Toronto Paramedic Services

Statutory emergency medical services provider

The City of Toronto Paramedic Services (TPS; formerly known as Toronto Emergency Medical Services) is the statutory emergency medical services provider in Toronto, Ontario, Canada. The service is operated as a division of the City of Toronto, under the Community & Social Services cluster. The service is funded by the municipal tax base, and operates similarly to other municipal divisions, such as the Toronto Parks, Forestry & Recreation division, or the Toronto Water division, but retains operational independence from other divisions. While under municipal government control, it is subject to provincial legislation and licensing. It is not the only service provider in its area; private for profit medical transport services also provide routine, non emergency transports and coverage for special events, but the statutory emergency medical system is the only provider permitted to service emergency calls.

The City of Toronto has operated an ambulance service directly on an uninterrupted basis since 1883, when the City of Toronto Health Department acquired two ambulances to transport those with infectious diseases to the local sanitarium. Full time emergency ambulance service began in 1888, with the provision of emergency ambulance service by the Toronto Police Force, which eventually operated four horse drawn vehicles. Prior to these two municipal initiatives, ambulance service was provided for the young city by a variety of means, including both hospital based and private companies. This 'broad spectrum' approach to service delivery would continue for more than ninety years. Toronto may very well be able to claim to have the first formally trained 'ambulance attendants' in North America, with the Toronto Police Force ambulance service staff receiving five days of formal training in their jobs from the St. John Ambulance Brigade in 1889. Training included first aid skills, anatomy and physiology. Such training for ambulance attendants was unheard of at that time, outside of military circles. The police constables assigned to the ambulance also did regular policing, when not required for ambulance calls. As the city grew and technology progressed, so did the ambulance service. The first motorized ambulance was actually purchased by a local funeral home in 1911, and the Toronto Police Ambulance Service began the conversion from horse drawn to motorized vehicles in 1913, with the process largely completed by 1918. Over the years, the two City of Toronto departments would have their services supplemented by more than 130 individual ambulance operators, most of them private companies, and in suburban areas by several of the tiny, local fire departments. The two municipal services would finally be merged in 1933, when the Toronto Police Department turned the operation of their ambulances over to the Department of Public Health, and ended their involvement in the city's ambulance service. This service would grow again in 1953, as the result of the creation of the municipality of Metropolitan Toronto, dramatically expanding the required service area. Service would continue in this fashion until 1967, when the amalgamated City's suburban fire departments surrendered their ambulances, resulting in the evolution of the Department of Public Health Ambulance Service into the City operated Department of Emergency Services (DES). Some private companies, and one operated by the provincial government, would continue to operate in 'Metro' Toronto until 1975, although with centralized dispatch services provided by DES. The Metropolitan Toronto Department of Ambulance Services was created in 1975 under the leadership of John Dean, and absorbed the five remaining private ambulance companies and single provincial service, providing a single, unified ambulance service in Metro Toronto. Known colloquially as Metro Toronto Ambulance or simply Metro Ambulance (although never its official name) the service provided ambulance services from 1975 to 1998. Metropolitan Toronto was restructured during 1998, transforming it from a regional government overseeing six member municipalities into a single, unified city, and many municipal and regional services were restructured as a result. Metro Ambulance became Toronto Ambulance then Toronto Emergency Medical Services in 1998 under the leadership of Chief Ron Kelusky, in order to reflect its evolving role from primarily a provider of medical transportation to an actual provider of medical care. It was at that time that the service undertook a rebranding with the unique forward facing A on all of its vehicles. The service introduced its first paramedics in 1984 (although experiments in pre hospital advanced life support actually began in 1969). Toronto EMS introduced many other innovations, including the concept of dedicated ground based critical care transport ambulances in 2000, as well as many specialty support units described in this article, many of which were originally conceived and pioneered by the service. As of April 2005, the departments and commissioners were replaced by divisions under the city manager (and deputy managers). Toronto EMS now operates under the city's Emergency Medical Services Division. It is the largest municipal EMS operation in Canada and at the time was led by Chief Bruce Farr. In July 2014, Chief Paul Raftis announced that as part of a rebranding effort, Toronto EMS will change its name to Toronto Paramedic Services. The change follows a national trend and drive for the adoption of Paramedic as the publicly recognized title for prehospital emergency care providers. On October 1, the new name came to effect.

