There was a comment about Fire Fighters needing there sleep incase of a big fire – does any other "emergency service" get "extra" sleep, on the off chance that there is an "emegency." It is a mentality problem. There is a reason that everyone wants to be a Fire Fighter – its kind of a sweet deal, and there are lots of opportunities to pat yourself on the back.

    I believe that Police and Paramedics exist so that Fire Fighters can have hero's too! If I have a fire, then I want a Fire Fighter. Hey, better thought, can we teach them construction skills too so they can paint, do plumbing and fix my roof – this should help increase their call volume………?!!!!!!!

    • wow…another bitter, jealous civilian. I guess you couldn't get a firefighter job either.

      • Maybe a civilian that pays taxes ?

        • Well not a civilian, but I do work for a living…and pay taxes ;)

      • So many bitter paramedics. Makes me laugh.

        • Now bitter ?
          Is that the extent of information for intelligent debate, you can muster ?

          Jim your responding on a level that is pure emotion, there are far better ways to skin a cat in the IMPROVED delivery of Pre Hospital actual Medical Care and it is not located in the back of a Fire Truck, yet with a huge union promoting themselves just based on a faster 2 minute response time and there decreasing call volumes perhaps we should steal from Peter to pay Paul?

          One also is forced to look at continuity of care in this scenario (are the FF PCP) to accompany to hospital or just hand off ? Many correct diagnosis are made with good history taking and relaying this information to the attending MD … getting even more subordinate layers in the mix DOES complicate the issues .

        • Well, there is a lot to laugh at when you have the time to do so. I just can't help but think that, instead of putting $ into training FF's to be paramedics…why doesn't the $ go into…oh, I don't know, getting more Paramedics? Maybe then they would find the time to show up first to a medical problem, lights a blazing, make the call to the news paper about the big save, get the picture taken, and be back in bed before the sun comes up.

          How would most FF's respond if other emergency persons (police, EMS, etc) wanted to say that if they show up to a fire first, they will handle the fire and call off the Fire Department? Fire Departments would be having aneurisms over the prospect.

          This is what is being suggested by the FF with medical emergencies. In all seriousness, I got nothing against Fire Fighters, but this article and the entire outlook is ridiculous.
          Don't mistaken practicality for bitterness Jimbo – I've never had to find justification in my profession.

  73. I am not missing any point my friend, although my pre reading skills could be improved oops.

    "More Ambulances on the road mean more delayed in the ER" Where is the logic in this statement ?
    You as others have assumed that I must "just" be a medic (folly) When the real fact is that the offload to beds is the real issue, this because of changing demographics ie "medical call volume" the lack of clinic's and retiring GPs (mine is) then account for the abuse of the ER, the catch all or 7/11 of the medical world. I am extremely strong supporter of assigning Paramedics to ERs this has been trailed in EDM an Calgary yet unfortunately under the wing of nursing and their "turf" that said, the advantage to the practitioner to maintain and improve skills remains in the Health Care environment not in a Fire hall, just look to the success rates in the field of ETI alone (WONG et all) in the US with the FF/ALS based services that clearly identifies a huge problem.

    And if you really are an ALS provider you would know that to door (specialist services) are the real determining factors to improved outcomes ie angio suite, surgery or ICU.

    So look to the multiple other posts that I have taken my time to respond to in a logical and applied experienced manner the fact remains that the present proposed Fire/EMS model is FAR MORE expensive to operate and not good utilization of medical resources, even though the pipe dream of FF/ALS were actually even become near to a realistic solution for the thousands of communities that are provided services by Volunteer Fire Services.

    • Vital Heart Response could also be carried on an ALS pumper, with multiple providers, not a single one (paramedic chase car/PRU). We are talking about optimum at-your-door service, not cost or status of ER's. It seems you keep losing site of the fact that all of us should be keeping the public's best interests in mind, as they do pay our salaries. Fire station proximity integrated with advance life support service provides shorter response times, therefore giving the patient the best of both worlds ;)

  74. Your sounding a bit stressed there Wayne, there is help if you need it http://www.tema.ca/

    • Stressed Squint because of fools such as you. If you have all the answers why don't you become a politician or a medical director so you can make changes because right now it seems all you want to do is fight with firefighters. Good solution.

