FRS, Ambulances and Paramedics

[Dyson]

So, we watched the LFB thing the other night, as did many people who aren't in our job and have no connection to us. the tax payer, the communities we serve...

As we watched the RTC, 2 hours waiting for an ambulance, which is a longer that usual wait for me, but a regular occurrence all the same.

As a tax payer, as a member of the community, I'm asking why the FRS don't have ambulances and paramedics equipped to deal with this?

They can see on TV they do elsewhere, why don't we?

This was a completely perfect example of why we need to think differently now, forget half arsed co--responding, and papering up the cracks, lets have our own staff hired, and our own equipment which is fit to deliver the service the punters deserve. 

Feels like a 3rd world country at the moment....

[Cardiff_Fire]

If done properly as above, and as I (believe?) has been done successfully in Dublin I don't really see the issue. Seems to be a successful model elsewhere.

However it only takes a quick look at the payscales of various metropolitan depts in the USA and indeed in Dublin to see that these dual role firefighters are earning quite a bit more than us.  (I don't want to open the pay can of worms but it's probably the biggest issue on my watch and others I've spoken with regarding expanding our medical abilities).

I think with a workforce expected to go to 60(and longer I'd wager in the years to come) it might suit some in their twilight years as well.

 I wish I had, and that there was a simple answer. I think it would require a complete step change in the attitudes of us, our bosses, the local and central govts and the general public.

[HoldFast]

I think it's definitely the way forward. It would make sense for pumps and ambulances to turn out together and arrive together. Better for crews and casualties and means both fire and ambulance will have all the support and tools needed from the off to make the right decisions. Also reduces problems encountered like fire and ambulance crews using different words of command and probably would make for a smoother working process, not to mention an increased understanding of both sides of the job by all involved.

It would particularly benefit fire stations in rural areas where the wait for an ambulance can be that bit longer. I know from my brief stint as a con-op how few ambulances can be available at any one time, and it really is worrying. I applied for Dublin a couple of years ago and the paramedic role was something that really appealed to me.

[Cashybai]

Mmmmm..... I'm torn here, torn between bunging the dosh at & properly funding the ambulance infrastructure that's already in place, or bunging funds into a new venture within the bounds of the LFB.. personally funding the two simultaneously might mean funds bound for one getting diverted to the other which might make neither as efficient as we'd want....

[WayneHealey]

Exactly that Neil, why underfund one service that desperately needs it, to fund another service to have a go at it...  fund the NHS properly, give it the resources it needs to properly supply the demand, roll out more education like we have done to reduce the amount of call outs, so that the right NHS resources only go to those that actually need them and let us the fire service get on with with what we do best. I'm not saying we haven't got room to evolve I'm just saying why expand our role to this when the ambulance service is already there and has that clinical expertise. 

[Eddier]

By funding one you are also funding the other as you are reducing the demand on NWAS. 

[WayneHealey]

Sorry, I think I'm reading this wrong, but this doesn't make sense to me.  Sorry for being simple. 

By funding one you are funding the other? Do you mean by underfunding one service which it's failing it's targets as a result, to achieve said result we should fund another service to back the failing service up? 

But what about fire service demands as a result...

just an opinion 

[Steve]

Two completely different funding streams, two different Government departments... fund the FRS, don't fund the FRS it won’t make a difference to the NHS and drill down... ambulance funding. It isn't like “I'll only go to Spain this year instead of Dubai, then I can get a better car”.... It’s all UK Government Money, but you cannot look at one compared to the other (as we would personally with my holiday/car analogy).

Yes, absolutely fund the NHS where it needs it, social care and mental health... that will reduce the burden on critical care (A&E plus ambulances)... I also think the GP service being more flexible (not being a Tory here) but two systems of appointments, day appointments for the elderly, kids and those in long term illness, then appointments on another book for working people in the late afternoon & evenings. There also needs to be some punitive regime for those who don't keep appointments? (Hmmm the bureaucracy alone will probably double the budget).

