Fire Service
Roles and Responsibilities
York/Durham Region Base Hospital Program, May 1, 2007 – Section Three
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OVERVIEW
The Base Hospitals and their Medical Directors feel that it is essential for
firefighters in the field to display good judgment in adjusting to the uniqueness of
various events. You have been provided with written medical direction/oversight,
resuscitation guidelines, and a roles and responsibilities document. It is up to
you (the firefighter) to apply these in the field using common sense, while
ensuring public safety and best care for the patient. The Base Hospital Medical
Director expects all pre-hospital care providers (including firefighters) to inform
the Base Hospital of any unique events that do not follow the written medical
directives/oversight, and resuscitation guidelines. An example of this is a patient
removed from frigid ice water into an aluminum boat and safe use of the SAED
cannot be done as directed. The Base Hospital would expect a detailed MAR
explaining the incident and the rational for your treatment plan.
Medical Assist Report (MAR)
The Base Hospital Medical Director expects a firefighter to complete a MAR in
the following circumstances:
•
In all situations where fire service arrives before EMS and provides
patient care. Examples of this would be:
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•
oxygen administration
application of dressing to control bleeding
All cardiac arrests, whether fire is first or second on the scene. This
includes all obviously dead patients as well. This enables us to track
and provide quality assurance and continuous quality improvement for:
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save percentages
number of rescuers managing the cardiac arrest
types of cardiac arrest causes
ages of cardiac arrest
seasonal causes
effectiveness treatment plans
improve future response by learning better ways to treat unique
situations
All MARs must be forwarded to the Base Hospital for review within 14 days of the
event. This includes attaching the SAED EKG data after a cardiac arrest. This
data must be in a hard (printed) copy.
It is imperative that cardiac arrest patients who are revived in the field with a
Return Of Spontaneous Circulation (ROSC), have their MAR and EKG
immediately faxed to the hospital that receives the patient. A list of the
York/Durham Region Base Hospital Program, May 1, 2007 – Section Three
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community hospitals that are in, or surround, both the York and Durham Region
are provided as follows:
Hospital
Ajax /Pickering, Rouge Valley
Phone Number
905-683-2320
Ext. 1210
Bowmanville, Lakeridge Health 905-623-3331
Ext. 1381
Cobourg, Northumberland Hills 905-372-6811
Ext. 4411
Etobicoke General
416-747-3364
Hospital for Sick Children, 416-813-5807
Toronto
Markham Stouffville Hospital, 905-472-7111
Markham
North York – Branson Site
416-635-2552
North York General Hospital
416-756-6001
Oshawa, Lakeridge Health
905-576-8711
Ext. 3755
Peterborough Civic
705-876-5060
Port Perry, Lakeridge Health
905-985-7321
Ext. 4953
Ross Memorial, Lindsay
705-328-6143
Royal Victoria Hospital, Barrie 705-728-9802
Ext. 4121
Scarborough Centenary
416-281-7270 if busy call
416-281-7404
Scarborough General
416-431-8181
Scarborough Grace Hospital
416-495-2400
Ext.
2550
Soldier’s Memorial, Orillia
705-327-9108
Southlake Regional Hospital, 905-895-4521
Ext. 6911
Newmarket
Sunnybrook Health Sciences 416-480-6100
Centre
Ext. 7207
Uxbridge Cottage Hospital
905-852-9771
Ext. 5261
York Central, Richmond Hill
905-883-1212
York-Finch (Humber River)
416-747-3857
York/Durham Region Base Hospital Program, May 1, 2007 – Section Three
Fax Number
905-428-8277
905-697-4688
905-372-9014
416-747-3324
416-813-7038
905-472-7026
416-635-2418
416-756-6793
905-721-4749
705-876-5075
905-985-5826
705-328-6164
705-728-5922
416-281-7455
416-431-8210
416-495-2551
705-325-4925
905-853-2206
416-480-6846
905-852-2462
905-883-2138
416-747-3787
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Provider and Instructors
It is expected that the provider and instructors certified by the Base Hospital
Medical Director will perform to the level of their knowledge and skill. The
provider must understand that, if they perform outside the expected level of care,
they are doing so without authorization or direction from the Base Hospital and its
Medical Director. An example of practicing outside your scope of direction would
be the administering any medication to a patient. This would include:
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•
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Aspirin (ASA)
Nitroglycerin (spray, tablets, paste)
Adrenalin (epinephrine)
Glucagon
Ventolin
Provider and Instructor Certification
The educational requirements of the program in which your fire service is
involved is outlined in the collaborative statement between the Base Hospital and
the individual fire service. This includes specific oversight for the various
programs in relation to pre-hospital care. All providers and instructors will have
an initial training program. Prerequisites for entrance into a program will be
assessed on an individual basis, and the fire service and Base Hospital will come
to a mutual agreement as how to best achieve the objective of the specific
program.
All providers and instructors will be expected to review their Base Hospital
education (specifically CPR/AED) every quarter of the year as outlined by the
base hospital This will be directed by the Base Hospital and will involve topics
which impact the effectiveness of resuscitation in the community. It is the
responsibility of the provider and instructor to review these topics as directed to
ensure best practice.
