Toronto EMS
Encyclopedia
Toronto Emergency Medical Services (EMS) is the statutory Emergency medical services
provider for the city of Toronto
, Ontario
, Canada
. The service is operated directly as a branch of the municipal government as an independent, third-service option provider, which means that the service is funded by the municipal tax base, and operates in much the same manner as any other municipal department, such as the police or fire department, or in some cases like a public utility, but retains its complete independence from all other departments. While under municipal government control, it is required to comply with legislation
and licensing standards provided by the Ontario provincial
government. It is not the only service provider in its area; private-for-profit medical transport services also provide routine, non-emergency transports and coverage for special events, but the statutory EMS system is the only provider permitted to service emergency calls.
service directly on an uninterrupted basis since 1883, when the City of Toronto Health Department acquired two ambulances to transport those with infectious diseases to the local sanitarium
. Full-time emergency ambulance service began in 1888, with the provision of emergency ambulance service by the Toronto Police Force, which eventually operated four horse-drawn vehicles. Prior to these two municipal initiatives, ambulance service was provided for the young city by a variety of means, including both hospital-based and private companies. This 'broad spectrum' approach to service delivery would continue for more than ninety years.
Toronto may very well be able to claim to have the first formally trained 'ambulance attendants' in North America, with the Toronto Police Force ambulance service staff receiving five days of formal training in their jobs from the St. John Ambulance Brigade in 1889. Training included both first aid
skills and anatomy
and physiology
, including all eight pairs (at that time) of cranial nerves
! Such training for ambulance attendants was unheard of at that time, outside of military circles. The police constables assigned to the ambulance also did regular policing, when not required for ambulance calls. As the city grew and technology progressed, so did the ambulance service. The first motorized ambulance was actually purchased by a local funeral home
in 1911, and the Toronto Police Ambulance Service began the conversion from horse-drawn to motorized vehicles in 1913, with the process largely completed by 1918. Over the years, the two City of Toronto departments would have their services supplemented by more than 130 individual ambulance operators, most of them private companies, and in suburban areas by several of the tiny, local fire departments. The two municipal services would finally be merged in 1933, when the Toronto Police Department turned the operation of their ambulances over to the Department of Public Health, and ended their involvement in the City's ambulance service.
This service would grow again in 1953, as the result of the creation of the municipality of Metropolitan Toronto
, dramatically expanding the required service area. Service would continue in this fashion until 1967, when the amalgamated City's suburban fire departments surrendered their ambulances, resulting in the evolution of the Department of Public Health Ambulance Service into the City-operated Department of Emergency Services (DES). Some private companies, and one operated by the provincial government, would continue to operate in 'Metro' Toronto until 1975, although with centralized dispatch services provided by DES.
The Metropolitan Toronto Department of Ambulance Services was created in 1975, and absorbed the five remaining private ambulance companies and single provincial service, providing a single, unified ambulance service in Metro Toronto. Known colloquially as Metro Toronto Ambulance (never its official name) or simply 'Metro Ambulance' (although never its official name) the service provided ambulance services from 1975 to 1998.
Metropolitan Toronto was restructured during 1998, transforming it from a regional government overseeing six member municipalities into a single, unified city, and many municipal and regional services were restructured as a result. Metro Ambulance became Toronto Ambulance, and later adopted its current name, in order to reflect its evolving role from primarily a provider of medical transportation to an actual provider of medical care.
The service introduced its first paramedics in 1984 (although experiments in pre-hospital advanced life support actually began in 1969). Toronto EMS introduced many other innovations, including the concept of dedicated ground-based critical care transport ambulances, as well as many specialty support units described in this article, many of which were originally conceived and pioneered by the service.
As of April 2005, the departments and commissioners were replaced by divisions under the City Manager (and Deputy Managers). Toronto EMS now operates under the city's Emergency Medical Services Division. It is the largest municipal EMS operation in Canada.
EMS has 1,171 members including paramedics and other support staff. These are categorized as follows:
Epaulettes with rank/qualification are shown below and are worn on all forms of dress:
as a training academy for both primary and advanced care paramedics, through the Canadian Medical Association
. Although in the past, the service has trained all of its own advanced care paramedics, training Level I to Level II has been suspended indefinitely and Level III training has slowed significantly in the past three years. Factors including new dispatch and management approaches, as well as funding has resulted in this discontinuation of further Advanced Care training. Toronto EMS has chosen not to pursue primary care paramedic training over the short term.
