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 medics’ Sydney 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
Australian Emergency Law 
The expansion of the Paramedics role to registered healthcare practitioners is an interesting one…..
I don’t see what the problem is. Fear based analysis by some isn’t helping. I enjoy the the fact the Firefighters in Victoria are there when a cardiac/respiratory arrest or potential case is called. THAT is the reason the EMR concept was created.
The same rhetoric from critics happened in Victoria.
Firefighters have increased their roles from firefighting to rescue services and no one batted an eyelid.
The cynics will say it undermines Paramedics. It doesn’t. This isn’t about egos but patients needing first responder care-defibrillation, CPR, oxygen in a timely manner. These are all considered first aid skills by most experts. Should firefighters refrain from on scene first aid and wait for Ambulance to do so?
Firefighters are sitting on their backsides most of their day, getting paid, why not use them productively?
Increasing the number of paramedics employed will only happen if paramedics actually want to work for ASNSW.
I totally agree Brent.
In a medical emergency such as cardiac arrest there is what is known as a chain of survival. Like any chain, if the links are weakened or broken, the chances of survival are severely decreased.
This chain has four links and they are the following
1: early access – arrival at pt within the shortest time possible
2: early cpr- the sooner CPR is commenced, the higher the chance of heart muscle survival.
3: early defribrillation: given that the heart is in a shockable rhythm from the Automatic External Defribrillator (AED) then the shock is vital for causing a stop, reset of the rhythm into sinus.
4: early difinitive care – this ranges from the care of a MICA paramedic to the additional care given in a hospital.
The sooner the first 3 parts of that chain occur, the higher the casualties chance of survival.therefore, the use of the MFB/CFA in victoria and fire rescue in nsw that would not necessarily be doing anything for up to 70% of most shifts, now respond directly to these jobs and decrease that early access times. Information shows that MFB fireies no do more work at night doing MFR than fire call outs on a regular basis, puts our taxpayers money usefully into the health of our population.
Fire brigade members will never be required to insert an IV cannula to give fluids, nor will they ever give advanced drugs, there is no risk to paramedics at all.
You are deluded Mr Eburn. This absolutly undermines Paramedics! If myself or a loved one suffer a Cardiac Arrest or any acute, time critical medical emergency, I want trained, competent PARAMEDICS on the scene providing me/my loved one with all treatment possible! “Fire and Rescue” should not even be involved. I want Fire Fighters available to FIGHT FIRES! To have a Fire Fighter providing “first aid” because there are not enough Paramedics to meet demand, or when there is an Ambulance stuck in “Bed Block” down the road, absolutly undermines Paramedics and is simply not good enough. The problem you don’t seem to understand is that emergency pre-hospital care is the core role of a Paramedic, not a Fire Fighter. Currently Paramedics resources are run unacceptly thin and this is risking lives. “Fire and Rescue” have better response times because there are so many of them! If this were truly about “response times” than the solution would be to provide more paramedics, or more to the point, free Paramedics from inapropriate, low acuity calls and bed block at hospitals. You are suggesting replacing the “core role” of Paramedics with a “Fire and Rescue” team, and reducing the role of a Paramedic to merly a mode of transport.
I don’t agree with your assessment of my understanding of the core role of paramedics, or that “I” am suggesting anything; but debate’s a good thing.
I was tempted to let sleeping dogs lie. However seeing that it’s acceptable to question the merit of non existent delusional beliefs, I have to chip in.
The concept of FireFighter First Responders is not to replace core paramedic work. One of the accepted core roles is transport to hospital. This is not, I would imagine, part of the NSWFB ensemble.
The reality is, that even if the bed block crisis (that affects every state) were solved, Ambulance would still be tied up. Demand is never met in ambulance as call load and acuity are dynamic. All the modelling in the world is about as useful as a paper mache bullet proof vest.
As semi-automatic defibrillation, CPR and even oxygen via a resuscitator are all first aid skills now, then as first responders, that is the scope of First Responder use.
Firefighters are idle between fire calls. That is why they are used. The concept of them not being available for Fire and Rescue Roles is also invalid as move up policies and excluding Rescue Crews allows responses targets for core firefighter roles to be met.
Perhaps we should take cervical collars and stretchers off firetrucks as they are Paramedic core tools. Even the oxygen equipment carried on Rescue trucks should be removed.
Lets take defibrillators and oxygen off St John, Surf Lifesaving, The Red Cross, The Australian Defence Force and every other organisation that doesn’t use paramedics doing “core ambulance work.”
