Provision of Ambulance Services at Rave Parties

(City Council on June 7, 8 and 9, 2000, amended this Clause by adding thereto the following:

“It is further recommended that the Executive Director of Municipal Licensing and Standards be requested to:

(1) submit a report to the Community Services Committee for its meeting scheduled to be held on July 13, 2000, on:

(a) the Jury verdict and recommendations arising from the Chief Coroner’s Inquest into the death of Allen Ho;

(b) the implications to the City of Toronto from the provincial Private Member’s Bill - ‘Rave Act 2000’; and

(2) co-ordinate the various reports and efforts underway in all other departments, agencies, boards and commissions with respect to this issue.”)

The Community Services Committee recommends:

(a) the adoption of the report dated May 3, 2000, from the Commissioner of Works and Emergency Services, subject to amending the recommendations to read as follows:

“It is recommended that:

(1) those organizing raves and similar events, with expected attendance of greater than 1,500 persons (based on both discussion with Toronto Ambulance and the apparent capacity of the site), be required to contract in advance with Toronto Ambulance for sufficient on-scene dedicated Advanced Life Support paramedic services as in the sole discretion of Toronto Ambulance may be reasonably required to protect life safety at an event;

(2) (i) Toronto Ambulance be designated as the sole emergency medical authority at such events and that no other person or entity be retained or used to provide emergency medical services on such properties; and

(ii) where Toronto Ambulance indicates that its services are not reasonably required, or when it cannot provide such services, the event organizer may obtain medical services by other means; (3) the cost of the services described above be paid in advance to Toronto Ambulance as a pre-condition for permission to operate the event on such properties; in addition, a refundable deposit of $2,500.00 shall be paid in advance to the City of Toronto sufficient to permit the recovery of any unanticipated Toronto Ambulance services arising from unforeseen circumstances at the event;

(5) the City Solicitor be directed to report on options to extend the recommendations contained in this report to all similar events held in the City of Toronto at non-City owned locations, including making such recommendations conditions for any City permits, licences, permissions, or City services, such as paid-duty policing, and also including any potential provincial legislative or regulatory changes that may be required; and

(6) the appropriate City officials be authorized and directed to take the necessary actions to give effect thereto.”;

(b) that the General Manager, Toronto Ambulance be directed to work with the Medical Officer of Health to promote harm reduction strategies at raves;

(c) that the report of the Commissioner of Works and Emergency Services and all amendments be forwarded to the following for comment thereon to the July 13, 2000, meeting of the Community Services Committee:

(i) the Toronto Dance Safety Committee; and

(ii) the Toronto Police Services Board, the Chief of Police, the Medical Officer of Health, and other appropriate staff working on the forthcoming report on Raves, requested by City Council at its meeting on May 9, 10 and 11, 2000.

The Community Services Committee reports, for the information of Council, having directed that:

(1) the City Solicitor be requested to submit the report requested in the new Recommendation No. (5) directly to Council for its meeting on June 7, 2000; and

(2) the General Manager, Toronto Ambulance be requested to report to the July 13, 2000, meeting of the Community Services Committee on the results of the Coroner’s Inquest into the death of Allen Ho. The Community Services Committee submits the following report (May 3, 2000) from the Commissioner of Works and Emergency Services:

Purpose:

This report seeks the direction of Council to implement certain specific measures to improve the life-safety protection afforded young people by Toronto Ambulance at “rave” dance events in the City of Toronto, most particularly those held on the property of the City, its Boards, Agencies and Commissions.

Financial Implications and Impact Statement:

The implementation of these recommendations will reduce the financial impact of rave events on the City of Toronto taxpayers by mandating the advance contracting of Toronto Ambulance services for these events, and by eliminating bad debt accruing to the City through the non-payment for such services. Advance arrangements for Toronto Ambulance services will reduce the Toronto Ambulance overtime budget impacts. Such overtime is currently incurred as due diligence requires Toronto Ambulance to increase staffing when raves are scheduled to cope with anticipated patient volumes, even in the absence of any funding from the rave promoter.

