City fire, EMS given another month to break tiered response stalemate
A decision on whether or not to restore a Tiered Response Agreement between city firefighters and Lambton EMS has been put off again.
Lambton County Council supported Sarnia Mayor Mike Bradley’s call Wednesday, to table discussion for another month to allow both emergency services to resolve the issue and report back.
The Regional Medical Director of the Southwest Ontario Regional Base Hospital Program, Dr. Matthew Davis — who is also an emergency physician at London Health Sciences Centre — told council there is evidence supporting early medical response for cardiac patients.
He said there is also expert opinion supporting early response to choking intervention and anaphylaxis.
“We know that early CPR increases survival about 30 per cent, so the earlier chest compressions are started, the better chance patients have of survival,” said Davis. “We know that early defibrillation is beneficial for cardiac arrest, so patients who are in a shockable rhythm, the quicker we can get a defibrillator to that patient, the higher chance they have of survival.”
But, Dr. Davis highlighted studies showing an increased risk to firefighters and residents from motor vehicle collisions associated with tiered response.
“I think in situations where medical benefit can be offered, such as cardiac arrest, the risk may be deemed acceptable. However, I think from a public health perspective, it’s very difficult to explain a devastating outcome when fire is responding to a call, but it can not offer any medical benefit. Especially when current evidence shows that there are a lot of calls that fire may go to where they can not offer any benefit to that call.”
Dr. Davis also referenced a model, developed by former Toronto EMS deputy chief Alan Craig, which reduced firefighter response to about 7 per cent of all paramedic calls and firefighters were only able to intervene in one out of 17 calls.
“In our opinion, in order to achieve the most benefit for the patient, while balancing the risk of treatment, these skills should only be performed by fully certified paramedics, in the pre-hospital setting. Paramedics have two years of college training, focused on this type of intervention. They’re moving to a three-year program because the increasing scope of pre-hospital medicine and the knowledge base that has grown.”
The agreement has firefighters respond to certain medical calls to assist paramedics, but the protocol was modified at the beginning of the pandemic with the fire service being dropped from some calls to limit all but absolutely necessary interaction between staff and the public.