F - delta.civicweb.net A Review of Delta... · Nenno, Delta Fire and Emergency Services Administrative Assistant • ATTACHMENT: A. A Review of the Emergency Medical Responder Program

To: Mayor and Council

The Corporation of Delta COUNCIL REPORT

Regular Meeting

From: Delta Fire & Emergency Services Department

Date: April 13, 2017

A Review of Delta's Emergency Medical Responder Program

The following report has been reviewed and endorsed by the Chief Administrative Officer.

• RECOMMENDATION:

THAT a copy of this report be provided to the Honourable Terry Lake, Minister of Health, Scott Hamilton, MLA Delta - North, and Vicki Huntington, MLA Delta -South.

• PURPOSE:

The purpose of this report is to provide a summary of the findings from a third-party review of Delta's Emergency Medical Responder Program.

• BACKGROUND:

On June 15, 2016, Delta Fire & Emergency Services completed its first year of providing enhanced pre-hospital care to Delta residents. As a result, a sufficient amount of corresponding data was also available to undertake a comprehensive review of Delta's Emergency Medical Responder Program. Delta commissioned Dr. Martha Dow to complete a third party review of Delta's Emergency Medical Responder Program to provide feedback on the outcomes of the program. Dr. Dow is a researcher and consultant working in the areas of public safety, education, and organizational change. She is also an Associate Professor in the Department of Social, Cultural and Media Studies at the University of the Fraser Valley. Findings and con'clusions from Dr. Dow's report will be used to support decision-making relative to the Emergency Medical Responder Program over the next few years.

Delta's Emergency Medical Responder Program was established in response to BC Emergency Health Services' implementation of changes to the BC Ambulance Services' Resource Allocation Plan which resulted in a significant number of codes being downgraded to Code 2 (routine) calls instead of their previous designation as Code 3 (lights and sirens). Following these changes, Mayor Lois E. Jackson, Delta Council and Chief Administrative Officer George V. Harvie saw a need to improve pre-hospital

F.06

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A Review of the Emergency Medical Responder Program April 13, 2017

medical care delivery for the municipality. Delta's Emergency Medical Responder Program would not have been possible without their unwavering support and collective determination to break through a number of difficult barriers, including meetings with provincial ministers and MLAs, and unsuccessful negotiations with British Columbia's Emergency Health Services and the Provincial Health Services Authority. This program would not be here today without their leadership efforts and Delta residents are better served because of it.

• DISCUSSION:

Dr. Dow's report, "Delta Fire & Emergency Services: A Review of the Emergency Medical Responder Program" (Attachment A) reviews the first 15 months of the Emergency Medical Response Program in Delta (June 2015 - September 2016). Report findings are based on a review of extensive documentation (e.g., legal opinions, memos, press releases, council reports) and data collection including emergency incident data, census statistics and discussions with key stakeholders.

Lessons Learned: The report provides a number of Emergency Medical Responder Program lessons learned from over the last 15 months. This framing of best practices is summarized below:

1. Implementation - cooperation between the union executive and senior management was needed to ensure commitment to the program. It was also essential to have a temporary training position to develop a training plan, coordinate examination schedules and acquire equipment and supplies.

2. Licensing - after holding initial practical evaluations to certify Emergency First Responders off-site, it was determined that having Emergency Medical Assistant Licensing representatives come to Delta allowed for more efficient processing of members through the licensing process. It was also important to implement a data management system to satisfy licensing requirements and track the completion of required educational credits.

3. Emergency Medical Responder Curriculum - Delta built its own Emergency Medical Responder curriculum based on Red Cross material. It specifically targeted the licensing requirements. This made-for-Delta model created an environment where responders were more open to adopting the program.

4. Accountability - monthly statistic reports are provided to Carl Roy, President and CEO, Provincial Health Services Authority who in turn sends them to Dr. William Dick, Vice President, Medical Programs BCEHS to ensure full disclosure (e.g., patient care information, response types and times, and treatment protocols administered). Dr. Dick reviews Delta Patient Care Report Forms and monitors the patient care that is occurring and says that he does not have any concerns. When there is an issue, Dr. Dick says that there has been no problem calling Delta Fire & Emergency Services to discuss the concern and asking for changes. In addition, the program is also overseen by Delta Fire & Emergency

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Services' medical oversight physician Dr. Allan Holmes who ensures that Delta's Emergency Medical Responders remain up to date with current protocols. Dr. Holmes also assists with ensuring operational usage guidelines are relevant for items such as Epipens and Naloxone.

5. Continual Improvement - Patient Care Reports filed by Delta's firefighters are reviewed and used to provide individual feedback and provide training and refresher curricular opportunities. Delta Fire and Emergency Services' independent contracted physician also provides medical oversight and recommendations to improve the program.

Emergency Medical Responder Program Outcomes: Dr. Dow acknowledges that the daily flow of people using the highway network to commute into or through the municipality during the day, coupled with a large geographic response area and an aging demographic necessitates the collective rethinking of municipal and provincial responses to pre-hospital health care in Delta. The Dow report suggests that Emergency Medical Responder Program provides a lowcost initiative aimed at supporting this collective response and that Delta's Emergency Medical Responders represent an integral part of the pre-hospital emergency health care matrix. The Dow report notes a number of positive program outcomes, including: .

Enhanced Skill Set

Through emergency medical responder level training, Delta's firefighters now have enhanced abilities to assess, triage and treat patients with a wider array of options, including the ability to:

• Perform chest auscultation • Provide IV maintenance • Establish nasopharyngeal airway • Provide enhanced traction and splinting • Take blood pressure • Assist in childbirth • Perform pulse oximetry • Use a common Patient Care Form • Use glucometer to measure glucose • Administer Nitroglycerin and ASA • Deliver Entonox

. When Delta's firefighters are able to use these emergency medical responder skills to respond to non-emergency related calls, it allows BC Ambulance Service to divert paramedics to more urgent call types.

Delta firefighters have also been able to utilize these skills when extricating a patient from a situation that is not accessible to BC Ambulance Service (e.g., a motor vehicle accident). This allows for a faster medical response resulting in quicker treatment for the patient.

Improved Service Delivery

The Emergency Medical Responder Program has provided patients with an enhanced response. During the period of June 15, 2015 and September 12,2016, Delta Fire and Emergency Services responded to 8540 incidents - 3119 incidents of which were medical calls (e.g., breathing problems, feelings of sickness, falls onto ground,

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unconscious/fainting, etc.). During these medical calls, Delta's firefighters used their emergency medical responder skills 75% of the time. It should also be noted that there have been no formal complaints and no Emergency Medical Assistants Licensing Board investigations associated with any of these incidents.

