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Mixing EMS, Firefighting Not Always Easy

The Toronto Sun via YellowBrix

October 12, 2010

TORONTO – Finding ways to cut spending and save money will almost certainly top the to-do list for Toronto’s next mayor.

If elected, Councillor Rob Ford has vowed to pursue drastic measures such as reducing the size of city council and shrinking the municipal work force.

But it’s a pledge by mayoral candidate George Smitherman that may be the most contentious.

Several months ago, Ontario’s former health minister suggested amalgamation — a term that still causes some Torontonians to shudder — as a way of dealing with the city’s cash shortfall.

More specifically, Smitherman promised he’d combine the Toronto Fire Service and EMS into one “integrated service.”

The idea has been suggested numerous times since the late 1990s.

It has been attempted in various forms in many other North American cities — often with terrible results.

Jim Brennan, a long-time Winnipeg paramedic, witnessed the devastation first-hand when that city’s politicians directed its EMS and fire departments to amalgamate in 1998.

So he urged whoever ends up at the helm of Toronto on Oct. 25 to think long and hard before proceeding with such a merger.

“Good luck!” Brennan said wryly, over the phone from Manitoba recently. “You’ve got a long road ahead.”

He said the decision to merge fire and EMS was meant to save the city money, shorten response times and create a more efficient service. But it instead touched off a decade-long nightmare, the effects of which are still being felt.

Brennan was named chief of the newly formed Winnipeg Fire and Paramedic Service (WFPS) in 2007 and charged with fixing the amalgamated mess.

Initially, the plan called for the formation of one group of first-responders, under one union, who would be cross-trained as fire fighters and as paramedics.

“They would be able to move between fire trucks and ambulances depending on the need at any particular moment, during the course of a shift,” Brennan said.

After nine years of trying, he said that original model had to be abandoned and new one drafted.

“There was so much discussion and so many different aspects addressed, but really, nine years later we were no closer to the goal than when we started,” Brennan said. “In fact, in some regards, we were behind.”

By the time Brennan was asked to take over as chief — a post that was suppose to be temporary — there was a lot of “animosity” between the unions and management.

Among many other things, he realized the idea of reducing the number of unions to one had to be dumped. And what began to take shape was something so different from the original model that Brennan is reluctant to even call it amalgamation.

“After a lot of work by a lot of people, we’ve got five unions involved in our service,” Brennan said. “And we ended up forging work-share agreements between those unions.”

The WFPS is comprised of two branches, the paramedic ambulance service and the fire department, and Brennan compared the new service to the armed forces.

“You have the air force, navy and army — they’re separate and distinctly different, but they work together with a common purpose, “ he said.

The WFPS has one combined dispatch centre with operators who are “cross-trained” to deal with fire and ambulance calls. And the service’s 37 fire trucks are manned by crews with a firefighter who is cross-trained as a Basic Life Support (BSL) paramedic.

“This allows us to send our resources where they’re needed,” Brennan said.

He said the firefighter paramedics alleviate stress to the system caused when EMS personnel are delayed while off-loading patients at hospitals.

Once on the scene, the firefighter paramedics can either cancel the call if no transport is required or treat the patient until an ambulance becomes available. They can also tell the ambulance to slow down if the injuries are not serious or call for an Advanced Life Support (ALS) medic if the situation is life-threatening.

Firefighters who take on paramedic duties receive a 2% wage hike, Brennan said. Similarly, ALS paramedics also get a raise.

As part of the merger, Brennan said it was agreed that each of the service’s 21 ambulances would eventually have an ALS-trained medic as part of the team.

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