. The system uses Computer-Aided Dispatch, including Tritech VisiCAD, augmented by PDS and Siren software and technology. The service utilizes a satellite-based Automatic Vehicle Locating
system in order to ensure that the closest appropriate response resource is consistently sent to each emergency call; all emergency response resources are included. The service utilizes a 800mhz Smartzone trunking
radio system for dispatch purposes. The Control Centre has direct landline contact with the 9-1-1 Center, all other emergency services, all acute care hospitals, and all EMS Stations. The service utilizes “Language Line” service to provide instant simultaneous translation of emergency calls in more than 140 languages. Toronto EMS operates the largest EMS Communications Centre in Canada, which was recently accredited as an International Centre of Excellence by the International Academy of Emergency Dispatch.
Toronto EMS operates a total of 41 dedicated EMS stations, geographically distributed across the 246 square miles (637.1 km²) of the City of Toronto. Emergency service headquarters (which is shared with Toronto Fire Services, but both services operate independently) is located at 4330 Dufferin Street in Toronto. This facility includes administrative offices, some education facilities, the EMS Communications Centre, Fleet Maintenance, Planning and Operational Support, and Materials Management/Logistics. The service is supplemented by well-developed EMS systems in neighbouring communities on three sides, with Lake Ontario
providing the southern boundary of the service area. Air ambulance
operations are provided within the City of Toronto by Ornge
, a privately owned air ambulance contractor, under contract to the Government of Ontario.
Based upon information provided by Toronto EMS, the service processed in excess of 535,000 calls through its Control Centre in 2007 (the most recent year for which complete data is available), resulting in 223,769 emergency calls being dispatched. Using the AMPDS system, which triage
s calls by severity for dispatch purposes, the actual dispatch volume by category for that same year was:
, with no one being refused care because they cannot afford it. As a direct result, hospital in-patient beds and Emergency Departments tend to be severely overcrowded, resulting in difficulties for paramedics transferring the care of their patients to hospital staff in a timely manner. Two to four hour delays in the transfer of care are commonplace, and six to eight hour delays are not unheard of. When this occurs, the service's ability to provide service to emergency calls in a timely manner will often degrade, because of decreased unit availability. Multiple stakeholders and various levels of government are currently seeking solutions to this problem, but have, so far, experienced only limited success.
The funding for Toronto EMS occurs as a result of a mixed formula, with fifty percent of funding coming from the municipal tax base and fifty percent from the provincial government. The funding of Toronto EMS is based upon its residential population, not its business day population. As a result, there are always more people requiring EMS services than the system has been funded for.
Language barriers and cultural misperceptions in Toronto's multicultural landscape are commonplace for Toronto's paramedics. The service subscribes to Language Line, a simultaneous telephone-based translation service which operates in more than 140 languages. This service is used by Emergency Medical Dispatcher
s processing 9-1-1
calls, or by paramedics treating patients in the field, on a daily basis. The service also operates its own ethnocultural access program.
The 'Baby Boom
' generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.
. This has resulted in a service which is extremely research-oriented and interested in outcome-based medicine. While this has provided any number of research opportunities for physicians and emergency medicine residents through the Toronto Base Hospital program, it has also permitted paramedics to function as supporting and as lead researchers, and in some cases, as the principal researcher of their own projects. All research conducted at Toronto EMS is pre-approved by the University of Toronto
Research Ethics Committee, and the findings of research conducted at Toronto EMS, by both physicians and paramedics, has been published in respected, peer-reviewed, international journals
.
races staged annually by the city's Chinese community. As another little known fact of community involvement by paramedics, all of the floats in the city's annual Santa Claus Parade
(one of North America's largest), are driven by volunteers from Toronto EMS, including both paramedics and a variety of other staff.
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
provider for the city of Toronto
Toronto
Toronto is the provincial capital of Ontario and the largest city in Canada. It is located in Southern Ontario on the northwestern shore of Lake Ontario. A relatively modern city, Toronto's history dates back to the late-18th century, when its land was first purchased by the British monarchy from...
, Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
. The service is operated directly as a branch of the municipal government as an independent, third-service option provider, which means that the service is funded by the municipal tax base, and operates in much the same manner as any other municipal department, such as the police or fire department, or in some cases like a public utility, but retains its complete independence from all other departments. While under municipal government control, it is required to comply with legislation
Legislation
Legislation is law which has been promulgated by a legislature or other governing body, or the process of making it...
and licensing standards provided by the Ontario provincial
Province
A province is a territorial unit, almost always an administrative division, within a country or state.-Etymology:The English word "province" is attested since about 1330 and derives from the 13th-century Old French "province," which itself comes from the Latin word "provincia," which referred to...
government. It is not the only service provider in its area; private-for-profit medical transport services also provide routine, non-emergency transports and coverage for special events, but the statutory EMS system is the only provider permitted to service emergency calls.
History
The City of Toronto has operated an ambulanceAmbulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
service directly on an uninterrupted basis since 1883, when the City of Toronto Health Department acquired two ambulances to transport those with infectious diseases to the local sanitarium
Sanatorium
A sanatorium is a medical facility for long-term illness, most typically associated with treatment of tuberculosis before antibiotics...
. Full-time emergency ambulance service began in 1888, with the provision of emergency ambulance service by the Toronto Police Force, which eventually operated four horse-drawn vehicles. Prior to these two municipal initiatives, ambulance service was provided for the young city by a variety of means, including both hospital-based and private companies. This 'broad spectrum' approach to service delivery would continue for more than ninety years.
Toronto may very well be able to claim to have the first formally trained 'ambulance attendants' in North America, with the Toronto Police Force ambulance service staff receiving five days of formal training in their jobs from the St. John Ambulance Brigade in 1889. Training included both first aid
First aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
skills and anatomy
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
and physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, including all eight pairs (at that time) of cranial nerves
Cranial nerves
Cranial nerves are nerves that emerge directly from the brain, in contrast to spinal nerves, which emerge from segments of the spinal cord. In humans, there are traditionally twelve pairs of cranial nerves...
! Such training for ambulance attendants was unheard of at that time, outside of military circles. The police constables assigned to the ambulance also did regular policing, when not required for ambulance calls. As the city grew and technology progressed, so did the ambulance service. The first motorized ambulance was actually purchased by a local funeral home
Funeral home
A funeral home, funeral parlor or mortuary, is a business that provides burial and funeral services for the deceased and their families. These services may include aprepared wake and funeral, and the provision of a chapel for the funeral....
in 1911, and the Toronto Police Ambulance Service began the conversion from horse-drawn to motorized vehicles in 1913, with the process largely completed by 1918. Over the years, the two City of Toronto departments would have their services supplemented by more than 130 individual ambulance operators, most of them private companies, and in suburban areas by several of the tiny, local fire departments. The two municipal services would finally be merged in 1933, when the Toronto Police Department turned the operation of their ambulances over to the Department of Public Health, and ended their involvement in the City's ambulance service.
This service would grow again in 1953, as the result of the creation of the municipality of Metropolitan Toronto
Metropolitan Toronto
The Municipality of Metropolitan Toronto was a senior level of municipal government in the Toronto, Ontario, Canada area from 1954 to 1998. It was created out of York County and was a precursor to the later concept of a regional municipality, being formed of smaller municipalities but having more...
, dramatically expanding the required service area. Service would continue in this fashion until 1967, when the amalgamated City's suburban fire departments surrendered their ambulances, resulting in the evolution of the Department of Public Health Ambulance Service into the City-operated Department of Emergency Services (DES). Some private companies, and one operated by the provincial government, would continue to operate in 'Metro' Toronto until 1975, although with centralized dispatch services provided by DES.
The Metropolitan Toronto Department of Ambulance Services was created in 1975, and absorbed the five remaining private ambulance companies and single provincial service, providing a single, unified ambulance service in Metro Toronto. Known colloquially as Metro Toronto Ambulance (never its official name) or simply 'Metro Ambulance' (although never its official name) the service provided ambulance services from 1975 to 1998.