Between this same reporting period, Delta Fire and Emergency Services responded to calls within an average of 5 minutes. They waited on average for an additional 10 minutes and 49 seconds for Be Ambulance Service to arrive on scene. The ability to respond quickly means that Delta Fire and Emergency Services is able to expedite the triage, treatment procedure and provide updates prior to the arrival of Be Ambulance Service and in some cases where the patient self-releases, Be Ambulance Services can divert to a higher acuity call.

Supports Delta's Emergency Plan

The Dow report found that the Emergency Medical Responder Program plays an integral role in the corporate Municipal Emergency Plan. Delta's geography and ,its reliance on transportation and utility infrastructure make it susceptible to isolation in the event of a disaster (e.g., earthquake). Delta's Emergency Management Office is well served to have Delta firefighters with enhanced assessment, triage and treatment capabilities. This will be beneficial during the response phase of a mass casualty event where the municipality may need to be self-sufficient.

Positive Public Feedback

To reinforce Dr. Dow's findings, Delta has also received positive feedback from the public regarding response times and patient care. This service enhancement has been of particular benefit to Delta seniors - especially as their demographic continues to increase year over year. Delta's Emergency Medical Responder system will always be viewed as adding value to the system of emergency support. It is not intended to devalue the critical role that Be Ambulance Service plays in this municipality.

Moving Forward with Next Steps:

Dr. Dow offers a number of next steps as the Emergency Medical Responder Program advances into its second year. These next steps are reflected in the following table:

Areas Potential Next Steps

• Develop and administer an instrument to assess patient experience and

Patient satisfaction with the EMR service delivery

Experience • Develop and administer a pain scale instrument to assess patient comfort prior to and after the administration of Entonox.

• Explore on-scene experiences of Delta firefighters in regard to utilization

Delta's of EMR interventions in instances differentiated by wait times less than and more than 10 minutes

Firefighters • Assess effects of EMR training on increased confidence and scene

assessment skills in relation to circumstances not requiring EMR skills

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• Assess the perceptions of Delta firefighters with respect to preparation, training, and comfort in utilizing EMR skills in the field

Delta's • Examine usage data related to EMR skills by Delta Fire and Emergency Firefighters Services to determine if these patterns are congruent with incident

characteristics or if they might be related to other considerations such as programmatic and/or participant factors

• Work with BC Emergency Health Services to assess the effectiveness of EMR skill utilization with a view to developing best practices

• Explore mechanism to improve inter-agency communication Inter-agency Cooperation • Encourage, in collaboration with pre-hospital care partners, ongoing

review of governing legislation and regulations to ensure that in the rapidly developing field of pre-hospital health care, the scope of practice dictated by those legal and regulatory parameters is congruent

Given the complex interplay of stakeholders and organizations involved collaboration, transparency and evidence-based decision-making has and will continue to be used to move forward with this value added program.

Implications: There are no financial implications.

• CONCLUSION:

A third party review of Delta's Emergency Medical Responder Program was commissioned to review the first 15 months of Delta's Emergency Medical Responder Program. Dow's report presents the lessons learned during program implementation, outlines a number of positive outcomes, and offers a list of next steps. These report findings will support senior management decision-making as Delta advances its Emergency Medical Responder Program over the next two years.

Delta's Emergency Medical Responder Program has demonstrated that Delta Fire & Emergency Services is committed to being a progressive, responsive change agent and partner in the provision of emergency pre hospital care services in the province.

Dan Copeland Fire Chief

Department submission prepared by: Paula Kolisnek, Senior Corporate Policy Analyst, and Christine Nenno, Delta Fire and Emergency Services Administrative Assistant

• ATTACHMENT:

A. A Review of the Emergency Medical Responder Program - Martha Dow PhD, University of the Fraser Valley Centre for Social Research

Attachment A

UNIVE~~dI OFTHE FRASER VALLEY

CENTRE FOR SOCIAL RESEARCH

Executive Summary

Attachment A Page 2 of26

Delta Fire and Emergency Services' Emergency Medical Responder (EMR) program was implemented after extensive 'stakeholder consultation and in response to Delta Council's commitment to responsive pre-hospital care for the citizens it serves. Additionally, the EMR program is viewed as a critical component of a comprehensive and integrated emergency preparedness plan. The EMR program was implemented in June 2015 and this report outlines the experiences to date. Overall, the EMR program in Delta has enhanced the skills and knowledge of Fire First Responders in a manner that supports patient care and is a proactive and evidenced-based approach to improving pre-hospital care capabilities.

Introduction

On June 15, 2015, Delta Fire and Emergency Services (DFES) transitioned from a First Responder level to an Emergency Medical Responder (EMR) level of certification. To date, 130 (79%) firefighters with DFES have been trained to EMR level. The EMR license enhances the Emergency Medical Assistant (EMA) skillset by providing First Responders with:

• Increased foundational knowledge in human anatomy, physiology, pathophysiology and ph~rmacology; and,

• Enhanced patient assessment skills.

And, the ability to:

• Perform chest auscultation;

• Establish nasopharyngeal airway; • Take blood pressure and perform pulse oximetry;

• Utilize a glucometer to measure and treat low blood glucose levels;

• Deliver Entonox for pain management;

• Administer select drugs induding Nitroglycerin and ASA;

• Provide IV maintenance;

• Provide enhanced traction and splinting;

• Assist in childbirth; and,

• Use a common Patient Care Report form.

A key benefit of upgrading Fire First Responders to EMR level certification is their enhanced ability to assess patient needs and communicate effectively with other pre-hospital care

personnel in a manner that supports patient care.

The purpose of this report is to review the first 15 months of the EMR program to provide

Attachment A Page 3 of 26

information to senior management to support decision-making as the City moves forward with the program. Extensive documentation associated with the program was reviewed, incident data since inception was examined, and discussions with key stakeholders were held.

