A common goal of care: Changes and partnerships at the WFPS

On a Monday night in April, the Winnipeg Fire Paramedic Service (WFPS) is called to a Maryland Street residence. There’s not much information available — crews gather it’s an overdose, but it’s unclear what kind.

When WFPS Deputy Chief of Fire Rescue Operations and Training Scott Wilkinson drives up with lights flashing and sirens blaring, there’s already an ambulance and fire truck on scene.

Within a few minutes of his arrival, paramedics clear the patient, and pack up to head back to the station. A relatively brief visit — but that’s not always the case.

“You just don’t know,” Wilkinson said. “It’s hard to tell what’s urgent, what’s not urgent, and what we’re going to run into when we get here.”

This call, Wilkinson explains, is a Priority One call: an urgent situation that triggers a “lights and sirens” response. The WFPS says about 75 per cent of calls fall into that category, and until recently, all the others were classified as Priority Two: considered urgent, but not life-or-death.

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But the WFPS is in the process of changing that triaging system to one that has five priorities, a change that aims to match each call with an appropriate response. And in a Canadian first, that response will sometimes come from non-emergency services groups like the Downtown Community Safety Partnership.

Downtown Community Safety Partnership

Established in 2020, the Downtown Community Safety Partnership (DCSP) supports residents and visitors to Winnipeg’s downtown core. Staff connect people to resources, provide transport, and conduct well-being checks, with a particular focus on the area’s unsheltered community.

“You run into some pretty interesting people on a daily basis, and then you start to grow some pretty good relationships with them,” said Connor Novak, who has worked with DCSP for two years.

DCSP staff also connect with WFPS services when more serious medical issues arise, and Novak says WFPS sometimes called on DCSP when assisting some of their familiar clients with non-urgent concerns. But one entity enlisting the help of another required a lot of back-and-forth to assign resources.

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DCSP dispatcher Joe Mac Donald says the move to the five-priority system, and an official working relationship, mostly eliminates that.

“Instead of having to make a direct call, now they can just send us the call quickly through our system and we get all their notes,” he said. “It’s much more efficient in that regard.”

Under the new system, the WFPS is able to assign low-acuity, Priority Four and Five calls to the DCSP. Both groups can communicate directly via radio, and it allows both groups to plan and assign crews accordingly. It’s the first time a Canadian emergency services agency has partnered with a non-EMS agency to respond to 9-1-1 calls in this way.

“I think the best word to use would be seamless,” said Novak. “Having as little steps as it takes to get appropriate response to situations… is extremely valuable to ensure the best practice and the best care for the people in the downtown community.

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“We end up dealing with situations that that make you think like, well, who exactly would have responded to this call before we existed?” he added. “You know, this isn’t an emergency situation, but it takes a lot of thought and a lot of navigating various resources.”

Triaging calls

A 9-1-1 call undergoes careful screening before it’s handed to DCSP.

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First, operators assess whether the incident requires police or paramedics – or both.

When a call goes to WFPS, operators use a pre-determined set of questions to triage the call into one of the five (formerly two) priorities. Staff then assign resources – ambulances and fire engines staffed with paramedics – to the highest priority calls, a process WFPS Communications Operator Jordan Brown calls a “juggling act.” “Degraded” is when under 30 per cent of EMS crews are available to go to a call – and Brown says it’s a nightly occurrence.

“We have to be very specific of holding them for the priority ones, which are the higher lights and sirens responses,” he said, adding it’s gotten worse since the onset of the COVID-19 pandemic.

When operating in “degraded,” Priority Two calls  — urgent, but not life-threatening — then go into a queue. Operators call every 30 minutes until a crew is assigned and paramedics arrive.

Many lower-priority calls move to the Enhanced Low Acuity Triage (ELAT) program, where a Community Paramedic further assesses the call.

“We’ll look up their history, we can look up their e-chart, we can look up their meds, their hospital visits, all their kind of encounters,” said WFPS Community Paramedic Nathan Epp. Epp can then connect the patient to other supports like home care or a mental health worker, and can arrange alternate transportation to hospital if appropriate. ELAT staff can also upgrade a patient if new information comes to light.

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Data-driven approach

With calls to WFPS increasing roughly seven per cent annually, WFPS Paramedic and Training Operations Deputy Chief Ryan Sneath says a more nuanced priority system that includes other care providers was much needed.

“If we don’t differentiate, we’ll continue down the same path we’re on right now, and we won’t be able to respond in a timely manner,” he said. “That’s the ultimate goal of this — those apparatuses are available in their community to respond to those high-acuity things, the things where time really counts.”

Winnipeg isn’t the first jurisdiction to move from a two- to a five-priority system. The Ottawa Paramedic Service (OPS) made the switch in April 2024, with results OPS Paramedic Chief Pierre Poirier says are promising.

“We moved from, I’ll say, a blunt instrument that really had two categories, low and a high. And the problem with the old system is that it significantly over-triaged calls,” he said.

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“We have to acknowledge that individuals are accessing our services that would be better suited accessing different health services or different services altogether,” Sneath said.

Winnipeg’s system uses its own data as a triaging guide, compiling information collected by the 9-1-1 operator and paramedics on scene to inform which calls require a high or low priority response.

“We have a very robust database that looks at well over a million patients that date back to June of 2012,” said WFPS Medical Director Dr. Rob Grierson. “You put those two things together. We can very accurately predict what a patient is going to look like when we arrive.”

Grierson adds the risk of a high-acuity situation being assigned a low-priority number is less than one per cent — and that the ELAT paramedic helps catch those cases, too.

Our neighbour’s model

The Winnipeg Fire Paramedic Service may be the first in Canada to dispatch calls to non-EMS groups like the DCSP, but in Minneapolis, a similar model has been in place for years.

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The Minneapolis Downtown Improvement District (DID) is a safety organization that works closely with private and public sector groups and police to support that city’s downtown. Similar to the WFPS and the DCSP, the Minneapolis Police Department and DID work together to support downtown residents and visitors.

In 2019, Global News travelled to Minneapolis for a look at the DID’s work.

“Our job is not to take over police services,” DID Director of Safety Initiatives Shane Zahn said at the time. “Our job is to be aware of police services, but to be more of that harm reduction support.”

The DID’s model inspired what would become Winnipeg’s DCSP.

Working together

The WFPS is phasing in the five-priority system, beginning with priorities four and five — the lowest-acuity calls. The DCSP took their first call from WFPS on May 8, 2024.

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Novak with DCSP says it feels great to work toward a common goal.

“Being able to say, ‘Yeah, we’re on route,’ is really rewarding,” he said, “knowing that we’ve been able to establish that partnerships and make it a lot stronger than what it was when we started.”

“If we needed them, we knew that they were just one radio hail away.”

The WFPS can’t say how long it will take to fully adopt the five-priority system, as they’re also looking at expanding partnerships with other groups, like the City of Winnipeg’s Community Safety Team, which focuses patrols on Winnipeg Transit. But the vision, Grierson says, is a network of helpers, getting the right care to the right patients.

“We have someone who has the ability to know their medical record and address some of those concerns, as opposed to just blindly picking them up and taking the emergency department. And the resource that is put back into the system allows us to respond in a timely fashion to those other emergencies.”