Toronto Paramedic Services


The City of Toronto Paramedic 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.

History

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. 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, 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 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 order to reflect its evolving role from primarily a provider of medical transportation to an actual provider of medical care.
The service introduced its first paramedics in 1984. Toronto EMS introduced many other innovations, including the concept of dedicated ground-based critical care transport ambulances, 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. Toronto EMS now operates under the city's Emergency Medical Services Division. It is the largest municipal EMS operation in Canada.
On 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.

Uniforms

Uniforms consist of:
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 . 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 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, and all equipment, radio, and medical electronics maintenance and repairs are performed on site by service staff.

Fleet numbering

2006 Orion Vii
1 One example in service on Toronto Islands due to road width restrictions
2 Special Operations
3 Unmarked, issued to senior operations staff
4 Used for transporting large groups/special teams for events or deployment
5 Equipped with multiple, mission specific pods

Historic/retired vehicles

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.com
2Multiple model years used by department until final retirement.
3 Examples may still be in service as utility vehicles

Staff

Paramedic Services has 1,207 members including paramedics and other support staff. These are categorized as follows:
The total number of paramedics is 887.
Toronto Paramedic Services operates its own Communications and System Control Centre, 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.

Operations

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 of the City of Toronto. Emergency service headquarters 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, resulting in 223,769 emergency calls being dispatched. Using the AMPDS system, which triages calls by severity for dispatch purposes, the actual dispatch volume by category for that same year was:

Ambulance Stations

District 1 - Northwest

The District 1 Hub is located at 01 Station. The Northwest quadrant is bounded roughly by Steeles Avenue to the north, Eglinton Avenue to the south, Yonge Street to the east, and Highway 427 & Mississauga border to the west.
StationAddressVehicles DeployedNotes
01 Station1300 Wilson AveBLS, ALS, ARU/PRU, SupervisorN/A
11 Station1135 Caledonia RdBLSN/A
12 Station1535 Albion RdBLS, ALSShared with Toronto Fire Station 413
13 Station555 Martin Grove RdBLSN/A
14 Station321 Rexdale BlvdBLSN/A
15 Station2753 Jane StBLS, ALSShared with Toronto Fire Station 142
18 Station643 Eglinton Ave WBLS, ALSN/A
19 Station2015 Lawrence Ave WBLS, ALSToronto Fire Station 442

District 2 - Northeast

The District 2 Hub is located at 20 Station. The Northeast quadrant is bounded roughly by Steeles Avenue to the north, Eglinton Avenue to the south, the Scarborough-Pickering Townline and Rouge River to the east, and Yonge Street to the west.
StationAddressVehicles DeployedNotes
20 Station2430 Lawrence Ave EBLS, ALS, ARU/PRU, Bariatric Unit, SupervisorN/A
21 Station887 Pharmacy AveBLS, ALS21 Station crews are controlled by the Southeast dispatcher.
22 Station3100 Eglinton Ave EBLS22 Station crews are controlled by the Southeast dispatcher.
23 Station115 Parkway Forest DrBLS, ALSShared with Toronto Fire Station 115
24 Station3061 Birchmount RdBLSN/A
25 Station8500 Sheppard Ave EBLS, ALSShared with Toronto Fire Station 212
26 Station4331 Lawrence Ave EBLS, ALS, ARUShared with Toronto Police 43 Division. A 26 Satellite Post is located at Toronto Fire Station 215.
27 Station900 Tapscott RdBLSShared with Toronto Fire Station 211
28 Station2900 Lawrence Ave EBLSN/A
29 Station4560 Sheppard Ave EBLS, ALS, ARUShared with Toronto Fire Station 243

District 3 - Southwest

The District 3 Hub is located at 30 Station. The Southwest quadrant is bounded roughly by Eglinton Avenue to the north, Lake Ontario to the south, Yonge Street to the east, and Etobicoke Creek to the west.
StationAddressVehicles DeployedNotes
30 Station100 Turnberry AveBLS, PRU, SupervisorN/A
31 Station4219 Dundas St WBLS, ALS, ARUN/A
32 Station9 Clendenan AveBLSN/A
33 Station760 Dovercourt RdBLS, ALSN/A
34 Station674 Markham StBLSN/A
35 Station265 Manitoba Ave BLS, Special Events Carts N/A
36 Station339 Queens Quay WBLS, Marine MedicShared with Toronto Fire/Marine Station 334
37 Station1288 Queen St WBLS, ALSN/A
38 Station259 Horner AveBLS, ALSN/A
39 Station155 The East MallBLSShared with Toronto Fire Station 432

District 4 - Southeast

The District 4 Hub is located at 42 Station. The Southeast quadrant is bounded roughly by Eglinton Avenue to the north, Lake Ontario to the south and east, and Yonge Street to the west.
StationAddressVehicles DeployedNotes
40 Station58 Richmond St EBLS, ALSN/A
41 Station1300 Pape AveBLS, ALSN/A
42 Station1535 Kingston RdBLS, ALS, SupervisorN/A
43 Station126 Pape AveBLSN/A
45 Station135 Davenport RdBLS, ALSN/A
46 Station105 Cedarvale AveBLS, ALSN/A
47 Station3600 St Clair Ave EBLSN/A

District 5 - Special Operations

The District 5 Hub is located at 55 Station. District 5 has stations in multiple quadrants and is responsible for Toronto Paramedic Services’ special operations teams, which include: Response Units, Critical Care Transport Unit, CBRNE, ETF, Bike Unit, and Emergency Support Units.
StationAddressVehicles DeployedNotes
51 Station63 Toryork DrESU Bus, ESU Truck, Bariatric UnitLocated in the Northwest quadrant and controlled by the Senior Dispatcher.
53 Station4330 Dufferin StBLS53 Station crews are controlled by the Northwest dispatcher.
54 Station4135 Bathurst StBLS, ALS, CBRNE, ARU54 Station crews are controlled by the Northwest dispatcher.
55 Station5700 Bathurst StBLS, SupervisorShared with Toronto Fire Station 112. 55 Station crews are controlled by the Northwest dispatcher.
56 Station3300 Bayview AveBLSShared with Toronto Fire Station 111. 56 Station crews are controlled by the Northeast dispatcher.
57 Station2075 Bayview AveBLS, ALSLocated at the rear of Sunnybrook Health Sciences Centre. 57 Station crews are controlled by the Northeast dispatcher.
58 Station12 Canterbury PlBLS, ALS, ETF, CCTUShared with Toronto Fire Station 114. 58 Station crews are controlled by the Northeast dispatcher. CCTU and ETF crews are controlled by the Senior Dispatcher.
59 Station235 Cibola Ave BLSShared with Toronto Fire Station 335. 59 Station crew is controlled by the Southwest dispatcher.

Special operations

In addition to regular operations, Toronto Paramedic Services staffs a Special Operations Division, tasked with the provision of Paramedic services in unusual circumstances. The elements of this unit include:
=Challenges=
As a result of how Canada's universal healthcare system is set up, 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.

Research

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 Toronto Base Hospital program, 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.

Community involvement

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 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, are driven by volunteers from Toronto Paramedic Services, including both paramedics and a variety of other staff.