Context

On May 25, 2015, after extensive discussion and ultimately unsuccessful negotiations with British Columbia's Emergency Health Services (BCEHS), undertaken since the fall of 2013, Delta Council enacted the "Delta Fire Regulation Bylaw No. 5855, 2001 Amendment (Ancillary Health Services) Bylaw No. 7426, 2015". The new bylaw outlines that

(1.2) 'Ancillary Health Services' means the provision of health care to an injured or sick person that supports, supplements or complements, or that is related or ancillary to, one or both of the following: i) 'Ambulance Services', or ii) Emergency Health Services', including, but not limited to, 'EMA FR Services' and 'EMR Services', until Ambulance Services, Emergency Services, or services provided by, from, in or through a Facility are willing and available to provide health care to that person.

Delta received independent legal counsel confirming the municipality's legal authority to provide EMR services through the bylaw amendment. In June 2015, Delta's Fire and Emergency Services implemented its EMR protocol.

In response, BCEHS sent its Metro Operations Staff a memorandum dated June 11, 2015 noting that "Delta [had] taken these actions unilaterally BCEHS does not support these initiatives and has serious concerns about their implementation". There has been some debate regarding the appropriateness of Delta's decision with questions raised regarding need, authority, legality, oversight, downloading, and the lack of system -wide response. The balance of this report reviews the rationale, implementation, lessons learned and next steps.

Why Emergency Medical Responder Certification?

Municipal Vision


The Corporation of Delta has asserted that the EMR program aligns with the DFES's vision of being "[a] dynamic fire service, always responsive to community needs, delivered by well trained personnel with broad roles and skills". Additionally, DFES's corevalues1 are often cited in support of this initiative as they relate to innovation, continuous improvement and timely and effective response.

Demographic Changes

Delta's population grew from 96,635 in 2006 to 99,863 in 20.11 representing 3.3% growth compared to 5.9% growth nationwide.2 While Delta's historic and projected population growth is slightly below the national average, a more meaningful representation of the population served by Delta Fire and Emergency Services must take into account the flow of people into and out of the municipality due to the industrial complexes, ferries, and shopping malls located within its boundaries.

These residential and daily population ~stimates in conjunction with an aging community, necessitate the collective rethinking of municipal and provincial responses to pre-hospital health care. Figure 1 illustrates the upward trend of both of these factors with the projected population growth resulting in a provincial population of 4,988,900 and a median age at death of 80.8 in 2020.3 The aging population presents significant cha~lenges for any system of pre-hospital care and necessitates high levels of interoperability. Adding to these unprecedented demographic stressors on the system are emerging health issues such as fentanyl overdoses that further strain the various components of emergency health services in Delta and the province at large.

1 Core Values: Quick response with compassion and professionalism; Public safety and community self-reliance; Positive, supportive, and safe work environment; Courage to innovate; Continuous improvement of community services; Quality leadership with vision, honesty, integrity, and open communication. 2 Focus on Geography Series, 2011 Census. https://www12.statcan.gc.ca/census-recensement/2011/as-sa/fogsspg/Facts-csd-eng.cfm?LANG=Eng&GK=CSD&GC=S91S011

. 3 http://www.bcstats.gov.bc.ca/StatisticsBySu bject/Demography /Population Projections.aspx

" ,

Figure 1: Be Population and Aging Population Projections (2000 to 2020)


It is in response to these realities that initiatives such as Delta's EMR program, Surrey Fire Service's and Vancouver Fire and Rescue Services' leading efforts with respect to Naloxone administration, and BCEHS's attention to demand modelling are critical elements of a progressive and responsive emergency services system.

Geography

By virtue of its geography and associated land use, Delta is especially vulnerable in large scale and complex emergency situations. Delta is located on 180.11 square kilometres4 of mixed urban, agricultural and industrial land use. While the population of Delta is 101,5465

resulting in comparatively high per capita fire expenditure assessments, analysis based on municipal sprawl and land use paints a different picture in regard to the reasonableness of these costs. The geographic spread across the three residential areas of Ladner, North Delta and Tsawwassen coupled with some of the specific features of the area including Burns Bog, significant agricultural areas, the Tilbury and Annacis Island industrial parks, Deltaport, Roberts Bank, and Boundary Bay Airport, provide important challenges to fire and emergency services responsiveness.

4 Statistics Canada, Focus on Geography Series, 2011 https://www12.statcan.gc.ca/census-recensement/2011/assa/fogs-spg/Facts-csd-eng.cfm?LANG=Eng&GK=CSD&GC=5915011 5 2015 Esti mate, http://www.bcstats .gov.bc.ca/Statisti csBySubject/Demograp hy /Popu lation Estimates.aspx

I I i

Service Demand


The population trends, including both permanent residents and non-permanent visitors and traffic, discussed above will continue to stress the health care system and necessitate innovative and collaborative approaches to providing care to the citizens of Delta. Prehospital events are particularly susceptible to these pressures as the proportion of seniors, a Significant user group, continues to grow. Importantly, pre-hospital incidents have been steadily increasing over the last decade and are projected to outpace population growth at an increasing rate (Figure 2). The strategic placement and staffing of fire halls coupled with the tactical review of utilization rates highlights the integral role that highly trained Fire First Responders play in the pre-hospital system of care in Delta.

Figure 2: Be Population Projections and Pre-Hospital Events (2000 to 2020)

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These projections with respect to pre-hospital events highlight the critical need, noted by all emergency services agencies, to focus on innovation, collaboration and evidence-based

decision-making.


In terms of the more specific demands for service of Delta Fire and Emergency Services, Figure 3 highlights the magnitude and increasing trajectory of the workload associated with MVIs and medical calls which are integrally connected to ar.guments for enhancing the skill levels of Fire First Responders.

Figure 3: Frequency and Type ofIncident - 2013 to 20156

Costs 0/ Skill Enhancement

The costs associated with this initiative are seen as minimal by DFES' senior management team given the anticipated benefits of the program (including potential financial savings to the system through improved patient outcomes, improved morale of Fire First Responders, and improved patient perceptions of care). The cost was approximately $180,000 allocated over three years (2014-2016) and was distributed in the following manner:

• licensing fees for 120 personnel ($60,000);

• backfilling for instructors and training and testing of members ($90,000);

6 Delta Fire & Emergency Services (2015) . 2015 Community Update Report.

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• equipment and training material costs ($20,000);

• medical oversight ($8,000); and,

• instructor training ($2,000).


Additionally, DFES has been allocated $25,000 per year to enable EMR maintenance, medical oversight, and equipment replacement.

Emergency Preparedness

Delta's location in terms of earthquake, flood and industrial accident risk has been a longstanding motivator for strategic approaches to emergency preparedness and interagency cooperation and innovation. Key considerations in this regard include, but are not limited to:

• daytime population growth;

• highway networks including the George Massey Tunnel and Alex Fraser Bridge;

• vehicular traffic;

• port traffic; and,

• rail traffic.

