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Should UK firefighters have to respond to medical emergencies?

09 Nov 17:00 by Pete Bouvier

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Following on from last week's article in the Guardian - Asking firefighters to be paramedics during a time of cuts is dangerous - Ralph Chadkirk, paramedic for the London Ambulance Service, shares his thoughts on the subject of co-responding to medical emergencies...

In 2001, the Fire Brigade’s Union determined that “all FBU members… shall not participate in any proposed co-responder initiative”. The position was clear, and remained unchanged for over a decade. 

At the FBU conference 2015 this statement was reconsidered. By this time, central funding of the fire services had been cut by over 30%, and the number of incidents the fire service attended had fallen to approximately 300,000 (compared to 2.9 million ambulance service category A calls). The fear of the FBU was real: will the government continue to fund to the same level a service for which demand is falling? 

This had not escaped the FBU. In an ‘Executive Council Policy Statement’ the FBU said: “given the threats from ongoing cuts… there are good reasons for believing it is in the interests of the fire and rescue service to include some role in providing emergency medical response in its portfolio of responsibilities”. 

What form co-responding should take has not been consistent. In Lincolnshire, firefighters are mobilised to incidents in an ambulance. At the same time an NHS paramedic in a car attends, and if need be, travels with the patient to hospital. In other areas of the country co-response takes on a form similar to the traditional community first responder. 

There are many benefits to co-responding. Ambulance service demand is rising, and services nationally are struggling to meet the A8 target (75% of life threatening emergencies receiving a response within 8 minutes). In the most serious medical emergency, cardiac arrest, time is of the essence: the chance of survival reduces with every second passed without good quality CPR or defibrillation. 

Fire services have the staff to be able to provide a quicker Basic Life Support response than the ambulance services could ever manage, and fire appliances have been carrying defibrillators since 2000. The FBU acknowledge this saying “the fire and rescue service generally has swifter response times than the ambulance service… and faster response times is (sic) undoubtedly in the interests of the thousands of people who suffer life-threatening… incidents annually.” 

Paramedics are healthcare professionals, trained to perform life saving interventions against a sound background of clinical knowledge. Similarly firefighters are specialists in extrication, technical rescue, and of course, fighting fires. It is doing each organisation a disservice to suggest that the other can easily take on a proportion of their workload without appropriate training, education and governance. 

There is also a theoretical risk that co-responding will pave the way for a takeover of the ambulance service. Such fears, whilst they may appear unfounded, should not be dismissed. The Chief Fire Officers Association has previously made clear that it aims to do this stating “[CFOA] propose that some elements of the ambulance service and the fire and rescue service could work more closely together which could potentially lead to combination”. 

The politics and issues surrounding co-responding are complex, and the debate is likely to continue well into the future. The benefits and risks of co-responding are clear. Co-responding schemes would benefit patients, and perhaps that supersedes the entrenched views on both sides of the debate.

Ralph Chadkirk is a paramedic for the London Ambulance Service. You can follow him on Twitter @rchadkirk