A Brief History of the Ambulance Service in
Ontario
Not unlike other jurisdictions, Ontario's ambulance services have emerged from roots
embedded in both health care and the private sector, evolving along a somewhat
convoluted path into the current municipally controlled service delivery models. While
the first municipally funded ambulance services appeared in Toronto as early as 1880,
and were similarly well established in Berlin-Waterloo (now Kitchener-Waterloo) by 1903.
Emergency Medical Services (EMS) were not municipal priorities in other parts of the
province.
During the first half of the 20th century, it was not uncommon to see private ambulance
services operating as sidelines for funeral homes, or even furniture stores, taxi and towing
companies. While some would see providing ambulance service as a serious conflict of
interest for the funeral director, their involvement was generally borne out of a commitment to
provide a much needed community service. not to mention that theirs was often the only
equipment in town capable of comfortably transporting patients lying down! The funeral
home was already staffed, the telephone answered 24 hours a day, and the staff's education
in the natural sciences, second only to that of the local physician.
In larger communities, a number of commercial ambulance services were often available,
although no means existed to co-ordinate their efforts. There was no provincial funding for
ambulance services, payment was on a full fee-for-service basis, and there were no uniform
standards for patient care, training or equipment. No 9-1-1 telephone or centralized dispatch
systems were yet in place, and a competitive element often affected quality of care provided.
Unlike today, it was sometimes better to be the last ambulance arriving at the scene of a
motor vehicle collision, rather than the first and fastest. Arriving ambulances commonly
blocked the ambulance ahead to prevent them from being able to transport patients. Thus,
the last arriving ambulance was the only one assured of a paying customer. Despite the
competition, there was no guarantee that the personnel aboard any of these ambulances
were even marginally trained. No standard of training was prescribed, and one 1963 study
revealed that only 141 of 181 operators contacted, even had staff with basic first aid training.
During the late 1960s, Dr. Norman McNally, then Director of the
Emergency Health Services Division (EHS) of the Ontario Hospital
Services Commission (forerunner of today's Ministry of
Health and Long Term Care), was charged with developing
"a balanced and integrated system of ambulance services."
out of a "hodge podge" of 425 services of widely varying quality that existed around the
province. Under his direction, EHS set out to first standardize training levels among
ambulance attendants, then improve vehicles and equipment. McNally's stated goal was
eliminating the private services, then consolidating them to gain benefits of scale, and
placing them under the control of hospitals where stable funding, training and quality
assurance could be maintained. Unfortunately, the cost of this worthwhile venture was
grossly underestimated, and financial limitations negated the government's wholesale
purchase of all private ambulance services. Doctor McNally instituted standardized training, vehicles and
equipment and radio communications. Part of the standardized training was held at Canadian Forces Base Borden for
all provincial ambulance attendants. This training, called the Fundamentals of Casualty Care, consisted of 160 hours of
anatomy and physiology, advanced first aid, splinting for fractures, and light rescue techniques. Benefits of the
programs established by McNally and EHS included standardized vehicles and training, and a province-wide radio
network in which an ambulance starting in Cornwall, Ontario could theoretically drive to Kenora, Ontario without ever
being out of radio range of a dispatch centre or having to switch channels.
From 1968-1973, licensed ambulance services could not be sold between operators. only
back to the Ontario Hospital Services Commission (the Ministry of Health after 1971). The
mid-1970s however, saw a reversal of this trend towards public consolidation, with a new
emphasis on private sector involvement in the management and delivery of ambulance
services. From 1973 on, service licenses and assets were bought and sold as business
undertakings.
What remained in place from the 1970s was an ever-evolving mix of approximately 175
publicly contracted (hospital and municipal), private, and directly operated (OPS) ambulance
services, that were all fully funded and directed by the Ministry of Health. Some 40% of these
services were operated by private individuals/corporations. Operations of the services were
managed centrally through six Regional Offices of the Emergency Health Services Branch.
Ambulances and major capital equipment were provided at no charge to the Operator, while
other expenses were detailed in Ministry-approved line-by-line budgets, and then cash
flowed automatically to the Operator. As any expenditure required prior Ministry approval
before proceeding, there was little if any capital risk to the Operator.
