STAFF REPORT
January 11, 2000
To: Community Services Committee
From: Barry H. Gutteridge, Commissioner, Works and Emergency Services
Subject: Tiered Emergency Response Report
Purpose:
This report provides Council with an overview of the purpose of the emergency response system employed by the three
emergency services within the City of Toronto.
Financial Implications and Impact Statement:
There are no financial implications associated with this report.
Recommendations:
It is recommended that:
(1) City of Toronto Council endorse the principle of Tiered Response as a "best practice" in the provision and delivery of
emergency services within the City of Toronto;
(2) the Sunnybrook Base Hospital in conjunction with Toronto Ambulance and the Toronto Fire Services undertake to
review the medical requirements associated with multi-agency responses to medical emergencies; and
(3) appropriate City Officials be given the authority to give effect thereto.
Council History:
The Policy and Finance Committee at its meeting of July 20, 1999 recommended "that the Commissioner of Works and
Emergency Services, in consultation with the Fire Chief, Police Chief and General Manager of Toronto Ambulance, be
requested to report to the appropriate Committee on the efficiencies and related savings on a better co-ordinated tiered
response." City Council adopted this recommendation at its meeting of July 27-29, 1999.
Background:
The term "tiered response" refers to the process of a co-ordinated response of the three emergency services to various types
of emergency incidents that occur within a community. Tiered response, or the response of two or more of the three
emergency services to the same incident is not restricted to only "medical" emergencies, as the protocols are designed to
cover a broad spectrum of situations within the overall realm of public safety. The current tiered response model is not
exclusive to the City of Toronto, as it is in place in the majority of all large urban centers throughout North America.
The Toronto model was implemented in the early 1980s with the introduction of the 911 emergency number. The primary
intent of 911 and the accompanying tiered response model was to ensure that in the first instance the most appropriate
emergency service was notified of an incident. In situations where time, circumstance and/or the nature of the incident
warranted, the response of the other emergency services would occur. Based on the type of incident, the first notification
would be to the "primary agency", with other agencies or emergency services notified if required. As an example, a
structure fire would result in the initial notification of the Toronto Fire Services as the primary agency, with Police and
Ambulance notified as the secondary agency responder. The primary purpose of the fire services in this case is to provide
immediate fire suppression and victim rescue, with Police providing investigative and crowd management and Ambulance
providing medical care for either the victims and/or fire-fighters.
In this example all three agencies respond and each have a specific and vital role. There are many examples unrelated to
medical responses that result in the notification and response of all three agencies.
In the case of medical emergencies, not all of the 911 medical calls result in a tiered response involving the Toronto Fire
and Toronto Police Services. In 1999, Toronto Ambulance responded to over 190,000 emergency calls. Less than 30% or
56,160 of these emergency calls were classified as potentially life threatening which under current protocol results in the
activation of tiered response. When a life threatening medical emergency is identified through the Toronto Ambulance call
triage system, it is important to ensure that immediate intervention occurs. The tiered response system is designed to ensure
notification of the Toronto Fire Services and in some cases the Toronto Police Service. While the primary agency is
Toronto Ambulance, time factors associated with the medical emergency warrants the rapid response of the Toronto Fire
Services and in certain cases the Toronto Police to provide immediate first response medical intervention. Projected figures
for Toronto Fire Services are 113,513 calls of all types. Of this total 52,562 calls were of a medical nature based on the
tiered response protocol, which is 46.30% of call volume.
In the case of a life-threatening emergency, time maybe a crucial factor in determining outcome and survivability. Due
diligence on the part of the community must ensure that its resources respond appropriately to these situations. The tiered
response system ensures that initial
intervention is guaranteed at a marginal expense. In cases where Toronto Fire Services arrives simultaneously with, or after
ambulance, Fire Fighters provide medical assistance and support to the paramedics. On a complex medical emergency
additional resources are often needed to effectively provide paramedic interventions. Fire Fighters are trained in Cardio
Pulmonary Resuscitation, advanced first aid, defibrillation and in the administration of oxygen. This training allows for
effective and time critical intervention in cases where they are first to arrive on scene. It should be noted that this is not a
duplication of service in any way.
Review of Tiered Response:
The review of tiered response has involved all services addressing two groups of issues; those related to non-medical
multiple service notification and those that were medical in nature. The non-medical notification review was based on the
appropriateness of multiple services responding to calls because of the need to ensure public safety in the given situation or
circumstance. The non-medical notification review addressed the "Primary Agency and Dual Response" notification
processes activated through the 911 system. It was determined that in the interest of due diligence and public safety that no
changes be made to this system. In fact the application of tiered response for non-medical requirements would be expanded
to include; Carbon Monoxide related emergencies and motor vehicle collisions on the Don Valley Parkway, the Gardner
Expressway and the 400 series highways. While appropriate notification protocols had been in place they were updated and
strengthened to reflect an improved level of response. In these cases there is no duplication of services due to the specific
nature of the incident and the need for the call is classified as potentially life threatening, due diligence and best practice
will continue to result in a tiered response. This practice has been fully endorsed and supported by the General Manager of
Toronto Ambulance, the Fire Chief and the Director of the Sunnybrook Base Hospital Program. Prior to implementing any
significant changes to the current protocols, a process of outcome research and validation should occur. This process will
be a joint undertaking with Sunnybrook and Women's College Health Sciences Center Base Hospital Program, Toronto
Ambulance and the Toronto Fire Services, with the goal of targeting combined responses to patients who would medically
benefit. Input will also involve the Toronto Police Services and other community agencies where appropriate. It is expected
that this initiative will take approximately one year to complete.
Conclusion:
The Tiered Response Program has been a successful and significant force in managing and ordering the response of Police,
Fire and Ambulance to emergencies within the City of Toronto. The model in place has been emulated by most other large
North American cities and clearly offers benefit to those in critical need of immediate assistance.
Public safety is of paramount concern and value to the citizens of our city. Over the next eighteen months the two primary
services, Ambulance and Fire will be working to refine the current model in order to improve the efficiency and
effectiveness of tiered response. The scheduled implementation of the Toronto Fire Services Computer Aided Dispatch
System (CAD) and the consolidation of the six former dispatch centers into one location will result in improvements to the
current model. Open architecture design and inter-operability of the fire CAD will enable direct linkages with both the
Toronto Police and Toronto Ambulance CAD systems. This offers a potential to further improve the linkages between the
three services and a more co-ordinated response to all types of emergencies that occur within the City of Toronto.
Contact:
Ronald L. Kelusky, General Manager Alan F. Speed, Chief
Phone: 397-9240 Phone: 397-4300
Fax: 392-2115 Fax: 397-4325
Dr. Brian Schwartz, Medical Director
Phone: 392-3883
Fax: 397-9060
Ronald L. Kelusky Alan F. Speed
General Manager, Toronto Ambulance Services Chief, Toronto Fire Services
Barry H. Gutteridge
Commissioner, Works & Emergency Services
RLK/sm
