Jump to content

Co-Responding


Bgjm21

Recommended Posts

As was mentioned by a few people, some brigades are receiving a significant amount of this type of call and that it is keeping stations afloat

So what do we think? Is the way to protect fire cover to fully embrace perhaps even merge with the ambulance service? Im not referring to the additional pay ect but simply wishing you guys thoughts from an operational perspective.

Link to comment

I don't think its a bad thing, fire are better located to access patients quicker in situations such as cardiac etc where time counts to give them a better start, I don't agree with attending everything like ambulance but the red 1/2 etc type calls then yes.  Two things it helps, 1 the patient when they need help but secondly it does keep stations open I think, it brings it money around here and funds its self.

Every area is different but around here in Humberside/Lincolnshire it works well, LIVES are big in Lincolnshire too and without them you would be waiting a long time for help!

Link to comment

In the short run yes it saves lives. Especially in really rural areas. Just take a look at Mid and West Wales's call stats for stations that do co-ro and you'll see a big upsurge. Big Mets are a bit different, its not like theres only two ambulances to cover an area the size of Worcester. End of the day we're a humanitarian service. And this is coming from someone who is joining a service that goes to falls response jobs

Long run? Lets not forget the reason fire crews are doing this, but thats part of the bigger picture

Edited by Luminoki
Link to comment

This topic has been argued to death and then some. 

There are only two options

Option A... refuse CR and concentrate on 'traditional fire calls' which are in annual decline due to the enormous CFS work done and which continues to be done, 'a safer' (I understand the sensitivities of this phrase regarding the dreadful tragedy at Grenfell Towers but was meant as 'by and large') built environment, safer vehicles etc etc and except the inevitable reduction in Firefighters and Fire Stations due to a reduction of need and relevance.

or

Option B... do what we have always done,  in so far as adapt and overcome and make a bloody good job of each and every new skill we have taken on since we stopped just putting water in fires!

If you can't evolve you will become extinct. That's not just my opinion that's science. So we are at a major junction in the future of the UK FRS. Do we cut our own throats or do we roll our sleeves up and make this new role part of our 'bread and butter' and become highly skilled in it as we did with RTC extrication starting all those years ago?

Lets not forget the job of getting people out of cars following a crash was, up until the mid to late sixties, the job of some Ambulance 'men' and which ever local garage was summoned to take the car away by the Police. All done with very crude equipment and zero training. Quite often the FRS were not even requested.

I'm sure that around some Fire Station mess tables there were some Firefighters appalled at this creeping new role as they were there to fight fires and to maintain fire cover! But now look where we are?

As much as I have tried to see both sides of the argument, been diplomatic, bit my lip etc over the last few years of this debate enough is enough. 

We should have been CR decades ago not years ago, decades. There is absolutely not one good reason both professional or moral to not do in order to keep us relevant and needed in this modern society at a time when all services are struggling. What makes us different than the majority of countries elsewhere? I just don't get it.

Personally speaking I've been very well trained by my Ambulance Sevice and upskilled to a point I'm now registered to give certain drugs when CR. I can also put a fire out and rescue people from an RTC too. Surrey has done the most CR jobs than any other FRS during this trial (nearly 6000) and that's just from about half the service! So you can see there is a demand.

If very soon the decision is taken to stop CR by the FBU then I will have to leave as sad as that is.

I may well be a Turkey... but I won't be voting for Christmas! ?

  • Kudos 3
Link to comment

Completely agree with you about everything you've said up until that last paragraph, the FBU as far as I'm aware are using it as a bargaining chip for a fairer wage and increased training etc in some areas, I personally do believe it is the way forward (look at Dublin fire brigade fighting to retain there ambulance service) however I do think proper investment in training, equipment and wages for people taking on additional skills is a fundamental part of making that work.

Link to comment
7 hours ago, BM96 said:

"Completely agree with you about everything you've said up until that last paragraph, the FBU as far as I'm aware are using it as a bargaining chip for a fairer wage and increased training etc in some areas..."