Police in some jurisdictions overseas do carry defibrillators and if they were similarly idle it might be worth considering; if they were cheap enough it might even be a common occurance
If our concern as pre-hospital professionals is the patient first and foremost then expecting that Paramedics are the only ones to deliver defibrillation, we are selling our public and patients short. When they are watching their loved one head towards the light they just want them saved. We know defibrillation works with CPR. Research shows that most other interventions like ETI and drugs don’t work and in fact may precipitate mortality.
Bedblock and other shortcomings of our profession are significant concerns but so is the lives of patients that can be saved promptly with access to the chain of survival as it was intended.
I also don’t see this as a threat to anyone’s “turf” so to speak and support the concept. However, the broader issue of increasing services to meet demand is something that could potentially be manipulated with this kind of strategy. Michael and Ruth rightly state that the Fire Service will not be providing transport as one of the factors that will ensure that Ambulance resources will still be required to meet demand. The problem is the way “demand” for service is determined which is still a large part to do with response times. A reduction in response times resulting from this strategy may artificially take the pressure off of government to provide an adequate resources to NSW Ambulance and further increase the demands in existing Paramedics “mopping up” the transports after the Fire Service has responded within 5 min and met the response KPI for that case. The other factor mentioned is community first responders which are a bit of a separate issue as they will transport if the system supports it and there are a number of places in NSW and other states where this is the case. There are obvious economic benefits for governments to utilise first responders in this way and often the communities do not even know that they are not receiving the same service as their city cousins as they wear the same uniform and drive the same ambulances but are far more limited in the potentially lifesaving interventions they can perform. Registration may in part resolve these issue if it is implemented correctly as there will soon be expectation that a “Registered Paramedic” responds to their community as is the case in the city whereas now the delineation is much less clear.
Jamie, there are some interesting comments on community first responders here. My experience with them is that they turn out very much in their service vehicles (eg FRNSW or NSW SES vehicles – though I’ve seen the SES with dedicated station wagons rather than their storm/rescue vehicles but still marked SES) not in ambulances and not in ambulance uniform. There is a difference between community first responders and honorary ambulance officers (who are members of teh ambulance service, appointed under the Health Services Act 1997 (NSW) s 67H, not SES, NSWFR or RFS community first responders) who are indeed volunteers with the ambulance service and wear ambulance uniform and drive an ambulance (I was one for two years) sometimes working with paid staff and sometimes in all honorary stations.
Hi Michael
Yes you are correct; I was using the wrong terminology when describing volunteer Ambulance Officers as community first responders. I do however stand by my comments in relation to the utilisation of volunteer or retained ambulance personnel by some state authorities. I completely agree that they are a valuable asset in areas of low workload where distance from qualified Paramedics is an issue. I also believe that some state authorities are shirking their responsibilities somewhat in areas where there has been significant development and population growth but the volunteer workforce remains. When I talk to people I know in these areas the common response is that they assumed the Ambulance personnel in their communities were the same as those in the cities. These are not small country towns that I am referring to but often what started out as small coastal villages that have had a boom of development in the area over the last 20 years or so resulting in a significant rise in population. As you would be well aware, the volunteers in these communities are highly dedicated people who do their absolute best but some of the workloads that they are enduring is beyond what I would describe as appropriate for that model of service provision. I can’t claim to know at what point the state ambulance authority decides to replace a volunteer service with a full time model but I would suggest that it doesn’t often happen until there is some kind of community uprising or local member takes it on as an election issue.
Jamie, there are interesting issues that I don’t have figures on but I’m sure the issues arise with all our emergency services. At what point does the fire service move from a fire station staffed entirely by part time retained fire fighters to a full time crew with a better response time? I’ve also wondered if people driving in the country realise the rescue service will be volunteer – there is no doubt that the volunteers do a fabulous job, but their response times must be lower if they all have to leave work, get to the station, get their uniform on and then turn out. On the other hand I do suspect that there are in fact policies in place, certainly in a country town I used to live in the Fire Brigade did move to employ full time firefighters to cover the day shift without loud public action. There’s a difference between the political imperative that the elected politicians face and the daily work of the public sector, whether I’m naive, a ‘pollyanna’ or just an optimist, I actually think the public servants spend a lot of their time actually trying to deliver a service, hence my reluctance to conclude, without evidence to the contrary, that the plan to use NSWFR as first responders is just a cost saving exercise, and not actually an attempt to improve the health services delivered to the community.
The magic word in the argument put up by NSWFB staff is “remuneration”.
The MFBB Chief Fire Officer at the time, implemented the first responder system in Metropolitan Melbourne to save jobs. I recall the CFA welcomed it including career fire fighters but the MFBB fought against it.
