Association of Municipal Emergency Medical Services of Ontario Premier Issue | Winter 2008 AMEMSO has many Hands, Faces and Friends…

These are just a few of them. Canada Post Publications Agreement Number 40609661

EMS Matters The official magazine of the Association of Municipal Emergency Medical Services of Ontario Winter 2008

Published for: The Association of Municipal Emergency Medical Services of Ontario (AMEMSO) Paul J. Charbonneau, President Frontenac Paramedic Service 2069 Battersea Road Glenburnie, ON K0H 1S0 (613) 578-9400 [email protected] www.emsontario.ca Opinions expressed in articles, reports or other content within EMS Matters are those of the author and do not necessarily represent the views of AMEMSO or its Board of Directors.

Published by: Matrix Group Inc. Publication Mail Agreement Number 40609661 Return Undeliverable Addresses to: 52 Donald Street Winnipeg, MB R3C 1L6 Toll Free Phone: (866) 999-1299 Toll Free Fax: (866) 244-2544 www.matrixgroupinc.net

President & CEO Jack Andress Senior Publisher Maurice LaBorde Publisher & Director of Sales contents Joe Strazzullo [email protected] Messages: Editor-in-Chief 7 Message from the President of AMEMSO, Paul Charbonneau Shannon Lutter 9 Welcome to EMS Matters [email protected] Editor Jon Waldman Reports: [email protected] 10 OBHG Prepares for Exciting Year Ahead Finance/Accounting & Administration 13 ORNGE: Virtual Hospital through Innovative Transport Medicine Shoshana Weinberg, Nathan Redekop, Pat Andress 17 Introduction of the Ontario Paramedic Association (OPA) [email protected] 18 2007: The Year of the Flood Director of Marketing & Circulation Jim Hamilton Features: Sales Manager Neil Gottfred 23 Green Future Sales Team Leader 25 Redefining Tiered Response in Ontario Declan O’Donovan Matrix Group Inc. Account Executives Conference Report: Travis Bevan, Albert Brydges, Lewis Daigle, 29 Reflections... Rick Kuzie, Miles Meagher, Marlene Moshenko, Ken Percival, Kelly Pound, Brian Saiko, Peter Schulz, 30 The Richard J. Armstrong Leadership Award Vicki Sutton 31 The EMS Chiefs of Canada Layout & Design 34 Emergency Medical Services—Exemplary Service Medal J. Peters ON THE COVER: Advertising Design Association Information: AMEMSO’s many James Robinson hands, faces and 35 Upcoming Events friends are part of 35 AMEMSO Board Members ©2008 Matrix Group Inc. All rights reserved. our premier issue. Contents may not be reproduced by any means, 36 AMEMSO Strategic Partners (Photos courtesy of in whole or in part, without the prior written 37 A Day in the Life of AMEMSO permission of the publisher. The opinions expressed AMEMSO, ORNGE and in this publication are not necessarily those of 38 Buyer’s Guide GlobalMedic). Matrix Group Inc.

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| Message from the President of AMEMSO |

We have seen many successes in the areas of partnerships and improvement of ambulance standards by working with AMO and Emergency Health Services. We continue to value and build these partnerships for the enhancement of EMS in Ontario.

By Paul Charbonneau, President, AMEMSO

Welcome to the premier edition of EMS gala. During this event, current industry leaders in the provision Matters, the Association of Municipal Emergency Medical Services of EMS care join together to share information and best practices of Ontario (AMEMSO) magazine. and to review new trends and patient treatment modalities. EMS matters to the paramedics who provide service at the The focus for the coming year is to continue to bring street level and bring their skills and expertise to the patient in education to our municipal EMS managers, look at diverse ways need. EMS matters to the dispatch staff who receive the initial of managing our assets, and continuously looking at Provincial call for help. EMS matters to supervisors and managers who methods of patient care delivery and standards. lead our resources during emergency care. EMS matters to the It is our pleasure to bring EMS Matters to you, and we look municipal and provincial politicians who strive to balance of the forward to your input and know you will find our magazine delivery of service to the residents of their communities. Most current, informative and the heart of EMS in Ontario. of all, EMS matters to the citizens of Ontario who become our patients; it matters to their peace of mind and comfort to know that, when needed, our EMS system will be there for them. AMEMSO is comprised of municipal emergency medical services, designated delivery agents, upper tier municipalities, First Nations EMS and ORNGE throughout Ontario. Our Association began as a venue to exchange information among those who were in the process of downloading ambulance services to the Municipalities throughout 2000 and 2001. The Association was incorporated in 2002 and we have grown now to 100 per cent municipal membership in 2007 so that the smallest to the largest EMS services in Ontario are represented. The Association has helped to build a strong provincial voice for EMS in the province. We are dedicated to the advancement and the promotion of Emergency Medical Services in Ontario. Our principal areas of interest include excellence in customer service, best practices, performance standards and measurements, administrative and operational efficiencies, vehicle and equipment standards and innovation and policy development and promotion. Our membership is committed to working together as a team to provide all members with information they may require to provide ambulance service to their residents. In addition, AMEMSO works with the Ministry of Health and Long-Term Care (MOHLTC) and the Association of Municipalities of Ontario (AMO) to exchange information. This exchange of information and communication is key to the improvement of EMS in Ontario. We have seen many successes in the areas of partnerships and improvement of ambulance standards by working with AMO and Emergency Health Services. We continue to value and build these partnerships for the enhancement of EMS in Ontario. AMEMSO hosts the annual Exemplary Service Medal awards ceremony and

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| Message from Communications and Media Relations | Welcome to EMS Matters By Jim Price, Communications and Media Relations, AMEMSO

On behalf of AMEMSO challenge our members to do better. We lead the industry by and the Editorial Team, I am advancing the causes of both the grass roots needs and the pleased to welcome you to EMS management philosophy necessary to build a world-class EMS Matters. In the spring of 2007, the system. Board of Directors made a commitment Volunteer boards are driven by the vision of individuals who, to focus on communication as one of its key goals. The launch of while watching the horizon, keep their eyes on the daily issues. this magazine is a visible part of that endeavour. A significant “thank you” is appropriate for our industry The launch of a periodical can be stressful. We have been suppliers. It is through the support of these advertisers that this extremely fortunate to have received multiple submissions from magazine is possible. I would also recognize the magazine editorial a broad base of sources. The team sought a balance between board and working group. information and education. EMS Matters is not intended to be There is one individual who must have special mention. Past a commercial entity nor is it intended to be a collection of President Terri Burton of Muskoka has a gift for multi-tasking. clippings. We seek informative, first-person articles about real She has the innate understanding of when to lead and when to life and real challenges concerning EMS in Ontario. This will be contribute. The unselfish gift of her time has been key to this the continuing theme as we move forward. launch and to the quality of the product we now present. She is but In its preparation, AMEMSO considered its “Unique Selling one example of the talent to be found within AMEMSO membership. Proposition”. In this case, it is not about besting the competition I hope you enjoy this premier issue. Your thoughts but rather in finding the core of its reason to be. We support and suggestions are welcome and may be forwarded to me at our members by sharing life experiences and best practices. We [email protected].

www.emsontario.ca | 9 | Reports | OBHG Prepares for Exciting Year Ahead

Monitoring and ensuring the quality of patient care and Making the most of service delivery is a vital element of any ambulance system. In Ontario the function of pre–hospital clinical data monitoring the appropriateness and quality of patient care is provided by a series of in Ontario! designated base hospital programs. The medical director of each base hospital program is responsible for certifying and delegating to each paramedic the authority to perform In early 2003 a multi-agency com- controlled medical acts. The base hospital medical director and other qualified emer- mittee was struck to, “advise the gency medical physicians monitor the quality of care provided by paramedics. Director of Emergency Health Services Branch, on information gathering and I am pleased to have the opportunity to contribute to the new AMEMSO magazine database issues relating to the provi- on behalf of the Ontario Base Hospital Group (OBHG). sion of ambulance based pre-hospital I would like to congratulate everyone on the first-class EMS leadership conference care in Ontario.” in Toronto this past September. The annual conference is a good example of how a The group’s mandate also included, strong OBHG/AMEMSO partnership can contribute to progress for the EMS system in “reviewing and updating patient data Ontario. collection and data reporting stan- The base hospital restructuring process is reaching its penultimate stage. The suc- dards and practices, necessary to meet cess of any new base hospital system will be measured by its ability to deliver key the current and emerging needs of services to the EMS providers and, by extension, our patients. The new base hospital stakeholders.”