I've been an FBU member since the day I joined, 02/05/2005 and they in a very strong position in terms of negotiating leverage at a time when public support of the FRS (and the Police and Ambulances post Grenfell and other major headline incidents such as London Bridge) is at the highest I've experienced and you would think this is great going into pay talks but the 2% and 3% starting point 'offer' on the proviso we sell our grandmothers is obscene so they have a very tough road ahead.

Had every FRS embraced the FBU sanctioned CR trial from the outset and made it the success we have we would have been in an even stronger position.

We will be losing the Grey Book. But we can either put in on the table ourselves voluntarily, offer to have CR and Flood Response made Stat Obligations which will need incorporating into the FRSA 2004 but and only but for a considerable increase and future pay structure... or they will rip it out of our hands after a messy long drawn out fight and impose what they want... we won't be going all out again that's for sure.

But when it comes to CR - I personally won't be be stopping it regardless of any instruction. It's too important on many levels and the FRS providing this role to Red 1s and 2s is one of my fundamental beliefs that I couldn't just forget.

  • Kudos 2
Link to comment
14 hours ago, Percy said:

Personally speaking I've been very well trained by my Ambulance Sevice and upskilled to a point I'm now registered to give certain drugs when CR. I can also put a fire out and rescue people from an RTC too. Surrey has done the most CR jobs than any other FRS during this trial (nearly 6000) and that's just from about half the service! So you can see there is a demand.

If very soon the decision is taken to stop CR by the FBU then I will have to leave as sad as that is.

Percy,

You are in a very fortunate position to have received fantastic training. In my service, we are expected to do Co-Res on a poorer standard of training than ever before. Instead of receiving training from a specialist, we are now adopting trickle-down training received from the Watch Officers, who in turn have been trained by non-specialists. By non-specialists I mean other FRS employees who have done 'the course'. Any way you cut in, with the best will in the world, that's not what the public expect or deserve when they dial 999 and ask for the Ambulance Service. Under these circumstances I have little appetite to do Co-Res. Train me properly and I'll buy in. 

Also - has anyone asked the ambo's how they feel about their jobs being done by us? I know how I'd feel about someone else attending a fire.

  • Like 1
  • Kudos 1
Link to comment

If I can answer the second point first as that's easier... yes, and personally speaking numerous times.

My work related Ambulances service, South East Coast Ambulance (SECAmb) cover the geographical area of Kent, East and West Sussex and Surrey! They are normally working in REAP 4 and more often than not REAP 5 (think of REAP 6 as during Armageddon). What this means in terms of pressure on crews is that breaks, welfare and refs are non existent. The reasons for this are obvious but we are where we are and simply blaming 'the evil Tories' will not provide any more life saving provision to the community nor allow my Ambulance colleagues I work alongside to have a sandwhich and a brew. At any one time the service is at +96% capacity. Black Friday, hot summer bank holidays etc they simply run out of capacity.

So in terms of how do my Ambulance colleagues feel about someone else doing their job? I have yet to meet or speak to one who is angry we are, and that's an honest answer not just one trying to support my argument.

We are exposed to and doing such a good job of Cardiac Arrest Response (see letter below) that SECAmb use the data downloaded from our Defibs in training sessions - to their staff!!. You would be surprised to know how little trauma and CA/Resus Amb staff go to as a percentage of calls and due to their size where as that's our CR bread and butter. So it's no surprise then the data is being used to show how effective our CPR is, chest compression depth, tempo, oxygenisation is etc... in a nutshell we are making a good job of it.

Now to answer the first point and one that had me doing a double take after reading! If this has been allowed to happen then it's a service embarrassment and the management team need replacing of both services, simple as that. How an Ambulance service can sanction Responding under their CQC Clinical Governance umbrella in this way without proper training baffles me when I know just how in depth our training is.

We have to mandatory annually qualify in...

Infection Control online exam

Safeguarding Children online exam

Safeguarding Vulnerable Adults  online exam

Clinical Governance online exam

The Immediate Emergency Care Responder qualification itself demonstrating competence with...

