Today’s correspondent is:

… involved with the development and delivery of the first aid training for the brigade.

I am interested in upskilling our own instructors so they have a higher level of training than what they are delivering (HLTAID014 Provide Advanced First Aid and HLTAID015 Provide Advanced Resuscitation).  I believe that a Cert IV in Healthcare (focusing on emergency care) would be an appropriate level for the instructors to have.

My question is would these firefighters who hold this higher level of qualification be required to perform higher levels of care when out on the trucks.  Would these firefighters have a risk of liability if they were only providing a more basic level of care in line with what Fire and Rescue is expected and equipped to attend?  For example if they had training in pain management but did not have the equipment on the trucks (such as the green whistle) would they be liable for not providing an appropriate level of care.

I know paramedics are registered with APHRA and have personal liability insurance but would someone with a Cert IV in Healthcare need anything similar.

My goal is to improve our training by having higher levels of training and knowledge for the instructors, not change what we are currently being asked to attend or change what equipment is on the trucks or asking the instructors to take on a greater responsibility medically whilst out on the trucks.

I have looked at the syllabus for HLT41120 – Certificate IV in Health Care (Release 1). It appears to me that a person who has completed this certificate, with units like ‘Confirm physical health status’ and ‘Assess and deliver basic clinical care’ may be able to undertake a more wholistic approach to patient care than someone with a first aid certificate. They may take blood pressures, measure oxygen saturation and consider a more detailed history. Perhaps they will use a stethoscope to auscultate the patient’s lungs. But if it were life and death it is not obvious what extra skills they will have.  That’s important because it might mean they know more, but not that they can do more.

But one can only do what one can do, and use what one has. Taking methoxyflurane (‘the green whistle’) for example, that is a scheduled drug so can only be carried and used with an appropriate drug authority. If the fire brigade don’t have that authority then the firefighters cannot be expected to use it, even if they know how. Remember that in the other case scenarios where these issues are discussed (such as Paramedic as ambulance volunteer ) it is assumed that the relevant equipment is available.  If it’s not, then it’s a completely different situation.

The standard of care expected of a firefighter/first aider would that of an ‘ordinary skilled’ firefighter/first aider but they have to apply all their knowledge to the benefit of the patient, not try to pretend that they don’t know what they learned outside a first aid course. Fundamentally any firefighter/first aider should use their best endeavours to benefit their patient. Failure to do so could be negligent if they chose to not do something they know needs to be done, know they can do it but say ‘but our fire brigade only expects us to have a first aid certificate and I learned this skill in another course’. 

It’s still the case that if you’re worried about a finding of negligence or the ever-dreaded criticism of the coroner, not performing a lifesaving task you’re familiar with and letting the patient die is more likely to be negligent and critiqued, than trying your best to save the patient’s life. But you cannot be under a duty to do what you cannot do, eg use equipment or drugs that you do not have and in the case of drugs, cannot legally possess, supply or administer. And being worried about training someone because it will make them better at their job seems perverse.

For a related discussion, see NSW Paramedic and fire fighter – when does one role start and finish? (July 8, 2015).

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association  and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.