Today’s question is about the handover of patients from fire and rescue services to ambulance.
Photo credit: Country Fire Authority https://news.cfa.vic.gov.au/news/mildura-firefighters-respond-to-medical-emergencies
The question is:
Is there a legal requirement for record keeping of any patient treatment conducted by Fire and Rescue? Our station officers complete ‘fire reports’ at the completion of every job. Chatting to a few Station Officers I discovered that unless it is a specific medical assist job type where we conduct CPR there isn’t much other information regarding patient treatment.
For example, if we attend a motor vehicle accident (MVA) the station officer might record in their report that firefighters conducted a patient assessment and provided treatment, but this could range from a small bandage to a tourniquet being applied. Should we have a specific form to be kept for any patient first aid treatment?
For clarification all firefighters here are trained to HLTAID014 Provide Advanced First Aid & HLTAID015 Provide Advanced Resuscitation and Oxygen Therapy. We are not paramedics, and we just have first aid skill sets.
The second part of my question is in relation to a handover once the ambulance service arrives. We conduct a verbal handover at this stage. This is an area of focus for our upcoming training in completing a more comprehensive verbal and written handover. My question is, are there any requirements for a written handover from one professional service to another?
I have deliberately removed reference to the jurisdiction because the answer doesn’t depend on the jurisdiction.
For a related post see Paramedic/firefighter keeping patient care records (February 20, 2020).
There is no general legal obligation to record first aid services provided. That is not to say it’s not a good idea to keep the records. The WorkSafe Australia Model Code of Practice for First Aid in the Workplace says (p. 19):
A record of first aid treatment given should be kept by the first aider and reported to managers on a regular basis to assist reviewing first aid arrangements. First aid treatment records are subject to requirements under Health Records legislation. Further information is available from the Office of the Australian Information Commissioner.
Work Health and Safety legislation deals with the risk to people from work so the duty to protect employees and others. Given that limitation, the code really relates to first aid in the workplace. Where first aid is provided to firefighters or people who are injured by the firefighters, that must certainly be recorded to keep track of how the fire service is managing risks created by it and its work practices. It is less clear that it would apply to firefighters giving first aid to someone who was injured by the event to which the brigade is responding as they are not injured by the work of the Person Conducting the Business or Undertaking. Compliance with the Code is not mandatory (Model Work Health and Safety Act s 275) but it may be evidence of compliance with WHS duties should the issue arise. Again, that will only arise with respect to a prosecution under the Act and so will again be relevant to injuries to, or caused by, firefighters. That is perhaps mere semantics as the Code of Practice confirms that keeping those records is a good idea.
First aid records serve a number of purposes including accounting and record keeping, as an aide memoir should that ever be required and to provide continuity of care and. To explain.
If a fire service is not keeping records of patient interaction, then it cannot count how often first aid is provided. What is not counted does not count. Patient records could be used to justify claims for funding (by demonstrating the value of the service), training (by showing what is required and perhaps that first aid is not enough), equipment etc.
If ever there is an issue, whether it’s a coronial investigation, a police inquiry, an inquiry from an insurance company trying to verify a claim, a court case etc a fire fighter may be called to give evidence. Given the time it takes for cases to reach court, or reports to be written, a fire fighter will have attended many call outs and will forget the details. Notes written at the time can provide a useful memory aid – an ‘aide memoir’ – to help recall the details and, if the details cannot be recalled, to say ‘this is what I wrote at the time so that’s what happened’.
Continuity of care relates to telling the next care providers, in this case the paramedics, but in turn the hospital what happened. This leads to the second question ‘are there any requirements for a written handover from one professional service to another?’ Again the answer is no, but that does not mean it might not be a good idea. It may be less relevant, and I’ll leave it to the paramedics to comment, because it depends whether the paramedics actually read it. They will of course do their own assessment and take their own history so may see little value in a form from the fire brigade. One would also assume that they will record that the patient received some first aid and perhaps had been bandaged prior to arrival. The legal answer is no there is no legal requirement for such a document. I’ll throw the question of whether it’s useful to the paramedics to answer.
Conclusion
It would be a very good idea for a fire service to have patient care records for firefighters to complete to record their first aid interactions. Save for the recommendation in the Code of Practice for First Aid in the Workplace there is no law that says those records must be kept. There is law – evidence law – about how records may be used. As a rule of thumb they are evidence as to what happened, without them there is no evidence and that may one day be a problem for the service, the firefighter, the patient or an insurer.
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.
Australian Emergency Law 
Good questions and of course great answers from Michael as always.
Speaking as a Paramedic, personally I would welcome any handover from first aiders on scene. Professional curtesy goes both ways and as modern clinicians we should be listening to those who have first responded to our patients and therefore contribute to the continuum of care.
An easy short format is to provide an IMIST-AMBO handover. I won’t go into depth here, however the information is easily google’d and quite simple even for laypersons.
HLTAID014 performance and knowledge element 4 – communicate details of the incident – contains requirements for RTOs to train and assess handover skills. So there may be tools your own provider prefers to use.
Lastly, written handover will never be turned down. However, keep it brief and maybe in for point form – perhaps IMISTAMBO format – with the patient name and DOB up the top and the Paramedics will love you for it. Verbal is just as good for us usually.
Cheers
Excellent work and does make a lot of sense. My question relates to hand written “rough notes” Do these need to be kept? or once transferred into a PCR can they be scrapped? how do we scrap them? What governs this?
As I said in my post “Save for the recommendation in the Code of Practice for First Aid in the Workplace there is no law that says those records must be kept. There is law – evidence law – about how records may be used. As a rule of thumb they are evidence as to what happened, without them there is no evidence and that may one day be a problem for the service, the firefighter, the patient or an insurer.” You do not have to keep ‘rough notes’; if you do they may be referred to if they’re relevant but if you don’t then they cannot be. That could be a blessing or a disaster depending on the issues. If you scrap them and they contain personal information eg details of a person’s name or injuries, put them through a shredder.