Toronto Paramedic Services
The City of Toronto Paramedic Services is the statutory emergency medical services provider in Toronto, Ontario, Canada. The service is operated as a division of the City of Toronto, under the Community & Social Services cluster. The service is funded by the municipal tax base, and operates similarly to other municipal divisions, such as the Toronto Parks, Forestry & Recreation division, or the Toronto Water division, but retains operational independence from other divisions. While under municipal government control, it is subject to provincial legislation and licensing. It is not the only service provider in its area; private-for-profit medical transport services also provide routine, non-emergency transports and coverage for special events, but the statutory emergency medical system is the only provider permitted to service emergency calls.
History
The City of Toronto has operated an ambulance service directly on an uninterrupted basis since 1883, when the City of Toronto Health Department acquired two ambulances to transport those with infectious diseases to the local sanitarium. Full-time emergency ambulance service began in 1888, with the provision of emergency ambulance service by the Toronto Police Force, which eventually operated four horse-drawn vehicles. Prior to these two municipal initiatives, ambulance service was provided for the young city by a variety of means, including both hospital-based and private companies. This 'broad spectrum' approach to service delivery would continue for more than ninety years.Toronto may very well be able to claim to have the first formally trained 'ambulance attendants' in North America, with the Toronto Police Force ambulance service staff receiving five days of formal training in their jobs from the St. John Ambulance Brigade in 1889. Training included first aid skills, anatomy and physiology. Such training for ambulance attendants was unheard of at that time, outside of military circles. The police constables assigned to the ambulance also did regular policing, when not required for ambulance calls. As the city grew and technology progressed, so did the ambulance service. The first motorized ambulance was actually purchased by a local funeral home in 1911, and the Toronto Police Ambulance Service began the conversion from horse-drawn to motorized vehicles in 1913, with the process largely completed by 1918. Over the years, the two City of Toronto departments would have their services supplemented by more than 130 individual ambulance operators, most of them private companies, and in suburban areas by several of the tiny, local fire departments. The two municipal services would finally be merged in 1933, when the Toronto Police Department turned the operation of their ambulances over to the Department of Public Health, and ended their involvement in the city's ambulance service.
This service would grow again in 1953, as the result of the creation of the municipality of Metropolitan Toronto, dramatically expanding the required service area. Service would continue in this fashion until 1967, when the amalgamated City's suburban fire departments surrendered their ambulances, resulting in the evolution of the Department of Public Health Ambulance Service into the City-operated Department of Emergency Services. Some private companies, and one operated by the provincial government, would continue to operate in 'Metro' Toronto until 1975, although with centralized dispatch services provided by DES.
The Metropolitan Toronto Department of Ambulance Services was created in 1975 under the leadership of John Dean, and absorbed the five remaining private ambulance companies and single provincial service, providing a single, unified ambulance service in Metro Toronto. Known colloquially as Metro Toronto Ambulance or simply Metro Ambulance the service provided ambulance services from 1975 to 1998.
Metropolitan Toronto was restructured during 1998, transforming it from a regional government overseeing six member municipalities into a single, unified city, and many municipal and regional services were restructured as a result. Metro Ambulance became Toronto Ambulance then Toronto Emergency Medical Services in 1998 under the leadership of Chief Ron Kelusky, in order to reflect its evolving role from primarily a provider of medical transportation to an actual provider of medical care. It was at that time that the service undertook a rebranding with the unique forward facing A on all of its vehicles.
The service introduced its first paramedics in 1984. Toronto EMS introduced many other innovations, including the concept of dedicated ground-based critical care transport ambulances in 1998, as well as many specialty support units described in this article, many of which were originally conceived and pioneered by the service.
As of April 2005, the departments and commissioners were replaced by divisions under the city manager. Toronto EMS now operates under the city's Emergency Medical Services Division. It is the largest municipal EMS operation in Canada and at the time was led by Chief Bruce Farr.
