To review successful service models of firefighters providing emergency medical care to the community

Recommendations: Due to the diverse nature of Australia’s fire agencies including geography, areas of responsibility and management structure, specific recommendations are not given as to which service delivery model or parts of would suit each individual organisation. Instead, the recommendations combine an initial process towards adopting a formal medical response, a minimum requirement of any move to a firefighter emergency medical program and recommendations in regards to creating efficiencies. Due to the diverse nature of Australia’s Fire agencies and communities, I believe a comprehensive needs analysis be conducted including, but not limited to, comparing ambulance and fire service response times and call rates in areas covered by career firefighters to identify areas where firefighters may be able to assist. This would allow informed discussions on whether in fact, a firefighter based emergency medical response would be beneficial or even needed within individual communities. Due to a somewhat ‘taboo’ approach to firefighter medical response by some Australian firefighters and firefighter representative groups, I believe it is imperative that all stakeholders, in particular responders, are in full receipt facts and implications of the implementation of such a service. The high majority of the apprehension appears to be driven by lack of education or lack of communication, or both. It became clear upon returning from travel, the high level of interest in the fellowship findings and a real interest of firefighters to open discussions about branching into an emergency medical based discipline. There appears to be a real trepidation amongst firefighters to speak openly about this support due to a loud minority of firefighters who are against a move towards any variation to their areas of responsibilities. To that end, firefighter representative groups (unions/associations) should anonymously survey their members and allow a ‘conscience vote’ to inform the inclination of their members to enter into a formalised medical response role to ensure they are truly representative of their wishes. One major finding from my travel was that any move towards any service delivery model which sees firefighters respond to emergency medical incidents is that it needs to be done cooperatively, and with complete transparency. I believe that the easiest way to do this is for fire agencies looking towards this type of implementation establish a working group with representation from the relevant fire agency, relevant Ambulance Service, Australian Resuscitation Council, Firefighter Union, and Paramedic Union to establish minimum standards of Firefighter Emergency Response to ensure a safe, efficient and financially responsible service to the community is developed. These minimum standards to be agreed on should include, but not be limited to: An appropriate response model and how that response model will be governed; Appropriate level of training and equipment; Appropriate welfare systems;Appropriate remuneration (if any); I strongly believe that any firefighter first responder program developed must be based on community needs and expectations with a scope to provide appropriate, safe, timely and effective medical interventions in response to medical emergencies for critically ill or injured patients. Particularly during London Fire Brigade’s emergency medical response trial, there seemed to be a great deal of confusion in the public arena about the fire fighters additional role and the program itself. I believe it’s important that prior to the implementation of any firefighter emergency medical response model, a comprehensive public media campaign be run to educate the public on the new program to remove confusion during response. London Fire Brigade’s Emergency Medical Response trial encountered several hurdles across the trial period. By having this trial and fluid approach, these issues were able to be rectified during the trial period to finish the trial with a well-rounded efficient and effective service. I believe it is imperative that if a formalised firefighter medical program is to be implemented, a comprehensive (1-2 years) trial be undertaken at identified service delivery locations. The importance of firefighter mental health and burnout, particularly in fully integrated Fire/EMS departments, was the single most common theme spoken about with the responders. They were all in agreeance that to maintain a safe and enjoyable work environment, any EMR program to be an “Opt In-Opt Out” program for all responders. As mentioned in the previous recommendation, firefighter welfare was paramount for both managers, supervisors and firefighters themselves. Although it appears that a combination EAP/CISM welfare support was consistent and deemed suffice across all destinations visited, I believe before the instigation of any firefighter first responder program, mental health first aid training for all responders and managers should be undertaken. Compulsory initial psychological assessments (benchmarking), as well as at regular intervals should also be considered. This recommendation is due to, in part, the common thread that although formal welfare programs were available to every responder, they were rarely used and that firefighters felt the best way to debrief or identify issues with themselves or their colleagues was done more informally around the workplace. During visits to fully integrated Fire based EMS agencies, it was clearly apparent both by interview and witnessing the working relationships at operational incidents that the benefits of having dual trained firefighter paramedics was extremely beneficial. It was also apparent that most firefighters who worked in departments who held a lesser firefighter-EMT role were passionate about developing their knowledge and skills beyond the EMT level to value-add to their role and the department, as well as provide more advanced assistance at medical related call-outs. To that end, it seems important to harness the passion of these types of people and fire agencies who take-on a formalised emergency medical response should facilitate and encourage responders to train to whatever standard (above minimum) they wish. E.g.- a firefighter wishing to train to paramedic level. Although most facets of fully-integrated ambulance and fire service and Fire-Based EMS appears to be “world’s best practice”, due to cultural and governance hurdles, it is unlikely this will be adopted in Australia. If a move is made towards having firefighters respond to emergency medical incidents in the community and to be able to harness some of the benefits of this type of service without full integration, I believe it is important that a system be put in place to facilitate firefighters who wish to conduct ’ride-alongs’ with paramedic crews. To either actively assist, or as an observer to gain experience. Outside operational response, major efficiencies were witnessed in seamless call taking and dispatching of crews within fully-integrated fire agencies. On the opposite end of the spectrum, London Fire Brigade saw unacceptable delays both call taking and dispatching crews due to ambulance and fire services who work independently of each other. I believe it’s vitally important that if firefighter emergency medical response is adopted, the integration of a state’s ambulance and fire communication facility and operations (including cross training staff) should be considered. In smaller states, further fire and ambulance Service integration to some level should also be considered. This should be looked at in areas with pre-existing arrangements where ambulance and fire already share infrastructure.

Keywords: Emergency Medical Response, fire fighter welfare, training and equipment, ambulance, delivery programs, remuneration