These and other particularities of the social, environmental, and geographic landscape elevate Delta's risk regarding a wide array of possible mass casualty incidents and support the argument that the municipality would be well served by the enhanced assessment, triage, and treatment capabilities associated with EMR trained responders.

One of the key arguments for licensing Fire First Responders to the EMR level is the benefit to the community of these types of skillset enhancements in the case of a major disaster that has the potential to isolate the community.

All Hazards Approach to Emergency Response, Scene Safety, Personal Protective

Clothing and Equipment

Calls for emergency services, by their definition, are often characterized by caller duress or anxiety and almost always necessitate descriptions of a complex set of factors by an untrained and often emotionally invested observer.

These realities and the unique training of firefighters, including but not limited to, Hazmat training, Technical Rescue training, Auto-Extrication training, and Wildland training situate


them as key first responders. It is reasonable to argue that the expansion of Fire First Responder skillsets is responsive to situations where patient access is limited and in some cases restricted to firefighters.

There are a number of events when firefighters are required to extricate a victim from a situation that is inaccessible to paramedics and/or requires the specialized rescue skills of a Fire First Responder. For example, the case of an accident victim that is pinned in an automobile with an unknown substance leaking from the transport vehicle that struck the motorist presents difficult challenges to a non-fire first responder. In these instances, Fire First Responders are uniquely situated to respond to the immediate and intertwined issues of scene management and safety and patient care.

Most recently, this argument was demonstrated with the restrictions placed on 8.c. paramedics in attending to situations where patients are in ditches that exceed the 35 degree limit imposed by the new, interim policy invoked by BCEHS. In instances where paramedics access is restricted, fire rescue personnel have the technical rescue skills and, in Delta's case, the enhanced EMR skills to assist BCAS and most importantly increase the likelihood of a timely emergency services intervention.

Importantly, in these situations Delta's EMR trained firefighters have an expanded skillset to respond when BCAS is unable to be at patient side. For example, in the case of severe discomfort associated with a limb fracture, EMR's may administer Entonox prior to transporting the patient to a location that BCAS can access.

Service Delivery

A consistent theme evident in a review of the various memos, legal opinions, press releases and formal proposals related to the implementation of the EMR program is Delta's assertion that training Fire First Responders supports improved service delivery to the citizens of Delta. There are two significant aspects of this discussion of service delivery: time on scene waiting for BCAS and an expanded repertoire of skills.

Between June 15, 2015 and September 12, 2016, the average wait time for BCAS to arrive on scene was 10 minutes 49 seconds. It is not the focus of this report to assess the reasonableness of wait times given the current challenges facing all sectors of pre~hospital

health care. However, it is important to acknowledge that a key piece of the rationale behind Delta's initiative is that in a health care context where Fire First Responders are routinely waiting for BCAS to arrive beyond 10 minutes and often waiting substantial periods of time, there needs to be greater ability to respond to patient need.

Having said that, too often wait time discussions turn into an exchange characterized by silobased thinking and positions. Instead, the EMR program is clearly not a critique of BCAS, but

I i-


simply an effort to expand Delta's ability to respond to current and future pre-hospital situations and challenges.

There has been a great deal of attention paid to differentials in response times and while this is one piece of a very complex puzzle, there are a variety of factors that contribute to a more nuanced understanding of the value of these statistics . . Most importantly, it is a legitimate claim by BCAS that there are a Significant proportion of calls that do not require an urgent response and in many cases should not have warranted a 911 response in the first place. In the latter case it is argued that misuse is associated with a real and perceived absence of alternatives. In the former situation, while lower priority calls may not require an urgent response, there may still be important assessment, triage, and treatment options available to an EMR trained first responder.

These factors combined point to the potential of enhanced firefighter training and skill sets to provide better opportunities for firefighters to more accurately assess, triage, and treat patients and update BCAS once on scene and as the situation evolves. These benefits have the potential for broader service delivery implications as it provides greater capacity for diverting paramedics to more. urgent call types.

Implementation --- -- --~-- --- --- --- - -- --- - - -

The implementation of the EMR program in June 2015 necessitated a significant undertaking in regard to training and licensing. The purpose of this discussion is to examine these details with a view to lessons learned and a framing of best practices.

Management and Membership

Critical to any First Responder innovation is understanding the legislative and regulatory limitations and opportunities that ground pre-hospital care in British Columbia. In "fdentifying the opportunities and limitations provided by existing rules, regulations, and policies, fire-department leadership will be better equipped to drive decisions that are likely to improve community involvement in managing population health as a means of improving patient outcomes and patient quality of life and reducing per capita health care costs" (Breyer, 2015, p. 941).

Integral to the successful implementation of the program, was the cooperation between union executive and senior management in solidifying their joint commitment to this enhancement of skills. This synergy forged a path for Delta firefighters to adopt the EMR paradigm. It is clear from the documentation associated with the beginnings of this initiative


that the driving force that forged this cooperation and sustained it through implementation was improved service delivery and it was around that principle that all parties rallied.

Essential to the success of the proEram was the establishment of a temporary training position to support the implementation of the program. The individual occupying that position was responsible for developing a training plan and calendar for examinations and the purchasing of equipment and supplies associated with the implementation of EMR protocol.

Introduction of the Program

The timely implementation of the program was contingent on the Fire First Responder instructors responsible for other in-house professional development being agreeable to undertaking the EMR training necessary to be certified to train the rest of Delta's members . . These instructors were EMR certified through the Red Cross and licensed through EMA Licensing.

Curriculum Development

Delta Fire and Emergency Services ultimately developed a training curriculum that built on the Red Cross material in a manner that more specifically spoke to licensing requirements in regard to theory, drug administration techniques, treatment skills, and the associated textbased and visual teaching aids. This undertaking was an acknowledgement that change is sometimes difficult and provided a positive and supportive signal to the membership with respect to institutional support for the initiative and the infrastructure necessary to ensure success.

Licensing Considerations and Best Practices

After the initial practical evaluations were held offsite, it was recognized that having Emergency Medical Assistant Licensing (EMAL) representatives come to Delta allowed for more efficient processing of members through the licensing process. Maintaining an EMR license is relatively straightforward with the responsibility for maintenance resting solely with individual. Delta has implemented a data management system to accommodate the reporting requirements of EMAL and to track completion of required educational credits and patient contacts where necessary.