Recommendations:

It is recommended that:

(1) those organizing raves and similar events on the properties of the City of Toronto, its Boards, Agencies and Commissions, be required to contract in advance with City of Toronto Ambulance for sufficient on-scene dedicated Advanced Life Support paramedic services as in the sole discretion of Toronto Ambulance may be reasonably required to protect life safety at an event;

(2) Toronto Ambulance be designated as the sole emergency medical authority at such events and that no other person or entity be retained or used to provide emergency medical services on such properties;

(3) the cost of the services described above be paid in advance to Toronto Ambulance as a pre-condition for permission to operate the event on such properties; in addition, a refundable deposit of $2,500.00 shall be paid in advance to the City of Toronto sufficient to permit the recovery of any unanticipated Toronto Ambulance services arising from unforeseen circumstances at the event;

(4) the General Manager, Toronto Ambulance, be directed to ensure appropriate consultation be undertaken with Toronto Police Services and the event organizers to ensure that proper arrangements are made for the delivery of emergency medical services at the event site, given police estimates of crowd size and the nature of the event; (5) the City Solicitor be directed to propose to the next meeting of Council a by-law which extends the requirements of the above recommendations to all similar events held in the City at any location for which any City permit, licence or permission, or City service, such as paid-duty policing, are required or requested; and

(6) the appropriate City officials be authorized and directed to take the necessary actions to give effect thereto.

Background:

Rave dance events in the City of Toronto are routinely attracting crowds of as much as 15,000 young people, and are frequently held on the properties of the City of Toronto, its Boards, Agencies and Commissions. At every major rave event, Toronto Ambulance is called upon to treat substantial numbers of patrons from age 12 and up almost invariably from drug overdoses. Many of these overdoses are immediately life-threatening due to unconsciousness, respiratory depression, and vomiting in patients who are too sedated to prevent airway obstruction. In recent cases at Exhibition Place, only the urgent intervention of Toronto Ambulance advanced life support paramedics averted the needless deaths of some of these patients.

Drug use by a portion of those attending raves is a fact of life. More particularly, it is common practice to consume multiple drugs, each providing a portion of the desired effect. Combinations of potent agents such as GHB, the anesthetic Ketamine, the amphetamine “Crystal Meth”, MDMA (“Ecstasy”), LSD and others, produce dangerous and persisting overdoses in some patients due to unknown drug purity, contaminants, and interaction with other substances including regular prescription drugs.

As currently organized, these events pose particular dangers to the safety of participants, and to the community at large:

(1) Toronto Ambulance is inevitably involved in every rave event which generates patients. At present, some event organizers do not contract with Toronto Ambulance to provide advanced life support coverage, relying instead on urgent requests to 911 once overdoses develop. Accordingly, Toronto Ambulance’s intervention is delayed until someone at the event decides an overdose is unmanageable. By this time, many patients’ lives are in immediate danger.

Some event organizers are contracting with various companies offering event first aid services, none of which are sufficient to manage life-threatening conditions. Overdoses require full advanced life support EMS intervention, and only Toronto Ambulance is capable of and licensed to provide such services in Toronto. In addition to overdoses, stabbings and shootings have occurred at these events, and, again, neither is within the scope of care of a first aid contractor.

Toronto Ambulance cannot provide the needed care if called to the scene only after such predictable occurrences materialize. Toronto Ambulance has routinely encountered situations where contracted first aiders had unwisely decided that a patient could “sleep off” an overdose. In addition, first aid contractors have often come under intense pressure from organizers or rave participants not to call an ambulance. Participants often believe that overdoses will resolve quickly and that a person can then resume dancing. This is profoundly unwise and may lead to an avoidable death.

To protect the safety of rave participants (many of whom are minors), Toronto Ambulance must be the sole emergency medical authority at such events, and be in place at the start of the event with sufficient resources to immediately intervene when an emergency arises.

