Cranbrook is forging ahead with plans to train firefighters with enhanced medical response capabilities, however, the union representing provincial paramedics says the new program is redundant and will add costs to the city.
Firefighters with Cranbrook Fire and Emergency Services (CFES) are set to receive Emergency Medical Response training and certification after developing a program approved and funded by city council earlier this year.
Cranbrook is the second municipality in the province to pursue EMR training for firefighters, following in the footsteps of Delta, which approved a similar program in 2015.
However, the Ambulance Paramedics of B.C., CUPE Local 873, says the program has redundancies, doesn’t provide additional live-saving training and adds additional costs to municipal governments.
The Rationale
The BCAS presence in Cranbrook consists of five full-time paramedics and 29 part time paramedics. Of that personnel, 33 are classified as primary care paramedics, while one is an advanced care paramedic. Three ambulances are on shift during the day, while two are on night shift.
Local paramedics responded to 2,300 calls for pre-hospital treatment last year.
However, the municipal government approved EMR training as an additional resource in the firefighter toolbox, airing the issue in council chambers a year ago.
At the time, Mayor Lee Pratt noted that the EMR training was being considered because CFES were sometimes first on-scene to a situation where people required medical attention.
“I think for our citizens, it’s a safety factor and sometimes it’s a life and death situation,” Pratt said, following a council meeting in September 2017 when the proposal was unveiled. “It’s not to be disrespectful to the ambulance attendants or paramedics at all; it’s just sometimes the way their system is set up and our system is set up, we’re there first.”
Since the program was legally approved nine months ago, the fire department has trained two officers in EMR to provide certification for the rest of the firefighters.
The start-up cost to get the program off the ground was $45,000, according to CFES.
The Issues
Cameron Eby, the president of CUPE Local 873, said EMR services does not help provide better patient outcomes outside of First Responder (FR) procedures during a recent presentation to city council.
Eby told council that EMR provides more diagnostic tools, but not much in the way of additional life-saving measures beyond FR.
“The rationale or the thinking behind that is not unique here in Cranbrook to other communities, and that is if we can do something to provide more of a service and save a life, then we want to do that, and I don’t think anybody faults anybody for having that rationale,” Eby said.
“The issue is that first responder program is designed to get to life threatening calls first, and deliver those life threatening interventions.”
He added that a new Clinical Response Model (CMR) in use by the BCAS to better categorize medical situations has improved median response times for calls in Cranbrook.
Eby pointed out that the city is responsible for medical oversight of the EMR program and indemnification, as B.C. Emergency Health Services only covers liability over FR treatment.
“Everybody gets sued if there’s a family or a patient that decides to go that route,” said Eby.
EMR also requires continuing education, which translates to roughly 20 hours every year, Eby added.
Given its role as fire response, Eby also raised concerns that firefighters resources could be spread thin if responding to a medical call and a fire event breaks out.
However, the main crux of Eby’s position is that the province already provides a medical response service through the BCAS and that municipalities feeling the need to provide EMR services is a symptom of the B.C. government neglecting that commitment.
“If a municipality is concerned that they’re not getting quick enough response times in a medical emergency, the solution is not to send somebody else; the solution is to get more paramedics and to get a quick response from the pre-hospital medical experts,” said Eby, in a follow up interview. “We’ve been championing that for a number of years without much results, however, in the last year, there has been a significant infusuion of more paramedics into a number of communities, including the Kootenays.
“When municipalities take on this responsibility, all they do is alleviate the pressure on the provincial government to make those changes.”
City responds
Cranbrook mayor Lee Pratt responded to Eby’s presentation by acknowledging that the BCAS has been underfunded by the provincial government.
“We believe that you do deserve more funding and we would certainly support that any way we can,” Pratt said.
However, he took issue with Eby’s characterization that Cranbrook Fire and Emergency Services had spent $2.75 million of it’s $4.3 million 2016 budget on medical assistance calls.
“Those guys are working, they’re already there on shift,” Pratt said. “We looked at it as just improving the efficiency of that department, rather than have them waiting for something to happen fire-wise, if they’re there and they can respond, then by all means, we’d use them.”
Pratt said there are two officers with CFES who are designated to certified as EMR trainers, who then train the rest of the department.
On the issue of liability, an agreement between B.C. Emergency Health Services and the city provides liability indemnification for actions taken under FR protocol, but not EMR.
Pratt told the Eby that the city is in negotiations with B.C. Emergency Health Services over EMR liability, however, the status of those talks remain unclear based on correspondence between city hall and BCEHS officials, which noted that Cranbrook would assume any liability incurred beyond FR protocol.
Scott Driver, the Acting Director of CFES, told media that his staff is currently trained and licensed at the EMR level, but that city is still working through liability issues, policy direction and operational supply chain inside the department.
“As soon as that stuff is taken care of, we’re going to roll that out operationally and that should be sometime within the next month or two where we’re delivering EMR services to the citizens of Cranbrook,” Driver said.
Driver congratulated the BCAS for their new model for faster response times, but noted that the fire department’s role is to address outlier situations when there may be a longer wait for an ambulance, for whatever reason.
“They’re not really frequent and it’s not a normal occurrence, but it does happen almost predictably regular,” he said. “In the last three months, with the new dispatch model, we’ve had one call per month that’s over a 30 minute wait to a call.
“So those are the instances where the local government has an opportunity to provide a different level of care and that’s what this council has asked the fire department to do.”