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:- Dark navy short or long sleeve police style shirt with departmental crest, reflective stripes around arms and Toronto Paramedic in reflective print on chest and back.
- Chartreuse high visibility jacket with Toronto Paramedic in reflective print on back as well as job title front and back.
- Dark navy cargo pants with reflective stripes around lower leg.
- White shirts for Supervisory/Management staff.
- Bicycle helmet and shorts for bike crews.
- Hard hat with visor as required.
- Black safety boots/shoes.
- FR Military style tactical shirt/pants, gloves, Ballistic helmet/riot helmet and Ballistic vest for tactical units.
- HAZMAT suits for CBRNE units.
- Dress uniform consisting of dark navy pants and tunic, white shirt, navy tie and forage cap. Paramedic uniforms have royal blue cap band and striping on pants. Management staff have black maple laurels as well as gold piping on cap peak. Striping is orange-gold for the honour guard.
Fleet
Fleet numbering
- 5XX - Paramedic Supervisor, Rapid Response, Special Operations
- 8XX - Ambulance, West
- 9XX - Ambulance, East
- ESUXX - Emergency Support Unit
Current fleet
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.com2Multiple 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:- Paramedics
- Other staff
Communications
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.| Station | Address | Vehicles Deployed | Notes |
| 01 Station | 1300 Wilson Ave | BLS, ALS, ARU/PRU, Supervisor | N/A |
| 11 Station | 1135 Caledonia Rd | BLS | N/A |
| 12 Station | 1535 Albion Rd | BLS, ALS | Shared with Toronto Fire Station 413 |
| 13 Station | 555 Martin Grove Rd | BLS | N/A |
| 14 Station | 321 Rexdale Blvd | BLS | N/A |
| 15 Station | 2753 Jane St | BLS, ALS | Shared with Toronto Fire Station 142 |
| 18 Station | 643 Eglinton Ave W | BLS, ALS | N/A |
| 19 Station | 2015 Lawrence Ave W | BLS, ALS | Toronto 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.| Station | Address | Vehicles Deployed | Notes |
| 20 Station | 2430 Lawrence Ave E | BLS, ALS, ARU/PRU, Bariatric Unit, Supervisor | N/A |
| 21 Station | 887 Pharmacy Ave | BLS, ALS | 21 Station crews are controlled by the Southeast dispatcher. |
| 22 Station | 3100 Eglinton Ave E | BLS | 22 Station crews are controlled by the Southeast dispatcher. |
| 23 Station | 115 Parkway Forest Dr | BLS, ALS | Shared with Toronto Fire Station 115 |
| 24 Station | 3061 Birchmount Rd | BLS | N/A |
| 25 Station | 8500 Sheppard Ave E | BLS, ALS | Shared with Toronto Fire Station 212 |
| 26 Station | 4331 Lawrence Ave E | BLS, ALS, ARU | Shared with Toronto Police 43 Division. A 26 Satellite Post is located at Toronto Fire Station 215. |
| 27 Station | 900 Tapscott Rd | BLS | Shared with Toronto Fire Station 211 |
| 28 Station | 2900 Lawrence Ave E | BLS | N/A |
| 29 Station | 4560 Sheppard Ave E | BLS, ALS, ARU | Shared 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.| Station | Address | Vehicles Deployed | Notes |
| 30 Station | 100 Turnberry Ave | BLS, PRU, Supervisor | N/A |
| 31 Station | 4219 Dundas St W | BLS, ALS, ARU | N/A |
| 32 Station | 9 Clendenan Ave | BLS | N/A |
| 33 Station | 760 Dovercourt Rd | BLS, ALS | N/A |
| 34 Station | 674 Markham St | BLS | N/A |
| 35 Station | 265 Manitoba Ave | BLS, Special Events Carts | N/A |
| 36 Station | 339 Queens Quay W | BLS, Marine Medic | Shared with Toronto Fire/Marine Station 334 |
| 37 Station | 1288 Queen St W | BLS, ALS | N/A |
| 38 Station | 259 Horner Ave | BLS, ALS | N/A |
| 39 Station | 155 The East Mall | BLS | Shared 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.| Station | Address | Vehicles Deployed | Notes |
| 40 Station | 58 Richmond St E | BLS, ALS | N/A |
| 41 Station | 1300 Pape Ave | BLS, ALS | N/A |
| 42 Station | 1535 Kingston Rd | BLS, ALS, Supervisor | N/A |
| 43 Station | 126 Pape Ave | BLS | N/A |
| 45 Station | 135 Davenport Rd | BLS, ALS | N/A |
| 46 Station | 105 Cedarvale Ave | BLS, ALS | N/A |
| 47 Station | 3600 St Clair Ave E | BLS | N/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.| Station | Address | Vehicles Deployed | Notes |
| 51 Station | 63 Toryork Dr | ESU Bus, ESU Truck, Bariatric Unit | Located in the Northwest quadrant and controlled by the Senior Dispatcher. |
| 53 Station | 4330 Dufferin St | BLS | 53 Station crews are controlled by the Northwest dispatcher. |
| 54 Station | 4135 Bathurst St | BLS, ALS, CBRNE, ARU | 54 Station crews are controlled by the Northwest dispatcher. |
| 55 Station | 5700 Bathurst St | BLS, Supervisor | Shared with Toronto Fire Station 112. 55 Station crews are controlled by the Northwest dispatcher. |
| 56 Station | 3300 Bayview Ave | BLS | Shared with Toronto Fire Station 111. 56 Station crews are controlled by the Northeast dispatcher. |
| 57 Station | 2075 Bayview Ave | BLS, ALS | Located at the rear of Sunnybrook Health Sciences Centre. 57 Station crews are controlled by the Northeast dispatcher. |
| 58 Station | 12 Canterbury Pl | BLS, ALS, ETF, CCTU | Shared 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 Station | 235 Cibola Ave | BLS | Shared 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:- Tactical Unit - Cross-trained paramedics providing medical support to the Toronto Police Emergency Task Force.
- Marine Unit - Cross-trained paramedics staffing the patrol vessels of the Toronto Police Marine Unit in order to provide support for Toronto Police personnel, EMS services on the waters of Lake Ontario, and EMS service to the Toronto Islands.
- HUSAR - Specially-trained paramedics operate together with elements of the Toronto Fire Services and Toronto Police Service to provide a joint-service Heavy Urban Search and Rescue team.
- CBRNE - Specially-trained paramedics operate together with elements of the Toronto Police Service and Toronto Fire Services to provide a joint-service Terrorism/Hazardous Materials Response team.
- Public Safety Unit - Cross-trained paramedics providing medical support to the Toronto Police Public Order Unit
- Emergency Response Unit - Single paramedics in SUVs, tasked solely with response to high priority emergency calls.
- Bicycle Unit - Paramedics equipped with mountain bikes, capable of providing either BLS or ALS services in off-road areas, or at special events. Team also works in concert with the Toronto Police bike team to provide first response capabilities in the Entertainment District on weekend nights.
- Emergency Support Unit - Paramedics trained to operate the service's busses and equipment trucks. These respond to all potential Mass Casualty Incidents, support for large crowd situations such as festivals and parades as well as responding to all calls involving aircraft at Toronto Pearson International Airport
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.