    • Stressed Squint because of fools such as you. I have been dealing with this for 30 yrs. Nothing here is new. We tried not to be involved in Paramedicine for years but the powers that be decide we would be. If you have all the answers why don't you become a politician or a medical director so you can make changes because right now it seems all you want to do is fight with firefighters. Good solution.

    • I am stressed because of 30 yrs of dealing with people like you. I assume you are from the Toronto area and are just in the beginning stage of all this. We have been going through this for 30 years in Winnipeg and have come to a pretty good working arangement. Except for a few disgruntaled people on both sides.Its not what either Paramedics or FF wanted i suspect but thats what Politicians wanted and we will work with it for the better good. So maybe you should look outside of Toronto and see that systems do work.

      • Toronto ?

        I offer a link to a very reputable organization and could help you, TEMA doest care where you live btw.

        My initial reply was to an AB FF/ALS service that very soon will be changing under that AHS AB umbrella.

        • Squint you keep showing your ignorance over and over. But since you aren't the expert in this field you are going to keep bashing you head against the wall until you realize things are changing weather you like it or not. The politicians want the cheapest solution possible and you can't do anything about it. So live with it.

          • So Wayne now I am an stressed, a fool, from Toronto, now ignorant, and not an expert … this certainly makes your position rather silly when you use this terminology does it not ? Please when you go to a gunfight maybe take a gun instead of a knife, rather apparent that you are the one that feels threatened ?

            Yes the politicians do want the best cost effective solution and not chest pounding without credible studies and factually information. The Prime Ministers Council on Health Care are rather well informed (in passing) the true studies in efficacy reflect the needs of the population / voters.

            Wayne so circle your wagons and shoot to the inside as you are under serous delusion In fact I am very pro improved Delivery of Health Care (prehospital) The cost effective way you propose of a Fire Medic in every hall is not only very expensive but is an American model that is proven not to work.

            You have not made an intelligent point for debate so far other than Live with It , Get with the Program … la la la, could it be that your dogmatic position is folly and non productive ? Politician's are on the bandwagon to crush large unions, perhaps your not reading between the lines ?

            cheers and please contact TEMA

          • To the politicians it is very efficient to use the fire service for ems. They see manpower and salarys already paid for that they can use, include a manditory pcp requirement on an application and presto all they are paying for is some medical equipment and a little more diesel fuel.

            The cost of adding an additional salaried Paramedic costs more and is a bigger increase to their anual budget.
            Municipalities can maintain there fire coverage and service but also provide assistace to the EMS services.
            I'm not saying that this is the best for both worlds but I think that that is what they see.

  75. NO! Its called be innovative!

    • Thats not what I would call it .

  76. CONT
    I don't think anyone will argue that. The resistance comes from the integration of 2 previous separate entities with there own policies, public perceptions, traditions and yes; unions. It willbe a logistical nightmare to amlagamate these service completely as both side will have to make concessions but the ends justifies means. I along with hundreds of other Paramedic/FF (ACP/FF for my non Albertans) have the fortune of already working for integrated departments. And yes I'm sure someone will point out that Alberta Health Services is attempting to remove the ambulances from municipal jurisdiction, but just because AHS thinks something is a good idea doesn't make it so. The bottom line is we are all public servants and the public desrve the most efficient model.

    • And oddly enough some of we ALS providers believe that this is an improved model in delivery of Health Care Services, improved utilization, improved communications networks and based with the other members of the Health Care Team to improve and maintain skill sets. Show me one ALS Paramedic that does NOT want to spend more time in ER, Angio, Mat, and observing Surgery and I will show you a FF/Medic.

      If one looks to the US Florida or California and how the Fire/Medics and statistics in evaluation of skills and success rates in arrest or even ETI its a no Brainer that this is just not the way to go in Canada. btw is IAFF an influence in these areas … YOU BET THEY ARE !

      • I support Paramedics (ACP) in the hospital setting. I think they can be better utilized than RNs and LPNs in many departments. I also support running ambulances out of hopsitals strickly for interfacility transfers. And yes a hospital based paramedic that spends time in ER, Angio, Mat , and the OR would be better suited at critical long distance transfers. But thats where I draw the line. Emergency scene responses is the Paramedic/Firefighter bread and butter. I'd rather work on a multi trauma from an MVC in a ditch in -40 than transport a critical patient 5 hours. Pre-hospital scene response and hospital based are 2 different unwritten specialties. Lets stop pretending they're not.