Delta found that by creating its own EMR curriculum that more specifically addressed licensing requirements and providing multiple and accessible test preparation strategies there was a greater openness to adopting the program. Despite these efforts, there were failures in both the medical and trauma scenarios and the continuous improvement model

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employed by DFES facilitated remedial evaluations when necessary and was an important and proactive strategy to promote successful completion of any and all requirements.

Accountability protocols have been developed by DFES which include monthly disclosure to the Vice Chair of the Provincial Health Services Authority (PHSA) of patient care information, response types and times, and treatment protocols administered.

Additionally, key elements of the program include independent physician oversight7 and thorough and continual assessment of Patient Care Reports completed by Delta firefighters. This information is incorporated into individual feedback to firefighters and generalized training and refresher curricular opportunities.

Experience to Date - - -- -~ - -

Data for the period from June 15, 2015 to September 12, 2016 was reviewed. Of the 8540 total incidents responded to by Delta Fire and Emergency Services, 3119 (37%) incidents were medical calls that resulted in the generation of a medical report and an entry in the FDM system. As represented in Appendix I, there was a wide range of presenting symptoms and/ or characteristics of those 3119 calls, resulting in a multitude of incident type codes being generated.

This range is important as first responders and paramedics report that incident classifications often change once first responders are on scene and able to better assess the situation. Upskilling to EMR provides Fire First Responders with additional assessment and triage skills to support the work of BCAS once they arrive on scene.

7 Dr. Allan Holmes of Iridia Medical is the current EMR external resource.

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Of the 3119 incidents where EMR skills were used between June 15, 2015 and September 12, 2016, there have been no formal complaints and no EMALB investigations. However, there have been a small number of incidents discussed with BCEHS in regard to best pracqces indicating that the oversight protocols are providing important formative opportunities.

The most common diagnostic procedure employed in conjunction with blood pressure and other EMR protocols is the pulse oximeter, used in 51 % of the cases in both critical and non critical situations, with some of the most contentious skills available relating to drug administration and airway management being utilized in a very small number of cases (Figure 4).

Figure 4: EMR-Specific Skill Utilization June 15, 2015 - September 12, 2015


In relation to non-EMR specific skills usage compared to EMR specific skill usage, 42% of skills practiced were non-EMR skills. In other words, these were skills that Fire First

Responders already had under their EMA certification (Figure 5).

Figure 5: EMR-Specific Skill Utilization versus All Skill Utilization June 15, 2015 - September 12, 2015


Importantly, the EMR skills are being utilized in a wide variety of situations prior to and after BCAS arrival on scene providing an indication of need in the former and inter-agency cooperation in the latter.

Conclusion

The Emergency Medical Responder program is a positive addition to the pre-hospital landscape in Delta, British Columbia. There are no indications that the implementation of EMR level certification of Delta firefighters has had any deleterious impact on patients or the system at large.

The EMR program is a low cost initiative that supports improved patient care:

• Fire First Responders represent an integral part of the pre-hospital emergency health care matrix and any response to a mass casualty event and EMR level training enhances their abilities to assess, triage, an<;l treat victims;

• EMR level training provides a wider array of options to support responsive patient care; and,

• Enhancing assessment and charting skills and increasing the options available to respond to patient need may reduce the likelihood that inappropriate interventions may be applied and enhance the communication with other responders on scene.

Moving Forward

The purpose of this report was to review the experiences to date associated with the implementation of the EMR program in Delta. To facilitate this review, extensive documentation and feedback from various stakeholders was examined.

Based on this review, some potential next steps as the program moves into its second and third years may include:

Patient Experience

• Develop and administer an instrument to assess patient experience and satisfaction with EMR service delivery;

~ .


• Develop and administer a Pain Scale instrument to assess patient comfort prior to and after the administration of Entonox;

First Responders

• Explore on-scene experiences of Delta First Responders in regard to utilization of EMR interventions in instances differentiated by wait times less than and more than 10 minutes;

• Assess effects of EMR training on increased confidence and scene assessment skills in relation to circumstances not requiring EMR skills. In other words, explore how firefighters' perceptions with respect to enhancing their professionalization through more advanced certification had a more expansive impact than simply on EMR situations;

• Assess the perceptions of Delta firefighters with respect to preparation, training, and comfort in utilizing EMR skills in the field;

• Examine usage data related to EMR skills by DFES to determine if these patterns are congruent with incident characteristics or if they might be related to other considerations such as programmatic and/or participant factors;

Inter-Agency Cooperation

• Work with BCEHS to assess the effectiveness of EMR skill utilization with a view to developing best practices;

• Explore mechanisms to improve inter-agency communication; and,

• Encourage, in collaboration with pre-hospital care partners, ongoing review of governing legislation and regulations to ensure that in the rapidly developing field or pre-hospital health care, the scope of practice dictated by those legal and regulatory parameters is congruent.

This report highlights the importance of collaboration, transparency and evidence-based decision-making in moving forward on pre-hospital care initiatives given the complex interplay of actors and organizations involved. The EM R program in Delta demonstrates that Delta Fire and Emergency Services is committed to being a progressive, responsive change agent and partner in the landscape of fire, rescue, emergency services in the province.

Resources

1. Articles


Breyer, T. 2015, tlAn Analysis of Rules, Regulations, and Policies to Identify Opportunities and Limitations for Fire=Based EMS Systems to Integrate into Healthcare Using a

Community Paramedic ModeL" International Fire Service Journal of Leadership &

Management, 941-948.

2. Agreements

First'Responder and BC Emergency Health Services Collaboration and Indemnity Agreement. BCEHS - The Corporation of Delta. 25 September 2014.

Amending Agreement to the First Responder and BC Emergency Health Services Collaboration Agreement. BCEHS - The Corporation of Delta. 25 September

2014.

3. Correspondence

Barter, Bronwyn. tiRe: President's Update." 12 June 2015.

3.1. Electronic

McKintuck, Guy. tiRe: License Documentation and Summary of EMAL EMR Scope of Practice." Received by Dan Copeland, 11 December 2014. E-mail.

Sieben, Nikki. tiRe: Quick Fact Sheet, Delta & B.C. Emergency Health Services Tentative Collaboration Agreement, re Delta Firefighters to Respond as Emergency Medical Responders." 29 September 2014. E-mail.

