Health Committee on Oct. 4th, 2012

[Colin Carrie, Conservative, Oshawa, ON]

I agree, and that's why I'm asking you now. I do disagree with you when you say the confusion is at the federal level, because in each municipality, each jurisdiction, each province, it's different. By actually tightening things up at the federal level, what we heard from our witnesses anyway, is that you'd be taking away some of their flexibility.

My question would be, and in agreement, why wouldn't we get ahead and talk to the provinces and jurisdictions now, not during a pandemic?

[The Chair, Conservative, Joy Smith]

Mr. Marks, we're just about out of time for Dr. Carrie's questions and we have to go to Mr. Goodale, so can you quickly wrap it up?

[Scott Marks]

Very briefly, regardless of what goes on...the provinces will always have the flexibility to view this as a guideline. The federal guideline was confusing, because we fit the definition for emergency health responders, yet we were pulled out of it by specifying firefighters separately. That's where the confusion is.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Marks.

Now we'll go to Mr. Goodale.

[Ralph Goodale, Liberal, Wascana, SK]

Thank you very much, Madam Chair.

With everybody else here today, I want to express our appreciation for the presence of these witnesses and the very useful testimony they are giving. It's very helpful to the committee.

On that last point, Mr. Marks, it seems to me that it's clear in the Public Health Agency of Canada Act that when you have a public health emergency of some kind that affects people in more than one province, there is a jurisdiction and a responsibility that then falls at the federal level. It is up to the Government of Canada, obviously in consultation with the provinces and a lot of other groups, to make sure that the guidance that's given about sequencing is as clear, proper, and appropriate as it can be. Within that national guideline, there is flexibility for provinces to make local decisions if their circumstances are dramatically different. Obviously, guidance is guidance. It's not a legally binding rule, but it is helpful to say at the national level that, in principle, all other things being equal, this is the order that seems to be the most appropriate.

You, of course, have made a very powerful case today for a high-priority ranking for first responders.

I was taken in the testimony a couple of days ago by the Public Health Agency officials. It didn't seem to be clear that they had a grasp of the point that firefighters do a variety of different things. You fight fires, thank God, but you also are first responders, along with your colleagues, the EMT folks and others. In that capacity, you function very much like front-line health care workers. If it weren't for you on the scene of some very dangerous situations, some of those victims would not actually get to the doctors and nurses who are waiting for them in the emergency rooms.

What we're being asked to do here is to go back uphill to the origin of the problem and to make sure that you're dealing with the disease situations ab initio and not just coming in partway through. I think your points there are very well taken.

I have three questions. One is very specific to the EMTs. I'm happy to hear about the situation in Saskatoon.

I wonder, Mr. Hills, if you could comment on the situation. Pardon me for being parochial, but in Regina as well...was this a Saskatchewan situation you were describing, where you had access to the vaccines, or was that Saskatoon-specific?

Let me just ask the other two questions and then I'll allow you a full response.

Secondly, I wonder if we could have a description of some of the circumstances at the scenes of difficult accidents and so forth that you have to deal with. How risky and dangerous and exposed to disease and infection are your members actually in real-life circumstances?

Finally, on this issue of consultation, I'm glad to hear that PHAC has been in touch with the IAFF in the last 24 hours. But would all of you and your organizations expect to be consulted in this process of developing a new protocol on vaccine sequencing by the Public Health Agency as they are putting together their recommendations for new protocols about public sequencing?

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Goodale.

Unfortunately, it was a four-minute question and we only have three minutes left, so be mindful of that.

We'll begin with Mr. Hills, and forgive me if I have to cut you off. We try to give everybody equal time.

Mr. Hills.

[Paul Hills]

As far as what happened in Regina is concerned, I can't speak to specifics there, but perhaps I can look at it from the point of view that it's the same thing as federal-provincial jurisdictions. Different EMS services and different fire services have different coordinated responses on how well they work together. We have a very good relationship in Saskatoon with our fire department. It was a no-brainer for us when vaccines became available that we would go out and do it for them. That's the kind of relationship we have.

As far as Regina goes, since their EMS services are run by a health region, they would probably have different guidelines and probably not have the paramedics. They would send out their own nursing staff to do it.

Availability on vaccine I can't speak to specifically, but in Saskatoon, once it became available, we went out and did that.

As far as exposure—

[Kevin White]

I can speak to that.

How exposed are we, or how are we exposed? I work in Barrie, Ontario, and 80% of the time we're the first responders in advance of the paramedics to medical calls. When a medical call we're tiered out to is defined as shortness of breath, any chest pains, gross bleed, or unconsciousness for any reason, we're tiered out, and 80% of the time in my area we're there first.