Despite two government initiated major reviews of EMS governance and structure, this rather
eclectic mix of "private", hospital, municipal and OPS ambulance services remained in place
until the 1998 Local Services Realignment initiative of the Harris Conservative government.
Toronto’s Ambulance Service in the 1800s
The first organized ambulance service in Toronto started on June 22, 1832 (Toronto
was known as the Town of York at the time) by the Board of Health to transport
victims of cholera. Mr. John Blevins was the “carter” of this vehicle. Our first Mayor,
Mr. William Lyon McKenzie, also worked as an attendant on this cholera ambulance.
This was the start of a civic ambulance service.
The Board of Health also recommended in their daily meeting on June 29, 1832,
“that carters employed to convey the bodies to the graves and to the hospital be
sworn in as Special Constables, and that a relief of Constables be provided for every
four hours.” The work load that cholera placed on these men was so demanding that
they needed this regular relief. We may never know how many carters were infected
during this time.
During the summer of 1832 there were 535 cases of cholera resulting in 205 deaths.
Toronto had a population of less than 10,000 at the time.
For the next forty years the ambulance service bounced between public and private
run systems.
Toronto General Hospital Ambulance
In 1881 the Toronto General Hospital In 1881, the Toronto General Hospital started
an ambulance service. This service would continue to operate until the early 1930s.
Toronto Police Ambulance
On June 1st 1888 the Toronto Police Ambulance Service was formed to deal with
emergency calls in Toronto. The police eventually operated four horse-drawn
ambulances during this time, gradually replacing them with motorized vehicles
starting in 1913.
The first formal training for ambulance attendants was conducted in 1889. This
training course was approximately five days long, and was conducted by St. John
Ambulance for the Toronto Police Force.
Department of Public Health Ambulance
In 1889, the City Of Toronto’s Department of Public Health (DPH) took over the
responsibility of transporting contagious patients. Previous to this the City had
contracted this service to a funeral home operated by Michael McCabe. The first fulltime employee of the DPH ambulance was an individual named Frank Hague, who
operated the service from his home.
The 1900s
The first mechanized ambulance in the City of Toronto was introduced in February
1911. This ambulance, operated by A.W. Miles Funeral Home, was manufactured by
the T. Eaton Co. built on a Chalmers automobile chassis. The inaugural
run was on March 17, 1911.
In August of 1933, the Toronto Police turned their ambulance service over to the
Public Health Department, expanding the Department’s role into
responding to emergency calls. Along with a number of private
ambulance services, the Department of Public Health provided
ambulance service to the citizens of Toronto continuously from 1889
until midnight on December 31, 1966.
The first mechanized ambulance in the City of Toronto was introduced
in February 1911. This ambulance operated by A.W. Miles Funeral
Home, was manufactured by the T. Eaton Co. and it was built on a
Chalmers automobile chassis. The inaugural run was made on March 17,
1911.
Over 130 different ambulance operators at one time or the other have
provided ambulance service in the Metropolitan Toronto area.
In 1953, the Corporation of the Municipality of Metropolitan Toronto was
formed by provincial legislation. This new tier of government was given responsibility
for all major local services and infrastructure, such as water treatment, major roads
and Police services. The ambulance services, however, were not amalgamated at
that time. They contained minimal patient care equipment, the patient areas were
cramped, and the services were all individually dispatched. Ambulance service
remained fractured and sporadic, and delayed responses were common. Clearly, the
system needed further improvement.
The Carl Goldenberg Report of 1966 recommended a number of changes take place
in the operation of civic services in the Metropolitan Toronto area. One of those
recommendations directed the Municipality of Metropolitan Toronto to take over and
operate all remaining public ambulance services, in addition to setting up and
operating a central Ambulance Dispatch Centre to coordinate all ambulance calls in
Metro Toronto.
The Department of Emergency Services
As a result of the Goldenberg Report, the Municipality of Metropolitan Toronto’s
Department of Emergency Services (D.E.S.) was formed, under the direction of
Commissioner John Pollard on January 1, 1967. Mr. Pollard, a retired army colonel,
brought about a number of changes, including mandatory training for ambulance
attendants, larger ambulances and the centralization of dispatch for all ambulances
in Metro Toronto. The new Department also absorbed all of the remaining fire
department ambulances, bringing to an end the era of fire service-based ambulance
service in Toronto.
