COUNTY OF SIMCOE
To:
COMMITTEE OF THE WHOLE
Section:
Consent – Human Services - Paramedic Services
Item Number:
CCW 14-249
Meeting Date:
May 27, 2014
Subject:
Paramedic Services Incident Response Unit
Recommendation:
THAT Item CCW 14-249, regarding the Paramedic Services Incident Response Unit, be received for
information.
Executive Summary:
The following report provides an update on the County of Simcoe Paramedic Services Chemical,
Biological, Radiological, Nuclear, (CBRN) Incident Response Unit (IRU) comprised of specially trained
paramedics that was introduced to County Council in 2008 and became fully functional with the signing
of the CBRN Memorandum of Understanding in April 2011. The IRU is a member of the County CBRN
team along with Barrie Fire and Police Services to support technical response for the local Fire
Services to complex emergency scenes. The IRU provides management for larger and/or complex
scenes linking closely with allied agencies, the Simcoe Muskoka District Health Unit and our partner
hospitals to assist in protecting the public, responders and victims while managing communication
between the scene, support agencies, external resources and receiving hospitals.
The IRU is comprised of paramedics who have specialized training to use skills, techniques and
medications to provide support for technical incidents to provide timely complex care for patients
injured, exposed or contaminated in a CBRN incident. These paramedics have jointly trained with
response partners enabling them to work in the warm zone providing advanced patient care operating
under the provincial medical protocols supported by a CBRN tactical response specialist Physician from
our Base Hospital.
The IRU Paramedics are scheduled in normal deployment and do not represent an additional layer of
staffing.
Background/Analysis:
The three (3) main focuses of the IRU Paramedics are, Complex Scene Support, CBRN incidents and
mostly recently is expanding to include support during police tactical incidents.
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Complex Scene Support
Larger more complex emergency scenes require an organized approach to site, resource and patient
management. Identified sectors for patient; triage and care, patient transport and Paramedic Scene
Command as part of multi agency unified command requires the assignment of staff as sector officers.
IRU paramedics receive additional orientation and training on these sector officer roles and
responsibilities and related documentation and communication requirements. When such a scene
occurs, IRU Paramedics who are on duty are used in these sector officer roles whenever possible.
Complex scene support was the first specialized role identified and rolled out to IRU Paramedics.
Chemical, Biological, Radiological Nuclear (CBRN)
There are times when people can be exposed to potential harm from chemical or other toxic agents as
a result of vehicle collisions, industrial accidents, fires or foul play. The IRU has formed strong bonds
with the Fire and Police services in the County of Simcoe and the Cities of Barrie and Orillia. Since its
inception, this team has responded successfully to numerous hazardous materials incidents in a
number of municipalities. IRU Paramedics were also requested and contracted to provide CBRN
support to the G-8 Summit in Huntsville in June of 2010.
A recent notable example was the November 2013 Collingwood OPP station exposure where local
Collingwood Fire service, Barrie Fire Service and the OPP Provincial Response Team (UCRT)
collaborated to successfully conclude the incident. The onsite IRU Paramedics were able to quickly
assess those exposed, ascertain the medical risk and contamination potential to reduce the patient
impact. Further, the IRU was tasked to support the safe entry and monitoring of the OPP response into
the hazard area when they secured the site and made safe and removed the evidence and agent. This
event clearly identified the success of the multi agency response from different jurisdictions to work
together to, quickly and efficiently resolve this high risk event. Events are debriefed in order to refine
and improve team operations and effectiveness.
The successful implementation of this team continues to be considered a best practice by the Ontario
Office of the Fire Marshal. The Simcoe Muskoka District Health Unit has partnered to support the
development of the CBRN Emergency Health Guidelines identifying patient care and responder
approach to hazardous event to protect the responders, victims and community. The health guidelines
are acknowledged province wide as a comprehensive and supportive guiding document and are utilized
by our local Fire, Police, Paramedics and hospitals.
The important responder medical monitoring developed to protect the local CBRN response team
members while in action has been successfully transitioned to general operations to be used by all of
our paramedics, to all fire and police services who require monitoring when exposed to environmental
or operational extremes. This medically reviewed program is uniquely designed to monitor the health of
the responders and provide guidance to their command on their safe continued physical activity while
protecting individual personal health information.
The IRU Paramedics are trained to research patient decontamination and treatment needs based on
type of patient exposure and toxidromes (patient signs and symptoms known to be associated with
various toxins). IRU Paramedics carry medical countermeasures to various toxins such as cyanide.
IRU Paramedics commonly support allied agencies at fires due to the potential for patient exposure to
hydrogen cyanide gas, a toxic product of combustion. If the patient is still breathing or is able to be
resuscitated they are a candidate for this countermeasure.
Tactical Police Operations Support
Similar to the gap in patient care previously identified in CBRN events, a similar vulnerability exists in
police tactical events. Without the specialized training, equipment and tactical protective equipment
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the paramedics assigned to these events are held considerable distance from the event and are limited
to the timeliness access and type of patient interventions. In recent years, tactical paramedic programs
have been established in support of local police organizations. Tactical Emergency Medical Support
(TEMS) teams operating within the inner perimeters of police operations have been able to improve the
likelihood of survival for critically wounded or ill patients through timely medical support and pre-hospital
care.