At the time in the late 90s, the Victorian Department of Human Services was pushing to implement CERT programs. There were unofficial CERT units floating around such as Craigeburn SES.
The mantra of “First Aid Saves Lives” has been around since WW2. There are many studies that the use of SAED by police, fire fighters, community groups and public access SAED has saved hundreds possibly thousands of lives in the western world. The ARC, Australian and American Red Cross and St John Ambulance advocate this.
The fire brigade has a high public image, no matter what activities they choose or to do or not to do. No one ever questions the FB unless its a coronial inquiry, as they are a sole purpose group that is paid (in most cases) to sit around and wait for something to happen. This can be seen as elitist and reflect in the corporate culture behaviour by its members.
With multi-skilling being the buzz word of the 80s and 90s and in the new century changes in the way we work, upskilling and service provision should be put before “remuneration”
HI Michael – The problem is the ASNSW hasn’t increased staff levels since 1998 and are currently short 750 Paramedics. NSW population has increased dramatically in this time and that’s why ASNSW battles to achieve appropriate response times. This push for 1st responders is to save the cost of employing the correct amount of Paramedics needed to provide the service the public expects.
I am a Paramedic and also a Retained Fire fighter so I can see fears facing the fire fighters. The Fire fighters want ASNSW to employ the correct amount of Paramedics and not just pass off the poor response onto other services to cope with.
Cheers
Tony
Tony, there’s no doubt great dissatisfaction with ASNSW and across the country regarding ambulance workloads, staffing and rostering. But call me idealistic I’m not convinced that ‘[t]his push for 1st responders is to save the cost of employing the correct amount of Paramedics…’ because it would make so little difference, the first responders still need to be supported by paramedics and no service can afford to have sufficient slack to meet all peak demand so there will always be cases where ambulances may be delayed or a fire crew would be closer, so why not consider using these resources to benefit the patients. Internationally fire services led the development of paramedic services and the fire authorities are paid for out of the public purse, if this is a service they can supply – making sure all the industrial issues are dealt with and that they are still available for their core function of fighting fires – then that’s for the good. It should be noted that the Ambulance reform paper (which also advocates moving non urgent patient transport away from the ambulance service, again following Victoria’s lead) is just a proposal paper. This system is not yet in place but an idea to be explored. The issue with the article in the Herald and the implication from the comments is the inference that fire fighters will be used instead of paramedics, not just a first response to provide some care. For example in the story by the ABC (Outrage at plan for firies to act as ambos) we are told:
But it’s not an issue of firies or paramedics, but firies then paramedics. Paramedics are trained in all sorts of life saving and highly complex interventions but ‘it’s not really the same sort of training that a specialist emergency medical practitioner has been through’ but that doesn’t mean we shouldn’t have paramedics or respond them to emergencies. If the option is having a fire fighter, trained in first aid and with an oxy-via and defibrillator, or no-one for 5 minutes, isn’t it better to send the fire brigade to do something, not to provide the sort of care a paramedic would provide, but to do something that’s better than nothing, until the paramedics get there?
The Chief Executive of the Ambulance Service is quoted as saying:
If all that’s true (and the various unions/staff may want to argue it’s not true, but in a Pollyanna way, let’s assume it is) then provided the industrial issues are considered, the plan can only be for the benefit of those in need and fire fighters may not have joined the fire service to be paramedics, but again, in a Pollyanna sort of way, my experience and hope is that they joined because they like the challenge and the capacity to help. They already turn out to lots of non-fire events and help their fellow emergency service workers and their community in all manner of ways. This could just be another string to their already impressive bow?
A great response michael
Once again, we see the proposed solution to the NSW ambulance service’s many problems is to set up a parallel system involving fire service first responders. While I would not argue against the need to get a defibrillator to a patient in cardiac arrest in as short a time as possible, I strongly believe the answer to Ambulance Service of New South Wales particular problems is not by duplicating the response system. How does it make any sense to send a big red truck with four firefighters to a medical call when ambulances and their highly qualified crews of two are sitting ramped at public hospitals. During the 1990s, ASNSW introduced motorcycle paramedics in the Sydney CBD specifically to respond to cardiac arrests faster in very dense traffic. Traffic densities have increased and now someone wants to send a huge truck into that traffic.
This is not a dispute over turf, it is a dispute over the need to ensure ambulance services are funded AND MANAGED with the best interests of patients in mind. This current proposal is a sad indictment of the way the NSW ambulance service has been managed and funded for more than a decade. Increasing the numbers of paramedics is not always the most effective solution.