        On a side note I am a proud member of the IAFF. But they have no say in what the province of Alberta and AHS legislate. This has nothing to do with unions. We're talking about the same set of skill being used in 2 different settings. We both know paramedics are no longer just pre-hospital emergency medical service providers. We've move into a more clinical setting. This stigma of what we do has to change. Some of us will stay on the front lines and some of us want to move into hospitals. .

      • somebody needs to do their homework about AHS !! Obviously has not been in the industry that long.

  77. The use of fire aparatus and ALS trained firefighters in first reponse is an excellent first step toward the most efficient model of emergency response. I think the ultimate goal is a fully integrated system where both ambulance and fire trucks are manned by members trained in 1001 and advanced life support. (For the layman 1001 is an international fire training accreditation). Pumper trucks co-respond with ambulances on critical calls and are only used as first response when no ambulance is available. If a pumper is to respond alone there is no degradation in service as the pumper has all of the ALS equipment, drugs, and trained personel an ambulance does. By far this is the most efficient system.

  78. Getting a emergency responder to a pt's side is only part of the equation. Rapid transport to definitive care is also a large part of that equation. It doesn't matter how many drugs or lifesaving skills a Paramedic or Firemedic has, if they cannot transport to an appropriate recieving facility those drugs and skills mean little.

    The answer is not to cross-train firefighters to paramedic levels, but to put more paramedic staffed ambulances on the road to shorten response times.

    I'm not up on the latest wages, but I suspect this probably makes sense financially as well due to wage differences between firefighters and paramedics.

  79. Is there a model that will work for all Cities/Municipalities, or rural areas? I really doubt it! Is it beneficial to get a trained caregiver there to start the good ole "Chain of Survival"? You bet it is! Whether that person arrives on a Fire appartus or in an Ambulance, it will improve the chances of a cardiac arrest victim greatly (and many other patients as well)
    I am proud to be a FF/ALS Paramedic and work in a Fire Dept. that has been providing Ambulance service to our community since 1912. And it works GREAT for this community. I doubt that our model would work in Toronto, but having a FF there in 5 minutes and starting the "chain" is better than 8-10 with nothing at all.

  80. I will 1st off say I am a Paramedic and yes I am biased and think we have the best job in the world. I work in Ottawa where we have a "Tiered response" system where the Ottawa Fire Service responds to unconscious, seizures, MVC's etc… I have a great working relationship with the fire 1st response and find them a valuable asset to have on big calls for their ability to do CPR, carry my equipment and assist me in getting my patient to the truck and on to the hospital. That is where their job ends… They have a role and that is to provide 1st aid and CPR and they do an excellent job at it. I give positive feedback and send emails to their capt. when they do an excellent job in "Assisting us".

  81. Is there a model that will work for all Cities/Municipalities, or rural areas? I really doubt it! Is it beneficial to get a trained caregiver there to start the good ole "Chain of Survival"? You bet it is! Whether that person arrives on a Fire appartus or in an Ambulance, it will improve the chances of a cardiac arrest victim greatly (and many other patients as well)__I am proud to be a FF/ALS Paramedic and work in a Fire Dept. that has been providing Ambulance service to our community since 1912. And it works GREAT for this community. I doubt that our model would work in Toronto, but having a FF there in 5 minutes and starting the "chain" is better than 8-10 with nothing at all.

    • Perhaps look to the studies, Seattle and Vancouver out of hospital arrest survival … are you teaching CPR to assist in the "Chain of Survival" ? Boasting that your service has in some way superior is personal opinion, that this is GREAT is again just chest pounding and false bravado.

      Are you aware of what the local and rural strictly Ambulance operations think of you …. please a reality check is in order and well past due.

  82. Here, Here. Another inflated attempt for the fire dept to justify their overinflated budgets. The reason fire dept's are called upon is because they are more often then not, available at their fire hall. Ambulances are often not due to their call volume. The focus is on the wrong area here. We need more invested into the Emergency Medical System and bring more trained and educated paramedics to where they are needed. Training the firefighters to do more medical calls only disperses the funding and does not solve the problem at the root. Put the money into the EMS services so they can do what they do best..Save lives. Leave the fire department to put out their fires and then we can evaluate their budgets and "need" based on their own stats not on the tail of the EMS.