So we are the medics on scene. We're trained to emergency medical response level, and we are, in our case, the responders, so we are definitely exposed first. We listen to our county-run paramedics as to what parameters we need to follow when we get there, but they're the ones who are automatically inoculated.

[The Chair, Conservative, Joy Smith]

Okay.

[Daniel Albert]

Madam Chair, could I answer the last question?

[The Chair, Conservative, Joy Smith]

Yes, please, Mr. Albert.

[Daniel Albert]

Are we ready to participate with l'Agence de la santé? Yes, we are ready. The Canadian Association of Fire Chiefs has already offered their collaboration. So to that question, yes, we are ready to work with l'Agence de la santé.

[The Chair, Conservative, Joy Smith]

Okay, and thank you very much for your very concise and helpful comments.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

That last comment that Kevin White made about 80% of the time being the first responder, that's very telling. Is that something that is common among firefighters? I know you mentioned that at your station, in particular, it was 80%. But if you're the first medical response team so often, obviously that's a very compelling case for why you'd want to be vaccinated on a priority basis.

In your discussions with IAFF, is it your sense that it's a common percentage around the country?

[Scott Marks]

The percentages can differ, and obviously in a case such as Barrie, which has expanded into a bedroom community of Toronto, and there are still some rural areas serviced, it's probably a little bit higher.

In the city of Toronto, where I was a firefighter for 28 years, on average Toronto firefighters are on scene first or simultaneously with EMS 50% of the time. So I would say 50% would be the low end; it's anywhere between 50% to 100% of the time. For the vast majority, over 95% of the professional fire services in Canada provide emergency medical response as part of a tiered response system.

[Patrick Brown, Conservative, Barrie, ON]

Go ahead, Kevin.

[Kevin White]

I'd like to point out that when we are called it's usually in the most severe cases. It's not just because someone needs transportation to the hospital. We're called because there is a need. In the upper echelon of medical response, that's when they ask firefighters to attend, and that's in Barrie, where we're the first ones there 80% of the time.

[Patrick Brown, Conservative, Barrie, ON]

I know of a firefighter in Barrie, Nevin Hamilton, who is also a paramedic. I know that in some cases with fire forces, they actually contract out to do the paramedic services in their individual municipalities.

A general question to the panel: Kevin, is that something you've looked at in Barrie, and do we see firefighters actually performing that service elsewhere in the country?

[Kevin White]

I can speak to that first. I know there are a lot of municipalities across Canada where paramedics and firefighters even work on the same truck. You could have a situation where there's a paramedic who does have tier one access and is available to get the inoculation, but the firefighter riding in the same unit does not have the same access.

That's the situation you brought up with Nevin Hamilton, who is a paramedic. He had front of the line service for the H1N1 inoculation, yet the firefighters on our squad did not.

[Scott Marks]

Further to the same question, there are a number of municipalities in Canada where the paramedic service is administered through the fire department: Winnipeg, Lethbridge, and Strathcona County in Alberta. Those are the examples that spring to mind.

An interesting situation happened in Strathcona County, where all firefighters are trained as paramedics and they do provide the paramedic service, with funding through the Alberta Health Services. In Strathcona County the provincial health jurisdiction looked at it and determined that firefighters did not get first-level priority. So although they were paramedics as well, they didn't get access to the H1N1 inoculation. The strange thing that occurred, which is what I'm talking about, is the confusion that had Strathcona County had separate paramedic and fire units, the paramedics would have got it and firefighters would not have. Because they were one unit, administered out of the same department, no one received it. Again, this is why the guideline is very unclear, and we have a problem.

[Patrick Brown, Conservative, Barrie, ON]

In terms of the guideline that you talked about before, I know there were questions about approaching the provincial government. Is it your expectation that if the federal guideline were changed, you would approach every provincial government to make sure they would honour those changes, knowing that it's only a guideline, however loose that may be?

[Scott Marks]

I think it would make it so much easier for us if, for instance, some provincial jurisdiction stated that they were not going to provide firefighters with the vaccine even though the guideline suggested they should. We would be looking for some sort of rationale to back that up.

I think we all agree that there are sometimes circumstances that dictate certain things in certain areas, but in the absence of any specific circumstances, I think it would make our situation as firefighters much easier to be able to go to the provincial medical officer and say, “Here's the federal guideline. Why are you not honouring this?”

[Patrick Brown, Conservative, Barrie, ON]

In a jurisdiction like Nunavut, where they're not the first responder, wouldn't it be reasonable to expect they wouldn't be on that priority?

[Scott Marks]

If there is a reason why the firefighters aren't in the same situation, then obviously the jurisdiction would be able to make that decision and justify it.

[Patrick Brown, Conservative, Barrie, ON]

Daniel, I think you had a comment.