It’s not a duplicate response system, it’s a tiered system.
It makes every sense to send the closest emergency resource with a defibrillator.
If it’s a Fire Truck, then that is what it is.
No different to a motorcycle. Why send a motorcycle when you could send an ambulance?
First responder systems exist world wide as TIERED responses not replacement services.
The best interests of a patient are served by a defibrillator and CPR.
Having sufficient ambulance and paramedics is separate issue. It wouldn’t matter if you put a paramedic on every corner. They would all be used up in a heart beat, still requiring first responder support. No different to hospital beds. Build more hospitals, they will come. Despite calls of despair, no matter how many you build and how many beds they open, they will fill up. It’s about smart use of services, not bottomless pits of supply.
This is not a tiered response system; the operative word being system. It is a bandaid approach to addressing the major problems of the ASNSW.
As I said in my original response, I applaud any system that would reduce the time it takes to get a defibrillator to a patient in cardiac arrest.
My point is simply that the introduction of another player is counter productive unless the operational “problems” of the ambulance service are addressed first. The ambulance service has had a tiered response system for almost 30 years and is the agency best suited to responding to medical emergencies.
We don’t need to emulate the American system. We are still not American and our emergency medical system (system, not service) is superior.
Brent you wrote “It’s not a duplicate response system, it’s a tiered system.
It makes every sense to send the closest emergency resource with a defibrillator.
If it’s a Fire Truck, then that is what it is.”
If this is honestly only about getting a defibrillator on as soon as possible why aren’t the police also being trained and called to the same emergency?
Whiskey Zulu said “If this is honestly only about getting a defibrillator on as soon as possible why aren’t the police also being trained and called to the same emergency?” That’s an interesting question and for those with time for extra reading, and who think the US always leads the way, I’ve just come across this (47 page) article: Fey, Clint J, “Improving cardiac arrest survival through the utilization of trained law enforcement officers” http://www.usfa.fema.gov/pdf/efop/efo46211.pdf
Summary/abstract:
Sudden cardiac arrest remains a leading cause of death nationally. The problem was that the West Metro Fire Protection District lacked a comprehensive cardiac arrest incident response policy that engaged trained law enforcement officers. The purpose of this research was to examine the feasibility of utilizing trained law enforcement officers to reduce response times and improve cardiac arrest survival rates. The researcher examined the following three questions: (a) What is the current cardiac arrest survival rate in the West Metro Fire Protection District and how does it compare nationally? (b) What is the average and 90th percentile response time to cardiac arrest incidents in the West Metro Fire Protection District and how do the times compare to those of law enforcement? and (c) What current law enforcement cardiac arrest response policies exist both locally and nationally and what are the key factors for success? To answer these questions, the researcher examined response records from cardiac arrest incidents, obtained response time data from the Lakewood Police Department and performed several interviews with the program coordinators of successful police AED programs. Results indicated that no consistent national data for cardiac arrest survival exists but that West Metro Fire’s survival rate had room for improvement. Data showed that, on average, law enforcement arrived to critical incidents faster than fire/EMS personnel and that engaging law enforcement in cardiac arrest incidents had historically improved survival rates elsewhere. Suggestions were made to pursue a partnership with local law enforcement to craft a comprehensive policy in order to engage police officers in CPR and the use of an AED device.
As a firie I can see the merit in providing a first responder service to the people of NSW. However there are a couple of big concerns that most of us have when being told we will be taking on this additional work. First and foremost is the training; having only completed a basic first aid course, there is nothing worse than trying to deal with a critical medical emergency and feeling completely over whelmed or un prepared. That feeling of uselessness (for lack of a better word) makes dealing with the traumas we face regularly, infinitely harder to deal with and overcome. Sure we see a lot of other traumatic things in our line of work, but we are trained to deal with the impacts of fires, car accidents and other such incidents and can leave those jobs knowing we did the best we could for the people involved.
Just spare a thought for the impact this will have on the crews themselves as they try to save someone’s mother, father or child with in-sufficient training for the role the public will come to expect of us (they don’t all end with smiles and hugs all round!). Seriously think of what it would be like if it was your child involved and you got under trained firies instead of an ambo. Give us the tools, training and resources to make a difference and we will!
And let me tell you the training we get in our core roles is virtually nonexistent, so I don’t see the gov’t ponying up the dollars to cover this. We currently have to jump through hoops just to get our first aid certificate renewed every three years (many are out of date waiting for the training). Don’t get me started on other training aspects of our job.