Of the 242 vehicles in the Toronto Paramedic Services fleet, 150 are CMVSS / Ontario Standard Type III ambulances. Of these, approximately 100 are in service at any time on a typical, mid week, day shift. These vehicles are currently supplied by Crestline Coach Ltd. They are mounted on Chevrolet Express van chassis with boxes custom built by Crestline to suit the needs of the service. The department currently employs Chevrolet Tahoe SUVs for First Response and supervisory vehicles as well as an assortment of fully equipped but unmarked vehicles (Primarily Dodge Caravan and Ford Taurus) for senior management. Toronto Paramedic Services currently operates a fleet of custom built busses and equipment support vehicles for use during mass casualty or large scale events. Toronto Paramedic Services operates its own repair facilities, located at the service's Headquarters complex. All maintenance and repair work (with the exception of body work), and all equipment, radio, and medical electronics maintenance and repairs are performed on site by service staff.

Year Make/Model Type Builder/Modification Origin Status 1908 Horse Drawn Wagon/Carriage Ambulance Petrolia Wagon Works Canada Static display1 1954 Packard Ambulance Henney United States Working display / PR vehicle 1966 Pontiac Bonneville Wagon Ambulance Example United States Working display / PR vehicle 1971 19932 Dodge Ram Van Type II Ambulance United States Working display / PR vehicle 1983 20032 Ford E350 Type II Ambulance Various United States Retired 1990 20052 Ford E350 Cutaway Box Type III Ambulance Crestline United States Retired 1980 Plymouth Volare Wagon First Response United States Retired 1993 20012 Jeep Cherokee First Response United States Retired 2001 Ford Crown Victoria Police Interceptor First Response/Management Stock Canada Retired3 2001 2006 Chevrolet Tahoe First Response/Supervisor Rowland United States Retired3 1981 Chevrolet Impala Wagon Supervisor/First Response Stock United States Retired 1996 20002 Dodge Caravan Supervisor Stock United States Retired 1988 OBI 01.508 Emergency Communications Unit Canada Retired 1963 GMC TDH 4517 Ambulance Bus United States, Canada Retired 1980 OBI 01.504 Ambulance Bus Canada Retired 1980 OBI 01.502 Ambulance Bus Canada Retired 1981 OBI 01.502 Ambulance Bus Canada Retired 1982 OBI 01.502 Ambulance Bus Canada Retired 1986 OBI 01.508 Ambulance Bus Canada Retired 1988 OBI 02.501 Ambulance Bus Canada Retired GMC Step Van Emergency Support Unit United States Retired 1987 Ford C800 Emergency Power Unit 100 kW Generator and Lighting Unit United States Retired 1985 Ford C800 Emergency Support Unit United States Retired 1976 Chevrolet Suburban Emergency Support Unit Off Road Rescue United States Retired 1993 Ford F 450 Cutaway Emergency Support Unit Cargo Box United States Retired
1 Vehicle actually owned by Lambton County heritage museum. Previously on display at Toronto EMS HQ. Similar to vehicles that would have been operated in Toronto during Late 19th/Early 20th century. http://www. horsedrawnambulance. com2Multiple model years used by department until final retirement. 3 Examples may still be in service as utility vehicles

Toronto Paramedic Services operates its own Communications and System Control Centre (called a Central Ambulance Communications Center or CACC "Kaack"), including emergency medical dispatch, patient distribution and system oversight. Toronto Paramedic Services participates in the community wide 9 1 1 system, and triages emergency calls using the Advanced Medical Priority Dispatch System. The system uses Computer Aided Dispatch, including Tritech VisiCAD, augmented by PDS and Optima Live software and technology. The service utilizes a satellite based Automatic Vehicle Locating system in order to ensure that the closest appropriate response resource is consistently sent to each emergency call; all emergency response resources are included. The service utilizes a 700 mHz P25 Phase II trunking radio system for dispatch purposes. The Control Centre has direct landline contact with the 9 1 1 Center, all other emergency services, all acute care hospitals, and all Paramedic Stations. The service utilizes “Language Line” service to provide instant simultaneous translation of emergency calls in more than 140 languages. Toronto Paramedic Services operates the largest EMS Communications Centre in Canada, which was recently accredited as an International Centre of Excellence by the International Academy of Emergency Dispatch.

