This blog post was written with my colleague Ruth Townsend and it also appears on her blog site: Health, law, ethics and human rights.

Firefighters may be asked to act as first responders to medical emergencies in the Sydney metropolitan area (see ‘Firies say they can’t step in for medicsSydney Morning Herald, 31 January 2013).

Ambulance officers (now generally referred to as paramedics) have historically been responsible for the‘first-aid’ emergency treatment of people in the pre-hospital environment and the transport of those people to hospital for more complete medical care.  The introduction of advanced life support paramedics in New South Wales in 1975 saw an expansion of the scope of paramedic practice beyond just the emergency first-aid response. Today paramedics deliver advanced, definitive care at the scene of an accident or illness and have skills to diagnose and monitor patients, administer drugs, including drugs of addiction, through a variety of routes and provide other high level interventions.  In-line with this expansion of skills has come an expansion of education with a shift away from on-the job vocational training to tertiary level qualifications. Today’s paramedic completes a three year degree before beginning their ‘on road’ experience.

Paramedics are busy, as the story notes “the number of ambulance responses increased from 1,149,820 in 2010-11 to 1,183,795 last year”.  Responding the local fire brigade can reduce the response time to an emergency.  The Metropolitan Fire Brigade in Melbourne has had this first responder role since 2001.  A study of the results of the first seven years of the MFBs ‘emergency responder program’ shows that firefighter ‘first responders’ are able to be on the scene with the patient, providing initial care such as CPR as well as assurance and comfort that further help is on the way.  Firefighters spent, on average, 4.8 minutes with the patients before handing over to paramedics (see Boyle M et al, ‘The first 7 years of the metropolitan fire brigade emergency responder program – an overview’ (2010) 2 Open Access Emergency Medicine pp 77-82).   In New South Wales the increased demand for emergency services and the expectation that people in rural and remote communities will  receive a level of service commensurate to the service provided in cities has seen the Ambulance Service of NSW, in conjunction with other emergency services such as the NSW State Emergency Service, NSW Rural Fire Service and Fire and Rescue NSW roll out the community first responders program.  Members of the emergency services, most of them volunteer, respond to ambulance calls to provide immediate first aid pending the arriving of the ambulance paramedics.

It’s true that “fire brigade officers received first-aid training, but it was nowhere near as advanced as training for paramedics” but whether its community first responders or full time Sydney firefighters there is no suggestion that these emergency service workers are taking on the role of, or “replace”, ambulance paramedics.  They are not expected to be trained to the same level or to transport patients from the scene of their illness or accident rather they provide initial first aid care (which could include the administration of oxygen, the use of automatic defibrillators and performing CPR) pending the arrival of the paramedics.  There is no suggestion that the fire fighters will be used to provide non-emergency patient transport services.

We understand there is a level of concern from firefighters regarding the expansion of their role – they will tell you that they didn’t become firefighters so they could be paramedics – there is really little basis for their concerns. Those concerns include:

  • Fear that they may be legally liable if they misapply or fail to provide healthcare to the patient. This fear is unfounded. The law offers them protection from any personal liability and they will only be expected to act reasonably in the circumstances; not to act as paramedics.
  • That they may not be remunerated sufficiently for undertaking this increased responsibility; but it should be noted it is already part of the role of the Fire Brigades (now known as Fire and Rescue NSW) to “take measures anywhere in the State for protecting persons from injury or death” even if the risk does not come from a fire or hazardous materials incident (Fire Brigades Act 1989 (NSW) s 7).
  • That they may not be sufficiently remunerated for learning new skills. This is a matter for the firefighters and their employer to determine. There are many examples of negotiations in enterprise agreements for increases in pay commensurate with increases in skill.

The ambulance service reform plan commits NSW Health to establishing “a project group with NSW Ambulance, Fire & Rescue NSW, the Rural Fire Service, the Ministry of Health, the Health Education & Training Institute, and the Agency for Clinical Innovation. This project group will work to resolve industrial, training and management issues affecting implementation…” of the First Responder Program.  This should give the firefighters the opportunity to raise and address these concerns but shows that this is not an immediate demand upon them

Paramedics are also facing role changes to meet the needs of the community.    With the likelikhood that paramedics will become registered healthcare practitioners within the next 2 years, there are moves  to expand their workplace beyond just the emergency pre-hospital care environment and extend it to include the management of patients at home within the community and deliver primary, preventative healthcare measures, like immunisations, within their local government area. This expansion of role and scope of practice is already being trialled in South Australia. Rather than seeing this expansion of the role of firefighters as a negative, it should be seen as part of the ongoing cooperation between the emergency and health care services to deliver faster, and improved emergency assistance.  Firefighters have always provided first aid when required, eg for people injured in a fire, and have always been ready, willing and able to assist other emergency services, including the ambulance service, when requested.  This is another opportunity for them to contribute to the well being of their community but not at the expense of, or to replace the excellent service provided by NSW paramedics.

Ruth Townsend and Michael Eburn
31 January 2013