All this going on while stations are being closed, vacant positions are not being filled and our basic award conditions are being attacked. And before you jump on the bludging, overpaid firie band wagon, I joined this job to help make a positive difference in people’s lives. But this is still my job, my occupation, my way of feeding my family and putting a roof over their heads, as all us workers in the state try to do. So cut us a bit of slack when we try and defend our award conditions against politically driven agendas.
Solve the root of the problem outright, get our health system fixed, get the ambos out of emergency wards and back on the road with the resources they need and then if firies are needed, so be it. Let’s not settle for patch work fixes to critical services so a political party can crow about their so called good deeds!
Andrew, these are good points and good to hear from someone directly from the ‘fire ground’. There are I think two issues here, the first is whether using FRNSW resources as first reponders if they are available; the second is the industrial issues that need to be dealt with. As has been said elsewhere I don’t think this proposal is about getting a firie instead of an ambo, it’s about getting a firie before an ambo.
But having said that I don’t deny for a minute that the government also needs to solve the issues relating to ambos being tied upat hospitals, that firies need edequate training (and it suprised me when I was an ambo, a very long time ago now, when people said we were trained to handle trauma etc; my training involved how to handle it technically, not emotionally, perhaps things have changed) and compensation, and job security and all the things mentioned. Again, as I’ve said elsewhere I at least am prepared to assume that the propsers of this idea are really concerned with improving community services rather than a cheap way to try and solve larger problems that they are not able to fix without a different level of commitment. They have to come up with a proposal for the world as it is, rather than as they hope it might be. Changing the resource choices is a matter for the MPs, not the public servants who are asked to think about options to improve service.
Perhaps we can ask in the best of all possible worlds, with the ambos and firies and hospitals appropriately resourced, there would still be a delay between ringing 000 and getting an ambulance on scene, if a fire crew are closer and can do CPR and use a defib, and have been trained to do so, would getting them there to do something pending the arrival of an ambulance be a good idea? It’s a practice used around the world so is there something in it for us, or does the fact that unlike other places (such as the USA) both our ambulance and fire services are state run mean that we don’t need this model?
I hope we can distinguish the issues regarding whether its a good idea in the best of all possible worlds from the industrial issues, but I also hope and believe that no one contributing to this blog is on the “bludging, overpaid firie band wagon”.
There is another group out there that are willing to help and have a better training base then Fire-fighters. They work for free and do it happily.
It is the St John’s volunteers. Why can’t they give them a bus for the night and let them do what they want too. The fire services have the RFS that work for nothing. Why not have a Volunteer side to the Ambos’.
A lot of Fire fighters are not against the idea. We just want to be trained to a level above sticking a jelly bean under a tongue of a type 1 diabetic and witnessing a death. Don’t forget that we can’t even give someone their angina meds or a diabetic Glucagon. Any fool knows that if you don’t inject glucagon into a type 1 diabetic in a low they will die.
Michael
Thanks for the very reasoned comments. Personally, I have the utmost respect for fire-fighters and count some as long time personal friends. My concern is not about using fire brigades in general, my concern is that it is a cyncial proposal instead of fixing the response capabilities of the ambulance service. Rather than setting up a paralell system (call it what you will) I believe the reasons that ambulances are not readily available to respond should be addressed. ASNSW has a proud history of excellance in prehospital care through innovation, “pushing the envelope” and setting itself high standards. Unfortunately, it has been failed in recent times through concentrating on those aspects of the organisation those in charge understand, rather than putting their efforts where they should be; that is clinical care and patients.
It has been shown time and time again that the earlier C.P.R. and defibrillation is provided in cardiac arrest the greater the chance of survival this is not about having the fire service transporting patient’s, but having them respond if they are close at hand.
It should also be pointed out that public access defibrillation is now being taught as part of as part of an advanced first aid course to the public so why can’t these skills be used by the fire service I think the ambulance officers union should get of their high horse and stop spoiling for an industrial fight. At the end of the day if it helps save a life why the hell not but as long as the fire service officers receive the appropriate training to enable them to carry out the first responder task. While I see the merits of St John volunteers under taking this task I don’t think it would work in a busy metropolitan city environment as the key here is having the resources on hand ready to go. If you rely on the volunteer model you will be at the mercy of trying to have volunteers on hand a bit hard when the volunteers have to hold down a job.
I can also see the ambulance officers union point of addressing the attrition rate of paramedics but I see that as completely separate issue.
Michael, thanks for your feed back and the very reasoned responses from everyone so far. I think if we were to grossly simplify the matter with out taking into account the many other issues people have raised, then yes firies acting as first responders makes sense. There is no denying that getting someone (anyone for that matter) to a critical incident quickly, will have some form of a positive impact.