Metropolitan Toronto was restructured during 1998, transforming it from a regional government overseeing six member municipalities into a single, unified city, and many municipal and regional services were restructured as a result. Metro Ambulance became Toronto Ambulance, and later adopted its current name, in order to reflect its evolving role from primarily a provider of medical transportation to an actual provider of medical care.
The service introduced its first paramedics in 1984 (although experiments in pre-hospital advanced life support actually began in 1969). Toronto EMS introduced many other innovations, including the concept of dedicated ground-based critical care transport ambulances, as well as many specialty support units described in this article, many of which were originally conceived and pioneered by the service.
As of April 2005, the departments and commissioners were replaced by divisions under the City Manager (and Deputy Managers). Toronto EMS now operates under the city's Emergency Medical Services Division. It is the largest municipal EMS operation in Canada.
Staff
TorontoToronto
Toronto is the provincial capital of Ontario and the largest city in Canada. It is located in Southern Ontario on the northwestern shore of Lake Ontario. A relatively modern city, Toronto's history dates back to the late-18th century, when its land was first purchased by the British monarchy from...
EMS has 1,171 members including paramedics and other support staff. These are categorized as follows:
- Paramedics
-
-
- Level I - (Primary Care Paramedic)- 463 positions. Must complete minimum of 1,400 hours of training in a community collegeCommunity collegeA community college is a type of educational institution. The term can have different meanings in different countries.-Australia:Community colleges carry on the tradition of adult education, which was established in Australia around mid 19th century when evening classes were held to help adults...
prior to employment. Successful completion of provincial certificationCertificationCertification refers to the confirmation of certain characteristics of an object, person, or organization. This confirmation is often, but not always, provided by some form of external review, education, assessment, or audit...
exams is also required. - Level II - (Enhanced Primary Care Paramedic)- 217 positions. Requires an additional 572 hours of training in order to use expanded skill set and scope of practice. Only uses advanced skills when teamed with a Level III paramedic.
- Level III - (Advanced Care Paramedic)- 184 positions. In addition to Level II training requires a further 360 hours of training and 480 hours of preceptorship. Always the senior paramedic on a normal emergency unit.
- CCTU - (Critical Care Transport Paramedic)- 17 positions. In addition to Level III training, requires an additional 1,142 hours of training and 240 hours of preceptorship. Typically work only on Critical Care Transport ambulances.
- Emergency Medical Dispatchers - 112 positions. (Service trains its own EMDs to international standard)
- Management/Supervisory staff - 100 positions.
- Clerical support staff - 15 positions.
- Facilities maintenance - 19 positions.
- Vehicle maintenance/mechanical - 18 positions.
- Materials management/Logistics - 10 positions.
- Level I - (Primary Care Paramedic)- 463 positions. Must complete minimum of 1,400 hours of training in a community college
-
Uniforms
Uniforms consist of:- Dark navy short or long sleeve police style shirt with departmental crest, reflective stripes around arms and Toronto EMS/Paramedic in reflective print on chest and back.
- ChartreuseChartreuse (color)Chartreuse is a color halfway between yellow and green that was named because of its resemblance to the green color of one of the French liqueurs called green chartreuse, introduced in 1764...
jacket with PARAMEDIC on the back - Dark navy cargo pants with reflective stripes around lower leg
- White shirts for Supervisory/Management staff
- Bicycle helmet and shorts for bike crews
- Hard hatHard hatA hard hat is a type of helmet predominantly used in workplace environments, such as construction sites, to protect the head from injury by falling objects, impact with other objects, debris, bad weather and electric shock. Inside the helmet is a suspension that spreads the helmet's weight over the...
with visor as required (construction sites, vehicle extricationVehicle extricationVehicle extrication is the process of removing the vehicle from around a person that has been involved in a motor vehicle accident, when conventional means of exit are impossible or unadvisable. A delicate approach is needed to minimize injury to the victim during the extrication...
etc...) - Black safety boots/shoes
- FRFire-retardant materialA fire resistant material is one that is designed to resist burning and withstand heat. It is used in the bunker gear worn by firefighters to protect them from the flames in a burning building. Most auto racing drivers also wear fire-retardant materials in case their car catches fire...