  83. I’ve read a good number of these posts and much of what I am reading is bickering amongst the unions and preservation of each others jobs. Well good work. Apparantly, what best for John Q. Public doesn’t matter.

    Being a firefighter, then a paramedic, then a paramedic manager then a fire chief…the basis is simple…what is best for the patient, what is going to best serve John Q. Public!

    Being from both sides of the coin (where the services are separate) the need to do this and combine the services to service the public both with care and service needs, but to alleviate the tax burden that both services place on each and every tax payer.

    With ballooning budgets, the answer is not always “lets throw some more money at the problem” but to “look at what we have to achieve better results” and the data speaks loads…case in point – Winnipeg AND many cities, towns and regions within the USA. Yes I said it, the USA.

    Quit the bickering because at the end of the day its not us that have the power to make these decisions, it comes back to the will of the public through the politicians.

    In ending I will add…the paramedic service where I am from supports the integrated model…this is something that we will begin planning for in the very near future. Watch for the headlines!

    • You are so correct on all points. The bickering MUST stop. The front line people, Firefighters and Paramedics are at the will of the politicians.

      • I guess you do not believe in the democratic process nor transparency of government nor fiscal responsibility.

        Bicker ? Well not me, I play out my role in holding government agencies responsible and accountable anything less is un Canadian.

    • First off a huge difference between bickering and informed intelligent debate.

      So you make a good point there sethball the BEST for the PATIENT and then complicate it with Public safety and Fire protection service.

      Throw money at the problem NO …. throw Brains at it for long term, look over the big ponds to see what they are doing there first shall we?

      And I absolutely disagree comparing US to Canada is like comparing apples to kiwi fruit , yes the data speaks for itself, lower standards in education, higher costs for response, increased Health Care Insurance rates (volunteer services everywhere) and have you noticed Obama and his incentive to improve Health Care for all, just saying.

      Oh yea Do you have a chopper every 20 square miles too that crash and kill entire crews ever month ?

      Don't know where your from mate but quite obvious your Pro integrated services and not what is the best delivery services … please stop your whining.

  84. Can't possibly read all the comments, Seems most are like little kids fighting over the last cookie anyway. Don't see much concern for people in need of help just mostly turf protection. Any way in the few comments I did read there were mention of the Toronto fire fighter in the picture read the caption on the photo pasted below. Just goes to show that some people are not very astute are they, sure hope they are more through at there jobs.

    Every pump truck in Winnipeg has a cross-trained firefighter-paramedic

    • Nope some of us fight for the best way to care for the actual patients and don't use IAFF union tactics to accomplish this.

      And your cross trained are "primary" care not Advanced Life Support Providers in passing.

  85. I only have just over a year of experience as a full time PCP and 5 years experience as a volunteer fire fighter and Ive seen first hand what a great system having PCP training on the fire side is an asset in both rural and urban setting. These are two different jobs with different cultures but when you have 6 or 8 people working together and forgetting which group you belong to the patient care is always almost better. You see the difference in patient care when you have a firefighter that hates doing medical or a paramedic that hates the fire dept. and they cannot see pass that the patient care suffers. So what im really trying to say is lets forget what patch we have on our arms and do what is best for the patient because… isnt that what we are there for. So i encourage every firefighter, FIRE/PCP, PCP, ICP, ACP to forget the two differences and work together. I agree EMS needs more funding but I dont think cutting the Fire Dept. budget is the way. The system is not perfect, some bugs need to be worked out, but if both sides listen to one another we might get there!

  86. Obviously a one sided argument pro FF, with a token statement from EMS.
    Here in the UK FF do not respond to medical calls but given the stats regarding fire calls decreasing, the FF management are itching to do medical calls to justify their budget.
    They are very professional and good at their jobs, but they shouldn't dilute their skills by branching out into EMS.
    If the govt. want the same response times from EMS as fire can deliver, then fund EMS appropriately. Also fund fire appropriately as to their decreasing workloads.