In July 2014, Chief Paul Raftis announced that as part of a rebranding effort, Toronto EMS will change its name to Toronto Paramedic Services. The change follows a national trend and drive for the adoption of Paramedic as the publicly recognized title for prehospital emergency care providers. On October 1, the new name came to effect.
Uniforms
Uniforms consist of:- Dark navy short or long sleeve police style shirt with departmental crest, reflective stripes around arms and Toronto Paramedic in reflective print on chest and back.
- Chartreuse high visibility jacket with Toronto Paramedic in reflective print on back as well as job title front and back. Certain Specialized Operations teams have their own distinctive coloured jackets: CBRNE paramedics wear Orange, Critical Care paramedics wear Red and Tactical paramedics wear Black.
- Dark navy cargo pants with reflective stripes around lower leg.
- White shirts for Supervisory/Management staff.
- Bicycle helmet and shorts for bike crews.
- Hard hat with visor as required.
- Black safety boots/shoes.
- FR Military style tactical shirt/pants, gloves, Ballistic helmet/riot helmet and Ballistic vest for tactical units.
- HAZMAT suits for CBRNE units.
- Dress uniform consisting of dark navy pants and tunic, white shirt, navy tie and forage cap. Paramedic uniforms have royal blue cap band and striping on pants. Management staff have black maple laurels as well as gold piping on cap peak. Striping is orange-gold for the honour guard.
Fleet
Of the 242 vehicles in the Toronto Paramedic Services fleet, 150 are CMVSS / Ontario Standard Type III ambulances. Of these, approximately 100 are in service at any time on a typical, mid-week, day shift. These vehicles are currently supplied by . They are mounted on Chevrolet Express van chassis with boxes custom built by Crestline to suit the needs of the service, As of 2025 new ambulances are built on the Crestline Fleetmax 2.0 ambulance platform. The department currently employs Chevrolet Tahoe SUVs for First Response and supervisory vehicles as well as an assortment of fully equipped but unmarked vehicles for senior management. Toronto Paramedic Services currently operates a fleet of custom built busses and equipment support vehicles for use during mass-casualty or large-scale events. Toronto Paramedic Services operates its own repair facilities, located at the service's Headquarters complex. All maintenance and repair work, and all equipment, radio, and medical electronics maintenance and repairs are performed on site by service staff.Fleet numbering
- 5XX - Paramedic Supervisor, Rapid Response, Special Operations
- 4XX,8XX - Ambulance, West
- 9XX - Ambulance, East
- ESUXX - Emergency Support Unit
Current fleet
2006 Orion Vii1 One example in service on Toronto Islands due to road width restrictions
2 Special Operations
3 Unmarked, issued to senior operations staff
4 Used for transporting large groups/special teams for events or deployment
5 Equipped with multiple, mission specific pods
Historic/retired vehicles
1 Vehicle actually owned by Lambton County heritage museum. Previously on display at Toronto EMS HQ. Similar to vehicles that would have been operated in Toronto during Late 19th/Early 20th century. http://www.horsedrawnambulance.com2Multiple model years used by department until final retirement.