The success of any new base hospital system will be The time is ripe measured by its ability to deliver key services to the to enable EMS EMS providers and, by extension, our patients. stakeholders in Ontario to measure, then adjust performance agreement provides us with a unique opportunity to establish clear and to an improved level of measurable performance indicators that are meaningful in terms of your needs and those of your community. The base hospitals are ultimately accountable (through their care, then follow up by host hospitals) to the Ministry of Health and Long Term care (MOHLTC) and I encour- measuring the gains. age all AMEMSO members to work in partnership with their base hospital to complete a memorandum of understanding that will describe how the elements described in the Performance Agreement will be successfully delivered in your service area. That seemed like quite a daunting The true power of our new relationship will become evident as we work together task at the time, but here we are, five to serve our communities and find solutions to delivering pre-hospital care, which years later, having clearly identified respects the diversity found in Ontario. Whether it is a large urban centre, a rural set- the biggest barriers to data standard- ting or a First Nations community, all EMS systems present unique challenges that base ization and collection and created a hospitals must meet equitably. made-in-Ontario solution. There was a The Ontario Base Hospital Group (OBHG) and the provincial Medical Advisory real opportunity, with significant vari- Committee (MAC) has two subcommittees. There is the database subcommittee and the ance in data points, limited collabora- education subcommittee. The MAC and OBHG report to the MOHLTC. The MAC is respon- tion between agencies and a dearth of sible for the medical oversight of all Paramedic Programs in Ontario. analytical expertise, particularly out- It is important to note that AMEMSO has representation on all of the committees side the larger centres and beyond the and subcommittees and provides valuable input and insight. cardiac arrest patient. In general data Our two subcommittees are the real workhorses of our system. The subcommittee points were poorly defined, creating has delivered a substantial volume of educational content to the MAC that is now a real challenge for quality managers available for all base hospitals. and researchers alike. Our submission continues in the next column with an article from the Database As we now head into 2008, on the Subcommittee. AMEMSO participates on this committee as well. horizon this year is a core minimum set of standardized clinical data defi- Robert Burgess nitions that can be expanded on, a Chair, Ontario Base Hospital Group (OBHG) new and ACR with the data points

10 | consistent between both the paper ACR and the electronic ACR, to be raised to the highest common denominator, not the low- and revised provincial documentation standards. est. Every one of us has room to improve, and without a common This set of new definitions as well as a new ACR is designed yardstick, debates about attaining improved clinical care will for Ontario with the expectation it will help support evidence never end. Stay tuned to your local AMEMSO representatives and based medicine, and build a foundation for best practice through to your base hospital colleagues for a progress report as 2008 province wide clinical benchmarking. The time is ripe to enable unfolds. EMS stakeholders in Ontario to measure, then adjust to an improved level of care, then follow up by measuring the gains. John Trickett Expect to be provided with the tools in 2008 to enable the bar Chair, OBHG Data Management Sub Committee

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| Reports | ORNGE: Virtual Hospital through Innovative Transport Medicine By ORNGE Most people who live in new name, ORNGE, to better reflect the full Communications Centre (OCC). The OCC pro- Ontario know that if they need the ser- scope of the services it provides. vides the service as defined by the Ontario vices of a health-care provider, there is one With the stated mission of providing Ambulance Act. ORNGE aircraft can and does that is near-by and ready to assist them. patient care with innovative transport medi- respond to an accident scene or remote The vast geography of Ontario, one million cine, ORNGE works to give the residents of areas when they are requested by the local square kilometres has the potential to cre- Ontario seamless access to healthcare by land ambulance CACC. ate a barrier to that quality health care in operating from 22 bases located across the In order to qualify for inter-facility air remote and rural areas. ORNGE works daily province. Nine of these bases are staffed transport by ORNGE, the patient must meet to remove that barrier by operating one of 24 hours a day, 7 days a week. ORNGE the requirements of the Ambulance Act: the largest most sophisticated programs of consists of over 300 dedicated employees, • Have suffered a trauma or an acute onset aero-medical transport in North America. including paramedics, paediatric transport of illness which could endanger their The air medical transport program nurses, patch physicians, lead educators, life, limb or function; or evolved from a very humble beginning researchers and office staff who champion • Have been judged by a physician or in 1977 with a single helicopter based in the organizations’ vision of propelling life other designated health care provider to Toronto. Over time, many different regions with innovation. be in an unstable medical condition and of the province established their bases As a provincial resource, ORNGE is dedi- to require, while being transported, the with paramedics practicing under regional cated to providing quality patient care to care of a doctor, nurse or paramedic and base hospitals using either helicopters, also the people of Ontario regardless of geog- the use of a stretcher. called rotor wing aircraft by aviators, or air- raphy. The coordinated service enables the Additionally, one of the following criteria planes (fixed wing aircraft). The individual utilization of aircraft from different regions must be met to qualify for air transport: programs grew and expanded independ- to provide service when and where it’s • The transfer involves one way travel of ently until 2005 when the Ontario Ministry needed. distances greater than 240 kilometres; of Health and Long Term Care created a While most visible when landing at the • All land ambulance transport alternatives single, non-profit organization to coordin- scene of an accident, many of ORNGE’s have been exhausted; ate all aspects of the aero-medical transport patient admissions are for the purpose of • Specialized equipment and/or escorts/ system. Originally known as the Ontario transporting from one facility, often a small paramedic staff are required; or Air Ambulance Service Company, it began regional hospital, to a larger facility provid- • The out of facility time is critical (land operations in January 2006. In August of ing access to specialized care. trip would be detrimental due to timing the same year, the organization adopted a Unlike Emergency Medical Service pro- and/or condition). viders, ORNGE is not accessible to the The ORNGE Communications Centre also public through 911. The dispatch of an provides medical transfer (MT) authoriz- ORNGE is the responsibility of the ORNGE ation numbers to each patient requiring

An ORNGE helicopter is ready for lift-off when the call of duty comes. (Source: ORNGE).

www.emsontario.ca | 13 transfer, from one healthcare facility to history, scope of practice and resources They are experienced and highly trained in another within the province of Ontario. within ORNGE put it on solid footing to providing specialized care to patients in the Patient screening began as a direct response design and implement an integrated land medical transport environment. to the SARS outbreak. The process helps and air inter-facility transport system. For municipalities the benefits may prevent the spread of infectious diseases by By creating an integrated land and air include relieving pressure on land ambu- ensuring that facilities are advised and noti- inter-facility transfer system for critically lance services allowing them to focus on fied when they need to take precautions. ill or injured patients, ORNGE can provide their municipal mandate and on 911 emer- seamless inter-facility transport for these gency calls. For hospitals this change may The integration of land and air patients. lead to a reduced need for the provision In June 2007, the province proclaimed ORNGE advanced care and critical care of escort staff to accompany critical care the Health System Improvements Act (2007), flight paramedics are trained to provide care patients on transfers. (Bill 171) which designated ORNGE to cre- for critically ill or injured patients outside the The implementation of the integrated ate an integrated land and air system. The traditional bricks and mortar of a hospital. land and air transport system will be intro- duced through a number of phases. The first phase will be in the Ottawa area, where ORNGE is planning on having a land ambulance operational by mid December. This vehicle will be designated for use to provide inter-facility transport to critically ill or injured patients. ORNGE will recruit and as required, train paramedics at the ORNGE Academy of Transport Medicine to deliver this level of care required by the patients while they are admitted to the ORNGE virtual hospital.

Innovation, compassion, collaboration The men and women who work at ORNGE embrace our values of innovation, compassion and collaboration. They are committed to advancing the frontiers of transport medicine. Under the leadership of Dr. Christopher Mazza, ORNGE president and chief executive officer, staff from all levels of the organization identify with and work towards improving care for our patients. The health and well being of patients who are admitted by ORNGE for medical transport in our virtual hospital is our number one priority. We continue to work together internally and externally to deliver on our promise.