  87. Well said medic UK !

  88. Sooooo let me get this straight. Most of the FF on here seem to be all for providing first aid and what not when they are first on scene and determining whether an ambulance is actually required or if said ambulance can keep roaming to remain available for real medical emergencies. Soooo hows about this. All ambulances carry fire extinguishers. Hows about paramedics go to minor fires that can be put out with a simple fire extinguisher that way fire trucks remain available for more serious fires??

  89. Fact of the matter is…we each have our own specialties. I dont want to fight fires and I'm pretty sure most FF dont want give medical care. Truth is, its easy to teach someone how to use the tools. I know how to use a hose and a fire extinguisher. I'm sure lots of FF know how to use spray bottles and push a plunger on a needle, and push a button. Fact is….FF dont know the mechanics behind what the medication there giving is doing. All they know is "chest pain = nitro". And I admit that I dont know jack about the inner workings of a fire, but I'm not tring to be a FF. If you dont know the inner workings of the body and know exactly what your doing, your going to do more harm than good. If you mean it when you say that your thinking about the patients best interests, then stick with what you know and are trained to do.

  90. As a medic, I like having the FFs on calls where their expertise matters such as MVCs, rescues, or when we need sheer manpower to extricate patients in cardiac arrest, seizure, or those that are unconscious as it frees my partner and I to provide patient care. Our EMS-FD relationship can be rocky at times, but overall, our guys know how to assist us in the best manner possible.

    I don't know about Manitoba, but in Ontario, EVERY medic is prohibited from advising a patient they don't need to be seen in the ED. If that is the desired end result, the Ministry of Health will have none of it. I also can't foresee municipalities paying FFs their wages and tuition to go to school for two years (as is the minimum requirement by the Ontario MOH) while paying OT to the others to cover their shifts. Nor do I see FDs submit the Fire Marshal AND MOH regulations/laws. As far as response times go, we are stationed in the fire halls, sometimes we get paged first, sometimes second, but we always arrive on scene first.What about the areas covered by volly FFs?

  91. In relation to assessments, physicians at our hospitals recognise that medics are the best for assessing patients, even more than themselves and nurses (their words, not mine) as it is what we do day in, day out. I've have calls for "arm pain" and called it in as a stroke following a detailed assessment. It was a TIA or mini-stroke. Lethargy and minor confusion due to an intracranial bleed. If one wants to effectively recognise the many subtleties of the multiples health related problems, you have to be exposed to it on a daily basis. Currently, it is not something that FFs are in any way capable of doing at this time.

  92. Most FF I know have minimal interest in providing advanced medical care. Personally were quite happy when we turn the corner and see the ambulance already on scene. I'm quite content to stand back and take direction from EMS. They are the higher medical authority. I have no problem priming an IV, performing CPR, setting up the stretcher or carrying a stair chair. Anything to make their job easier so they can focus their attention on the patient. Isn't patient care the main priority? EMS is underfunded and unfortunately they don't receive the same public recognition (hero label) as FF. Sad and unfair.

    • Well at least one FF sees the bigger picture, is a team player in the delivery of pre hospital health care, agreed and thanks there ONT FF.

      As far as recognition, well just speaking for myself: Ones rewards come from that touch of the hand from the little old gal in CHF thats now breathing easier, the homeless drunk off the street that recognize you on that frequent flyer call and calm down immediately …. because they know your name and its "hey bro wasup " The mother of the 6 year old asthmatic child that can't speak because of the tears in her eyes but you know that she is great full, the Rural Family Practice MD when you show up to fly that poly trauma MVC patient out, so he can get back to providing primary care to his community and TRY to catch up with the waiting room back load. The overladed nursing home LPN when that suspected CVA patient (and most likely a close with) receives the care they need.

      Ones rewards are not of this world and ANY thanks is just gravy, just the way it is.