However, where i unfortunately differ in view is the assumptions that we are having to make in order to make this proposal work. Call me a skeptic, but based on the cuts and other changes coming down the pipeline for not only firies, but other essential services as well, i simply cannot accept that the government is proposing this simply for the benefit of the community. For mine it wreaks of a “band aid” and short sighted approach to solving the bigger problem.
Will firies likely end up doing the role of first responder? Well from what we are all hearing, yes. It certainly sounds like the decision has already been made for us. Do i think we will get adequate training to take on the role properly, unfortunately no. There is simply no money left to provide the training (that is according to our heirachy anyway) I could provide many examples to support my claim, but that will likely go beyond the scope of this topic.
As a firie, would i personally ‘like’ to do first responder myself, put simply, no. I considered becoming an ambo and felt it wasn’t for me. Would I take on the role if necessary to help out the public, absolutely. I only hope that the Gov’t and FRNSW management will provide us with the right training and tools to do the job right!
Andrew
I think you have hit the nail on the head that the issue is really whether this proposal is a bona fide effort to improve patient outcomes, which is all for the good; or is it an attempt to paper over cracks in the system and to avoid fixing issues in paramedic staffing, and probably more importantly, in staffing public hospitals. And that depends on who you’re talking about, the public servants (and I declare that for short time I was a public servant in NSW Health) have to do what they can with what they have, they can’t fix the hospitals any more than the paramedics can, so their proposal may well be a ‘bona fide effort to improve patient outcomes’ at least bona fide by them; but that doesn’t mean that the elected government can’t and shouldn’t take responsibility for the state of health care in NSW. But then there are always demands on governments to provide services that they can’t afford whether its health care, education, law and order services, social welfare services, roads etc, etc, etc. These are ‘wicked problems’ but given ‘the state as it is’ (rather than the state as we wish it was) what does the proposal look like?
I join you however in hoping ‘that the Gov’t and FRNSW management will provide [you] with the right training and tools to do the job right!’ If it really is intended as a cynical cost saving exercise then let us hope that the costs of equipping and training the fire fighters are not also cut. I infer from the debate here that the front line paramedics and fire fighters may not have much confidence in that outcome?
Michael
A different angle is that the legislation ( Fire Brigades Act 1989) in NSW suggests something other than the perceptions of what fire fighters do, as has been discussed in the comments here. In short one will encounter scant evidence of “firefighters” or any focus just on “firefighting” in the provisions of FB act as such relate to FB operations. These terms are almost a popular invention, and so poulalrly assuming that a fire fighter fights fires only. It is perhaps a handy description for use by those opposed to the reforms.
These perception of course are a far cry from the actual arrangements in NSW. In NSW, a “fire brigade” ….”must”… “try by all possible means to render the site of the incident safe, and save any lives and property that are in danger”. Not much firefighting or many firefighters to be seen there. These provisions apply irrespective of anything to the contrary” in any act”. This of course includes therefore, anything to the contrary in The Fire Briages Act itself given that the Fire Brigades Act meets the criteria espoused by the term “any act”.
I am certain therefore that the arrangements are intended to promote a confidence within members of a fire brigade, whilst in attendance at an incident, to do all they can do to save lives. The proposal as discussed acts to merely reinforce and promote this simple notion.
The purpose as Fire Brigades Act as stated in its own peamble is to protect life and property. Would not the protection of life also encompass the preservation of life? Are not the efforts of a fire brigade when using anything from a defibrillator to a doorbuster in order to save a life, wholy representative of a fire brigade trying “by all possible means to save any lives” with the emphases on “ALL and “ANY”? I am not a member of any emergency service but is clear that the functions and the onus posed upon members of a fire brigades, as they are in the case of other services as well, are matters concerned about broader public safety issues and less about firefighters and firefighting.
These are some interesting comments but a bit more context is required. It is the Commissioner’s duty – and therefore the duty of any fire brigade established to do the Commissioner’s duty (s8) – to
That section is referring to fires and HAZMAT incidents. Section 11 does not say that it is the duty of a fire brigade to “try by all possible means to render the site of the incident safe, and save any lives and property that are in danger”. It is headed “Brigades to proceed with speed to suspected fires or hazardous material incidents” (emphasis added). The section goes on to say:
The reference to an ‘incident’, in context, is not any incident but a hazardous materials incident.