In July 2005, the government of Ontario announced the appointment of ORNGE (for- merly the Ontario Air Ambulance Services Co.) to co-ordinate all aspects of Ontario’s air ambulance system. ORNGE, a non-profit body accountable to the Ontario government through a performance agreement, is now responsible for all air ambulance operations including the contracting of flight service providers, medical oversight of all air para- medics, air dispatch and authorizing air and land ambulance transfers. For more informa- tion, visit www.ornge.ca.

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| Reports | Introduction of the Ontario Paramedic Association (OPA)

By Glen Gillies, Director, Public and Media Relations, Ontario Paramedic Association

The idea to form the Ontario Mission Statement of the OPA Paramedic Association came as a result Our mission is to provide leadership for of a steering committee of Paramedics Paramedics and to promote the art and sci- who began the ambitious task of creating ence of Paramedicine. We serve Paramedics a legal and administrative structure for and their patients by advocating the high- the Association in 1995. This professional est ethical, educational and clinical stan- association became a registered “not for dards for the profession of Paramedicine. profit” organization representing the pro- fessional interests of Paramedics across the Goals of the OPA province of Ontario. • To promote the highest standard of • Conserve life, alleviate pain and suffer- Since its formation, the OPA has care for our patients; ing and promote health; worked to enhance the professional image • To represent the professional interests • Provide care based on human need with of paramedics, to improve communica- of all Paramedics in Ontario; respect for human dignity, unrestricted tions between paramedics, and to lobby for • To pursue self-regulation under the by consideration of nationality, race, improvements to the standards of patient Regulated Health Professions Act; creed, colour, status, sex, religion, care. One communication tool, the OPA • To assist academic institutions to sexual orientation, type of illness or Listserver, which is graciously provided develop Paramedic education which is mental or physical disability. Without by the SmartRisk Foundation, has been an relevant, comprehensive and accred- fail, protect and maintain the patient’s important resource for members to share ited; safety, dignity and privacy; ideas, consult fellow paramedics, provide • To facilitate research and continuing • Preserve and protect the confidentiality direction to the OPA Executive, and net- medical education; of any information, either medical or work. This listserver can be accessed by • To raise public awareness about the personal, acquired through professional visiting: ontario.paramedic.association@ role of Paramedics and the different contact with a patient, except where lists.smartrisk.ca. The OPA website features levels of care that fall within the scope the disclosure of such information a variety of informational pages for the of Paramedicine; is necessary to the treatment of the general public, paramedics, and of course, • To take an active role in the develop- patient and the safety of other health our members. It can be accessed by visit- ment and promotion of programs with- care professionals or is required by the ing: www.ontarioparamedic.ca. In addition in the community that serve to reduce employer or the law; to our Listserver and website, the OPA and/or prevent injury or illness; and • Not use professional knowledge, skills, News is a bi-monthly newsletter published • To work collectively with government equipment or pharmaceuticals in any in Canadian Emergency News magazine agencies, Base Hospitals, ambulance; enterprise detrimental to the profession and is sent to all members as part of their and owner/operators, unions, other or the public well being; membership package. health care professions and the public • During the performance of her/his In 2001, the OPA held its first to promote the highest level of care duties he or she will conduct them- Provincial conference focusing on educa- for all people. selves In a manner that will reflect tion and networking for paramedics. The credit upon the profession; and OPA’s “Paramedicine” conferences continue OPA Code of Ethics • Encourage the trust and confidence of to grow each year. This year has been no The practice of Paramedicine requires the public through high standards of exception. Paramedicine 2007, recently knowledge and compassion, along with professional practice, conduct, compe- held in Niagara Falls September 18-20, concern and sensitivity for the well being tence and appearance. 2007, was the first time Emergency Medical of the patient. In keeping with this phi- Communication and partnerships are Dispatchers and EMS Communications losophy, every Paramedic shall: the keys to the future. Together, we can Officers were included as apart of the • Maintain certification with their work as a group to improve our profes- conference with a specialized educational respective ambulance services and the sion and the services we provide to our stream put together entirely by their peers. governing base hospital(s); patients.

www.emsontario.ca | 17 | Reports |

A GlobalMedic team arrives in Pakistan. (Source: GlobalMedic).

2007: The Year of the Flood By GlobalMedic

“Worst in years”; “worst destroyed, water sources are contaminated medical bags with the essential medication in decades”; “worst ever”. and disease and illness set in. and supplies. As a GlobalMedic veteran, These phrases have been used to Location: Toronto, Ontario, Canada. he knows what to expect and what will describe the flood catastrophes of 2007. It’s February 2007. There is no fear of be needed. The team will include four Spanning from Sub-Saharan Africa to flooding here. A group of local profes- others, including the charity’s Director of southern China, these floods devastated sional emergency workers shake off the Emergency Programs, Rahul Singh, a full- some of the poorest communities in the cold and gather at the world headquar- time Toronto EMS worker. The team will world and exasperated the already dire ters of GlobalMedic. Some of the police be equipped with 2 NOMAD water purifica- living conditions. officers, firefighters and EMS workers help tion units which can churn out 100 litres While always tragic, initial fatalities to pack gear for the relief mission to Indo- of clean drinking water per minute, 12 due to floods are just the beginning of the nesia, while others are preparing to go TREKKER water purification units which devastation. As water levels rise, so does on the mission themselves. GlobalMedic purify 4 litres of clean water per minute the opportunity for water-borne disease, runs capacity building programs in post- and 6.8 million Aquatab water purifica- which can put a stranglehold on commun- conflict nations and provides disaster relief tion tablets (one tablet purifies one litre ities and entire nations. Floods set off services to large scale catastrophes around of water). However, clean water alone a chain reaction of events: homes and the world. The majority of the volunteers will not meet the primary needs of Indo- villages are enveloped leaving entire com- are Ontario EMS paramedics. nesia’s affected population. The team is munities displaced, a years worth of crops Toronto paramedic Mike Larsen packs also bringing 2 inflatable field clinics, 1.5

18 | “You can see the water stains on the wall purification units and clinic set-up as still. It destroyed all their clothing and this equipment will be left behind and their beds.” continue to be used by the affected com- The team would remain in Jakarta for munities long after the GlobalMedic team two weeks, purifying thousands of litres of has returned home. water while training members of partner organizations on the equipment’s oper- Bangladesh is the most densely popu- ation. All of the equipment brought was lated nation on earth. The city streets are then donated to ensure relief operations lined with bicycle rickshaws far outnum- continued after the GlobalMedic team’s bering cars, which keeps traffic at a pace departure. that is, well, as fast as a bicycle rickshaw. The flood waters eventually recede, only The road is the only land not complete- to leave stagnant water in congested urban ly devoured by floodwater in the desert. It areas, overflowing sewers and contaminat- resembles the runway of an island airport— ed city water, a steady breeding ground for an earthy strip surrounded by water. This water-borne diseases. Bangladesh suffered strip of land is now home to thousands. A massive flooding this August, affecting the flood in the deserts of Pakistan has forced majority of the country. A staggering 20 entire villages out of their homes and million people were affected by the floods under tarps and propped-up beds on the which left 52 per cent of the nation under- road side. water. GlobalMedic responded by sending a In July 2007, a five-member GlobalMed- five member team, including Peel Region ic Rapid Response Team answered the call paramedic James Ligas. “Nothing could of duty. The team includes Rahul Singh, have prepared me for it” said Ligas while York Region paramedic Julie Grainger and working long hours at the relief camp, Toronto Police Sergeant Don Ryan. Sta- surrounded by an area that was once the hub of the village, but is now a muddy field dotted with makeshift shacks constructed of discarded materials. Yvonne Malbasha, an 2007: The Year of the Flood Ottawa EMS paramed- ic is also on the team. million essential medicine tablets and 2.6 tioned outside the city of Larkana, the As Malbasha is transported by boat to an million Oral Rehydration Sachets. team braved a punishing 52 degree heat island cut off from aid, she describes the Upon arrival in Jakarta, the team clears and long days to provide a capacity of lingering affects of the disaster. “This is goods at customs and immediately heads 144,000 litres of clean drinking water daily, where the river completely overflowed its to an affected area. They arrive at a village distributed 3.25 million water purification banks, and further on is the flooding which that appears more Venetian than Indones- tablets and operated a 13x22 inflatable is still continuing,” she says. ian. The town blocks are now segregated field hospital. GlobalMedic installed and operated 12 by a grid of lazy rivers; the only possible The resiliency of the villagers is palpable water purification units, and a mobile field mode of transportation hospital which treated now is a raft and stick. “All of this was underwater,” he says. “You can see over 2,500 patients The team springs into a day, and trained action, setting up water the water stains on the wall still. It destroyed all their members of Muslim purification points and clothing and their beds.” Aid UK on the gear. stationing medics at a GlobalMedic estab- temporary hospital. The lished a relief camp team distributes aid in Jakarta itself and and humbling. Some have lost everything, in Sirajgonj, 140 kilometres northwest also to outlying villages. Larsen surveys a others almost everything, yet they remain of the capital city Dhaka and also within village outside of Jakarta left gutted by the undeterred and accepting of what needs Dhaka itself. GlobalMedic also donated high waters. to be done. The GlobalMedic team trains enough essential medicines to treat 30,000 “All of this was underwater,” he says. local members of Muslim Aid UK on the patients.