Ontario Government Funding
In 1968, the Ontario Ministry of Health began to take an interest in how ambulance
service was provided. In addition to the establishment of regulations and standards,
the Ministry of Health began to operate ambulance services throughout the province,
either directly or under contract. In Toronto, this included the acquisition of the
largest private ambulance firm, known as Amalgamated Ambulance Service Ltd., and
the creation of the Ontario Ministry of Health’s York Toronto Ambulance Service. In
addition, the Ministry established a mandatory 160 hour training program for all
Ontario ambulance attendants. This training took place at both Canadian Forces Base
Borden and the Metro Toronto Department of Emergency Services training school in
Toronto. This advancement in training set a new standard of care that would be
delivered by the ambulance staff of the day.
Advanced Care
In 1962, the first experiments in the pre-hospital care of cardiac patients were
conducted successfully in Belfast, Northern Ireland. The City of Toronto conducted a
similar experiment starting in July 1969 with a trial cardiac ambulance known as
“Cardiac One” operating from 45 station on New Street. The ambulance crew worked
with a hospital intern, carrying a large portable monitor to observe changes in the
patient from the time of pickup to the time of arrival at the hospital. It would be
another fifteen years before advanced care came to Toronto’s ambulances. In 1972
the Province of Ontario began to train ambulance crews through the community
colleges.
This new program, which started in September 1972 at Humber College with a class
of 25 students, provided 1,400 hours of theoretical, practical, clinical and field
training. Some of the first graduates of this course are still employed at Toronto
EMS.
The college paramedicine program is now typically two years long, and still provides
the standard for entry-level training into the field.
Amalgamation of Ambulance Services
In 1974, a number of tragic incidents involving the deaths of children and long
ambulance response times caused the Province to make the municipality the sole
ambulance service provider in Metro Toronto. As a result, the Department of
Ambulance Services (D.A.S.) was formed in February 1975, amalgamating the five
remaining private services (Hallowell, Kane, Locke-Metro, Ogden, and Watson), the
Provincial York Ambulance Service, and the Department of Emergency Services
ambulances into a single municipal ambulance service.
The infrastructure inherited by the new service included resources which were
scattered across the city in makeshift facilities. Headquarters was housed in a
decommissioned police station at 674 Markham Street, the dispatch centre was in
rented space at the Toronto Transit Commission headquarters, the garage and stores
were in a dilapidated warehouse at Spadina and Davenport, and the training school
was in another former police station at 135 Davenport Road. Crews were housed in
rented and borrowed facilities, trailers, and old service stations around the city.
Innovations by the new authority included centralized coordination, Emergency
Support Units, a station construction program, public CPR education and a
centralized emergency number (911). The new Toronto Ambulance Headquarters at
4330 Dufferin Street opened in 1981. For the first time, the critical functions of
administration, dispatch, stores, vehicle maintenance, and training were housed
under one roof, allowing the key functions to be fully integrated. The modern
ambulance service had truly begun.
First Advanced Care Paramedics
In 1984, Toronto’s first Advanced Care Paramedics hit the streets, armed
with an additional 1000 hours of training. (can you find Fader??)
In 1995, Toronto EMS introduced defibrillation as an emergency skill for
all paramedics. Later, in cooperation with the Ontario Ministry of Health,
the standard paramedic skill set was expanded to include the
administration of six of the most critical emergency drugs.
Toronto EMS Today
Today, under the direction of Chief Paul Raftis, Toronto EMS operates one of the
finest Emergency Medical Service systems in the world. Toronto EMS operates from
forty-five ambulance stations located across the city.
Our fleet of 208 vehicles includes 152 ambulances, 22 single-paramedic emergency
response vehicles, 16 mountain bikes and a staff of 950 paramedics who provide
pre-hospital care to the city’s residents and visitors. Computer-aided dispatch and
automatic vehicle locating systems work together to ensure that response to an
emergency is as timely as possible. Toronto EMS also provides medical support to
the Toronto Police Service Emergency Task Force, the Public Safety Unit, CBRN
(chemical, biological, radiological and nuclear response), the Heavy Urban Rescue
Unit and the Toronto Police Marine Unit. Our training programs and community
health initiatives are all in place to provide the citizens of Toronto with a better place
to live.