Since having the pleasure of working with staff and stakeholders of Chatham Kent Emergency Services a few years ago, I have followed your progress closely, albeit through media coverage. You have a significant decision in front of you regarding the future of EMS and Fire services and the best way to meet your community’s needs.
I understand the challenges associated with this type of decision and respect your need to determine what’s best for CK now and in the future. I am submitting this unsolicited letter in support of your Chief and his team. With respect, I would like to draw your attention to a couple of items that may be of assistance as you make this difficult decision.
I have known the Fire Paramedic Chief professionally for over 20 years. We worked together for many years to at the Toronto “Bandage 1” air ambulance base as Critical Care Flight Paramedics and at Sunnybrook Hospital where I was a Registered Nurse. Chief Stuebing regularly participated in clinical rounds and as an inaugural faculty member for the Flight Paramedic Academy. He was considered to be one of the most responsible and knowledgeable instructors we had. His ability to balance academic knowledge with practical application was second to none. Over the past two decades I can assure you that Chief Stuebing has been committed to excellence in patient care, clinical practice for paramedics and firefighters, and championing synergies between emergency and allied services. I am confident that the discussion regarding the ethical merit of proposal in front of you or the potential for detrimental effects to patient care are disingenuous and far from factual.
The Fire Paramedic Chief was the Program Manager for the Hamilton Health Sciences Base Hospital program where he was responsible for ensuring that paramedic licensure met the academic, clinical and practical rigour required for the delivery of safe, high quality patient care while meeting legislative requirements. Not only does he have years of experience in ensuring paramedics are safe to practice, he championed evidence-based medicine as Research Coordinator for the Research Outcome Consortium (ROC). Sunnybrook is a member of ROC and committed to using evidence to guide decisions and policy in prehospital care. I hope that you see that Chief Stuebing’s past experience demonstrates that he consistently has let evidence guide his decision making.
Besides working as colleagues, I also had the opportunity to learn about CK and its EMS and Fire Services when I was asked to help facilitate a strategic planning process for Chatham-Kent Fire and Emergency Services (CKFES) shortly after the Chief’s arrival in 2013. I can assure you that CKFES undertook a robust process to identify challenges and opportunities facing Fire and EMS now and into the future. As part of this initiative, community partners and stakeholders were invited to participate. All legislation, regulations and council bylaws, industry best practices and guidelines were reviewed to ensure the organization was fully aware of the challenges, opportunities and legislated responsibilities that CKFES needed to consider before outlining options for council’s consideration.
As a previous president of the Paramedic Association of Canada (PAC) and the Project Director, I led the development and adoption of the National Occupational Competency Profiles for Emergency Medical Responders, Primary Care Paramedics, Advanced Care Paramedics and Critical Care Paramedics. I met with paramedics across the country and saw many different service delivery models. I have a somewhat unique and non-traditional perspective on the profession, role of paramedics and their “territory”.
In the US, EMS evolved through the unlikely marriage of Public Safety and healthcare. In Canada, we were birthed in healthcare. We value our close relationship with our physicians and that alignment. However, every system is a little different, and every community has unique needs. I strongly uphold the belief that the title, licence and/or registration of the paramedic is paramount and must be protected at all costs. That certification process is key to ensuring highly quality patient care. A second certification or vocation must not interfere or deter from that, however the vehicle that provides transportation should not matter. We deliver paramedics to patients by helicopter, bicycle, argo’s, or ambulances. Why can we not deliver trained certified professionals in a big red truck? Assuming that the professionals are certified and competent in both disciplines, why does the delivery vehicle matter?
Chief Stuebing has always been passionate about this and his unique perspective has helped guide him through many service improvement initiatives in other jurisdictions. He rose through the ranks of BOTH disciplines to the highest levels of responsibility – now as your Chief and previously certified as a Critical Care Flight Paramedic. This is from where his “unique” perspective has evolved.
When developing the Competency Profiles, the intention was to create a “measurement ruler” against which a practitioner could be measured and, secondarily, to assist with the portability of credentials between jurisdictions (a requirement of Article 7 of the Agreement on Internal Trade). It was not intended to, nor does it, recommend service delivery models. In fact, the competency framework avoids that completely by outlining the psychomotor, cognitive and affective requirements to safety provide patient care by paramedics. As a member of the Canadian Medical Association’s Accreditation team for all levels of paramedics, Chief Stuebing understands this completely.