3 Examples may still be in service as utility vehicles
Staff
Toronto Paramedic Services has 1500+ members including paramedics and other support staff. These are categorized as follows:- Paramedics
Management structure and how to identify:
- Acting Supervisor: 2 stars
- Supervisor: 3 stars
- Deputy Commander - Duty Officer: crown
- Commander: crown + leaf
- Deputy Chief: crown + leaf x2
- Chief: crown + leaf x3
- Other staff
Chiefs
The Toronto Paramedic Services Chief is appointed by the Mayor of Toronto and oversees the operations, management, and supervision of the Toronto Paramedic Services.| Name | Tenure | Ref |
| Ron Kelusky | 1998—2003 | |
| Bruce Farr | 2003—2011 | |
| Paul Raftis | 2011—2022 | |
| Bikram Chawla | 2022—present |
Communications
Toronto Paramedic Services operates its own Communications and System Control Centre, including emergency medical dispatch, patient distribution and system oversight. Toronto Paramedic Services participates in the community-wide 9-1-1 system, and triages emergency calls using the Advanced Medical Priority Dispatch System. The system uses Computer-Aided Dispatch, including Tritech VisiCAD, augmented by PDS and Optima Live software and technology. The service utilizes a satellite-based Automatic Vehicle Locating system in order to ensure that the closest appropriate response resource is consistently sent to each emergency call; all emergency response resources are included. The service utilizes a 700 MHz P25 Phase II trunking radio system for dispatch purposes. The Control Centre has direct landline contact with the 9-1-1 Center, all other emergency services, all acute care hospitals, and all Paramedic Stations. The service utilizes “Language Line” service to provide instant simultaneous translation of emergency calls in more than 140 languages. Toronto Paramedic Services operates the largest EMS Communications Centre in Canada, which was recently accredited as an International Centre of Excellence by the International Academy of Emergency Dispatch.Operations
Service is provided to a residential population of approximately 3.2 million people, which rises to approximately 5 million on most business days.Toronto Paramedic Services operates a total of 41 stations, geographically distributed across the of the City of Toronto. Emergency service headquarters is located at 4330 Dufferin Street in Toronto. This facility includes administrative offices, some education facilities, the Communications Centre, Fleet Maintenance, Planning and Operational Support, and Materials Management/Logistics.The service is supplemented by well-developed Paramedic Services in neighbouring communities on three sides, with Lake Ontario providing the southern boundary of the service area. Air ambulance operations are provided within the City of Toronto by Ornge, a privately owned air ambulance contractor, under contract to the Government of Ontario.
Based upon information provided by Toronto Paramedic Services, the service processed in excess of 535,000 calls through its Control Centre in 2007, resulting in 223,769 emergency calls being dispatched. Using the AMPDS system, which triages calls by severity for dispatch purposes, the actual dispatch volume by category for that same year was:
Ambulance Stations (6 Districts + Special Operations)
District 1 - Northwest
The District 1 Hub is located at 01 Station.| Station | Neighbourhood | Address | Vehicles Deployed | Notes |
| 01 Multifunction Station | Downsview-Roding-CFB | 1300 Wilson Ave | BLS, ALS, ARU/PRU, Supervisor, Logistics and Administrative | Post 01 & 01-Logistics in the same building, D1 Hub |
| 12 Station | Mount Olive-Silverstone-Jamestown | 1535 Albion Rd | ALS | N/A |
| 13 Station | Willowridge-Martingrove-Richview | 555 Martin Grove Rd | BLS | N/A |
| 14 Station | West Humber-Clairville | 321 Rexdale Blvd | BLS | N/A |
| 15 Station | Glenfield-Jane Heights | 2753 Jane St | ALS | Shared with Toronto Fire Station 142 |
| 17 Station/Post | Humber Summit | 50 Toryork Dr | BLS, BLS New Hire FTO | N/A |
| 19 Station | Weston | 2015 Lawrence Ave W | BLS, ALS | Shared with Toronto Fire Station 442 |
| 51 Station | Humber Summit | 61 Toryork Dr | 61 Toryork Dr | Located in the Northwest quadrant but controlled by the Senior Dispatcher for Spec Ops |
District 2 - Northeast