Coroner’s Inquests such as the one for the Ottawa Carlton Transpo incident, that resulted in severe
personal injury and death; recommended the establishment of a TEMS Unit to more appropriately
manage patient and responder needs in these situations. The Ontario Provincial Police has TEMS
paramedics deployed with their specialty teams but they do not offer 24-hour county-wide service and
typically only provides coverage in areas not serviced by the municipal police services throughout the
county. The OPP TEMS team is a provincial team and therefore are only available within the county
when not deployed elsewhere in the province. There are municipal Tactical Paramedics supporting
police services in Toronto, York, Peel, Halton, Ottawa, and Hastings Quinte.
Local Perspective
With City of Barrie Police providing tactical services to a significant percentage of the county population
in Barrie, Midland, CFB Borden and South Simcoe, the opportunity to provide support from the County
of Simcoe Paramedic Services was added to the IRU capabilities. Normally, paramedics assigned to
Tactical responses have been staged some distance away from the scene limiting the rapid intervention
required in the potential life saving interventions. Tactical training and equipment provides the ability for
paramedics to be closer to the incidents and have a more immediate response to injuries faced by the
responders and citizens. These paramedics are provided with specialized training, equipment and
techniques related to injuries from weapons, tactical weapons, explosive devices and other hazards
such a booby traps. The tactical IRU members also trained in CBRNE provides a broad based hazard
support since, as in the local July 2012 Virgilwood Crescent incident, sites can contain chemical as well
as explosive hazards.
A small number of IRU Paramedics are currently undergoing Tactical Emergency Medical Support
training with the Barrie Police and the Base Hospital. Although the IRU Paramedics will accompany the
police tactical team on operations, they will be protected and behind the entry team. Barrie Police has
supplied the tactical training and the indicated personal protective equipment.
Memorandum of Understanding (MOU)
With the establishment of the relationship with the Barrie Police Department, there is a desire to outline
the nature of the initiative as the parties undertake training and prepare the program. A draft
Memorandum of Understanding (MOU) is attached as Schedule One (1) of this item. The MOU
outlines the Objectives and Scope, Operations, Responsibilities, and Training. It is important to note
that the MOU is not meant to be contractual in nature and clearly demonstrates the limitations of the
County of Simcoe Paramedic Services and does not guarantee the availability of IRU Paramedics to
respond to the incidents or take part in the training exercises.
Deployment of IRU Paramedics
IRU Paramedics perform regular duties when not assigned to technical calls and do not represent
additional staffing. They are included in the daily compliment available to respond to any patient call as
required.
All County of Simcoe Paramedics are routinely deployed to all CBRN and police tactical incidents in the
County of Simcoe. When IRU Paramedics are available to respond, they are deemed as the preferred
paramedic resource for these calls. The Strategic Deployment plan provides for these paramedics to be
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re-tasked from normal duties to these technical incidents, relieving the first assigned paramedic
resources to be used in normal operations.
When fully staffed, there are only 16 IRU paramedics available for deployment in the County of Simcoe.
In normal circumstances this means that a maximum of 4 will be available on any given shift assuming
there are no IRU Paramedic vacancies or absences. With this small number of IRU Paramedics there
can be no guarantees that an IRU Paramedic will be able to respond to any particular event. Allied
agencies are aware of this reality
Financial and Resource Implications:
Training requirements associated with the IRU team was included within the department training budget
following Council’s approval in 2008 and is maintained as part of the ongoing Paramedic Services
operational requirements. Additional start-up training costs associated with the expanded role in
supporting police during tactical situations in the 2014 budget included $17,000 for staff training
hours and $12,000 for the training program. There are no additional budgetary costs for the
maintenance of these additional medical skills as they will be included within the regular IRU training
hours in subsequent years.
The medical equipment carried by the IRU team medics include a selection of normal patient care items
in addition to additional pieces such as Intraosseous infusion kits, tactical tourniquets, and
Tracheotomy sets estimated at approximately $12,000 for start up.
The Barrie Police Service provides all equipment and training associated with safety and security
aspects involved in a tactical situation valued at approximately $30,700.
A settlement avoiding arbitration was reached this month regarding a number of policy grievances
submitted in 2008 relating to the article of technological change and the training and risk associated
with the IRU. The mediated settlement provides for an annual stipend of 1.75 percent payment of base
wage rate for IRU members starting in 2014. This amounts to approximately $1,500 annually.
Retroactive payment of $200 per year was agreed for active members back to 2008.
Relationship to Corporate Strategies:
Strengthen Social, Health and Educational Opportunities:
“Establish partnerships to identify opportunities for strengthening human services and education to
support improved health and well-being for our residents”.
Growth Related Service Delivery
“Create and strengthen partnerships with key stakeholders to support communities through the delivery
of sustainable services”.
A Culture of Workplace and Operational Excellence
“Create and maintain a healthy work environment that:

Provides services to residents in a fiscally sustainable and responsible manner
Reference Documents:
No reference documents.
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Attachments:
Schedule 1 – Memorandum of Understanding
Schedule 1 - IRU BPS
TEMS MOU.pdf
Prepared By: Andrew Robert, Director and Chief, Paramedic Services
Approvals:
Date
Jane Sinclair, General Manager, Health & Emergency Services
Trevor Wilcox, General Manager, Corporate Performance
Mark Aitken, Chief Administrative Officer
May 16, 2014
May 20, 2014
May 20, 2014
SRT - Rev 2 – August 2013