  93. Big change in Topic, this news reporter should do better reporting before doing a huge Mag article….
    Firefighters always in the glory!!! This is not Glory…….
    I was shocked this week to find out how many fire fighters have impaired charges,and the fire services hide the issue???
    Clarington (East of Toronto) ,has a captain still working, I know we all like to drink, but i think, if you work in this type of job, you would totally not drink and drive
    But the 3 district Chiefs will slide it under the carpet, Why 3 Chiefs?
    I am a tax payer and totally embarrassed that we have a criminal firefighter on the service, just shows the competence of the 3 chiefs, this firefighter just got charged with driving with no license, do they do there jobs
    I know its different from topic,but I am concerned ,all papers,magazines and Tv all show the Fire fighters as hero's, now the Whitby Church fire,first big fire in years.No one cares about human life
    Lets start thinking about one big regional fire dept in the region of durham,Why pay 17 chiefs????
    Tax payer

  94. You tell me which is more cost effective. Staffing more ambulances ($100-130 thousand dollar piece of equipment plus wages for two paramedics per shift) or continuing to staff fire/rescue apparatus that would otherwise sit idle ($200 thousand plus piece of equipment plus wages for four firefighters per shift)? Don't forget first responding firefighters will still need to call for an ambulance every time a patient requires transport. Do not be fooled by the IAFF PR machine. The number of structure fires has been steadily declining for many years and once busy departments are now looking for other ways to justify their existence.

  95. NEWSFLASH.

    Fire/PCP = Primary Care paramedic
    PCP on ambulance = Primary Care Paramedic

    most of winnipeg ambulance paramedics = PCP

    uhh…

  96. Firemedics in Ontario will never exist. Why? Because according to the Ontario Ambulace Act one must, legally be a paramedic to provide patient care. The 3 legislated requirements are:
    1- Be a graduate of an approved Ambulace and Emergency Care programme;
    2- Be certified by a Base Hospital; and
    3- Be employed by an ambulance service

    Since firemedics would be employed by a fire dept, they do not meet the legal requirements to provide patient care within the paramedic scope of practice.

  97. "So on a 911 medical just call ask yourself would one question you rather see:
    A Fire Fighter EMR show up at your door or an highly trained medically Professional?"

    Speaking as a paramedic of 15 years, eight of which at the CCP license, and as a volunteer with fire departments for about 12 years, I want to see someone arrive AND LEAVE WITH ME QUICKLY for the hospital. Fire can do both, so can police (Baltimore, Maryland's State Troopers & NYC's ESU). The problem with EMS & Fire is both have adapted poorly and slowly. EMS puts too much stock in its "our advanced skills" and Fire in its "hero history". Give me someone with symptom relief, ASA, Defib/AED and the absence of an inflated sense of self, solid triage and assessment capability, and I couldn't care less if it said, "Ladies Auxillary" on their shoulder.

  98. Why is it that no one looks at the per-capita cost of emergency services in a given community, sees that fire service usually have the second highest budget, sometimes the highest depending on how polices services are delivered, yet are the most inefficient, sending a non-transport capable vehicle with 4-5 firefighters to put one oxygen mask on one pt. the majority of the time, occassionally defibrilate and do cpr, when for a fraction of that cost, ems delivers comprehensive basic and advanced medical intervention and transport capability, often with only 2 paramedics. It's about time the politicians and public looked beyond the "hero" facade, demanded accountability and seriously considered where to invest hard earned tax dollares to best serve their communities.

  99. Interesting. Alberta Health Services is on the process of dissmanteling all 16 of it's Integrated FIRE / EMS departments. Crushing all dual trained emergency ALS providers. The fear is that after this outcome, there will cease to remain any ALS pumps in the province.

  100. I hate paramedics. All they do is whine and bitch and complain. If they don't like their job then go be a garbageman or something. We firefighters like to refer to them as our "little sisters" beacause they are always tattling and trying to cause trouble among the greatest job in the world. Firefighting.

    • And I hate asparagus …. the point was what again , oh yes Nurguts is a child.

  101. Nurguts, thanks for showing the world how full of yourself you are, along with many of your colleagues. In reality, we could do without EMS (no prehospital health care). We could do withought Firefighters (no more basements of saved). We couldn't do without police thought! So, who's greatest? Not you, that's for sure. Overpaid to sleep and wash your personal vehicles.

  102. Seeing all these comments, and especially the ones from Paramedics directed at the Fire Service, I can only hope that should I need an ambulance, that I get a dedicated, knowledgable, and happy to be employed paramedic, rather than the ones on here who maybe should find a new line of work. When the public calls for help, they want someone there fast, they don't care what uniform it is. The public is why you choose this career. Some of you really need to grow up.

  103. It's time we realized that we we are spending way too much money on the service that has most staff that provides the least amount of protection. time to channel the money to the services that really protect lives.

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