The District 2 Hub is located at 20 Station.| Station | Neighbourhood | Address | Vehicles Deployed | Notes |
| 20 Station | Dorset Park | 2430 Lawrence Ave E | BLS, BLS New Hire FTO, ARU, Supervisor | D2 Hub |
| 23 Station | Don Valley Village/Henry Farm | 115 Parkway Forest Dr | ALS | Shared with Toronto Fire Station 115 |
| 24 Station | L'Amoreaux | 3061 Birchmount Rd | BLS | N/A |
| 25 Station | Rouge | 8500 Sheppard Ave E | BLS, ALS | Shared with Toronto Fire Station 212 |
| 26 Station | West Hill | 4331 Lawrence Ave E | ALS, ARU, BLS Spare | Shared with Toronto Police 43 Division |
| 26 Post | Centennial Scarborough | 5318 Lawrence Ave E | ARU | Shared with Toronto Fire Station 215 |
| 27 Station | Milliken/Malvern | 900 Tapscott Rd | BLS | Shared with Toronto Fire Station 211 |
| 28 Station | Bendale | 2900 Lawrence Ave E | BLS | N/A |
| 29 Station | Agincourt | 4560 Sheppard Ave E | ALS, ARU | Shared with Toronto Fire Station 243 |
District 3 - Southwest
The District 3 Hub is located at 30 Station.| Station | Neighbourhood | Address | Vehicles Deployed | Notes |
| 30 Station | Weston-Pelham Park | 100 Turnberry Ave | BLS, PRU, Supervisor | D3 Hub |
| 31 Station | Kingsway South | 4219 Dundas St W | ALS, ARU | N/A |
| 32 Station | High Park | 9 Clendenan Ave | BLS | N/A |
| 35 Station | Liberty Village/CNE Grounds | 265 Manitoba Dr | BLS, Special Events Carts | N/A |
| 37 Station | Parkdale | 1288 Queen St W | BLS, ALS | N/A |
| 38 Station | Alderwood | 259 Horner Ave | BLS, ALS | N/A |
| 39 Station | Islington-City Centre West | 155 The East Mall | BLS | Shared with Toronto Fire Station 432 |
District 4 - Southeast
The District 4 Hub is located at 42 Station.| Station | Neighbourhood | Address | Vehicles Deployed | Notes |
| 21 Station | Wexford-Maryvale | 887 Pharmacy Ave | BLS, ALS | N/A |
| 22 Station | Scarborough Village | 3100 Eglinton Ave E | BLS | N/A |
| 41 Station | Broadview North / Thorncliffe Park | 1300 Pape Ave | BLS, SickKids ACTS | N/A |
| 42 Station | Birchcliffe-Cliffside | 1535 Kingston Rd | BLS, ALS, Supervisor | D4 Hub |
| 43 Station | South Riverdale | 126 Pape Ave | BLS | N/A |
| 46 Station | Danforth - East York | 105 Cedarvale Ave | ALS | N/A |
| 47 Station | Cliffcrest | 3600 St Clair Ave E | BLS | N/A |
District 5 - North Central
The District 5/Special Operation Hub is located at 55 Station.| Station | Neighbourhood | Address | Vehicles Deployed | Notes |
| 11 Station | Yorkdale-Glen Park | 1135 Caledonia Rd | BLS | N/A |
| 18 Station | Forest Hill | 643 Eglinton Ave W | BLS, ALS | N/A |
| 53 Post | York University Heights | 4330 Dufferin St | BLS | Book on at 01 Station. |
| 54 Station | Clanton Park | 4135 Bathurst St | CBRNE, CRU, ARU | Senior Dispatcher control for Spec Ops assignments |
| 55 Post | Newtonbrook West | 5700 Bathurst St | Supervisor | D5 & Spec Ops Hub. Shared with Toronto Fire Station 112. |
| 56 Station | Newtonbrook East/Bayview Woods | 3300 Bayview Ave | BLS | Shared with Toronto Fire Station 111. |
| 57 Station | Bridle Path-Sunnybrook-York Mills | 2075 Bayview Ave | ALS, BLS Spare | Located at the rear of Sunnybrook Health Sciences Centre. |
| 58 Station | Willowdale | 12 Canterbury Pl | ETF, TRU, CCTU, BLS | Shared with Toronto Fire Station 114. Senior Dispatcher control for Spec Ops assignments. BLS car book on at 01 station. |
District 6 - South Central
The District 6 Hub is located at 34 Station.| Station | Neighbourhood | Address | Vehicles Deployed | Notes |
| 33 Station | Dovercourt-Wallace Emerson-Junction | 760 Dovercourt Rd | ALS, BLS Spare | N/A |
| 34 Station | Bloor-Annex | 674 Markham St | BLS | D6 Hub, Safe City, Community Medicine |
| 36 Station | Waterfront Communities | 339 Queens Quay W | BLS, Marine Medic | Shared with Toronto Fire/Marine Station 334 |
| 40 Station | Church-Yonge Corridor | 58 Richmond St E | BLS, ALS | N/A |
| 45 Station | Yorkville | 135 Davenport Rd | ALS, BLS Spare | N/A |
| 59 Station | Toronto Islands | 235 Cibola Ave | BLS | Shared with Toronto Fire Station 335. |
Special operations
In addition to regular operations, Toronto Paramedic Services staffs a Special Operations Division, tasked with the provision of Paramedic services in unusual circumstances. The elements of this unit include:- Tactical Unit - Cross-trained paramedics providing medical support to the Toronto Police Emergency Task Force.