All that done, problem solved (lets imagine that for a moment)> Then, what about the Fire Service.... Fire Down (notwithstanding the recent busier spell). How long does anyone think the current colour of Government is going to sustain a Service that has less than 10% operational utilisation? Yes they should, yes we spend times doing other stuff, and yes we are an insurance policy. But I'll shake the hand of the man or woman who can make that argument and win. Even the FBU, although rightly asking for better reward for it, recognise the game is up... Advocating new ways of working. Something else needs to come into what we (you) do. If it isn't at the more skilled and valuable end, such as additional medical skills and responses, then what will it be? Safety checks in the home, home help, handyman? Believe me, the whole community engagement piece is looking ever more over the precipice into that world....

This industry need to take on additional professional work, maybe following Grenfell and maybe a change in Fire Safety law, more in terms of professional inspection and assessment? That would be better than the other alternative to medical work.

[TandA]

To play devils advocate, I will lob an RDS view at you here and say that Steve's model may be the way forward in the big cities but won't work when you get more rural.  

I am one of those elusive RDS employees who has a primary employer that allows me to respond to emergency calls from work.  I could stretch that goodwill to cover Red type medical calls as that is still clearly saving life and rendering urgent humanitarian assistance.  However home safety checks, home help, handyman, snow clearance, road clearance etc don't fit into his definition of emergency, they are more like poor planning and that doesn't constitute a reason for me to run off from work at short notice.  Same will go for a lot of self employed RDS who will leave a client job for emergencies but won't want to be turning down work to check on Mr Smith's handrails.  It is a fine line between keeping us busy enough to justify our existence and involving us in too much non-emergency stuff that will just lose employer and employee goodwill.

[Steve]

Agreed mate...

Of course RDS is only being paid when they need you so on that basis (wih the exception of training etc) the operational utilisation is very high. Mine focusses on wholetime, especially those stations that are very quet.

[Dyson]

Id like to see it tried, one  brigade or even one region, have the ambulances at our stations, have the paramedics in our uniform, working together, training together....

for those who say its not possible, perhaps you need to think differently? lets find reasons why we can do stuff, not why we can't....

this TV show, has laid the problem out for the whole count\try to see. is everyone just going to ignore it?

 

[Bubbles]

From a civilian point of view, I would like to see this tried out as well. 

My elderley neighbour (She is 90) required an ambulance recently after falling out of her bed a 4am in the morning, I was called by her careline to ask if I could stay with her until the ambulance arrived.... It eventually did 4 hours later. 

I am well aware that the ambulance crews were very busy and stretched to the limit that night but it was a long wait for us both.

It would be interesting to see if this would work.

[Dot]

There's some great points here, loving the fire service law/safety one from Steve, and just to add my two-penneth I'd like to see a mix of the two. With our utilisation rates as they are (which I do dispute because all that's looked at is incidents), but obviously not as high as ambulances, I'd TUPE their Paramedics across to us, paint ambulances red and mobilise them to the red 1 and 2 calls they struggle so much to achieve. Ensure easy access to hospital and available again quickly. Leave the ambulance service doing patient transfers... It's so easy with rose-tinted spectacles on!! Take a peep at this...

 

[HoldFast]

Europe have ambulances on fire stations, as do the US and other countries. Its tried and tested. It works, and has done for a lot of years. I stayed on a fire station in France a few years ago on a work trip and the ambulance far far surpassed the engines in terms of turnouts. It was none stop. If anything it would reinvigorate the job for a lot of people as well as give it a good kick up the backside for people like myself who want to be as busy as they possibly can be. For a country that has some of the most professional organisations in the world, why are we so far behind and so resistant to change?

[OscarTango]

It might be a slight tangent but to what extent are fire based EMTs in other countries trained in comparison to the our ambulance services? 

I've been led to understand that the pre-hospital care UK paramedics can provide is a bit more extensive than other countries combined ambulances. Hence the scoffing that ensures from some Paras when it's suggested that firefighters also be full paramedics......

[HoldFast]

Personally I'm not aware how big the training gap is but having experienced EMTs (and in some cases Paramedics i.e. Dublin) on an ambulance turning out alongside a fire engine in my opinion would be invaluable. A lot of NHS/ST Johns ambulances ride around with only EMTs and ECAs on anyway. I have often thought taking on the full role of a paramedic (as you rightly say Oscar they are highly skilled and qualified) in addition to the firefighting role map would be a big ask, but I can see it working in certain areas.