Defib/Resus/O2 therapy

Major Trauma

Catastrophic Haemorrage Control  

Traction Splint application 

Pelvic Splint apication 

KED fitting

Collaring and boarding 

Clinical observations including...

Blood pressure assessment

Oxygen Saturation

and re register to administer the following drugs...

Oxygen

Entanox 

GTN

High dose aspirn

Salbutamol 

(and soon Epinephrine)

 Surrey Chart.jpg

Surrey Tweet.png

This is the gold standard which all other FRS will follow and should already be doing if hey are CR for their own legal and corporate protection never mind the safety of the casualty!

I tried to download my IECR workbook we use but it's too large.

Perhaps take the bull by the horns and become a lead for CR in your organisation. Tell your top brass how you are doing CR is shocking and you should use Surreys version as a template. I will be only too happy to assist you.

  • Thanks 1
  • Kudos 1
Link to comment

I think the last two posts sum up the difference in the training, response levels and consequently the differences in opinion for co-responding.

Surrey would appear to be leading the way here, some others may be close to that level, but I suspect many will be about the level Geeooo has experienced with the Scottish FRS. Now it is quite clear which one we should be trained to, however unless there are National Minimum Standards set for co-responding, is it likely to happen?

  • Kudos 1
Link to comment

So is the Surrey skill set listed above compulsory for all operational staff? If it is you are getting mugged off badly with no pay deal for all that extra work, basic life support and first aid should be the limit for us as a service in my opinion. Anything above that should be a voluntary specialist skill. I speak from a London perspective though and realise that in the sticks it's a little different waiting for an ambulance. 

  • Kudos 1
Link to comment

Yes it is compulsory but I don't mind getting mugged off if it means us becoming higher trained, move valuable, more relevant with being operationally much busier and having the skill to save people's lives... who knows maybe somebody someone I love or know?

For a visual reference - yes Surrey has many leafy areas but it is also Kingston (I know I know) etal and the area with the busiest CR pump, Staines, is the next station along the A30 to Feltham (the exact same Station build from the Middlesex days) and after G56 the next pump closest to T5. Spelthorne is a similar West London conurbation to Feltham packed into our smallest borough but with the densest population, so we are not talking darkest leafiest remotest Haslemere out in Narnia as I call 'those' places which are demographically polar opposites to many Surrey towns.

  • Kudos 1
Link to comment

I tell you what Percy, that's a skillset and a half. Hats off to you, however on the entirely valid discussion of salary implications I'm sure people are currently being paid ARAs for a lot less skill and competence. Honestly, all admirable notions of life-saving aside (in no way meant as a dig, I promise) how is that not undervaluing ourselves?

Going back to my second point, I have personally spoken to many paramedics on the subject, all of whom want us to have nothing to do with doing their job for them. Funny how opinions are so massively different in different geographic areas actually. I can see both points - job protection V proper rest breaks. No easy solutions for the ambos, but at present I do not think we are the solution.

  • Like 1
  • Kudos 1
Link to comment

True it's been done to death this topic but I think it's highly relevant and will remain so for a while yet.

In full agreement with Percy. My brigade is next to his and we have broadly similar training, with the exception that we don't yet carry enetenox or any analgesic (though in my opinion I think its one thing that would be a huge help), nor at the moment GTN spray but it is an every changing picture and with Surreys influence this may well happen. We all do a five day course that covers most of what Percy has listed plus a lot more station based input from the training team. We have the opportunity to third man with the ambulance for a shift which Im waiting to do myself. About nine on-call and an everying increasing number of wholetime watches do it here, soon to be everyone.

There is a massive training implication as these are subtle skills that need practicing on top of what you already do (we are on-call as well so double those concerns) but unlike say, big working BA jobs, you are going to these jobs very regularly and your sharpen up quite quickly.

