Firefighter Pre-Hospital Care ProgramModule 1

EMS System and

Prehospital Organizational Structure

Firefighter Pre-Hospital Care ProgramModule 1

At the end of the lesson and upon completion of the post course quiz, the participant will demonstrate an understanding of :

• the various levels of Prehospital care within the GTA

• how tiered response works and who is deemed the primary agency

• resources utilized by Toronto EMS

• current standards, regulations and medical directives

Firefighter Pre-Hospital Care ProgramModule 1

Standards, Regulations &

Medical Directives

ALSAdvanced Life Support

Standards and Regulations

The fire service is an organization with hundreds of years of tradition and recognition. In comparison, EMS is a fairly new addition and patients will often have questions about paramedics.

All prehospital care provided by paramedics and firefighters is regulated by Provincial legislation such as the:

• Basic Life Support Patient Care Standards• Advanced Life Support Patient Care Standards

Provincial EquipmentStandards for OntarioAmbulance Standards

Version 2.0

December 2011

Standards and Regulations

In addition to the Patient Care Standards, every ambulance in the province must be equipped following the Provincial Equipment Standards for Ontario Ambulance Standards.

Medical DirectivesThe Ontario Basic Life Support and Advanced Life Support Patient Care Standards are responsible for regulating patient care to a minimum standard.

If a Base Hospital program wishes to change, alter or increase the level of care their prehospital care providers such as firefighters or paramedics deliver, they must have the care endorsed by the Provincial Medical Advisory Council and published in Medical Directives.

Quality AssuranceBase hospital is responsible to its physicians, the Ministry of Health, prehospital care providers and the patients in its area of responsibility to ensure the highest standards of patient care are in place at a call.

Quality Assurance is the process to ensure these high standards are meet. Q & A can include audit andreview processes with the intention of finding and solving deficiencies inpatient care.

Firefighter Pre-Hospital Care ProgramModule 1

PrehospitalCare

Providers

PARAMEDIC

Primary Care Paramedics

A Primary Care Paramedic ( PCP ) in Ontario is designated by an epilate with a single silver strip. A PCP may perform up to 5 delegated medical acts in addition to following standards found within the BLS and ALS Patient Care standards.

In the City of Toronto only, you may also encounter Level 2 paramedics that are identified by 2 silver strips. A level 2 paramedic can perform a few more patient care skills that a PCP can’t.

PARAMEDIC

Advanced Care Paramedics

An Advanced Care Paramedic ( ACP ) in Ontario is designated by an epilate with a two silver strips. In Toronto only, they can be identified by three silver strips.

In addition to the skills conducted by a PCP, an ACP may perform more, but not limited to, advanced delegated medical acts such as intubation, cardioversion, IV therapy and narcotic pain management.

CRITICAL CARE

Critical Care Paramedics

Critical Care Paramedics ( CCP ) in Ontario is designated by an epilate with a three silver strips and the wording Critical Care. A CCP can be found in the air ambulance program and Toronto EMS’s Critical Care transport program.

In addition to the skills conducted by a PCP and ACP, a CCP may perform more, but not limited to, advanced delegated medical acts such as chest tubes, cardiac balloon pumps and blood administration.

EMS Management Designations

Chief Deputy Chief Commander

Deputy Commander

Superintendant Deputy Superintendant

Firefighter Pre-Hospital Care ProgramModule 1

Tiered Response and

Primary Agency Designation

Tiered Response in Toronto

Firefighters, paramedics and police officers respond to emergency calls involving ill and injured people under a formal agreement – the tiered response program. The intent is to get an appropriate professional responder to an emergency scene as quick as possible.

With respect to prehospital care, firefighters and police officers provide valuable assistance to paramedics at such times.

Primary Agency

When a citizen calls 9-1-1, the following Primary Agency chart is utilized to determine the primary agency.

The chart was developed by the City of Toronto Tiered Response Committee, which has members from police, fire and ems.

Firefighter Pre-Hospital Care ProgramModule 1

TorontoEmergency Medical Services

Specialized Resources

Tactical Medics are Advanced Care Paramedics that receive tactical training. Their primary responsibility is to care for tactical police and tactical fire personnel.

CBRN Medics are Level 2 and Advanced Care Paramedics that receive specialized training in CBRN equipment and administration of CBRN antibodies.

Specialized EMS Response Units

Emergency Support Vehicles

Toronto EMS Support Vehicles will hold the equipment equivalent of 10 – 15 ambulances.

The ESU pictured above is unique in that it transports specialized modules such as Special Events, CBRN and Bike Medics. The ESU can then leave the module at the scene.

Emergency Support Vehicles

The multi-patient support vehicles can manage 6 stretcher patients and 6 ambulatory (walking) patients.

This ESU is only staffed by a PCP driver.

EMS Vehicle Hazards

In addition to the passenger side door retractable step, be aware of the location of the 7 oxygen cylinders within the vehicle.

If you respond to a vehicle fire involving an ambulance, these cylinders will become hazardous to you.

Retractable step

Oxygen Cylinder Locations

For All Questions Pertaining to this Module,

Contact Your E.M.S. Command Coordinator.