(I'm also led to believe) most of what Paramedics deal with isn't trauma based, so surely it makes sense for the fire service to specialise in this area. After all most incidents we attend that require casualty care involve some sort of trauma.

Also, what do people think to the idea of employing people through the fire service specifically as a paramedic or an EMT? You wouldn't need to worry about effectively retaining the knowledge that comes with 2 different job roles, and maybe it would provide a bit of scope for the older hands to move across in their later years if the firefighting side of the job does become a bit of a strain. What with the ever increasing retirement age and all. Just a thought 

Edited August 8, 2017 by JamesL

[Alan]

Some Pros and Cons from someone who works in a combined Fire/EMS service (Dublin)

Pro

It accounts for 70% of our work which means pumps are always busy which maintains the argument for keeping stations and appliances

You get the skill set on scene as soon as the first appliance arrives. There's no delay in definitive patient care.

Dublin city has one of the highest survival rates of pre hospital cardiac arrest in the world

At a major incident we can put 80 paramedics on scene within minutes and still maintain fire/rescue cover

We are the statutory provider in Dublin of both Fire/Rescue and EMS which means dual trained personell work within the fire service incident command structure and understand the terminology. 

Granny falling out of bed type calls can be dealt with by a pump crew who can assess the patient and see if they actually need an ambulance at all.

Cons

Ongoing training takes up 80% of the training budget and 75% of allocated training hours. It's expensive to maintain all our staff as licenced paramedics or advanced paramedics.

In a time of limited budgets having everyone trained as paramedics who operate a rotational shift model (every 3 days and nights) isn't best use of available funds

Fire/Rescue training has suffered as a result of having to constantly maintain and upskill to the required paramedic standard.

Trying to secure funding from different Govt depts is a pain and requires some very astute senior managers to be able to deal with the myriad policies and civil servants.

It's an ongoing battle with our equivalent of NHS ambulance service who are constantly fighting to remove our funding and control and effectively subsume our 999 only ambulances into the greater pool of ambulance/pts work. The result of this is that there are 2 ambulance services with 2 controls working in the same area with a hell of a lot of duplication.

FYI working on an ambulance isn't something thats handy. 90% of DFB's accident statistics come from ambulance work with back injuries and assaults accounting for the vast majority. It's not something that I would move people into in the autumn of their career. In fact wherever possible we do the opposite, keeping them on the appliance if at all possible as their chance of being injured so close to retirement is greatly reduced.

[Dyson]

Thanks for sharing Alan, interesting stuff.

[WayneHealey]

Alan makes a great point with regards to training.  Core skills training would almost definitely take a hit just to ensure medical skills are updated and maintained.   We talk about the reduction in fire calls overall, but it's still our bread & butter and the public expect, I expect us to be excellent in this area, which. I believe we are.  Definitely more special services attended year on year with RTCs being a large part of that, more floodings, Hazmats on the rise, etc.   

Speaking to an advanced paramedic within my borough recently, he said if co-responding was to come in, we'd be very busy as they were already working at quite a reduced capacity and LAS do struggle to provide ambulances.  

Also with excellent preventative work we do in CFS, would we, will we still be able to do as much as we do now? 

Just a thought.

[Bgjm21]

Correct me if I'm wrong but is it not A&E waiting times that also really contribute to he ambulance shortage? With crews being tied up there for long periods of time. Fire and Rescue Service ambulances would surely be met with the same issues. The fundamental problem is cash, not enough cash for A&E not enough cash for ambulances, not enough cash for fire service. The ruling mob aren't going to increase funding because the fire service is responding to ambulance calls, look at the NHS, busier than ever still receiving real term budget cuts year on year. It's not about being efficient to the government undernieth it all, there policy and actions are an ideological political decision to have much much smaller public services.

The mantra just now might be "cuts because calls are down" but even if calls soared back up, it would change to "living within our means".