Military styleBattledressBattledress, or fatigues in the general sense, is the type of uniform used as combat uniforms, as opposed to 'display' dress or formal uniform worn at parades and functions. It may be either monochrome or in a camouflage pattern...
tactical shirt/pants, Ballistic helmet and Ballistic vest for tactical units - HAZMATNBC suitAn NBC suit is a type of military personal protective equipment designed to provide protection against direct contact with and contamination by radioactive, biological or chemical substances, and provides protection from contamination with radioactive materials and some types of radiation,...
suits for CBRNE units - Dress uniforms for senior staff
Epaulettes with rank/qualification are shown below and are worn on all forms of dress:
- 1 Silver Stripe - Paramedic Level 1 (PCP)
- 2 Silver Stripe - Paramedic Level 2 (Intermediate, being phased out though training/attrition)
- 3 Silver Stripe - Paramedic Level 3 (ACP)
- 2 Gold Maple Leaf - Acting Superintendent
- 3 Gold Maple Leaf - Superintendent
- 1 Gold Maple Leaf and Crown - Deputy Commander
- 2 Gold Maple Leaf and Crown - Commander
- 3 Gold Maple Leaf and Crown - Deputy Chief
- 4 Gold Maple Leaf and Crown - Chief
Training
In addition to the education and skills training obtained prior to employment, the EMS Education Unit performs all pre-employment skills assessments, and also new employee orientation courses. Toronto EMS also provides all inservice education for a staff of more than 1,100 people. Inservice education may include the introduction of new equipment, procedures or techniques, may include items which have been mandated by the provincial government, or may include issues which have been identified in past practise. Toronto EMS provides all education and training for all advanced care paramedics (those above Level I), through its Christopher J. Rubes Centre for EMS Studies. Level I training must be obtained prior to employment. The service also operates a network of pre-selected Field Training Officers. The Christopher J. Rubes Centre for EMS Studies, which is operated directly by the service, has received accreditationAccreditation
Accreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
as a training academy for both primary and advanced care paramedics, through the Canadian Medical Association
Canadian Medical Association
The Canadian Medical Association , with more than 70,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation...
. Although in the past, the service has trained all of its own advanced care paramedics, training Level I to Level II has been suspended indefinitely and Level III training has slowed significantly in the past three years. Factors including new dispatch and management approaches, as well as funding has resulted in this discontinuation of further Advanced Care training. Toronto EMS has chosen not to pursue primary care paramedic training over the short term.
Fleet
Of the 242 vehicles in the Toronto EMS fleet, 150 are CMVSS / Ontario Standard Type III ambulances. Of these, approximately 100 are in service at any time on a typical, mid-week, day shift. The rest of the fleet are support vehicles (mainly buses and trucks) supervisory vehicles, and single paramedic response vehicles. Toronto EMS operates its own repair facilities, located at the service's Headquarters complex. All maintenance and repair work (with the exception of body work), and all equipment, radio, and medical electronics maintenance and repairs are performed on site by service staff.Fleet numbering
- XXX - Ambulances
- ESUXX - Emergency Support Unit
- XX-XXX - Paramedic Supervisor, Logistics Support, Rapid Response
Communications
Toronto EMS operates its own Communications and System Control Centre (called a Central Ambulance Communications Center or CACC "Kaack"), including emergency medical dispatch, patient distribution and system oversight. Toronto EMS participates in the community-wide 9-1-1 system, and triages emergency calls using the Advanced Medical Priority Dispatch SystemAdvanced Medical Priority Dispatch System
The Advanced Medical Priority Dispatch System , is an Emergency Medical Dispatch system developed and marketed by Priority Dispatch Corporation. AMPDS is primarily used in the United Kingdom, where it is medically approved...
. The system uses Computer-Aided Dispatch, including Tritech VisiCAD, augmented by PDS and Siren software and technology. The service utilizes a satellite-based Automatic Vehicle Locating
AVL
AVL may refer to:*Acadèmia Valenciana de la Llengua *Approved Vendor List*The United Nations Audiovisual Library of International Law*Aroostook Valley Railroad...
system in order to ensure that the closest appropriate response resource is consistently sent to each emergency call; all emergency response resources are included. The service utilizes a 800mhz Smartzone trunking
Trunking
In modern communications, trunking is a concept by which a communications system can provide network access to many clients by sharing a set of lines or frequencies instead of providing them individually. This is analogous to the structure of a tree with one trunk and many branches. Examples of...
radio system for dispatch purposes. The Control Centre has direct landline contact with the 9-1-1 Center, all other emergency services, all acute care hospitals, and all EMS Stations. The service utilizes “Language Line” service to provide instant simultaneous translation of emergency calls in more than 140 languages. Toronto EMS operates the largest EMS Communications Centre in Canada, which was recently accredited as an International Centre of Excellence by the International Academy of Emergency Dispatch.
