Immediately after the implementation of the BC Emergency Health Services new Clinical Response Model, Surrey Fire Service chief Len Garis said he noticed a “dramatic” decrease in the number of overdoses the department was being called to.
In May of 2018, BCEHS implemented a new colour-coded Clinical Response Model (CRM), which is based on “existing, successful systems” around the world.
READ ALSO: Fire chief says 911 dispatch system change in B.C. risks patient safety, April 12, 2019
Similar to a hospital emergency department, CRM determines a patient’s condition in a colour-coded system, with a “key goal” to “improve response times to the most life-threatening medical emergencies.”
The colour codes are: purple for immediately life-threatening; red for immediately life-threatening or time-critical; orange for urgent/potentially serious but not life-threatening; yellow for non-urgent (not serious or life-threatening); green for non-urgent (possibly suitable for treatment on scene); and blue for non-urgent, further clinical telephone triage and advice.
BCEHS says firefighters aren’t notified of every call “because if they are responding to a patient with a non-urgent condition, they could be tied up when we need them to respond to a life-threatening call.”
But fire first responders are still notified for purple and red calls. Firefighters are notified of orange calls, “where an ambulance response is likely to take more than 10 minutes to arrive at scene.”
“I’m a little bit careful at raising the alarm bells, but I can say for sure that we did see a dramatic decrease in the number of overdoses (that the department was called to),” Garis said. “The concern was was that the response model basically said that if their response was going to be less than 10 minutes, then we wouldn’t be co-responding. If it was greater than 10 minutes, then we would.”
With that, Garis said, there were two concerns with the new system.
The first was that the 10-minute response to a potential overdose victim was too long because the department was providing between five- and six-minute response times, he said.
The second concern, he said, had to do with the “call-taking mechanism.”
“The triage over the phone is difficult in the first sense to diagnose what that result might be. In other words, whether it’s an overdose.”
Garis gave a hypothetical example of how the colour code of call could change once a fire department arrives on scene.
“A call comes in and it says that somebody has a conscious collapse or somebody is crouched or something on the side of the street or in a restaurant or in a store — it doesn’t really matter where — and then we get there, it’s determined that it’s an overdose. It’s because of the quality of the caller not always being able to appropriately diagnose the information to the ambulance dispatcher, so it gets called in their best effort to try and identify this and send it. Potentially, that call turns into an overdose.”
A change in colour code, Garis said, happens about 30 per cent of the time.
BCEHS said the CRM is “working well,” with early data showing response times are improving for potentially life-threatening medical emergencies.
In Surrey, BCEHS communications officer Shannon Miller said for the purple and red calls, “the response time has improved in Surrey since the CRM was implemented.”
“Our resources are being better matched to patient care,” Miller said.
However, Garis said, the decrease in overdose calls the department is dispatched to can also be attributed to Surrey Fire Service working with City of Surrey and Fraser Health to distribute naloxone kits “to individuals who are in the at-risk population.”
“The case is we sometimes see less calls for emergency because they’re managing the overdose themselves using naloxone to revive themselves,” Garis said. “There’s a couple of things that happened all at once, so it’s really difficult for us to put our finger on something.”
However, Garis said, the BCEHS and fire departments “historically haven’t communicated well in terms of a co-response,” highlighting a recent report by the auditor general.
READ ALSO: Slow response, poor co-ordination hamper B.C. firefighters, paramedics: report, Feb. 27, 2019
The report, released on Feb. 27, 2019, says that BCEHS is “effectively managing access to ambulance and emergency health services in some areas,” but the “co-ordination of access to emergency health services with fire departments needs to be strengthened.”
“For a number of reasons, improving co-ordination will not be easy,” a release about the report states. “One challenge is that fire department first responders are employed by local governments, while BCEHS is part of the provincial government. Further, BCEHS and some municipalities have different views on how fire department first responders can best support BCEHS in providing effective access to emergency health services. Support from the provincial government may be needed to improve co-ordination between BCEHS and fire department first responders across the province.”
Under the First Responder program in B.C., according to BCEHS, fire departments can provide basic first-aid training and emergency health services such as CPR and defibrillation while paramedics are en route to a medical emergency call.
READ ALSO: One-in-five 911 calls are ‘non-emergencies’: E-Comm, Nov. 30, 2017
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