(2) Rave events often generate multiple simultaneous patients. Unless Toronto Ambulance can pre-plan and pre-staff these events, a single rave event can drain, and has in the past drained, all available paramedic service from the neighbourhoods surrounding the event. This places the lives of those in the broader community at risk, and transfers the true costs and risks of these private “for-profit” events onto the general population.

For instance, the rave on April 22, 2000, at the Better Living Centre in Exhibition Place produced twelve overdose patients within a one-hour period, stripping local paramedic coverage, and requiring Toronto Ambulance to bring in its multi-patient ambulance bus, numerous ambulances and other staff. The scope of care and the life-threatening nature of the overdoses was substantially beyond the first aid contractor on the scene.

Accordingly, Recommendations Nos. (1) and (2) of this report provide for the designation of Toronto Ambulance as the sole emergency medical services provider at events, and mandate that arrangements for the provision and funding of such services be made in advance. While this report focuses primarily on raves occurring on City property, Toronto Ambulance urges Council to extend these life-safety provisions as broadly as possible to events occurring on private property. To this end, Recommendation No. (3) requests the assistance of the City Solicitor in developing a by-law to require the same provisions wherever the co-operation or permission of the City of Toronto is required in order to stage an event.

(3) Certain rave promoters and their contractors have proven to be poor credit risks, and bills for Toronto Ambulance services have gone unpaid. Toronto Ambulance has referred at least one of these accounts to City Legal for action. Prepayment for planned Toronto EMS services, and the provision of a refundable deposit against contingencies, would reduce the financial risk to the City and its taxpayers. Such provisions would also help narrow the field of those producing raves to those with sufficient resources and experience to responsibly manage an event.

Council has in the past undertaken broader consideration of the management of rave events, including issues of zoning, physical facilities, supervision and policing, and Toronto Ambulance supports these initiatives. These initiatives have included the development of a broad protocol for rave events, currently under consideration by other City departments and divisions. However, Toronto Ambulance believes that the urgency of the life safety issues arising from events in the past months warrants specific provisions for emergency medical services as a separate and immediate action of Council.

Conclusions:

Toronto Ambulance is gravely concerned that failure to correct this component of event safety will result in avoidable deaths or enduring disability from an otherwise innocent entertainment activity. It is the experience and best judgement of Toronto Ambulance as the City’s Emergency Medical Services provider that this action is urgently warranted by the now well-established risks to the safety of young people in the community.

Contact:

R.L. Kelusky, General Manager Toronto Ambulance Services Tel: 397-9240/Fax: 392-2115

(City Council on June 7, 8 and 9, 2000, had before it, during consideration of the foregoing Clause, the following report (May 31, 2000) from the City Solicitor:

Purpose:

This report responds to the request of the Community Services Committee for information relating to the legal ability of the City to require the organizers of raves and other similar events to provide and pay for Advanced Life Support paramedic services at such events.

Financial Implications and Impact Statement:

There are no financial implications associated with this report.

Recommendation:

It is recommended that this report be received for information.

Background:

At its meeting of May 18, 2000, the Community Services Committee had before it a report dated May 3, 2000 from the Commissioner of Works and Emergency Services which contained various recommendations relating to the provision by Toronto Ambulance of dedicated Advanced Life Support paramedic services at raves and similar events. The report of the Commissioner of Works and Emergency Services included a recommendation that an event organizer be required to pay for the paramedic services in advance and provide a refundable deposit of $2,500.00 to permit the recovery of any unanticipated costs arising from unforeseen circumstances at the event. The Committee directed the City Solicitor to report directly to City Council’s meeting of June 7, 2000 on options to extend the recommendations contained in the Commissioner’s report to all similar events held in the City of Toronto at locations not owned by the City, including making such recommendations conditions for any City permits, licences, permissions or City services such as paid-duty policing and also including any potential provincial legislative or regulatory changes that may be required.