Operations
Service is provided to a residential population of approximately 3.2 million people, which rises to approximately 5 million on most business days.Toronto EMS operates a total of 41 dedicated EMS stations, geographically distributed across the 246 square miles (637.1 km²) of the City of Toronto. Emergency service headquarters (which is shared with Toronto Fire Services, but both services operate independently) is located at 4330 Dufferin Street in Toronto. This facility includes administrative offices, some education facilities, the EMS Communications Centre, Fleet Maintenance, Planning and Operational Support, and Materials Management/Logistics. The service is supplemented by well-developed EMS systems in neighbouring communities on three sides, with Lake Ontario
Lake Ontario
Lake Ontario is one of the five Great Lakes of North America. It is bounded on the north and southwest by the Canadian province of Ontario, and on the south by the American state of New York. Ontario, Canada's most populous province, was named for the lake. In the Wyandot language, ontarío means...
providing the southern boundary of the service area. Air ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
operations are provided within the City of Toronto by Ornge
Ornge
Ornge is the air ambulance service for the province of Ontario and for the Ministry of Health and Long-Term Care...
, a privately owned air ambulance contractor, under contract to the Government of Ontario.
Based upon information provided by Toronto EMS, the service processed in excess of 535,000 calls through its Control Centre in 2007 (the most recent year for which complete data is available), resulting in 223,769 emergency calls being dispatched. Using the AMPDS system, which triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
s calls by severity for dispatch purposes, the actual dispatch volume by category for that same year was:
-
-
-
-
-
-
-
-
-
-
-
-
- Echo: 4,311
- Delta: 76,595
- Charlie: 31,126
- Bravo: 64,572
- Alpha: 36,674
- Non-Emerg: 25,775
-
-
-
-
-
-
-
-
-
-
-
Special operations
In addition to regular operations, Toronto EMS staffs a Special Operations Unit, tasked with the provision of EMS services in unusual circumstances. The elements of this unit include:- Tactical Paramedics - Cross-trained paramedics providing medical support to the Toronto Police Emergency Task Force.
- Marine Paramedics - Cross-trained paramedics staffing the patrol vessels of the Toronto Police Marine Unit, in order to provide support for Toronto Police personnel, EMS services on the waters of Lake Ontario, and EMS service to the Toronto Islands.
- HUSAR - Specially-trained Toronto EMS paramedics operate together with elements of the Toronto Fire Services and Toronto Police Service to provide a joint-service Heavy Urban Search and Rescue team.
- CBRNE Paramedics (Chemical, Biological, Radioactive, Nuclear & Explosive) - Specially-trained Toronto EMS paramedics operate together with elements of the Toronto Police Service and Toronto Fire Services to provide a joint-service Terrorism / Hazardous Materials Response team.
- Public Safety Unit - Cross-trained paramedics providing medical support to the Toronto Police Riot Squad.
- Emergency Response Unit - Single paramedics in rapid response vehicles, tasked solely with response to high priority emergency calls.
- Bicycle Unit - Paramedics equipped with mountain bikes, capable of providing either BLS or ALS services in off road areas, or at special events.
Challenges
Toronto EMS operates in a system of universal health careUniversal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
, with no one being refused care because they cannot afford it. As a direct result, hospital in-patient beds and Emergency Departments tend to be severely overcrowded, resulting in difficulties for paramedics transferring the care of their patients to hospital staff in a timely manner. Two to four hour delays in the transfer of care are commonplace, and six to eight hour delays are not unheard of. When this occurs, the service's ability to provide service to emergency calls in a timely manner will often degrade, because of decreased unit availability. Multiple stakeholders and various levels of government are currently seeking solutions to this problem, but have, so far, experienced only limited success.
