Henri Gagne is a lucky guy, having survived a crisis where he needed CPR, but he has not been fortunate enough to get answers to all of his questions about the system that dispatches firefighters to medical emergencies.
The Hillsburgh resident wrote a letter to the Town of Erin last December, complaining that the Fire Department did not respond after a 911 call, and questioning provisions of the Tiered Response Agreement that Town Council approved in 2012.
Fire Chief Dan Callaghan said it appears that the Erin Fire Department should have been dispatched, but they were not signalled to respond.
The agreement with the dispatch centre and the ambulance service says that firefighters will always be dispatched (or “tiered”) in the most severe emergencies, where loss of life is an immediate threat. But in other serious cases that are slightly less severe, they will only be dispatched if an ambulance is expected to take longer than 15 minutes to get to the scene.
“A lot can happen in 15 minutes,” said Gagne in his letter. “My understanding is that the Town of Erin Fire and Emergency Response Services can respond and be on the way in 5-7 minutes. That extra 6-8 minutes can make a tremendous difference to the health and welfare of the patient.”
Gagne says the 15 minute time frame in the agreement could be shortened and the medical criteria changed, allowing firefighters to be dispatched in a greater percentage of serious cases.
Callaghan says that while there was a problem in this case “the agreement is solid”, based on experience and agreement among Wellington County fire chiefs.
“Fifteen minutes is reasonable,” he told The Advocate. “We have to determine where we can make a difference.”
Firefighters can perform Cardio-Pulmonary Resuscitation (CPR), provide First Aid and supply oxygen if needed, but are not qualified for other medical interventions. They can also collect information and help keep victims comfortable until an ambulance arrives.
“I recently had need of emergency services where fire was not tiered (ambulance only 9-10 minutes out) and I subsequently required CPR,” said Gagne. “Had my wife not had the foresight to immediately call my son-in-law (who is a volunteer firefighter) after her 911 call, I wonder if I would be able to write this letter. My doctors didn’t think so. The two of them performed CPR until the ambulance arrived.
“While I was lucky that night, the ambulance was here in 9 minutes, what about next time when they may be 12 minutes out? What about the safety of others in the community?”
On March 4, Callaghan responded to Gagne, as requested earlier by Council. The chief said that based his conversations with Gagne, the call for help “should have activated an immediate tiered dispatch of Station 50 Hillsburgh to your home, as the information fit the Code 4 Response Criteria.”
Gagne has obtained a recording of the 911 call through a Freedom of Information request, but has not received an explanation from the Ministry of Health, which oversees the Cambridge Central Ambulance Communication Centre (CACC), as to why his emergency was not treated as a tiered call.
Gagne is not satisfied with Callaghan’s letter, since it did not address his questions about the agreement. He also pointed out that when Town Councillors approved the agreement in October 2012, the agreement was emailled to them, but not published for the public.
The agreement is not confidential, and can be downloaded with background documents at:
When a 911 call is made in the Erin area, it is routed either to the OPP, the fire dispatch system (for regular fire calls), or the CCAC (for medical calls). If the medical emergency meets the criteria of the most serious Code 4 category in the Tiered Response Agreement, Erin Fire is dispatched, regardless of the ambulance time.
If the emergency falls in the less urgent (but still Code 4) category, Erin Fire is only dispatched if the ambulance is more than 15 minutes away.
When there was no ambulance stationed in the Town, ambulance response times were often over 15 minutes, so firefighters were responding to most serious medical emergencies. Now that an ambulance is stationed part-time in Hillsburgh, firefighters are not called out as often.
For the Erin village station, there were 137 tiered calls in 2012, compared to 81 in 2013. For the Hillsburgh station, there were 72 tiered calls in 2012, and 37 in 2013.
Chief Callaghan could not provide the average response time for tiered calls, though response is quicker in the urban areas where the fire halls are located.
If a person is “not breathing”, or has “vital signs absent” it is a tiered response in all cases. But if they have a “breathing problem”, or “chest pain”, it is in the less severe category.
Callaghan said it is relatively common for people to have breathing problems or chest pain for some time before they call 911.
He said it would not be appropriate to send firefighters to all medical calls, and in the case of the less severe Code 4 calls, having firefighters arrive a few minutes before the ambulance normally does not make a difference in the medical situation.
Guelph Fire Chief Shawn Armstrong, who is responsible for the Guelph Wellington ambulance service, has been asked by The Advocate to provide average ambulance response times for the Town of Erin, but has not done so.
He has also not responded to a request for the total number of ambulance calls per year, the number of Code 4 calls and the number of tiered Code 4 calls.