Toronto firefighters are no longer being dispatched to a number of urgent medical calls, prompting concerns within the ranks that opportunities to provide life-saving interventions are being missed.

The changes to the city’s 911 protocol were put into place in June 2012 in an effort to optimize the delivery of emergency services. But according to high-ranking past and present members of the Toronto Fire Service, not sending their trucks, which can often be first on scene, to dozens of types of medical calls — including certain kinds of strokes, chest pains and gun shots — is putting residents at risk.

“There could be patient jeopardy, that’s the potential,” said former Toronto fire chief Bill Stewart, who opposed the changes before he retired last year. “If the city wants to play Russian roulette with the dollars and cents of not sending fire(fighters), that’s their decision.”

The decision to stop sending firefighters to the medical calls was made on the recommendation of the city’s tiered response committee, which includes representatives from fire, police and emergency medical services.

Former emergency room doctor Brian Schwartz, co-chair of the tiered response committee, said the changes, which were based on the recommendations of a panel of medical experts, had nothing to do with cost-cutting, and are instead part of a continuous effort to refine the system.

Unlike in past reviews, Schwartz said he and the other doctors relied on nine months of electronic data gathered by paramedics in the field, made available for the first time in late 2011. The data offered a more accurate view of the medical calls where firefighters, who carry defibrillators and receive basic medical training, could provide effective intervention, he said.

“When we’re looking at tiered response, we have to look at outcome,” Schwartz said. “Were they (firefighters) actually needed from a medical standpoint? Were the skills they bring to the call required?”

Based on the data, the medical experts recommended that firefighters only be dispatched to types of urgent medical calls where they intervened (or could have intervened) in at least one per cent of cases, a threshold Schwartz called “medically quite reasonable and ethical.”

Data provided by the Toronto Fire Service shows that following the review, firefighters were removed from more than 50 types of medical calls, including one described as “stabbing/gunshot/penetrating.” They were also added as first responders to 22 kinds of medical calls, such as certain types of allergic reactions, pregnancy complaints and cardiac arrests.

The data have since been updated and reviewed again, and firefighters were recently reinstated in a half-dozen types of medical calls, including certain kinds of traffic accidents and chest pain complaints.

John MacLachlan, executive officer of the EMS committee for the union that represents Toronto firefighters, was concerned about the changes, and asked area captains to keep him abreast of any medical calls where they believed that they had not been dispatched soon enough — or at all.

MacLachlan, who is an acting captain, estimates that up to 25 calls have been brought to his attention each month. Of those, he has deemed a total of about 120 to be “cause for concern,” and passed them on to his superiors.

The latest: the police shooting death of 18-year-old Sammy Yatim.

Cpt. Paul Beames said his squad was returning to the fire hall at College and Bathurst Sts. when they happened upon the police barricade around midnight Saturday. Beames said a police officer at the scene told him they needed help from fire “because EMS was delayed.”

Beames said his crew assisted with CPR and began to prep the defibrillator before EMS arrived several minutes later. EMS dispatchers are responsible for alerting firefighters when they are needed on medical calls, but they did not do so in this case, as Beames later learned.

Beames told the Star that it’s tough to predict what his team, if dispatched earlier, could have done to save Yatim, who suffered “major chest trauma.” But he sees this call as an example of when firefighters “should have been called.”

(Schwartz would not comment on this case but said that when cardiac arrest is caused by penetration, “the survival of these patients is zero.”)

Toronto EMS Deputy Chief Gord McEachen said paramedics were not delayed in responding to Saturday’s police shooting, and arrived at the scene in less than six minutes.

Firefighters weren’t called because the information provided did not indicate fire should be dispatched, McEachen said.

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“The tiered response process is all medically based,” he said. “The recommendations from this group of physicians, that’s what we base our decisions on.”

Toronto fire Chief Jim Sales said there is more that can be done to ensure that paramedics and firefighters are pursuing a more “collaborative approach.”

“Are we responding to the correct number of medical calls? That’s a question, and I think we need to continue asking that. I don’t feel that this is a proprietary business.”