What is important in this context is s 7 which says:
The difference is the Commissioner is required, it is his or her duty to take action with respect to fire and hazardous materials incidents. The Commissioner is authorised, it is his or her call, to take measures to protect others from injury or death, such as by providing road crash rescue services or taking part in a medical first responder program. The fire brigades can do that, they don’t have to; they do have to deal with fires and hazardous materials incidents.
Thanks. Agree that in the context of the comments made s7 but I disagree otherwise. It is reasonable to assume that the saving of life may in fact be the only action taken at such events. Possibly not all fires are extinguished and not all hazardous materials incidents are rendered safe before more people are affected. My point is that NSW FB can implement a first responder arrangement, now, today. First Response -Medical is reasonably one of numerous “possible means” able to be used for the saving of lives at fires and hazardous materials incidents. Burns, smoke intoxication, hazardous materials exposure, cardiac arrest, blunt force trauma and organ damage from explosive overpressure events may be life threatening. The victim may even be another fire brigade member. Do fire brigades do this now, in terms of their statutory roles? Is there a first responder capability for victims of fires and hazardous materials incidents?After all, one does not need to be called, directed or dispatched in order to assume the role of first responder, medical or otherwise. You just need to be on the spot with all possble means available to you.
Debate on the relevance of s7 becomes more interesting if it highlights how FB First Response – Medical could be employed in non-core roles, if at the same time it is NOT applied in core roles to begin with.
Thadeus
I think section 7 is the critical section of the Fire Brigades Act 1989 (NSW). You said there was ‘scant evidence of “firefighters” or any focus just on “firefighting” in the provisions of FB act’ but I submit that ss 6 and 11 are indeed clearly directed at firefighting and hazardous materials, what we might think of traditional fire fighting roles. Neither ss 6 or 11 would justify or authorise a first responder program of the sort being contemplated.
If the fire brigades attend a fire or hazmat incident and people are injured, they can perform first aid and could rely on s 6 if they needed to but actually they don’t need any specific authority; anyone can do first aid at a fire or elsewhere. Equally they don’t need authority to provide first aid to a person who has collapsed with a cardiac arrest, but they may need authority if they want to proceed to the scene of the collapse under lights and siren.
Section 11 says the brigades are to proceed with all speed to a fire or hazardous materials incident not to any incident. That could cause some difficulty if they proceeding, lights and sirens, to a cardiac arrest. Further, if we go back to the road rules, we know that a member of FRNSW is an emergency worker and therefore their fire truck is an emergency vehicle and can get the benefit of regulation 306 when proceeding as part of their duties. Clearly their duties include proceeding to a fire or hazardous materials incident; but it may not include going to a cardiac arrest as that is not part of their duties as set out in s 6.
You could argue that a fire fighter’s duties are whatever the Commissioner says they are but there has to be some limit, otherwise the Commissioner could decide that the FRNSW is going to operate an urgent pizza delivery service. Rule 306 of the Road Rules 2008 would not apply as it would not be reasonable for the exemption to apply but equally I would think a court would want to say that running a pizza delivery service is not part of a fire fighter’s, or FRNSW’s, duty. This would also be relevant to industrial law, I am not an industrial lawyer but there has to be limits on what an employer can require an employee to do. I think it would be reasonable for a person who joined the fire brigades to say they are not willing to run a pizza delivery service and there is nothing that would allow the Commissioner to insist. With s 7 the Commissioner is authorised to take action to protect ‘persons from injury or death and property from damage’ so it would be part of the duties of a fire fighter to take the action that the Commissioner has chosen for that purpose (subject of course to the terms of their employment and all the other industrial issues that have been raised in this debate and which I’m not attempting to resolve here).
Finally s 7 means the Commissioner can take action to preserve and protect life which in turn means he or she can arrange for the fire brigades to perform that function (s 8). That may give some reassurance that s 78 will apply. Section 78 says:
Without s 7, taking part in a community first responder program would not be doing something ‘for the purposes of executing this or any other Act’ as, absent s 7, there is nothing to bring this action under the Act and this, in my view, is because s 6 really does refer to fighting fires and hazardous materials incidents, not some general provision or obligation to preserve life at any incident. (It should be noted that s 78 is irrelevant for employed fire fighters; the doctrine of vicarious liability would protect them from personal liability in any event; but it does provide protection for the service and volunteers such as members of the community fire units).
In short I agree that FRNSW could “implement a first responder arrangement, now, today” but that is because of s 7, not because they can provide first aid to someone injured by fire or exposure to hazardous materaials. Without s 7, there would be even greater industrial complexity and it is doubtful that they would be justified to travel lights and sirens to assist a person who was not at risk from a fire or hazardous materials incident. So I stand by my view, taking part in road crash rescue, community first responders and many other tasks that FRNSW undertake is justified by s 7, not ss 6 and/or 11 nor by the fact that many of the skills would be relevant when attending a fire or hazardous materials incident.