[JelHead]

The issue with comparing the model of Dublin to the UK is that yes there called paramedics in Ireland but a UK registered paramedic is more like an advanced paramedic over there, The paramedic over there is like a NHS trust technician. The model I can see working and that for 90% of patients would work is fire fighters trained as technicians alternating between pump and ambulance with paramedics on cars as back up/first response

[Hmckay91]

This spans the Atlantic but the problem IMHO is our healthcare systems paradigm.  Too few ambulances, responding to too many non-emergent incidents, bringing a disproportionate amount of non-emergency patients to overbooked emergency rooms and have to wait to offload, because of too few doctors/beds/space... all under the strict controls of outdated and closed medical care doctrines and delivery models.  It is painfully obvious that most if not all Health Care Provider agencies don't' know how to run an emergency service...

There are several service delivery models that are successful and all are really a different road to the same place.  Here we have transitioned from a primarily municipal based EMS model to a provincial EMS model.  The provincial model recognizes three basic varieties; for profit contractor, provincial employees, and non-profit contractors.  Integrated fire/ems services were recognised but essentially had to "rebid" on their current service area.  The province also imposes levels of service that are often not equal across the province and not up to the standards most community expects.  With "centralised dispatch" that attempts to send the "closest" ambulance; an ambulance can leave our community unprotected; for an appointment trip to the city (8 hours round trip) and not return for 14 hours and be timed out working in and around the city.      

In our case as a small city (pop of 15000) with a hospital, 90% of patients are still sent to the big municipal centres (3 hour Ambulance drive) because of the reduced capacity of the local hospital due to "attribution", "right sizing", "lack of doctor recruitment", centralised medical doctrine and centralized funding.  They can't/won't even set a compound fracture...

If an elderly person falls out of bed at the "old folks manor" the staff are not allowed to assist them back in, an ambulance is required to assess the patient and help them back in.  If we rethink who/what/when/how then it just follows that we could use our resources differently/better/more efficiently for better patient and community outcomes.  

Taking a step back I always wonder at the fascination and promotion of having paramedics in large metropolitan areas regardless of what uniform they wear.  Arguably, when patients are 15 minutes from a Critical Care Facility with improved levels of care, why do we want paramedics playing about?  Even first aiders can administer basic life saving interventions for those low probability/high risk events.  It seems fairly obvious that paramedic advanced life saving skills/medical oversight would be of more value in the remote/rural areas where that critical care facility with improved levels of care are hours away?

Until we break down this paradigm it is irrelevant which uniformed service fills the gap to bring "Auntie" to the Hospital...

[Alan]

6 hours ago, JelHead said:

The issue with comparing the model of Dublin to the UK is that yes there called paramedics in Ireland but a UK registered paramedic is more like an advanced paramedic over there, The paramedic over there is like a NHS trust technician. The model I can see working and that for 90% of patients would work is fire fighters trained as technicians alternating between pump and ambulance with paramedics on cars as back up/first response

And thats the model that works in Dublin. The basic level medics do about 90% of the work with advanced medics mostly in a non transporting role on rapid response vehicles. Where we have an excess of advanced medics we can man pumps with a cross trained advanced medic as well as the normal crews. At the moment it's rare that scenario happens but as numbers increase it will be the norm.

[Eddier]

On 07/08/2017 at 12:48, WayneHealey said:

Sorry, I think I'm reading this wrong, but this doesn't make sense to me.  Sorry for being simple. 

By funding one you are funding the other? Do you mean by underfunding one service which it's failing it's targets as a result, to achieve said result we should fund another service to back the failing service up? 

But what about fire service demands as a result...

just an opinion 

It was a slightly flippant reply mate. I was making the point perhaps poorly, that by taking some of the strain off NWAS by responding to some of their jobs it increases their capacity. Of course that is just papering over the cracks and not an answer to any of the issues highlighted earlier.

I don't think it's purely a problem with funding either. However I do think that if were going to do it this is something that we do need to properly. So I mean full funding and training as a career path for those firefighters that volunteer and have the aptitude, to paramedic level. 

[JelHead]

To become a paramedic takes at least 2 years full time for a complete novice, for a member of ambulance staff with at least 2-3 years operational experience can be done in a year full time or 2 years part time. Cost for internal candidates for a full time course is around 30k each, part time is around 10k. Training firefighters to become paramedic is not realistic due to cost and the time it takes. Technician yes, as that can be done a lot quicker and cheaper