- Marine Unit - Cross-trained paramedics staffing the vessels of the Toronto Fire Services in order to provide support for Toronto Fire personnel and Paramedic services on the waters of Lake Ontario, and Paramedic service to the Toronto Islands.
- HUSAR - Specially-trained paramedics operate together with elements of the Toronto Fire Services, Toronto Police Service and Sunnybrook Health Sciences Centre Emergency Physicians to provide a joint-service Heavy Urban Search and Rescue team.
- CBRNE - Specially-trained paramedics operate together with elements of the Toronto Police Service and Toronto Fire Services to provide a joint-service Terrorism/Hazardous Materials Response team.
- Public Safety Unit - Cross-trained paramedics providing medical support to the Toronto Police Public Order Unit
- Emergency Response Unit - Single paramedics in SUVs, tasked solely with response to high priority emergency calls.
- Bicycle Unit - Paramedics equipped with mountain bikes, capable of providing either BLS or ALS services in off-road areas, or at special events. Team also works in concert with the Toronto Police bike team to provide first response capabilities in the Entertainment District on weekend nights.
- Emergency Support Unit - Paramedics trained to operate the service's busses and equipment trucks. These respond to all potential Mass Casualty Incidents, support for large crowd situations such as festivals and parades as well as responding to all calls involving aircraft at Toronto Pearson International Airport
- Critical Care Transport Unit / Team - Highly specialized paramedics responsible for moving extremely critical patients requiring ICU level care between hospitals; such as from regional hospitals to specialized neuro, trauma and cardiac centres. CCTU is also southern Ontario’s regional ECMO transfer team, responsible for moving patients on life saving ECMO care; covering southern Ontario from Windsor to Sudbury to Ottawa. Recognizable by their distinctive red sleeved uniform shirts and marked Toronto Critical Care Paramedic ambulances.
Challenges
Hospital in-patient beds and Emergency Departments tend to be severely overcrowded, resulting in difficulties for paramedics transferring the care of their patients to hospital staff in a timely manner. Two- to four-hour delays in the transfer of care are commonplace, and six- to eight-hour delays are not unheard of. When this occurs, the service's ability to provide service to emergency calls in a timely manner will often degrade, because of decreased unit availability. Multiple stakeholders and various levels of government are currently seeking solutions to this problem, but have, so far, experienced only limited success.The funding for Toronto Paramedic Services occurs as a result of a mixed formula, with fifty percent of funding coming from the municipal tax base and fifty percent from the provincial government. The funding of Toronto Paramedic Services is based upon its census population, not its business day population. As a result, there are always more people requiring EMS services than the system has been funded for.
Language barriers and cultural misperceptions in Toronto's multicultural landscape are commonplace for Toronto's paramedics. The service subscribes to Language Line, a simultaneous telephone-based translation service which operates in more than 140 languages. This service is used by Emergency Medical Dispatchers processing 9-1-1 calls, or by paramedics treating patients in the field, on a daily basis. The service also operates its own ethnocultural access program.
The 'Baby Boom' generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.