Initial certification of a provider and/or instructor will depend on the specific needs
of the fire service. For example, an EMR provider program is 120-hours in
length. The EMR instructor process includes successful completion of the EMR
program, selection by the fire service for instructor status, and then, an additional
40-hour instructor program. On the other hand, fire services performing only a
Resuscitation (CPR/AED) program will require 16-hour provider program. Upon
completion of the provider program, the instructor candidate is chosen by their
fire service and then must take a 16-hour Base Hospital instruction program.
Provider and Instructor Re-Certification
All providers and instructors will need to re-certify yearly with the Base Hospital
to maintain certification. The re-certification process will be directed by the Base
Hospital through a mutually accepted method approved by the individual fire
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service. Depending on the type of provider and instructor required by the fire
service, the amount of continuing education will vary. For example, an EMR
service provider and instructor will require 16 hours to maintain their credentials
with the Base Hospital. On the other hand, a fire service performing resuscitation
(CPR/AED) only will require 8 hours per year to maintain their providers and
instructors.
Cross Certification
Cross Certification of providers and instructors will be done on an individual
basis. Each situation is unique and the Base Hospital feels that a templated
answer could leave both the Base Hospital and the fire service in jeopardy.
Instead, the Base Hospital will review each request by the fire service and come
up with a mutually accepted process to facilitate the needs of the provider and/or
instructor Cross Certification. This will ensure the best practice for public safety.
Pre-Hospital Equipment
It is the sole responsibility of the fire service to purchase, maintain and keep in a
state of readiness resuscitation and first aid equipment. This should include (at a
minimum):
• Semi-Automated External Defibrillator (SAED)
• Bag-Valve-Mask (BVM) adult and child
• Suction Device
• Oral airways (all sizes)
• Oxygen Tank
• Non Rebreather Masks for adults and children
• Pressure dressings (large and small)
• Triangular bandages
• Kling
The fire service must have a bio-medical agreement for servicing of their SAED.
This can be provided by Lakeridge Health Corporation and will be noted in the
collaborative statement between the Base Hospital and the fire service. The fire
service will need to create and use a detailed check sheet of their pre-hospital
equipment. This should be completed as directed by the fire service. The Base
Hospital recommends that SAEDs be checked following the SAED
manufacturer’s direction. If the SAED uses rechargeable batteries, then a
cycling program needs to be established. For example, the battery in the SAED
is cycled to the charger. The one from the charger becomes the spare battery
carried with the SAED. The spare battery is then placed in the SAED and
checked to ensure the SAED is operational. If the fire service is using nonrechargeable batteries, then the status light, signaling the SAED is ready, needs
to be checked regularly. It is recommended that full time departments check
their SAED at the beginning of each shift. Part time departments can check the
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status light once per week. Always ensure that there are two non-rechargeable
batteries with each SAED (one installed and one spare).
Emergency Patient Care Tasks
Firefighter/Provider
In a tiered response system, firefighters are charged with the role of providing
primary Basic Life Support (BLS) care to the sick and injured. At scenes where
the fire service arrives first, care must be rendered according to established
treatment plans. At scenes where EMS is present, the fire service will assist the
paramedics with patient care. The responsibilities of the firefighter/provider are:
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Scene control and safety
BLS airway management
Respiratory support (ventilation and oxygenation)
Cardiac compressions
Control of severe bleeding
Support of spinal injury
SAED
Firefighter/Instructor
In addition to the roles of the firefighter, the instructor will also serve as a
facilitator for his department. The instructor will deliver current and new training
programs to their department. The instructor will also be a resource, serving to
answer questions, solve problems and act as a liaison with the Base Hospital.
The responsibilities of the firefighter/instructor are:
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•
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Delivery of CPR/SAED certification and re-certification programs for
Health Care Providers
Delivery of other patient care programs sanctioned by the Base
Hospital (i.e. First Responder/EMR)
Serve as a resource
Paramedic
The paramedic is the ‘on scene’ medical authority. In this role, they will be held
responsible for medical decisions related to patient care.
The Primary Care Paramedic (PCP) is responsible for:
• CPR/SAED
• Symptom Relief
• BLS Patient Care Standards (Ministry Of Health standard of care)
York/Durham Region Base Hospital Program, May 1, 2007 – Section Three
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The Advanced Care Paramedic (ACP) is responsible for:
• CPR/Manual Defibrillation
• Advanced airway control
• ACLS medications and directives
• BLS/Advanced Life Support (ALS) Patient Care Standards (Ministry
Of Health standard of care)
The Base Hospital
The Base Hospital provides medical control and support for all programs
encompassing patient care issues.
The responsibilities of the Base Hospital are:
• Certification and re-certification of CPR/SAED programs
• Provide training and certification of CPR/SAED instructors
• Facilitate instructional and resource material for CPR/SAED, First
Response, EMR, PCP, and ACP programs
The Base Hospital Physician
The Base Hospital physician provides the medical control of any delegatable
medical acts and ensures BLS/ALS guidelines. It is the physician’s license under
which the SAED program operates and provides oversight for fire service
programs. All providers (firefighters and paramedics) cannot permit another
rescuer to perform outside the scope of practice deemed by the Base Hospital
physician.
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