www.emsontario.ca | 19 The GlobalMedic team would return to The team on the ground is operating displaced. Forty per cent of the nation’s Bangladesh in November following the path a mobile field hospital which is treating water supply was compromised, heightening of destruction carved out by Cyclone Sidr. The over 1,000 patients a day and has restored the need for clean drinking water. Sgt. Don death toll sailed past 3,000, and even while access to clean drinking water for over Ryan of Toronto Police and Julie Grainger this article is being written, there are fears 50,000 civilians in the area through the of York EMS were deployed to install mobile the toll could surpass 10,000. GlobalMedic operation of two large-scale water purifica- water purification units in areas cut off by has deployed a rapid Response Team to Saud tion units. the destruction left by Hurricane Noel. The Khali region in southern Bangladesh. Bonnie team also distributed 153,200 tablets of Stewart, a Kingston paramedic is on her November 2007 did not pass without essential medicine, to help stave off the first mission with GlobalMedic. “I was very flooding once again occurring, this time onset of water-borne diseases. impressed with GlobalMedic considering their in Central America. Firstly, the Dominican Hurricane Noel, in conjunction with two operation was the first and only one in the Republic had much of its infrastructure weeks of steady rainfall, also resulted in area,” she comments. damaged or destroyed while 66,000 were massive flooding throughout the state of Tabasco in southern Mexico. The low-lying areas of Villahermosa, the state capital of 500,000 people, were under up to 8 feet of water. The GlobalMedic team of five, including three Ontario EMS workers, was equipped with an Explorer Water Purifica- tion Unit, which can purify 64 litres of water per minute. As well, the team installed and operated 10 mobile water purification units in remote villages cut off from aid, and set up water distribution points within Villaher- mosa. Upon reflection of the mission, Peel Region EMS paramedic Tommy Leblanc said, “my first mission with GlobalMedic proved to be challenging as we identified the areas without potable water, and then traveling to these areas, while trying to communicate with the local organizations in a different language (Spanish). We were able to provide clean water to several remote villages still flooded and without potable water, using the Trekker purification units…The mission was a unique experience for me and I am already looking forward to my next mission. The people we are helping in other countries are thankful for what we do and the residents of Villahermosa expressed their appreciation over and over while we were there. We bring relief and hope in times of need, and to me, that is satisfying.” Sean Large, also a Peel Region EMS para- medic added, “the most gratifying moment for me was being in the small Village of Ranchero, being surrounded by a bunch of kids, all glad that GlobalMedic was there to provide clean drinking water. There were kids as young as five bringing us water containers to fill with clean water for their families.” Rob Capancioni, of Toronto EMS, was also one of the paramedics deployed. “The most positive experience of the whole mission,” he remarked, “was setting up a water

20 | distribution point in a park in Villahermosa members from Indonesia respond to the GlobalMedic relies on the commit- and engaging with the locals.” relief efforts in Yogyakarta following an ment, charity and volunteerism of Ontario GlobalMedic also provided water puri- earthquake. They were equipped with EMS paramedics. They give their time fication units, water purification tablets water purification units and water puri- and effort; cross oceans and continents; and trained personnel for relief efforts fol- fication tablets. to help people in need whom they have lowing the floods in Sudan, Kenya and GlobalMedic has deployed on 11 never met. As evidence begins to link Somalia. missions thus far in 2007. Since its incep- climate change as the possible cause of tion, GlobalMedic has produced over 20 this years flooding, GlobalMedic must While floods have been a dominant million litres of clean drinking water, unfortunately be prepared to deal with destructive menace in 2007, other types donated over 100 million water purification these disasters again in the new year. of calamities have occurred throughout tablets and 53 million tablets of essen- GlobalMedic is committed to providing the world this year, and GlobalMedic has tial medicine. GlobalMedic has set-up and hope, and to helping those in need, help responded. operated nine inflatable field hospitals. themselves. • On April 2, 2007, off the coast of the Solomon Islands in the Pacific Ocean, an earthquake registering 8.1 on the Richter scale, which was followed by three successive earthquakes, triggered a tsunami with waves of 10 metres enveloping the Western provinces of the Solomon Islands. A three member Rapid Response Team distributed and provided training for 10 portable water purification systems. They also distrib- uted 550,000 water purification tablets and emergency medical gear. The team was comprised of three Toronto-area EMS workers, including Julie Grainger, Dave Hutcheon and Rahul Singh. • In March 2007, renewed fighting between the Tamil Tigers and the Sri Lankan government forced thousands to flee their homes and villages in Sri Lanka. Three Toronto-based members, along with two Indonesia based team members installed portable systems in a number of villages and created a large scale potable water distribu- tion program to serve up to 100,000 civilians daily. The team trained local Sri Lankan members of Muslim Aid UK ensuring the units will continue to provide those affected by the conflict with clean drinking water, long after they left region. • In late August 2007, Peru was the victim of an earthquake registering 7.9 on the Richter scale. GlobalMedic deployed a three-person team, specially trained in canine search and rescue operations and water purification. The team was successful at clearing rubble piles and body recovery, as well as installing Trekker water purification units in IDP camps and field hospitals and distributing essential medicines. • 2007 also saw a GlobalMedic team

www.emsontario.ca | 21

| Features | Green Future Region of Waterloo EMA “LEEDs” efficiency pursuit By John Prno, Director, Emergency Medical Services, Region of Waterloo

“It’s not easy being green…” per cent and water consumption by 85 per A melancholy musical moment by Kermit the Frog. While cent. The financial result is a natural gas and hydro bill reduction of some $22,000 Kermit’s issue was the colour itself, to many of us, an environ- annually. mentally progressive “green” workplace has become a matter Yes, building green costs more, but not dramatically so. The $3 million building of pride, even if some of the issues are not the norm in EMS budget was increased approximately 15 management circles. At Region of Waterloo EMS, you’re just per cent when the decision was made to go LEED Gold. Nineteen thousand square as likely to hear the talk swing to waterless urinals, or the feet in size, the building uses wood frame big flush with dual-mode toilets using rain water collected from the roof… Conversations construction for the administrative office component and engineered steel for the that are definitely not the norm elsewhere! garage structure. Wood was used because it is a renewable resource and engin- Alongside many others, these fea- vehicle emissions… reducing the size of eered steel chosen because the technique tures won the EMS Headquarters and Fleet our so-called “environmental footprint”. Centre the coveted LEED (Leadership in Built in 2004-2005, the building Energy and Environmental Design) “Gold” boasts green features that include radi- When compared to other designation, the first from the Canada ant hydronic in-floor heating powered by similar buildings, leading Green Building Council for a commer- high efficiency boilers, energy recovery cial facility. With energy use in build- ventilation and solar panels providing edge technologies have ings responsible for 40 per cent or more much of the building’s electrical needs. of greenhouse gas emissions in the High efficiency light fixtures coupled with enabled the building to developed world, modifying building con- sensors to detect both ambient light and reduce energy consumption struction techniques is one important way motion, automatically limit electrical light to battle the effects of climate change. to when it’s really needed. When com- by 60 per cent and water As EMS is very much in the transportation pared to other similar buildings, leading consumption by business, efforts such as these are neces- edge technologies have enabled the build- sary to at least offset our considerable ing to reduce energy consumption by 60 85 per cent.

