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Politics putting patients in peril: ER doc warns against push for firefighters to respond to more 911 calls

Last Updated Apr 11, 2019 at 2:36 pm PDT

FILE: (Photo by Dustin Godfrey for NEWS 1130)
Summary

ER doc says if local firefighters handle more medical calls, it will drive up costs, won't improve response times

'They'll basically be sitting at the scene, holding their hand, and comforting him,' said Dr. Martin McNamara

PORT COQUITLAM (NEWS 1130) – Don’t let politics get in the way. That warning is in a letter to the mayor of Port Coquitlam from a longtime ER doctor in Ontario.

Dr. Martin McNamara is speaking out against a push by local firefighters to handle more calls that would typically be handled by paramedics. He says it will drive up costs and won’t improve response times.

RELATED: 9-1-1 calls for medical emergencies shouldn’t be an ambulance monopoly: Coquitlam mayor

McNamara, who works with an advocacy group called Send Paramedics, is responding to a recent directive from Fire Chief Nick Delmonico asking city workers to divert most 911 dispatch calls to the fire department because ambulance response times are too slow.

“Fire service will continue to respond to calls where they’re not needed. Firefighters themselves will begin to fatigue and tire from this. You’re not going to see any improved benefit to the patient care. There’s not going to be a shorter wait time at the hospital … Patients will not be receiving pain control, analgesia, antibiotics, cardiac drugs from the firefighters. They’ll basically be sitting at the scene, holding their hand, and comforting them. While that’s laudable, it really don’t add much to the patient experience. It will certainly add to the cost in Port Coquitlam, in terms of fire service vehicles.”

“It makes much more sense to pressure the province to up-staff paramedics and to actually increase the paramedic presence in the communities,” McNamara said.

“There’s so much knowledge that’s required to do EMS well. It’s not something that should be done as a part-time job.”

He argues sending firefighters to non-urgent calls such as broken limbs is a risky move. “You’ll see no improvements in outcomes for the patients. You’ll see higher tax rates for the Port Coquitlam people and you’ll see that the municipal budget — the fire service — will be taking a larger bite of the municipal budget, as years go by.”

“There’s so much knowledge that’s required to do EMS well. It’s not something that should be done as a part-time job or something to back up an already busy schedule that the fire service has,” he said.

“Most firefighters have First-Aid, CPR [training]. They’ve gotten some short courses on airway management, how to deal with time-critical emergencies. Compare that to the basic paramedic in Ontario or across Canada, who has a basic 2,200 hours of training … follow that up with constant, continual medical education, pharmacology — it’s a field that’s evolving very quickly and I don’t think the fire service is in any way, shape or form in a good position to take over that care.”

McNamara claims basic training manuals have changed from four pages when he started to now more than 400.

Earlier this year, B.C.’s auditor general said she had concerns about response times for ambulance, saying they were below target. McNamara says that’s a big concern, and says time-sensitive calls should be responded to by fire or police, if it means reaching the patient sooner.

“I have no problems at all with them going to the scene and starting CPR and putting on the defibrillator,” he said, noting he believes the general public should be trained to perform those life-saving measures.

“It should be a whole strategy, not just relying on one service to fill in the gaps of the other services.”

He argues the bigger discussion should be about how to improve ambulance services and paramedic services in B.C.

McNamara is a former coroner, firefighter and paramedic. He says giving firefighters more control didn’t work in Winnipeg, where costs ended up going up and response times didn’t improve.

“They have paramedics responding on fire trucks … The initial thought of this was that if paramedics responded on fire trucks, they could go to a scene more quickly. They’re geographically located better … they can do an assessment at the scene, they can re-route paramedics and ambulance services to more important calls. But what actually happened is Winnipeg has the slowest ambulance response time and the highest off-load delay times compared to many cities across Canada.”

He has written to Port Coquitlam mayor Brad West, with the hope he’ll make sure both sides work together so patients don’t lose out.