Paramedics Respond to concerns of firefighter first responder status

Response re: Delta Optimist August 23, 2018 article “Mayor upset firefighters sidelined”
https://www.delta-optimist.com/news/delta-mayor-upset-firefighters-not-being-alerted-to-all-emergency-calls-1.23410372

Dear Mr. Gyarmati;

I write in response to your article published August 23, 2018, ‘Mayor upset firefighters sidelined’. Unfortunately, this article contains incorrect and misleading statements. I believe it is important that the citizens of Delta are correctly informed of the matters raised in the article.

Delta’s firefighters are indeed highly trained- for fire suppression and technical rescue, but not for medical emergencies. In 2015, Delta’s firefighters transitioned from First Responder (FR) to the Emergency Medical Responder (EMR) level. Doing so involved only 21 hours of additional medical training, followed by 84 hours of practice hours, for a total of only 105 hours of additional training and education[1]. In contrast, the paramedics serving the Delta area are trained to Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP) and Critical Care Paramedic (CCP) levels. Education for these paramedics range from 9 months to 4.5 years in total. It is in fact the BCEHS paramedics who possesses the highly specialized training to deliver advanced medical care to the sick and injured citizens of British Columbia.

The additional skills that Delta’s firefighters can provide at the EMR level do not provide any additional immediate lifesaving procedures or treatments, but rather, are increased diagnostic and symptom relief in nature[2]. Delta’s firefighters cannot administer IV’s, or IV medication, as stated in the article. EMR’s may only maintain an already running IV during an interfacility patient transport, which firefighters do not partake in. Time-critical interventions like; CPR, defibrillation, assisted breathing, airway management and bleeding control are all within the scope of all first responders in BC, at the FR level of training. It is these types of interventions where seconds count and every available responder is always sent, in the quickest fashion possible.

In May of 2018, the BC Emergency Health Services (BCEHS) implemented a new way of classifying the urgency of a medical call, called Clinical Response Model (CRM). Highly trained medical dispatchers and call takers receive and triage medical calls, using an internationally implemented and reviewed protocol. CRM then uses evidence-based decisions to classify what types of medical calls are assigned one of six priority levels. The two highest levels (purple and red) are immediate life-threatening type events where fire first responders and the highest possible level of paramedic are requested to respond as quickly as possible. Middle level acuity calls (orange and yellow) are non-immediately life-threating situations. These types of calls trigger a request for fire first responders only when paramedics are expected to arrive in greater than ten minutes from the time the 911 call is answered. This evidence-based medical call triage process happens nearly 1,500 times a day in BC, with instant consultation and review available by physicians and advanced care paramedics, 24 hours a day / 7 days a week.

Simply put, this medical call triage system and CRM ensure that the right resources are sent to the right patients in the right amount of time. It ensures that valuable emergency resources, including fire first responders, are prioritized to the patients that need them urgently. Since implementation, paramedic response times to life-threatening emergencies has improved significantly. Paramedic response times to non-life-threatening medical calls has improved slightly or stayed the same. This is thanks to additional paramedic resources added and the CRM system better assigning resources to the patients that need them.

Over-response to medical calls does not improve patient care. It also endangers the public and can jeopardize patient confidentiality. When critical emergency resources are tied up on calls which do not actually require their attendance, this means a reduced response capability to the call where they are truly needed. If fire first responders are busy at a non-life-threating medical call, then that means the patient in cardiac arrest, or trapped in the house on fire, will have to wait for another firefighter crew to respond. That puts lives at risk, unnecessarily. Over-response of emergency vehicles on our roadways is also an ever-present risk to the public. Lights and siren responses are a dangerous endeavour for the first responders and driving public, which should be reserved for true life-threatening emergencies. Finally, over-response to medical events puts at risk the patients’ expectation of confidentiality. Paramedics often see patients in their most vulnerable situations and it is paramount that only those responders actually needed for the specific situation are present.

As stated in the article, Mayor Jackson is concerned about her fire department’s budget, which she should be. In fact, amongst lower mainland municipalities, the Delta citizens are subjected to the second highest cost per capita for their fire department, second only to the City of West Vancouver. With the majority of the Delta Fire Department responses being medical assist to paramedics, the municipal taxpayers are effectively paying twice for a service provided by the provincial government. The reduction in Delta fire department medical responses, for calls in which the evidence says they are not required to attend, should be seen as a positive step for the municipality, as it eases fiscal pressures.

Mayor Jackson accuses the BCEHS of reporting false response time data, which is completely unfounded. She proposes that the Delta Fire Department be allowed to ‘listen in’ on all 911 calls and decide when they should respond, which would be a gross violation of patient confidentiality and result in a dangerous over-response of firefighters. These suggestions and allegations appear to be an attempt to justify the high fire department budget. None of this is in the best interest of patients or the citizens of Delta.

Good public policy is based on evidence-based decisions, rather than emotional-based decisions. The changes made with the Clinical Response Model have been done in an evidence-based fashion and are subject to ongoing medical review to ensure it remains to be the best practice. More paramedics, more dispatchers and more ambulances have been added to the system. All of these measures mean that the front-line medical professionals -paramedics- are getting to the patients who need them most, faster. I applaud the BC Government and BCEHS for taking these steps to improve prehospital patient care in BC and look forward to working with all our partners to make more system improvements.

If you would like to discuss this matter further, I would be pleased to do so. I can be reached at cameron.eby@apbc.ca or 604-273-5722.

Sincerely,

Cameron Eby
President
Ambulance Paramedics of BC
CUPE Local 873