The Region of Waterloo EMS Headquarters. (Photo courtesy of the Region of Waterloo Emergency Medical Services).

www.emsontario.ca | 23 absolutely minimizes the amount of steel coverings. Wherever possible, natural currently evaluating hydrogen fuel injec- required for the construction. products such as wood and linoleum were tion as a means of reducing fuel con- The principles of sustainable con- used instead of chemically based man sumption and more cleanly burning the struction aim to reduce material use, made products. For example, instead of diesel fuel our ambulances consume. Other use renewable resources where possible, high VOC vinyl wall coverings, sisal hemp means of reducing exhaust emissions are and utilize recycled content in building was selected to protect high traffic hall- also in the works. Administrative vehicles materials. On this project, over 75 per way walls. Hemp absorbs sound, is mould have moved to hybrid gas-electric tech- cent of construction waste was diverted and UV-resistant, does not off gas, and nology and this year even hybrid ERUs will from landfill and recycled, while 25 per doesn’t wear out! The key, to Greg Sather, be available. The number of environment- cent of the building materials contained the building’s architect, is simple. “As ally friendly choices is growing across all high recycled content. At the same time, Canadians, we spend 90 per cent of our aspects of our lives. over 40 per cent of materials were locally time inside buildings and so that environ- It may not seem easy to go greener, harvested and 70 per cent actually manu- ment should be as healthy as possible.” but just recently, Enermodal Engineering factured locally. It simply made no sense The Region’s experience with sustain- of Kitchener, one of the partners in to source an environmentally-friendly able construction has been extremely designing our project, received a LEED product on the other side of the con- positive. Since the completion of the EMS Platinum designation for its new Calgary tinent and then replace those benefits Headquarters and Fleet Centre, Regional office building…the first to receive the by burning huge amounts of fossil fuels Council has mandated that all new cor- highest possible rating under the pro- transporting it to our site. porate construction in excess of 10,000 gram, and I’m sure not the last. As cli-

Solar positioning was a key factor in the construction of the new EMS Headquarters in the Region of Waterloo. (Photo courtesy of the Region of Waterloo Emergency Medical Services).

In addition to energy savings, the goal square feet must meet at least the LEED mate change begins to visibly impact us of making this an employee friendly facil- Silver standard. Both the new police all, we simply don’t have another colour ity was also accomplished. Positioned on indoor weapons range and an addition choice to consider. It’s more than just the site to maximize solar positioning, to Police Headquarters (currently under social consciousness. It’s a matter of sur- day-lighting is used extensively through- construction) will exceed this standard, as vival that needs to be incorporated in all out the building’s skylights and wall will the various renovation projects under- we do. lights. Operable windows allow staff to way across regional facilities. customize their environment and dry con- An environmentally progressive work- The delivery of ambulance service in ditioning is used in lieu of air condition- place doesn’t end with the buildings we the Region of Waterloo is the responsibility ing where practical. A giant dehumidifier occupy. Site elements like ground water of the Emergency Medical Services (EMS) conditions locker room air by passing it protection utilizing a bio-swale to filter Division of Public Health. John Prno has over a large bank of silica beads, reducing parking lot water run-off, minimizing light been the Director of Emergency Medical humidity and temperature to a comfort- pollution and pesticide-free naturalized Services for the Region of Waterloo since able level, rather than chilling shower landscaping are just a few of the exterior 1999. Having served in a number of pos- users with an air conditioned exit. features incorporated into the headquar- itions over his thirty year EMS career, John While all manufactured products “off ters site. When the region’s anti-idling is a past Director of AMEMSO and cur- gas” volatile organic compounds (VOCs), policy generated EMS operational issues, rently the Chair of the Ontario EMS Awards a special effort was made to select low we looked for an alternative. Along with Committee and the EMS Lead for the VOC glues, paints, furniture and wall other Ontario EMS, Region of Waterloo is Ontario Municipal Benchmarking Initiative.

24 | | Features | Redefining Tiered Response in Ontario By Carmen D’Angelo, Director, Public Health and Emergency Services, Oxford County

paramedic services. The system involves an integrated network of allied emergency services working collaboratively with com- munity agencies and hospitals to establish Located in Southwestern Ontario, a chain of survival for medical emergen- cies. In addition, the integrated network Oxford County EMS is a division of Oxford County is also used to establish a coordinated Department of Public Health & Emergency Services. Carmen response to public safety situations. The term “Tiered Response” has been D’Angelo has been its Director since 2001. exhausted. Today, the cooperation amongst allied agencies to a vast array of both med- ical and public safety emergencies is best What is tiered response? My new model—MERiT agreements described as a new integrated emergency Traditionally in Ontario, a Tiered In 2005, various stakeholders redefined model. My suggested model can be called Response System was described as the pro- tiered response in Ontario. The tiered “MERiT” Agreements. The acronym of MERIT cess of dispatching the fire department to response program was described as, “the is translated to Multi-agency Emergency a medical call in order to provide emer- coordination of safety agencies (in) a Response Teams. gency patient care and monitoring until teamwork approach that improves upon the the paramedic crew arrived. response to specified emergency situations In 1997 there were 15 components and overall level of public safety in the Today, the cooperation adopted by the provincial government community.” for an Emergency Health Services (EHS) The guiding principles were revised to: amongst allied agencies System. One of these components was the 1. Ensure the timely availability of staff to a vast array of both provision of a multi-agency response to and resources to safely and efficient- life-threatening emergencies, referred to ly mitigate a life threatening/public medical and public as tiered response. With high call volumes safety incident; and safety emergencies is in medical emergencies, along with greater 2. Deploy adequately trained and resources in the fire service, there was equipped personnel to the scene of best described as a new merit in dispatching trained and qualified agreed upon life threatening/public integrated emergency fire personnel to the medical emergency. safety emergencies. Ten years ago, the guiding principles of The key difference between the guide- model. a tiered response program were: lines of 1997 and 2005 was the inclusion of 1. To deploy adequately trained and public safety emergencies. In other words, equipped public safety personnel to the focus of the program was greater than The 9-1-1 call the scene of agreed upon life threat- just fire services responding to life-threat- Upon receiving the 9-1-1 call, the CERB ening medical emergencies as soon as ening medical emergencies. The new model (Central Emergency Response Bureau) possible; and of 2005 involved the inclusion of allied or the Primary Public Safety Answering 2. To ensure the availability of sufficient emergency services working together when Point (P-PSAP) will ask the caller if they staffing and resources to safely and responding to public safety incidents... require police, fire or ambulance. The inter- efficiently access, treat, extricate and Today, as with many other jurisdictions national standard to answer the 9-1-1 call package sick or critically injured per- in North America and Europe, the Tiered is 10 seconds 90 per cent of the time. sons. Response System is more than just fire and Depending on the response of the caller,