At the bottom line I think more rural brigades will be swifter adopters of this than the big mets such as LFB/GMC who more or less still have enough "traditional" work and possibly less pressure to "look busy". As such it'l be a long time before we see any kind of national co-respodning standard. But it absolutely does work and make a difference.

  • Kudos 2
Link to comment

Right, my tenpennorth here. If we had gone down the American model a la Chicago, NY with integrated ambulances I'd be 150% in favour. If we go to the realms of integrated paramedic trained staff on watch I'm 135% in favour. I'll agree that if we get the skillset (and Surrey certainly look to be delivering that) I'm also in favour. Certainly in more rural brigades (certainly up near my home in Lincs/Cambs/Leics) I can see huge benefits. However there are some flipsides that have come out through Londons Trial. Firstly quantities. Some of the London trial crews are cracking in half a dozen or more Red1's a tour. Talking to Central London Paramedics, they're only doing that many Red 1's a month. The stress levels and mental trauma some crews are getting exposed to is phenomenal. Secondly, it's been suggested that potentially some of the busier London Boroughs could be generating 10 Red 1's a day. That's on top of our already somewhat stretched appliance numbers, and I don't hear any talk of pumps coming back to cover shortfalls.. Lastly, the nature of the calls themselves. Crews in London have been sent on stabbings, drugs related incidents, already deceased, pretty much everything in addition to straight forward(as straight forward as they can ever be) cardiac arrests. Don't get me wrong, it'll work if properly set up, but I'm concerned that Surrey is the exception rather than the rule...

  • Kudos 2
Link to comment

I know change is coming and I'd agree to it if the Fire Service were fully funded and equipped for it. I genuinely believe there is a desire to do things properly now in LFB as delivery and output now seen to have the word credibility before them. I hope my faith in the new team lasts.

However we have two very different kinds of fire service in the UK, in fact we have two very different types of fire service in London. There are stations across LFB and from what I read in many parts of the UK that count their calls on a weekly basis. I foresee no problem as far as the law of averages goes, with them doing CoRo as it is keeping them actively employed operationally as well as everything else we need to do.

But we all know there are stations in the poorest inner city areas of the UK where you can sometime count your shouts in hours and frequently in parts of the day. These are also the areas where the Ambulance service are flying backwards and forwards all day and night. So I'd imagine (as we are seeing in one of the CoRo trial Boroughs), it can begin to interfere with delivery of the service we are here to provide. My local station is (thankfully) very quiet operationally, less than 1000 calls per year, but ambulances are still hard to come by in these outer suburbs. So yes, I can see it working out here. With a caveat, as fire cover can be stretched if they do pick up calls.... if a neighbouring station goes out, then that automatically drops the CoRo tag until they are back again. Otherwise out here we really get into the '15 minutes for the nearest pump' realms... which although I know is life in some rural area, I want the 6 & 8 promised for the majority of the time if, god forbid, my time for needing the LFB comes.

As Cashy says above, the stations in central and inner London are quite busy, not many of the 4/5000 anymore. But north of 2500 calls which when you add all of the other work they now have to do and congestion, making a 15 minute AFA call into 40+ minutes out of the station, you can see what places like Euston, Soho, Shoreditch, Stoke Newington and the like are often out for several hours in the day. I am sure (probably without the severe congestion) that is reflected at certain stations across the UK's other Met Brigades and a few station in large Towns in the County FRS'

With this and the sheer demand for medical emergencies in these areas, I think it's a non-starter unless pumps are brought back or watch strengths increased and a CoRo vehicle put on the run (in which case why not put more first responders into the Ambulance trusts and co-locate them)? But there is a case for making some of the outer Met stations and the majority of County stations into CoRo stations as it is so difficult to justify fire stations that attend less than 1000 calls in a year. But instead of closing them, give them CoRo to guarantee a future and make sure those of us who live in these areas get to keep our local stations.