Watson, Doug. tiRe: E-Comm Update, Delta Fire Additional Medical Event Dispatches."

5 September 2014. E-mail.

3.2. Letter

Barter, Bronwyn. tiRe: Downloading of Ambulance Service in the Making." Received by Mike Ruttan, 14 September 2016. Letter.

Beach, Susan L., and Stewart McDannold. Received by Delta's Municipal Solicitor, 16 June 2015. Letter.

- - -. liRe: Emergency Health Services Act Opinion." Received by Delta's Municipal Solicitor, 26 March 2015. Letter.

- - -. liRe: Response to Letter Dated June 12, 2015 from BC Emergency Health Services." Received by Greg Vanstone, 14 July 2015.

Clark, Christy. liRe: Delta Firefighters Providing Enhanced Emergency Medical Care." Received by Lois E. Jackson, 29 September 2015. Letter.

Fisher, Les a.nd Jim Christenson. liRe: Prince George EMR Pilot Project." Received by All BCAS Staff, 19 May 2010. Letter.

Guscott, David. Received by Delta's CAO, 27 April 2015. Letter.

Harvie, George V. liRe: Delta Fire and Emergency Services Dispatch Data and Patient Care Forms." Received by Carl Roy, 23 July 2015. Letter.

- - -. liRe: Delta Fire and Emergency Services Dispatch Data and Patient Care Forms." Received by Carl Roy, 18 September 2015. Letter.

- - -. liRe: Delta Fire and Emergency Services Dispatch Data and Patient Care Forms." Received by Carl Roy, 19 October 2015. Letter.

- - -. liRe: Delta Fire and Emergency Services Dispatch Data and Patient Care Forms." Received by Carl Roy, 17 November 2015. Letter.

- - -. liRe: Delta Fire and Emergency Services Dispatch Data and Patient Care Forms." Received by Carl Roy, 15 December 2015. Letter.

- - -. liRe: Delta Fire and Emergency Services Dispatch Data and Patient Care Forms." Received by Carl Roy, 18 January 2016. Letter.

Jackson, Lois E. Received by All BC Mayors, 10 October 2014. Letter.

- - -. Received by Wynne Powell, 21 March 2014. Letter.

- - - . liRe: Ambulance Service in Tsawwassen." Received by George Abbott, 17 December 2008. Letter.

- - -. liRe: Delta Fire and Emergency Services - EMR Licensing and Practice." Received by Wynne Powell and Carl Roy, 13 July 20115. Letter.

- - -. liRe: E-Comm Offer of Assistance." Received by David Guscott, 5 February 2014. Letter.


- - -. (IRe: Firefighters as Emergency Medical Assistants." Received by Terry Lake, 8 October 2013. Letter.

- - -. (IRe: First Responder Partnership Agreement." Received by Wynne Powell, 22 January 2014. Letter.

- - -. liRe: Prince George EMR Level of Services." Received by Lyn Hall, 22 July 2015. Letter.

Jensen, Jodi. liRe: First Responders Agreements." Received by Dan Copeland, 3 November 2015. Letter.

Lake, Terry. liRe: Issues Discussed at UBCM." Received by Lois E. Jackson, 12 February 2014. Letter.

Meckling, Brent. liRe: Access Request Under the Freedom of Information and Protection of Privacy Act (FOIPPA)." Received by Freedom of Information Co-Ordinator, 21 July 2015. Letter.

- - -. liRe: Opinion dated March 26, 2015 and June 16,2015 from, Susan Beach regarding Emergency Health Services Act (the "Act")." Received by Delta's Chief Administrative Officer and Municipal Solicitor, 29 June 2015. Letter.

Powell, Wynne. liRe: Corporation of Delta & BCEHS Proposed Pilot Project and Collaborative Working Relationship." Received by Lois E. Jackson, 17 April 2014. Letter.

Roy, Carl. Received by Lois E. Jackson and Council, 12 June 2015.

- - -. Received by Lois E. Jackson and Council, 18 June 2015.

Valdivieso, S. (IRe: Second Response, Freedom of Information and Protection Privacy Act, File: PHSA 0061-15." Received by Brent Meckling, 20 January 2015. Letter.

3.3. Memo

Jensen, Jodi. Memo to Metro Operations Staff. 11 June 2015.

4. Releases

Delta Fire and Emergency Services. 2015.

Draft Delta. Delta and B.c. Emergency Health Services Develop Collaborative Agreement to Increase Pre-Hospital Medical Care. 2014.


,. :"

! I' r

Hon. Terry Lake. Paramedic Services Week. 2015.

5. Reports and Meeting Minutes

Chronology Report. Emergency Medical Responder License. 2015.

Delta Fire & Emergency Services 2013 Community Update Report. Vision, Mission Statement, & Core Values. 2016.

Delta Council Report. Delta Fire Regulation Bylaw No. 5855,2001. 2015. Print.

Delta Council Report. Enhancing Emergency Medical Care in Delta, Final Consideration and Adoption of Bylaw No. 7426,2015.2015.

Executive Council Report. Emergency Medical Response and BC Emergency Health Services Collaboration Agreement. 2014.

The Corporation of Delta and British Columbia Emergency Health Services. Meeting Minutes. 14 March 2014.

The Corporation of Delta & British Columbia Emergency Health Services. Meeting Minutes. 28 April 2014.

The Corporation of Delta & British Columbia Emergency Health Services. Meeting Minutes. 9 June 2014.

The Corporation of Delta and British Columbia Emergency Health Services. Meeting . Minutes. 21 July 2014.

The Corporation of Delta and British Columbia Emergency Health Services. Meeting Minutes. 2 September 2014.

The Corporation of Delta Bylaw, No. 7426. A Bylaw to amend the "Delta Fire Regulation Bylaw No. 5855, 2001."

6. Statistics and Other Information

Delta Cares - Mayor's Message on Public Safety Issues in our Community. 2 July 2015.

Delta Fire & Emergency Services. 2013. Vision, Mission, Core Values.

Delta Fire & Emergency Services EMR Licensing and Practice. Delta BC. 17 July 2014. Speech.


o

~


Lupini, Linda. "Delta is providing emergency care on its own./I Delta Optimist, 8 July 2015. http://www.delta-optimist.com/opinion !letters /delta -is-provjding-emergency

care-on-its-own-1.1993014. Accessed 13 November 2016.

7. Transcripts

"Linda Lupini's Comments." CKNW News. 15 July 2015. Transcript.