www.emsontario.ca | 25 the call is then transferred downstream to allied emergency services that are also by confirming existing and developing new to the requested Secondary Public Safety notified to respond to the 9-1-1 call. operating procedures. Answering Point (S-PSAP). At the S-PSAP In order to meet the 2005 guidelines of Finally, as existing in many local juris- (either the police, fire or ambulance com- the timely availability and deployment of dictions, strengthening teamwork approach munication centre) the caller is further resources to meet the needs of the emer- to MERiT involves training together. By interrogated to scope out the details and gency, an efficient priority dispatch system joint training, local allied emergency ser- priority of the emergency. is required. An efficient priority dispatch vices gain a better understanding of each At ambulance communications, the system is not only required at ambulance other and their roles on the emergency Ontario standard to process the emergency communication centres, but also at the scene. call (answer, interrogate the caller, assign communication centres of police and fire priority, and dispatch the most appropri- services. The communication system is the Conclusion ate crew) is 120 seconds 90 per cent of foundation of any MERiT Agreement. The term Tiered Response is antiquated the time. However, the data demonstrates and represents an era where paramedic ser- that the majority of provincially operated A teamwork approach vices required assistance in responding to ambulance communication centres fail to Despite these issues, the allied emer- life-threatening emergencies. This support meet this standard. gency services work remarkably well is still required given that the medical lit- It is the responsibility of the S-PSAP together in an often unstable working erature supports early CPR and rapid defib- receiving the call to notify other emer- environment. Upon arrival on an emer- rillation. However, the tiered response pro- gency services. With the call processing gency scene, the professionalism of the gram has evolved to include public safety time at ambulance communications, fire emergency responder—whether a para- emergencies. services are legitimately distressed that medic, police constable or firefighter—is Local MERiT Agreements could be the there are delays in being notified to the evident. Depending on the emergency, new model for allied emergency services to emergency call. there is an overall teamwork approach as redefine their integrated responses to both There is another concern. The current each service cooperates with each other in life-threatening and public safety emer- algorithm to prioritize the emergency order to respond to the emergency. gencies. For local MERiT Agreements to be call at the majority of Ontario’s ambu- There are several components that effective, communication systems need to lance communication centres is called the can strengthen this teamwork approach. adopt a functional priority dispatch system Dispatch Priority Card Index (DPCI). The One is radio communications. It would be to timely deploy the appropriate resources DPCI system has a significant amount of ideal if the allied emergency services had to the emergency. over-triage, where the call has been priori- an interoperable communication system. The communication system also needs tized as life threatening (Code 4), but the This would allow the senior officers of to be interoperable amongst the emergency paramedics do not encounter a patient in the respective services to be aware of the services. With the additional strengths distress once they arrive to the scene. activities on the emergency scene. of IMS and training, Ontario could be A patient priority system which over- Another component that can strength- described as having one of the best-inte- triages medical emergencies places sig- en the teamwork approach is the use grated emergency service systems in the nificant stress on the paramedic service’s of a common language and procedures world. And that could be MERiT. resources and deployment plans. Further, for medium to large-scale emergencies. the over-triage places paramedics and the Fortunately, Ontario is moving in this dir- Editor’s note: Due to space requirements, public in danger as the Paramedic will ection with the anticipated implementation references to some of the information con- be responding rapidly to the scene for a of the Incident Management System (IMS). tained with the article were submitted by patient who may not be in distress. Implementation of IMS will reinforce the the author but not printed. For references, This safety concern is now extended integrated response of emergency services please contact the author.

26 |

28 | | Conference Report | Reflections… AGM 2007 a success By Ric Rangel-Bron and Terri Burton

through the introduction of new modalities in the field for high performance EMS. Another key presentation at the Conference was an inter- active discussion led by EMS Chiefs Steve Rapanos (Alberta), Bruce Farr (Toronto) and Tony Di Monte (Ottawa). The session discussed a national vision on EMS as described in the “White Paper” authored by the EMS Chiefs of Canada. Also of great interest was a presentation on “Off-Load Delay & E.D. Wait Times” which focused on the utilization of emergency health services and quality of care the effects of emergency department overcrowding and ways to improve The sixth annual AMEMSO Conference emergency care. Speakers included: was held during the week of September 25, 2007 at the Metro • Dr. Michael Schull, a scientist at the Institute for Clinical Toronto Convention Centre and was dedicated to the advance- Evaluative Sciences (ICES) and an assistant professor in ment and promotion of EMS services in Ontario. the Department of Medicine; With the theme, “AMBULANCE: Reflecting On Our Future”, • Dr. Brian Schwartz, Medical Director of the Sunnybrook delegates from Ontario’s EMS and base hospital systems came Osler Centre for Prehospital Care; together for professional development and educational ses- • Chief Bruce Farr, Toronto EMS; and sions, a variety of networking and a very successful fundraising • Chief Anthony DiMonte of Ottawa EMS. effort for two local charities. Delegates visited 61 exhibitors in the Toronto convention AMEMSO was proud to partner with host agency Toronto EMS centre with all exhibits indoors and under one roof! The ability and the Ontario Base Hospital Group in this annual event. of bringing together a broad spectrum of EMS-focused com- Delegates heard from award-winning speakers and experts mercial suppliers provides a great opportunity for Ontario’s EMS in their fields from Canada and the United States, discussing a “decision makers” to review and compare the newest products full range of timely issues. Topics this year included: available to our industry. • EMS Driver Training Programme; For many, the highlight of the Conference was the Honours • Regional Paramedic Recruiting Programme; & Awards Gala, which recognized the 2007 recipients of the • Termination of Resuscitation; Canadian Emergency Medical Services Exemplary Service Medal. • Stroke Treatment; We were honoured to have Major General Richard Rohmer, • Canadian Forces Combat Trauma; Honorary Chief of Toronto EMS present medals and bars to • Patient Management in the Field; over 100 senior EMS members as authorized by Her Excellency, • Evidence Based Response Plans; Michaëlle Jean, the Governor General of Canada. This black tie • Using clinical Data to Optimize Paramedic Utilization and evening was a grand event, with over 550 people enjoying fine Firefighter Tiered Response Programs; dining as our profession’s finest were honoured for a lifetime of • STEMI Treatment; work within EMS. • Urgent Care Centres; AMEMSO extends its sincere appreciation to host Toronto • Patient Distribution Systems; and EMS under the leadership of Chief Bruce Farr and Chair Ric • Canadian EMS Chiefs of Canada White Paper. Rangel-Bron for an exemplary job. As well, special thanks to Additionally, delegates heard a presentation by Dr. everyone from Toronto EMS and Sunnybrook Osler Centre for Mark Eckstein, Director of Los Angeles Fire Department Pre-Hospital Care for their unselfish dedication to making the (the second busiest EMS provider in the United States) on event a huge success. We look forward to the 2008 conference “Teaching An Old Dog New Tricks”. This vision incorporates a in London, chaired by Director Denis Merrall and co-hosted with highbred mixture of PCP (primary) and ACP (advanced) skills Thames and Elgin EMS.

www.emsontario.ca | 29 | Conference Report | The Richard J. Armstrong Leadership Award

Background • Partnership and voice; An award is something given to a • Vision and values; person or a group of people to recog- • Knowledge and daring; nize excellence in a certain field. In this • Savvy and persistence; and case, it is to recognize excellence of • Personal qualities (passion, humour, EMS leadership. In Ontario, the person and empathy strength of character, whose career has captured that essence general maturity, patience, wisdom, is Richard (Rick) Armstrong. common sense, trustworthiness, reli- Emergency Medical Services in On- ability, creativity and sensitivity). tario were generally provided through a random network of community-minded The award volunteers when Rick entered the scene The Richard J. Armstrong Leadership Richard J. Armstrong in 1970. From his early days as a para- Award is to be awarded annually to an medic, he emerged as the top student in individual recognized for their signifi- It is important Ontario’s first advanced paramedic train- cant contributions to EMS in Ontario. The ing in Kingston in 1972, later returning Leadership Award will be presented for that we recognize as the assistant director and a clinical the first time at the Annual AMEMSO con- Ontario’s finest instructor for the program. ference in London, September 2008. More Rick joined the Ministry of Health in than one candidate may be nominated. EMS Chiefs, December of 1973 and became a region- It is important that we recognize al manager in 1976 where he remained Ontario’s finest EMS Chiefs, Directors, Directors, a driving force until 1999. With the Managers and Program Co-ordinators. Managers Provincial Realignment of Services ini- Therefore, we welcome any submissions tiative, he left the ministry to accept for this prestigious award. Please forward and Program the position of EMS director for Durham any completed nomination form(s) and Co-ordinators. Region. any supporting documentation to: Rick was the first recipient of the Terri Burton, Director Emergency Therefore, we Emergency Medical Services Chiefs of Services welcome any Canada (EMSCC) Award of Excellence, rec- Past President—AMEMSO ognizing his career of leadership and sig- District of Muskoka submissions for nificant contribution to EMS in Canada. 70 Pine Street The leading advocate and driving Bracebridge, Ontario P1L 1N3 this prestigious force behind the formulation of the An explanation of the criteria and award. Association of Municipal Emergency nominations forms are available on the Medical Services of Ontario, he was AMEMSO website. Additional informa- the President of the Association for 3 tion may be obtained through Amy Back terms. In doing so he exemplified the at (705) 645-2100 x.364 or via email at Dimensions of Sustaining Leadership [email protected]. Nominations close which include: April 30, 2008.