The funding for Toronto EMS occurs as a result of a mixed formula, with fifty percent of funding coming from the municipal tax base and fifty percent from the provincial government. The funding of Toronto EMS is based upon its residential population, not its business day population. As a result, there are always more people requiring EMS services than the system has been funded for.
Language barriers and cultural misperceptions in Toronto's multicultural landscape are commonplace for Toronto's paramedics. The service subscribes to Language Line, a simultaneous telephone-based translation service which operates in more than 140 languages. This service is used by Emergency Medical Dispatcher
Emergency medical dispatcher
An Emergency medical dispatcher is a professional telecommunicator, tasked with the gathering of information related to medical emergencies, the provision of assistance and instructions by voice, prior to the arrival of Emergency Medical Services, and the dispatching and support of EMS resources...
s processing 9-1-1
9-1-1
9-1-1 is the emergency telephone number for the North American Numbering Plan .It is one of eight N11 codes.The use of this number is for emergency circumstances only, and to use it for any other purpose can be a crime.-History:In the earliest days of telephone technology, prior to the...
calls, or by paramedics treating patients in the field, on a daily basis. The service also operates its own ethnocultural access program.
The 'Baby Boom
Baby boom
A baby boom is any period marked by a greatly increased birth rate. This demographic phenomenon is usually ascribed within certain geographical bounds and when the number of annual births exceeds 2 per 100 women...
' generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.
Research
Over the years, the presence of such a large system and call volume, along with a commitment to consistently capture high quality data, has permitted Toronto EMS to become a 'test-bed' for research projects involving both EMS and emergency medicineEmergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
. This has resulted in a service which is extremely research-oriented and interested in outcome-based medicine. While this has provided any number of research opportunities for physicians and emergency medicine residents through the Toronto Base Hospital program, it has also permitted paramedics to function as supporting and as lead researchers, and in some cases, as the principal researcher of their own projects. All research conducted at Toronto EMS is pre-approved by the University of Toronto
University of Toronto
The University of Toronto is a public research university in Toronto, Ontario, Canada, situated on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution of higher learning in Upper Canada...
Research Ethics Committee, and the findings of research conducted at Toronto EMS, by both physicians and paramedics, has been published in respected, peer-reviewed, international journals
Academic journal
An academic journal is a peer-reviewed periodical in which scholarship relating to a particular academic discipline is published. Academic journals serve as forums for the introduction and presentation for scrutiny of new research, and the critique of existing research...
.
Community involvement
Toronto EMS paramedics are heavily involved in various community programs and partnerships. Toronto's paramedics are active participants in the community which they serve. At the 'grass roots' level, Toronto's paramedics and EMDs fund a children's breakfast club, ensuring a nutritious breakfast for the children who live in several of the city's housing projects. Paramedics also participate in a variety of other events in the community, including their enthusiastic (and occasionally successful) participation in the dragon boatDragon boat
A dragon boat is a human-powered watercraft traditionally made, in the Pearl River delta region of southern China - Guangdong Province, of teak wood to various designs and sizes. In other parts of China different woods are used to build these traditional watercraft...
races staged annually by the city's Chinese community. As another little known fact of community involvement by paramedics, all of the floats in the city's annual Santa Claus Parade
Santa Claus parade
Santa Claus parades or Christmas pageants are parades held in some countries to celebrate the official opening of the Christmas season with the arrival of Santa Claus....
(one of North America's largest), are driven by volunteers from Toronto EMS, including both paramedics and a variety of other staff.
See also
- York Region EMSYork Region EMSYork Region Emergency Medical Services provides ambulance services and paramedic care for the municipalities within York Region. Before 2000, ambulance services were provided by 2 private operators , York County Hospital, Nobleton Volunteer Ambulance and Ontario's Ministry of Health...
- Durham Region EMSDurham Region EMSDurham Region EMS provides emergency medical services to Durham Region in Ontario, Canada.The service has 260 paramedics in ten EMS stations throughout the region...
- Peel Regional Paramedic ServicesPeel Regional Paramedic ServicesPeel Region Paramedics Services provides ambulatory and paramedic care for the municipalities within Peel Region, in Ontario, Canada. Paramedics operations are based in Mississauga....
- List of EMS Services in Ontario
External links
- Toronto EMS - official Website
- Toronto Police Services
- Toronto Fire Services