The models in front of you ensures that competent paramedics will provide the services needed. In addition, they also will provide firefighting skills sets required as an industry best practice to safely perform that work. The Fire Paramedic Chief was asked to champion this challenge when his former employer lost two fire fighters in a fire and the service was ordered to make tremendous changes to their training and promotion process. The only reason I am aware of this is because was involved as a consultant with the service changes that Winnipeg undertook when Fire and EMS were merged and similar concerns were brought forward. Chief Stuebing was part of the administration team that helped pull the service back on the rails. The delivery options currently proposed are not a mirror Chief Stuebing’s work with his previous employer. They have been designed by Chief Stuebing and his team to fit your communities’ needs.
Change is never easy. We hold on to the status quo because it is known to us and it is comfortable. I believe that leaders and leading organizations are compelled to examine and reflect on HOW work is done. The goal is always to improve and provide the best service they can in a fiscally responsible manner. You have been provided with some options for the future, but none of them should lead you to believe that patient care would be adversely affected. I am confident in Chief Stuebing’s analysis, proposals and his ability to implement changes that will result in positive outcomes for the people of Chatham-Kent. He will always put the communities, their residents and visitors first.
Of this, I am 100% confident.
Respectfully submitted.
Mary Beth Gibbons, RN, MA
This is a nice letter in support but I am surprised that you as a consultant would leave out some very important facts…the numbers! You spoke highly of the Fire Chief and his credentials but failed to mention the financial implications of a blended service and that after four years it will be a possible economic burden on the taxpayers of Chatham-Kent. This is a very important time for our community and we are geographically different than most other regions in Canada. I’m not sure if you have been to Chatham-Kent but we have a system that works well now. With our aging population the proper care of a fully trained paramedic is critical. We DO have the best Fire Department in Canada and they work well with our EMS service. It all comes down to two things…money and care. Why implement a model that will cost more in the long run and why jeopardize the quality of care our citizens now receive?
Thank you
Gary Patterson
I agree with you. A fully trained paramedic service is paramount. You do have that. I have to assume that the financial proposals in front of Council are accurate.
“I am submitting this unsolicited letter in support of your Chief and his team”?? I find that hard to believe since you were hired to consult on the CKFES Strategic Plan.
My activity with the strategic planning process was a few years ago. I have not been involved with the recommendations on service delivery options.
Its odd that you are supporting a blended model, however no study, report or any research material that I’ve come across supports such an inefficient deployment model. The fact that fire-related calls are declining year after year makes this an interesting topic. Do you find it strange that a fire department, with declining call volumes, with increased staffing levels, increased municipal budgetary pressures are looking to get into paramedic work? Could it be that the archaic fire response deployment model was created nearly 40 years ago. Could it be that fire chiefs and their unions are looking to foster “growth” to a profession that is not needed like it was years ago. This is empire building, plain and simple. CK Fire Dept responds to 3,000 calls per year, yet CK EMS responds to over 20,000… did you know that the fire dept responds to 797 medical calls, yes 797 out of 20,000 (less than 4%) and suddenly, they’re the authority in medical response?
This is about protecting fire departments budgets and their members on the backs of paramedics in the face of declining workloads and declining public need. Of this, I am 100% confident..
The author fails to mention the human aspect of this. The timelines are not acceptable. Regardless of whether or not you feel a Fire-Based EMS program is a good or bad thing (it’s been debated forever), the implementation puts dollars over people. The Chief has flat out said to the media if the Paramedics don’t want to also be Firefighters, then “This isn’t the place for them to work under a blended model”. There’s a small portion of Paramedics who also do volunteer fire already who I’m sure would be more than happy to perform both roles. The majority (>75%) who do not also want to run into burning buildings will be shown the door. That is not in any way shape or form reasonable. If you are going to change the job drastically, it needs to be done through retirements/attrition/etc, not within 1-3 years. So, who will get these empty vacancies when 3/4 of the Paramedic workforce is forced to quit? Young inexperienced college graduates who will take the job because they need one. If Ms. Gibbons family member was a Paramedic and faced with “Hey, now you have to put fires out too, and if you don’t want to, too bad, quit” I don’t think she would have penned such a letter.
Dollars matter. So do people.