30 | | Conference Report | The EMS Chiefs of Canada By Bruce K. Farr, Chief, Emergency Medical Services, Toronto

When one sees an ambulance racing down the street, lights flashing and siren sounding, most of us don’t give the picture much more than a moment’s thought. However, the very presence of that ambulance responding to the emergency medical needs of our community is the result of a very complex process. It includes components like training and recruitment, logistics and finance, medical control and the political arena.

To further complicate matters, this approach to service delivery and access complex process varies widely across to the best and most current information Canada. At the local level, service may available to its’ individual components, be provided by a provincial or territorial regardless of where they are located or government, the local municipality, pri- how they are operated? And how can EMS vate companies under contract or working across Canada be provided with a single, independently or, in some cases, volun- strong, unified voice to influence deci- teer groups. Even when such services are sion-makers and educate the public? operated by one of these groups, such The EMS Chiefs of Canada (EMSCC) The current pressures as municipalities, the model used can organization was established in 2002 to on Canada’s health care vary greatly, including meet these challenges. system call for a renewal and operation as independent At the moment, Beginning as a simple idea municipal departments, for the exchange of infor- redefinition of the traditional as sections of the local unlike nursing, mation, the organization model of pre-hospital fire department or health no reciprocity has grown to include not emergency care. In Canada, department, or even by only the senior executive private companies con- system exists level from the country’s Emergency Medical Services tracted to the municipal- for paramedics larger EMS systems, but (EMS) treats more than two ity. also those who run smaller million patients annually. An This situation has trained in one EMS operations of all sizes evolved from a time before and types. Full member- aging population, a shortage ambulance service was province who ship is open to anyone of healthcare professionals, called Emergency Medical wish to relocate to who runs an EMS system, and other challenges have Service (EMS), and contin- and all provinces and ter- ues to evolve today, based another. ritories are represented drastically changed the on provincial legislation in the membership. Non- roles for EMS in the overall and regulations, local policies and needs, voting membership is also open to those health care system. In order and local fiscal realities. Communities at the other executive levels such as man- can and should continue to design EMS agers and supervisors. In addition to pro- to address these growing systems that meet their own community viding EMS across Canada with a strong challenges and continue needs. The challenge is to provide a sys- national voice, the EMSCC have set some to meet the needs of their tem that is seamless and integrated, and very impressive goals for themselves. that incorporates all of the best prac- As a first goal, the organization seeks communities, EMS Chiefs of tices that have been identified for EMS, to be a repository of best practice infor- Canada say EMS systems regardless of their source. In short, the mation. In this respect, not only EMS must change the way they challenge is one of consistency. How can operators, but also key decision-makers EMS collectively meet the needs of the at the local level, policy-makers at the deliver services. communities, while ensuring a consistent provincial and federal level, and those

www.emsontario.ca | 31 in the field of EMS education will have cases in which the chief executive of an will be required. These other approaches a reliable source of information regard- EMS system possessed no career EMS expe- may include part-time study, self-directed ing the operation of the EMS systems rience. Canada requires a formal training learning or participation in conferences, that they influence. This information will program and body of knowledge for those assemblies and forums where they will include best practice models, the infor- who will be charged with the operation have access to the information available mation required for the development and of such a complex and critical function of from “the best and the brightest” minds reporting of both standards for opera- society, including, in many cases, formal in the field. tion and practice and for benchmarking academic credentials. While the preceding items represent and measuring the performance of their the areas of immediate interest for the local systems. It is felt that having such EMSCC, there are also longer term objec- information readily available and acces- How can EMS collectively tives. The organization wishes to create sible from a reliable source will greatly meet the needs of the a pool of subject matter experts, covering enhance the move towards consistency virtually all aspects of EMS operations. across Canada. communities, while These experts will be able to provide The organization has also embraced a ensuring a consistent input on such diverse topics as perfor- role as advocates for the EMS best prac- mance measurement, deployment model- tices that have already been identified, approach to service ing, training and standards, equipment, supporting local colleagues by speaking policy and procedure development and all authoritatively with a strong national delivery and access aspects of emergency response. Other pro- voice to key decision and policy mak- to the best and most posed areas of expertise include communi- ers at all levels of government. In this ty health, emergency preparedness, public role, the group will not only encourage current information education, budget and responsible fiscal system and standard development, but available to its’ individual management, and system design. This list will act as advisors on key elements of is comprehensive, but it is not exhaus- legislation and policy required by Canada’s components, regardless tive; other areas for providing expertise EMS at local, provincial and national lev- of where they are resources will no doubt be identified as els. Moreover, this advocacy will not be the process evolves. limited to government, but will expand located or how they are The other medium term goal of the to include other emergency service and EMSCC involves accreditation. This pro- public safety agencies, and the key stake- operated? cess is already a part of the reality of holders across the entire continuum of a great many types of service-oriented health care delivery in Canada, as well as Given the nature of the system, two organizations. It is, for example, a part any other area where it is felt that EMS in approaches will clearly be required in of the day-to-day reality of virtually all Canada has a role to play or a contribu- order to meet the needs of all involved. of Canada’s hospitals. Every hospital is tion to make. For those just embarking on their careers systematically reviewed on a three to four The EMSCC see EMS leadership devel- in EMS leadership roles, this is likely to year cycle and in North America non- opment as the next priority issue for the include either a community college diplo- accredited hospitals are an almost forgot- organization. Across Canada, the leader- ma or university degree specific to the ten part of the distant past. It is equally ship roles of the various local EMS systems field. This will ensure a consistent stan- important for Canadian EMS as an entity have evolved informally. As a result, that dard of education for the entry level: a to possess clearly defined standards, and leadership varies from former paramed- framework upon which experience can a formal process for ensuring compli- ics whose training was mostly “on the develop and grow. For those already in ance with those standards. Such a pro- job”, through to individuals with both the field for a substantial period of time, cess already exists for EMS systems in the a career EMS background and business another approach is needed. For these United States and within Canada EMS, the training, and to include some individuals people, already busy with career demands Province of Nova Scotia and the City of with either an MBA or some other type of or in more remote locations, other meth- Calgary have already voluntarily submitted graduate degree. There have even been ods of imparting the same information to the U.S.-based accreditation process.