Service is provided to a residential population of approximately 3.2 million people, which rises to approximately 5 million on most business days. Toronto Paramedic Services operates a total of 41 stations, geographically distributed across the 246 square miles (637 km2) of the City of Toronto. Emergency service headquarters (which is shared with Toronto Fire Services, but both services operate independently) is located at 4330 Dufferin Street in Toronto. This facility includes administrative offices, some education facilities, the Communications Centre, Fleet Maintenance, Planning and Operational Support, and Materials Management/Logistics. The service is supplemented by well developed Paramedic Services in neighbouring communities on three sides, with Lake Ontario providing the southern boundary of the service area. Air ambulance operations are provided within the City of Toronto by Ornge, a privately owned air ambulance contractor, under contract to the Government of Ontario. Based upon information provided by Toronto Paramedic Services, the service processed in excess of 535,000 calls through its Control Centre in 2007 (the most recent year for which complete data is available), resulting in 223,769 emergency calls being dispatched.

Hospital in patient beds and Emergency Departments tend to be severely overcrowded, resulting in difficulties for paramedics transferring the care of their patients to hospital staff in a timely manner. Two to four hour delays in the transfer of care are commonplace, and six to eight hour delays are not unheard of. When this occurs, the service's ability to provide service to emergency calls in a timely manner will often degrade, because of decreased unit availability. Multiple stakeholders and various levels of government are currently seeking solutions to this problem, but have, so far, experienced only limited success. The funding for Toronto Paramedic Services occurs as a result of a mixed formula, with fifty percent of funding coming from the municipal tax base and fifty percent from the provincial government. The funding of Toronto Paramedic Services is based upon its census population, not its business day population. As a result, there are always more people requiring EMS services than the system has been funded for. Language barriers and cultural misperceptions in Toronto's multicultural landscape are commonplace for Toronto's paramedics. The service subscribes to Language Line, a simultaneous telephone based translation service which operates in more than 140 languages. This service is used by Emergency Medical Dispatchers processing 9 1 1 calls, or by paramedics treating patients in the field, on a daily basis. The service also operates its own ethnocultural access program. The 'Baby Boom' generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.

Over the years, the presence of such a large system and call volume, along with a commitment to consistently capture high quality data, has permitted Toronto EMS to become a 'test bed' for research projects involving both EMS and emergency medicine. This has resulted in a service which is extremely research oriented and interested in outcome based medicine. While this has provided any number of research opportunities for physicians and emergency medicine residents through the Sunnybrook Centre for Prehospital Medicine (the Base Hospital), it has also permitted paramedics to function as supporting and as lead researchers, and in some cases, as the principal researcher of their own projects. All research conducted at Toronto EMS is pre approved by the University of Toronto Research Ethics Committee, and the findings of research conducted at Toronto EMS, by both physicians and paramedics, has been published in respected, peer reviewed, international journals.

Toronto paramedics are heavily involved in various community programs and partnerships. Toronto's paramedics are active participants in the community which they serve. At the 'grass roots' level, Toronto's paramedics and EMDs fund a children's breakfast club, ensuring a nutritious breakfast for the children who live in several of the city's housing projects. Paramedics also participate in a variety of other events in the community, including their enthusiastic (and occasionally successful) participation in the dragon boat races staged annually by the city's Chinese community. As another little known fact of community involvement by paramedics, all of the floats in the city's annual Santa Claus Parade (one of North America's largest), are driven by volunteers from Toronto Paramedic Services, including both paramedics and a variety of other staff.