"CKNW Interview with Mayor Lois E. Jackson./I The Jon McComb Show. 15 July 2015. Transcript.

Appendix I: Breakdown of Incident Types

Type Number Code Incident Type Description of

Incident Incidents Type

F6D2 Breathing problem - difficulty speaking between breaths 169

F26C2 Sick person - abnormal breathing 157

F17BIG Falls - on ground - possibly dangerous body area 140

F31D3 Unconscious/Fainting (near) - not alert 134

MEDl Medical aid routine BCAS or public 120

F6Cl Breathing problem - abnormal breathing 109

F26Cl Sick person - cardiac history 106

ASIST Assist the public or other agency 102

FlOC4 Chest pain - breathing normally 98

MED2 Medical aid emergency BCAS or public 98

F30Bl Traumatic injuries (specific) - possible dangerous body area 97

FlOD4 Chest pain - clammy 94

F17Bl Falls - possible dangerous injury 93

F31D2 Unconscious/Fainting (near) - severe respiratory distress 83

F26Dl Sick person - not alert 82

F10D2 Chest pain - difficulty speaking between breaths 71

F6Dl Breathing problem - not alert 63

FlOC2 Chest pain - cardiac history 53

F28C111 Stroke - breathing normally = 35 - <3 hours ago 52

F29B4U Traffic/Transportation accident - unknown status - unknown px 52

F29Bl . Traffic/Transportation accident - injuries 48

F29B4 Traffic/Transportation accident - serious hemorrhage 45

FI0Cl Chest pain - abnormal breathing 43

F17D3G Falls - on ground - not alert 43

% of

Incidents

5.42%

5.03%

4.49%

4.30%

3.85%

3.49%

3.40%

3.27%

3.14%

3.14%

3.11%

3.01%

2.98%

2.66%

2.63%

2.28%

2.02%

1.70%

1.67%

1.67%

1.54%

1.44%

1.38%

1.38%

'. "

Type

Code Incident Type Description

Incident

_~ype __ ~ ___ ~ __ ~~~-----~ ~ - - ---------

F6D4 Breathing problem - clammy


Number % of of

Incidents Incidents

- -- ---- ----43 1.38%

F12C4 Convulsions - not seizing now/effective breathing/>6/no seizure disorder 42 1.35%

F28ClL Stroke - less than 10 minutes - not alert 42 1.35%

F12D2 Convulsions/seizures - continuous/multiple seizures 40 1.28%

F4B1A Assault - possible dangerous body area 39 1.25%

F13Cl Diabetic problems - not alert and breathing normally 34 1.09%

F17D3 . Falls - not alert 26 0.83%

F21D3 Hemorrhage/lacerations - dangerous hemorrhage 26 0.83%

F21D4 Hemorrhage/lacerations - abnormal breathing 26 0.83%

F19D4 Heart problems - clammy 25 0.80%

F29B4V Traffic/Transportation accident - unknown status - many patients 20 0.64%

F29B1V Traffic/Transportation accident - injuries - many patients 19 0.61%

Fl0Dl Chest pain - not alert 18 0.58%

F30D2 . Traumatic injuries (specific) - not alert 18 0.58%

F29D2M Traffic/Transportation accident - high mechanism - pedestrian struck 17 0.55%

F6El Breathing problem - ineffective breathing 17 0.55%

F9El Cardiac/respiratory arrest/death - not breathing at all 17 0.55%

F6C1A Asthma problem - abnormal breathing 16 0.51%

F32Dl Man down (unknown problem) - life status questionable 15 0.48%

F18C2 Headache - abnormal breathing 14 0.45%

F19C2 Heart problems - abnormal breathing 14 0.45%

F21D2 Hemorrhage/lacerations - not alert 14 0.45%

MVI3 MVI - motor vehicle accident 14 0.45%

F19D2 Heart problems - difficulty speaking between breaths 13 0.42%

F23Cli Intentional overdose - not alert 13 0.42%

F28C2L Stroke -less than 10 minutes - abnormal breathing 12 0.38%

F29BlU Traffic/Transportation accident - injuries - unknown px 12 0.38%

F5C3 Back pain - fainting or near fainting 12 0.38%

F28C11g Stroke - breathing normally = 35 - >3 hours ago 11 0.35%

F2Cl Allergy/sting - difficulty breathing/swallowing 11 0.35%

F17D5 Falls - on ground - long fall 10 0.32%

F1Dl Abdominal pain - not alert 10 0.32%

F23D1A Accidental overdose - unconscious 10 0.32%

F23Dli Intentional overdose - unconscious 10 0.32%

F13Dl Diabetic problems - unconscious 9 0.29%

F30B2 Traumatic injuries (specific) - serious hemorrhage 9 0.29%

F12D2E Epileptic seizure history - continuous/multiple seizures 8 0.26%

Type

Code Incident Type Description Incident

Type

F28ClU Stroke - unknown - not alert

F18C1 Headache - not alert

F19C7 Heart problems - unknown status

F2D1 Allergy/sting - not alert

FllD1 Choking - abnormal breathing (partial obstruction)

F12C3 Convulsions - diabetic

F12D4 Convulsions/seizures - irregular breathing but not verified

F13C2 Diabetic problems - abnormal behaviour

F19D1 Heart problems - not alert

F28C11u Stroke - breathing normally = 35 - unknown start

F29D2L Traffic/Transportation accident - high mechanism - bike

F9E2 Cardiac/respiratory arrest/death - breathing uncertain

F10D3 Chest pain - changing colour

F12B1 Convulsions/seizures - breathing regularly but not verified

F17D2 Falls - on ground - unconscious or arrest

F28C1G Stroke - greater than 10 minutes - not alert

F29D5 Traffic/Transportation accident - not alert

F2Cli Allergy/sting - inj admin adv - difficulty breathing or swallowing

F2D2 Allergy/sting - difficulty speaking between breaths

F30D3 Traumatic injuries (specific) - chest or neck injury difficulty breathing

F17D4 Falls - chest or neck injury with difficulty breathing

F25Dl Psychiatric/abnormal behavioral - not alert

F28C10g Stroke - TIA (mini-stroke) history - >3 hours ago

F29D2P Traffic/Transportation accident - high mechanism - rollovers

F31A2 Unconscious/Fainting (near) - Fainting Episode(s) and Alert - Cardiac History

FllD2 Choking - not alert

F16Bl Eye problems - sever eye injuries

F23C1A Accidental overdose - not alert

F27D3S Stabbing - central wounds

F28Cl01 Stroke - TIA (mini-stroke) history - <3 hours ago

F28C2U Stroke - unknown - abnormal breathing

F29B3 Traffic/Transportation accident - multiple victims/multiple ambulances

F29B3V Traffic/Transportation accident - other hazards - many patients .

