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January 25, 2010
Toronto releases recommendations of the Working Group on Toronto EMS staging policy
The City of Toronto today released 10 recommendations from the Working Group on Toronto EMS Staging Policy - the standard operating policy that outlines the procedures to be followed when Paramedics decide to delay service because they believe the safety of staff or patients may be at risk.

Mayor David Miller asked City Manager Joseph Pennachetti to set up a working group to review the policy and strengthen and enhance the policy with input from key stakeholder groups. The effort came in response to recommendations released on October 8, 2009 from the Ministry of Health and Long-Term Care investigation into the events affecting ambulance service to 40 Alexander Street on June 25, 2009.

Upon receiving the recommendations from the City Manager, Mayor David Miller said, “I thank the group and the City Manager for their efforts in so quickly producing these valuable recommendations that not only provide an effective balance between patient care and paramedic safety but will assist our EMS responders by providing improved clarity and oversight. In order that other EMS operations across the province will benefit from this work, I will forward the recommendations to the Ministry of Heath and Long-Term Care and the Ministry of Labour to share with other jurisdictions.”

The Working Group, which met three times, October 30 and December 11, 2009 and January 20, 2010, was made up of representatives from the City of Toronto; Toronto EMS; Ministry of Labour; Ministry of Health and Long-Term Care; Toronto Civic Employees Union, Local 416 and CUPE Local 79; the City of Toronto Administrative, Professional and Supervisory Association (COTAPSA); and the Sunnybrook-Osler Centre for Prehospital Care.

The recommendations address three areas for action: policy; training; and data tracking and analysis.

City Manager Joseph Pennachetti said, “What makes these recommendations unique and I think particularly effective, is that the concerns of all the stakeholders are balanced: the Ministry of Health with regard to patient care standards, the Ministry of Labour which regulates worker safety, as well as the representatives of the paramedics, supervisors and emergency medical dispatchers, who provide patient care and oversight.”

The revised standard operating policy on patient care and scene safety and the enhanced training and tools, such as revised incident reports and checklists, will be provided to Toronto EMS staff beginning next week.
Toronto EMS Chief Bruce Farr said, “The recommendations of the working group reflect that it is appropriate for paramedics to delay service in situations where their safety is at risk. The revised policy, along with enhanced training and improved tracking and monitoring, will better equip EMS responders to make the right decision at the scene.” He went on to say that Toronto EMS is already in the process of implementing the recommendations.

Key actions planned for implementation include:
• Enhanced standard operating policy on patient care and scene safety takes effect immediately once training begins.
• Paramedic and supervisor training on the new delay of service policy and checklists starts February 1
• Communication Center staff training begins in mid March.

In addition, an update on the progress of implementation of the 13 recommendations from the Ministry of Health investigation into ambulance service at 40 Alexander St. was provided. All 13 recommendations have been addressed.

The following background material is available at
• Transmittal letter with working group recommendations, revised delay of service policy and forms/checklists for use by paramedics and supervisors
• Summary of recommendations and implementation of the Ministry of Health and Long-Term Care (MOHLTC) investigation into 40 Alexander St.
• Summary of recommendations of the working group on EMS staging policy and action plan for implementation

Toronto is Canada's largest city and sixth largest government, and home to a diverse population of about 2.6 million people. It is the economic engine of Canada and one of the greenest and most creative cities in North America. Toronto has won numerous awards for quality, innovation and efficiency in delivering public services. Toronto's government is dedicated to prosperity, opportunity and liveability for all its residents. For information about non-emergency City services and programs, Toronto residents, businesses and visitors can dial 311, 24 hours a day, 7 days a week.

Media contacts:
Kim McKinnon, Coordinator Public Information and Media, Toronto Emergency Medical Services, 416-392-2255,
Patricia Trott, City of Toronto Strategic Communications, 416-392-8937,



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