  • Kudos 2
Link to comment
On 08/07/2017 at 00:40, Geeooo said:

I tell you what Percy, that's a skillset and a half. Hats off to you, however on the entirely valid discussion of salary implications I'm sure people are currently being paid ARAs for a lot less skill and competence. Honestly, all admirable notions of life-saving aside (in no way meant as a dig, I promise) how is that not undervaluing ourselves?

Thanks Geeooo. I must admit I'm very very proud to have been one of 'noisy ones' behind it and even prouder of the way 'we' CR. I apologise for my ignorance in terms of the level of 'training' given (or not) to other FRS! It's appalling and unacceptable, clinically and professionally.

Could you imagine if UK wide we had all CR to the Surrey model for the FBU approved trial? Could you imagine then the bargaining power that would have brought when we knock on the door of Number 11 Downing St?

It's no good asking for pay rises prior to undertaking CR... the better position to be in is to have first demonstrated our capabilities, value which would have led to our services become indispensable.

Thats how you negotiate with leverage.

  • Kudos 1
Link to comment

Yes and no.  If you are doing it, and the employers are quite happy for you to continue, and staff aren't willing to stop it if necessary then the negotiating power you wield drops startlingly.  Would you pay the new higher price for that  item in the shop when you knew that if you just said no, the shop would sell it to you anyway for the current price?

  • Kudos 1
Link to comment

Surreys is basically the job spec of an ambulance technician at least based on the drugs listed above, which in itself is its own full time job so the real question, is having a model as extensive as Surreys costing people jobs in the ambulance service? If so where is the financial compensation for the people doing the work these people would have been doing? I'm much happier to stick to the London model of BLS and slightly enhanced first aid skills. 

Link to comment

It's not entirely the same. Ambulance techs (or rather ECSW/ECAs as techs are being phased out) have a wider array of drugs they can administer and do it more routinely. They also can therefore canulate and taking 3 lead/12 lead readings, and will generally have more thorough training in these areas. It might be a bit different in Surrey but here the medicines we can give are such that the patient can regulate their own intake (think o2, entenox, salbuatmol). Anything beyond that and you're into different clinical territory and that is quite rightly beyond our scope of practice as firefighters. 

The difference also is we are a quicker, additional response to an ambulance resource, not a replacement. We also don't convey to people to hospital (except in some dire circumstances like suspected sepsis or stroke). So it's not a zero sum "more co-responders = less emergency care assistants" situation.
 

  • Kudos 1
Link to comment

Hold on, you can convey people to hospital? That's absolutely mental, in an ambulance type vehicle appropriately equipped to convey non ambulatory people? Or the back of a fire engine on the floor with everyone's boots and leggings?

  • Kudos 1
Link to comment

Lincolnshire have 3 ambulances they can convey patients in.  They are as such co responders but with the ambulance as an extra capability.  They turn up as does a paramedic, paramedic jumps in back out his car and treats patient as they are conveyed and the other fire person drives his car to hospital and hands over, they cannot pick up calls till back in station area then.  Seems to work quite well as you could be waiting a long time for an ambulance in these areas.

Link to comment
2 hours ago, BurtMacklin said:

Hold on, you can convey people to hospital? That's absolutely mental, in an ambulance type vehicle appropriately equipped to convey non ambulatory people? Or the back of a fire engine on the floor with everyone's boots and leggings?

No we don't convey people to hospital as procedure. It has however happened on a few occasions where someone has been very sick and ambulance resources have been delayed or unavailable. We always have the ambulance Clinical Helpdesk on the phone and only they can make the call to convey someone and only if it's the best decision for the patient. It's for exceptional circumstances and when it happens it is investigated by the brigade.

Lincs have a different co-res model entirely, where as Matt says they have dedicated ambos and convey people as a built in feature.

  • Kudos 1
Link to comment

This is the benefit of co responding! 

This young person would of had a very different outcome if the fire service had not responded promptly. This is what anyone who joins the emergency services hopes to do! 

Link to comment
  • 2 weeks later...

So is co-res trial still active? last thing I read from union said not to do it after the 24th details to follow, no details followed.

Link to comment

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...