32 | A “made in Canada” accreditation pro- cess will ensure that all Canadian EMS systems, regardless of size, have a com- mon set of benchmarks and a means of assuring the Canadian public that their EMS system meets a high standard. Another aspect of this issue involves the accreditation of EMS training pro- grams, the development of a national training standard for front line staff and the portability of patient care cre- dentials across provincial and territo- rial boundaries. At the moment, unlike nursing, no reciprocity system exists for paramedics trained in one province who wish to relocate to another. This issue affects not only the movement of skilled paramedics in a routine manner, but also raises serious obstacles to one province assisting another through the provision of additional staff in a major disaster. A single set of national training standards and a system of reciprocity of creden- tialing will meet the future needs of paramedics, and their EMS systems. The EMSCC have identified six key areas of development, as a part of their vision for the future of Canadian EMS as a mobile health care service. This vision culminated in a white paper titled “The Future of EMS in Canada: Defining the New Road Ahead”. These key areas include emergency medical response, community health, training and research, public education, emergency prepared- ness, and injury prevention and control. This article has focused on the identity of the EMS Chiefs of Canada, their goals and objectives. Future articles will deal with each of these key areas in more detail. The next time you see an ambu- lance go racing by, pause for a moment to consider the potential of such a sys- tem for public good and remember the EMS Chiefs of Canada; working diligently behind the scenes to ensure excellence in not only their own local systems, but Your Industry also to ensure that the EMS system in Canada reaches that full potential, con- is Our sistently, comprehensively, every day. On behalf of the EMS Chiefs of Specialty Canada and all the staff at Toronto EMS, congratulations on the launch of To find out how Matrix can help your AMEMSO’s new magazine, “EMS Matters.” We appreciate the opportunity to submit association create an eye-catching magazine like this article and be a part of such an this one, call (866) 999-1299. exciting initiative.

www.emsontario.ca | 33 | Conference Report | Emergency Medical Services— Exemplary Service Medal

Most countries have, as part career contributions of Ontario’s paramedics. More of their honours systems, some form of official than 100 medal and bars were presented. award to tangibly express national gratitude for The award is not merely a long service medal. long and commendable service, particularly in fields It is first and foremost an exemplary service award of endeavour involving potential risk. Canada’s presented to those eligible members of the pre- Exemplary Service Medals recognize the men and hospital emergency medical service who have served women dedicated to preserving Canada’s public for at least 20 years in a meritorious manner. To safety through long and outstanding service. qualify, at least 10 of these years of service must The Emergency Medical Services Exemplary have been street level duty involving potential Service Medal, created on July 7, 1994, risk to the individual. Nominees must have been recognizes professionals in the provision employees on or after October 31, 1991, but may of pre-hospital emergency medical services now be active, retired or deceased. The current to the public, who have performed their year’s nominations are due by January 31, 2008 for duties in an exemplary manner, characterized presentation at the 2008 Annual Conference Gala in by good conduct, industry and efficiency. London. For more information, contact John Prno, In Ontario, 2007 was the seventh year that AMEMSO the Ontario EMS Awards Chair at pjohn@region. was privileged to host an awards gala honouring the waterloo.on.ca.

34 | | Association Information | Upcoming Events

February May Waterloo EMS Muster September AMEMSO Education Day AMEMSO Spring Meeting May 24, 2008 AMEMSO AGM February 13, 2008 May 6-7, 2008 Waterloo, Ontario September 23-26, 2008 Toronto, Ontario, Airport Hilton Toronto, Ontario [email protected] London, Ontario, Convention MChretien@ [email protected] Centre and London prescott-russell.on.ca Emergency Medical Services Hilton Hotel Emergency Medical Services Chiefs of Canada dmerrall@ April (EMS) Week Conference county.middlesex.on.ca National Paramedic Skills May 19–25, 2008 May 28–30, 2008 Competition Ontario Victoria, British Columbia October April 5, 2008 [email protected] [email protected] Paramedic Games 2008 Oshawa, Ontario, Voit/Durham October 23–26, 2008 College Campus Montréal, Québec wwww.paramediccompetition.ca [email protected]

AMEMSO Board Members AMEMSO Executive

President Past-President Vice President Treasurer Secretary Paul Charbonneau Terri Burton Dan Mccormick Michel Chrétien Neal Roberts Frontenac County District Municipality of Rainy River Prescott-Russell United Niagara Region Muskoka Counties Zone Directors Central Eastern Northern South/Western

Richard J. Armstrong Tom Bedford Joseph Nicholls Charles Longeway Durham Region County Of Lennox and City of Greater Sudbury County Of Brant Addington

John Lock Dan Chevrier Mike Trodd Denis Merrall City Of Toronto Leeds and Grenville District Of Timiskaming Middlesex County www.emsontario.ca | 35 | Association Information | AMEMSO Strategic Partners

AMEMSO would like to recognize the following organizations that devote countless hours of work and support to ensure the continued safety of Ontarians, Canadians and people around the world. EMS Chiefs of Canada Ontario Base Hospital Group Ornge Bruce Farr, President 10 Carlson Court, Suite 60 Christopher Mazza, MD, FRCPC, MBA Kelly Nash, Executive Director Toronto, ON 20 Carlson Court, Suite 400 3705-35th Street NE M9W 6L2 Toronto, ON Calgary, AB Tel: (416) 667-2207 M9W 7K6 T1Y 6C2 Fax: (416) 667-9776 Tel: (800) 251-6543 Tel: (403) 538-6142 www.obhg.ca Fax: (647) 428-2006 [email protected] [email protected] www.emscc.ca Ontario Paramedic Association www.ornge.ca PO Box 245 DMGF GlobalMedic Whitby, ON Ontario Ministry of Health and Wes Normington L1N 5S1 Long Term Care Manager Emergency Programs Tel: (416) 410-4303 (out of province) Emergency Health Services Branch 45 Cranfield Road, Unit 18 Toll-free: (888) OPA-LINE (Ontario only) Malcolm Bates, Director East York, ON Fax: (905) 668-2837 5700 Yonge Street, 6th Floor M4B 3H6 [email protected] Toronto, ON Tel: (416) 916-0522 www.ontarioparamedic.ca M2M 4K5 Cell: (647) 993-7460 Tel: (416) 327-7900 [email protected] Toll-Free: (800) 461-6431 Fax: (416) 327-7911 [email protected]

36 | | Association Information | A Day in the Life of AMEMSO (as seen through the eyes of its President) By Paul Charbonneau, President, AMEMSO that since we relied on the use of ERVs to Through consultation, cooperation and “What a difference ensure rapid response times to the citizens collaboration, the right result for Ontario’s a day makes, of Ontario, we simply needed ERVs to have citizens was achieved. My thanks to all those Twenty-four little hours, the same exemptions as ambulances under who struggled to make the importance of this the HTA. The calls continued through the issue heard and to those who toiled through Brought the sun and the flowers, night, to and from the Minister’s office, the that long night to come up with a solution. Where there used to be rain.” Emergency Health Services Branch, AMEMSO, This is an excellent example of how AMEMSO’s — What a Diff’rence the Attorney General and the Ontario Ministry support base and combined expertise serves of Transportation (MTO). By 0630 the fol- to assist the government in accomplishing a Day Makes lowing morning, the revised regulation was the seemingly impossible. As one Regional drafted and sent to the three Ministries for Police contact was heard to state while shak- acceptance and then on the Lieutenant ing his head in disbelief, “I can’t believe you I recall those lyrics by the Governor for signature and registration. The accomplished this so quickly. Can I send you Four Aces, going through my mind late on municipalities who had stated they were over some of our longstanding HTA issues to November 23, 2007. I had just received “the suspending service agreed to an extension to deal with?” Well, we’re not ready for those call” that new legislation, Regulation 556/07 allow the time necessary for the bureaucracy yet but in the mean time, we shall concen- Pilot Project—Emergency Response Vehicles, to move through its channels. At 1710 hours trate on ensuring this important Pilot Project had just been signed by the Lieutenant that day, the call came. The revised regula- becomes permanently enshrined in legisla- Governor and registered into law. tion had been registered and was now law. tion. It was very satisfying indeed. Only the day before, there was a flurry of calls to and from the office of the Minister of Health to discuss a confusing situation that had developed regarding Emergency Response Vehicles (ERVs) and the Highway Traffic Act (HTA). It had been a week where (following legal advice), some municipalities, to ensure they were operating within the law, had severely restricted the operation of their ERVs impacting response times and quality of care being provided. AMEMSO had become aware and was rightly concerned about a “Chief’s Bulletin” that had previously been released to the Province’s Police Chiefs, high- lighting the areas of the HTA from which the ERVs did not have exemption. I was told that the matter was clearly at the forefront of the Minister’s mind and that it would take a week to ten days to find a solution. What happened? Well, by 0700 Thursday, November 22, 2007, three large municipali- ties had made it clear to the Minister’s officer that as of 0700 hours Friday, November 23, they would also remove their ERVs from ser- vice. The Minister directed his staff to stay and work with us until they had a solution. Over the next number of hours, many conversations occurred between senior gov- ernment staff, myself and others as to what we needed in a new regulation. I told him

www.emsontario.ca | 37 | Buyer’s Guide |

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