One a word of caution, s 11 does say that the fire brigades are ‘despite anything to the contrary in any Act, proceed with all speed’ to a fire or hazardous materials incident. If I was a fire fighter I would not put too much faith in that section. We know from other discussions on this forum that the rule 306 of the Road Rules 2008 (NSW) only apply a limited exception and there is no exception for offences relating to being a licensed driver, driving under the influence, dangerous driving or manslaughter. A driver who travels at 200km/h in a 60km/h zone and tries to argue that such action was justified by section 11 would get a very short hearing. First the court would say that s 11 does not justify driving without due care or recklessly. If there was a crash I would suggest the court would also say that even if s 11 does allow travelling at ‘all speed’ it does not allow the driver to crash. Further in Bennett and Wood v Orange City Council; Board of Fire Commissioners (Third Party) (1967) 67 SR(NSW) 426 a court refused to allow someone to sue the Fire Brigades for failing to respond with all speed to the fire. The court said that the duties set out in s 11 were ‘descriptive only’ and not entitled to give anyone a right to sue, and equally I would suggest, are not intended to allow fire fighters to proceed recklessly or dangerously or to kill anyone along the way. As I say I don’t think anyone would be on very strong ground to argue that no other Act applied to restrict a fire fighter’s right or obligation to travel at whatever speed they like.
At best s 11 is there to tell the Commissioner and fire fighters that they are entitled and expected to proceed on ‘urgent duty’ when responding to a fire or hazmat incident, so it would certainly go a long way to saying that is a case where rule 306 should apply, but I would not expect to be able to rely in it for anything more (though of course you’d have a go if you were charged with reckless or dangerous driving).
Here’s a further contribution to this story, this time from “The Age” Report reveals personal toll on firefighters (http://www.theage.com.au/victoria/report-reveals-personal-toll-on-firefighters-20130217-2elcb.html). The report says that firefighters in Victoria suffer a number of symptoms and consequences of PTSD and that “firefighters’ biggest stress is their role as a first responder to medical emergencies and that some believe they are not getting adequate support”.
It goes on to say “A 30-year firefighting veteran, Danny Ward, told Fairfax Media that while he and his colleagues were well trained to deal with fires, they are not sufficiently supported to deal with the mental impact of attending car accidents, cot deaths, heart attacks and drug overdoses.”
My personal response to that is when I was an ambulance officer (I confess, again, a very long time ago) I don’t think we got any training on how to deal with these issues either. That is not advice to the firies to ‘harden up’ but, rather, hope that in the future they do get that support and hope that the ambulance service may do a better job in that regard than they did ‘in my day’ (though from what I hear from paramedics and now with their roster issues, I suspect not).
Michael Eburn
18 February 2013.
Don’t worry it won’t last when the Fire Brigade realise that the Ambulance service responds to over 35000 per month and that’s just in Sydney.Per the Sirens Magazine published monthly by the NSW Ambulance
I think there does need to be a bit of hardening up undertaken by those in our professions.
Although I am skeptical of industry-based research, we do need to be very mindful of cumulative stress reactions and disorders.
However, I think the article in some ways makes out that there is some horror to the medical aspects of firefighting, amplifying cases dreadfulness isn’t helpful.
There are great program’s in Victoria, we as a state have come a long way in peer support and mental health program’s for responders. Certainly much of it requires user initiation, but other components are incident related. One big thing is watching your colleagues and either offering support or referral or alerting managers to potential.
Perhaps if its too much ASNSW could take back all road rescue to protect firies from the nastiness of what we see?
Another story on this report, this time from the ABC program, “The Wold Today” (18 February 2013)- see http://www.abc.net.au/worldtoday/content/2013/s3692527.htm.
Here is my point of view. I am a full time firefighter with over 17 years of experience. I oppose the first responder proposal and it has NOTHING to do with money. It is incorrect to imply that the opposition to first responder work is about greed. The reason that money has come into the argument is because that is how the industrial system works; if you don’t want to do it, make it too expensive. The reason for not wanting to do it is because it does not fix the underlying problem; that the Health system is under-funded and poorly organised. It is a system that allows a patient with a blister to demand that an ambulance transport them to hospital and wait for hours because the injury is of the lowest priority but the ambulance is not allowed to drop them in the waiting room and go to real emergencies.
My argument is fix the system and if you them still need our help, I’d be interested to listen.