F2C21 Allergy/sting - inj admin adv - history of severe allergic reaction

F31Dl Uncbnscious/Fainting (near) - unconscious

MVll MVI - clean-up, no injuries


Number Type

of Code

Incidents Incident

Type

8 0.26%

7 0.22%

7 0.22%

7 0.22%

6 0.19%

6 0.19%

6 0.19%

6 0.19%

6 0.19%

6 0.19%

6 0.19%

6 0.19%

5 0.16%

5 0.16%

5 . 0.16%

5 0.16%

5 0.16%

5 0.16%

5 0.16%

5 0.16%

4 0.13%

4 0.13%

4 0.13%

4 0.13%

4 0.13%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

3 0.10%

I .

" I !:

Type

Code

Incident

Type _

VEFl

F12BIE

F12CS

F17B2G

F17DOG

F20DIH

F23C1V

F24D3

F24D4

F29D4V

F2C2

F31D4

F4D2A

F4D4A

FSDl

F9Dl

RESl

ALRMl

FUEl

F12CO

F12C2E

F12C3E

F12CSe

F12D4E

F14D2

F14D3

F1SClE

FlSD6E

F1SD8E

F17B2

F19CO

FIC2

F23C31

F23C4A

F23C41

F23C7V

F23D21

Incident Type Description

- -

Fire confined to a gasoline or unknown fuel source vehicle

Epileptic seizure history - breathing regularly but not verified

Convulsions - history of stroke or brain tumor

Falls - on ground - serious hemorrhage

Falls - on ground - override

Heat exposure - not alert

Poisoning (ingestion) - violent - not alert

Pregnancy/childbirth - imminent delivery (> 5 months/20 weeks)

Pregnancy/childbirth/miscarriage - third trimester hemorrhage

Traffic/Transportation accident - trapped victim -many patients

Allergy/sting - history of allergic reaction

Unconscious/Fainting (near) - changing colour

Assault - not alert

Assault - multiple victims

Back pain - not alert

Cardiac/respiratory arrest/death - ineffective breathing

Rescue - no immediate risk or danger

Alarm Activated - confirmed false alarm

Choking - choking verified

Convulsions/seizures - override

Epileptic seizure history - pregnancy

Epileptic seizure history - diabetic

Convulsions - history of strong or brain tumor - history seizures

Epileptic seizure history - irregular breathing but not verified

Drowning - not alert

Drowning - diving/suspected neck injury

Electrocution - alert and breathing

Electrocution - not alert

Electrocution - unknown status

Falls - serious hemorrhage

Heart problems - override

Abdominal pain - known aneurysm

Intentional overdose - antidepressants

Accidental overdose - cocaine

Intentional overdose -cocaine

Poisoning (ingestion) - violent - unknow.n status

Intentional overdose - sever respiratory distress


Number %

of of

Incidents Incidents

---

3 0,10%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

2 0,06%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

1 0,03%

Type

Code Incident Type Description Incident

_ I'{pe __ ~~~~ ___ -~-~ --~ --- ~~~ ------~- ------

F24DS Pregnancy/childbirth/miscarriage - high risk complications

F24D6 Pregnancy/childbirth/miscarriage - baby born (complications with baby)

F2SB1 Psychiatric/abnormal behavioral - serious hemorrhage

F2SB1B Psychiatric - both violent and weapons - serious hemorrhage

F2SD1V Psychiatric - violent - not alert

F2SD1W Psychiatric - weapons - not alert

F27D3P Penetrating trauma - central wounds

F27D3y Stab/gunshot/penetrating trauma - central wounds - self-inflicted stab

F28C1e Stroke - not alert - partial evidence (unknown time frame)

F28C1j Stroke - not alert - clear evidence (less than "x" hrs)

F28C2G Stroke - greater than 10 minutes - abnormal breathing

F28C2j Stroke - abnormal breathing - clear evidence (less than "x" hrs)

F29B2 Traffic/Transportation accident - multiple victims 1 ambulance

F29B2V Traffic/Transportation accident - serious hemorrhage - many patients

F29B3U Traffic/Transportation accident - other hazards - unknown px

F29B4X Traffic/Transportation accident - unknown status - unknown px add vehs

F29DO Traffic/Transportation accident - override

F29D4 Traffic/Transportation accident - pinned (trapped) victim

F29D4U Traffic/Transportation accident - trapped victim - unknown px

F29DSV Traffic/Transportation accident - not alert - many patients

F2901 Traffic/Transportation accident - no injury - confirmed - police refer

F2902 Traffic/Transportation accident - first party verified

F30Dl Traumatic injuries (specific) - uncons~ious or arrest

F31E1 Unconscious/Fainting (near) - ineffective breathing

F33DlT Transfer - suspected cardiac or respiratory arrest

F4D1S Sexual assault - unconscious or arrest

F4D3A Assault - chest/neck injury with difficulty breathing

FSCO Back pain - override

FSC1 Back pain - suspected aneurysm

F6D3 Breathing problem - changing colour

F7C2E Burns - explosions - difficulty breathing/swelling

F7C3 Burns - burns less than 18% of body

F8C1C Carbon monoxide/inhalation/hazmat - chemical - alert with diff breath

F9D2 Cardiac/respiratory arrest/death - questionable

MVI2 MVI - pedestrian or non-motorized vehicle involved

ODOUU Odour/smell or unknown origin, no report of smoke or fire

Total Incidents


Number %

of of

Incidents Incidents

- ~ - ---- ---- -

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 O.O~%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

1 0.03%

3119 100.00%

I I

r

Author's Biographical Information


~ - - - -- - - ~--- - - --- - - - -- -- - -

Dr. Martha Dow is a researcher and consultant working in the areas of public safety, education, and organizational change and is an Associate Professor in the Department of Social, Cultural and Media Studies at the University of the Fraser Valley. Contact her at [email protected] for further information.

Acknowledgments

. This report was commissioned by The Corporation of Delta.

Documents

F - delta.civicweb.net A Review of Delta... · Nenno, Delta Fire and Emergency Services Administrative Assistant • ATTACHMENT: A. A Review of the Emergency Medical Responder Program