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October 15, 2014, Toronto Paramedic Erin Stankevicius taking personal protective equipment training at Toronto Paramedic Services Headquarters in Downsview.

Ambulance services in Toronto, Hamilton and Peel – the region that includes Canada's busiest airport – are scrambling to prepare nearly 1,800 paramedics for Ebola after Ontario Ministry of Labour inspectors found they had not outfitted or trained their emergency responders well enough to safely transport patients with the disease.

The inspections were conducted on Oct. 14 in Peel and Oct. 16 in Toronto and Hamilton, two weeks after the first case of Ebola was diagnosed in the United States, and months after the Ebola epidemic in West Africa began to spiral out of control, raising the still long odds of the virus finding its way to Canada.

"At the time of this visit, it was learned that workers have not been acquainted by the employer with the hazard related to [Ebola virus disease]," according to the inspection report for Peel Regional Paramedic Services, a copy of which was obtained by The Globe and Mail. "Further, the workers have not been provided training and instruction related to the use, care and limitations [of personal protective equipment], including how to don and safely remove [it.]"

The reports for Toronto and Hamilton, also obtained by The Globe, reflect similar concerns. Some Toronto paramedics, worried about their potential exposure, were threatening to refuse work before the inspectors were called in, their union said.

Last week another case of Ebola was confirmed in the United States, this time in a New York doctor who had returned from caring for Ebola patients in Guinea. When he developed a fever Thursday, he was transported to hospital by ambulance – a reminder that paramedics, like their hospital colleagues, need to be ready to care for Ebola patients.

Public health officials in Canada, however, continue to stress that the risk of an Ebola case turning up here is "very low," and that the virus is transmitted only by direct contact with bodily fluids, making it difficult to catch.

Across Canada, provincial governments are taking different approaches to preparing their emergency services workers for Ebola.

In Quebec, the Health Minister has promised that specialized paramedic teams will be sent to pick up patients anywhere in the province if they test positive for the virus or if they display infectious symptoms such as vomiting and diarrhea after travelling to the outbreak zone.

Alberta, meanwhile, is training and outfitting emergency responders for Ebola, not designating specific ambulances or crews.

In Ontario, the Ministry of Health and Long-Term Care is in the midst of designating and equipping ambulances to transport patients with confirmed cases of Ebola to one of 10 treatment centres; the ministry is also looking at isolation pods for use in the designated ambulances.

But until at least the middle of this month, some paramedics in Toronto, Peel and Hamilton felt unprepared.

"There were obviously grave concerns from our membership with respect to their protection in the event of doing a suspect Ebola call, to the point some of our members were contacting us because they were on the verge of work refusal," said Mike Merriman, EMS unit chair for CUPE Local 416.

Adam Thurston, the acting commander of the community safeguard services program at Toronto Emergency Medical Services, said that now Toronto EMS is purchasing enhanced personal protective equipment. It is also sending supervisors out to deliver hands-on training sessions during lulls in paramedics' shifts, an approach the union calls ad-hoc and opposes.

"What we're trying to do is have one-on-one sessions," Mr. Thurston said. "Understand that we have to reach over [950] paramedics in a very short time period, as quick as we can. That's the best way for us to actually get out there and do it."

With reports from Allan Maki in Calgary and Les Perreaux in Montreal

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