Comments:

(A) Authority to Charge Fees for the Provision of Ambulance Services to Raves

In order for the City to charge fees for the services it provides, statutory authority to impose the fee is required. For example, the Police Services Act specifically recognizes that members of police services can perform paid duties. The issue of charging fees for ambulance services is addressed by section 20.1 of the Ambulance Act (the “Act”) which states:

“20.1 No person shall charge a fee or co-payment for or in connection with the provision of ambulance services, whether or not the person is transported by ambulance, unless the fee or co-payment is,

(a) a co-payment authorized under the Health Insurance Act; or

(b) a fee under this Act.”

Pursuant to this section, the City has no authority to charge a fee for the provision of ambulance services unless the fee is one of the type of fees identified in clauses (a) or (b) of section 20.1. The Health Insurance Act does require the payment of a prescribed amount by every person who is transported by ambulance. However, neither the Health Insurance Act nor the Ambulance Act permit the charging of a fee for the provision of stand-by ambulance services at raves or other similar events as contemplated in this report.

Because of section 20.1, the City of Toronto would not be able to charge fees for the provision of ambulance services to raves without legislation which expressly states that it supersedes the Ambulance Act or an amendment to the Act itself.

(B) Authority to Require the Provision of Ambulance Services at Raves

Although the City does not have authority to charge a fee for the ambulance services it provides, the City could require the use of ambulance services without a fee at raves or similar events. This could be accomplished in a number of ways as set out below.

At its meeting of May 9, 10 and 11, 2000, City Council approved a motion directing all agencies, boards, commissions and departments to suspend immediately the leasing of any City-owned facility for the purpose of holding raves. If at a future time the City decided to permit the use of City-owned property for raves, it could, as property owner, require the provision of ambulance services as a condition of obtaining a permit. Under the Municipal Act, the council of a municipality has authority to pass by-laws to license, regulate and govern businesses carried on within the municipality. The term “business” is very broadly defined in the Municipal Act as follows:

“business” means a trade, business or occupation and includes the sale or hire of goods or services on an intermittent or one-time basis, the showing for the purpose of sale or hire of samples, patterns or specimens of any good and an activity or thing a local municipality may licence under paragraph 6 or 7 of section 236 but does not include,

(a) a manufacturing activity or an industry, except to the extent that it sells its products or raw material by retail; (b) the selling of goods by wholesale; or (c) the generation, exploitation, extraction, harvesting, processing, renewal or transportation of natural resources.

The above definition would include a rave and the City therefore, could enact a by-law to license such an event. If the City did choose to license raves, the City could impose conditions on the license such as the requirement to provide Advanced Life Support paramedic services, the services of a private medical transportation service or appropriately trained medical personnel at the rave.

There is presently before the Legislature a bill which, if passed, would give the City authority to require the use of ambulance services at raves. Bill 73, “An act to promote public peace and safety by regulating late-night events” received first reading on May 3, 2000. Bill 73 contains provisions which would prohibit anyone from holding a rave without a permit issued by the municipality in which the rave is to be held. Bill 73 would also enable municipalities to pass by-laws prescribing conditions for permits and establishing standards for the holding of raves. It should be noted that Bill 73 is a private member’s bill and as such, may not become law.

Conclusions:

Section 20.1 of the Ambulance Act prohibits the charging of fees for ambulance services in most circumstances. At this time, there is no legislation, including the licensing provisions of the Municipal Act, which provide sufficient authority to charge fees for providing Advanced Life Support paramedic services at raves or similar events. New legislation which authorizes the City to charge a fee for such services notwithstanding the provisions of the Ambulance Act is needed.

The City, as property owner, could require the use of ambulance services for raves held on City-owned property. As well, through the licensing provisions of the Municipal Act, the City would legally be able to require the use of Advanced Life Support paramedic services at raves held on any property, whether or not it is owned by the City. The City has not exercised this authority to license raves and as a result, there is no City license, permit or other form of City approval which is required at this time in order to hold a rave on property which is not owned by the City. Accordingly, the City does not have the legal ability at this time to require a rave organizer to provide Advanced Life Support paramedic services as a condition of holding a rave on property which is not owned by the City.

Contact:

Shirley Mathi Solicitor Tel: 392-2989 Fax: 392-3848.)