Co-Responder Stations - What's Involved?

[TheSmiler]

Hi everyone,

I'm gearing up to putting my application in to join the retained station in my town soon, which is a co-responder station, and I'm looking to learn more about what's involved.

As far as I can tell, the co-responder role is primarily first aid based, with defibrillation, oxygen admin, dealing with unconscious casualties, bleeding, shock etc, ahead of the Ambulance Service's arrival.

I was wondering what's involved in the co-responder training? I've always been interested in this side of things.
For example, are Co-responder FF's trained to intubate or use IVs, or is it more a first aid type role?

[BurtMacklin]

intubation is really hardcore I wouldn’t associate it with corresponding and the fire brigade it’s more advanced life support, paramedics and doctors 

[TheSmiler]

Thank you - I thought as much to be honest with you.

From what I've read, it's the bare bones of first aid, which I find staggering considering co-responders are pitching up to 999 calls...

I'm interested to learn to what extent retained co-responders are trained, or is it similar to a standard first aid qualification an employer might send some employees on in the workplace?

[Rory-495]

When it gets brought up in LFB and during the trials a while back the crews were essentially sent out on "Red 1" calls (e.g. heart attacks, strokes etc.)

Considering we carry oxygen, airways and defibrillators it's a but reductive to say firefighters are first aiders... we are more like aggressive first aiders! 

The general gist is that we can get air into lungs, defibrillate people and prevent rapid deterioration before the ambulance can arrive, making their lives easier as they don't have to do a lot of the prep. Also there's 4+ firefighters who can muck in

[C_Iain]

@TheSmileryou’ll find a lot of variety between brigades as to what kind of medical calls they will & won’t turn out to (if they do it at all) and therefore what kind of training ff’s receive. 
Some will only send crews to Red 1 calls with risk to life, where others will go to lower priority calls like slips, trips and falls (or “Nan down” calls as I’m told they’re know as in certain brigades 😂)

The best thing you can do is get in to the station you’re looking to join on a drill night and ask the guys and girls themselves.

[BurtMacklin]

presumably you will be working under the clinical governance of the ambulance service for the area you serve. if this is particularly rural with extended travel times they may deem it necessary and worth while providing you with enhanced skills equipment and training. it really is dependent on the requirements of that service. in London the co-responding trial was all about getting a defibrillator and o2 on cardiac arrests in the shortest time possible so we didn’t require any enhanced training or equipment. 

[OscarTango]

With slight variations, you will generally receive a fairly thorough IECR course (most likely the same as wholetime) which is like First Aid at Work but with additional input on trauma care (Israeli dressings, chest seals tourniquets etc.)

If you are co-responding then you will likely get some additional Obs training in top of that. BP, o2 sats, Glasgow Coma Scale, possibly Blood Sugar but that is considered an invasive procedure (pinpricks) and may not be allowed under your services clinical governance. We used to be able to give salbutamol but that's been taking away for the now. You'll get some input on possible conditions and what to look for but you will, I must stress, not be diagnosing people. It's really just to aid your handover to the Ambulance.

As has been said, if you go to Cat 1 calls only then its immediate risk to life and you are basically there to put a defib or oxygen on someone and/or stop them bleeding to death.

Cat 2s are a different kettle of fish and you will end up being sent to all manner of stuff where you can basically just take obs and make small talk until the ambulance arrives. There are far, far more calls to Cat 2s than Cat 1s and the actual difference you make to patient outcomes will be a lot less. So have a discussion with the station about your (and their) level of involvement. It is a voluntary service dont forget.

I am pro co-responding as a concept but it can be a minefield. Not to put you off mind. Just worth having a thorough discussion with your prospective Watch Manager

[TheSmiler]

Thank you so much @OscarTango - really appreciate that.

Seems an interesting thing to be involved in

[Percy]

The whole ‘Co-Responding’, ‘EMR’ issue, even for RDS/On-Call, has never been fully thought out or standardised as it’s dependent on the local ambulance authority who’s behalf you are responding for and their local governance umbrella you will be performing the tasks under. So the term ‘Co-Responder’ (as Community Responder is) is different in each Brigade that performs it.

I am the most ardent supporter of EMR there is and personally, IMHO, ‘we’ should have been providing the role for decades regardless of shift pattern or location but even I can see that in its current state it is a dogs breakfast.

For me too, we can’t ‘just go’ to Cat/Red 1s.

Either we do it properly, fully or not at all - it’s not anywhere near ethical to only respond to someone in CA from say anaphylaxis, asthma or even an MI itself if in all three of those cases they could have been prevented from needing Defib/Resus had we gone to them in Cat/Red 2 status.

Anyway back on topic, all Ffs are trained to an already higher standard of emergency trauma care, much higher and more skilled than ‘Fire Aid’, especially if this is IECR either Intermediate and especially Advanced level.

’Most’ Brigades that currently have a Co Responding arrangement in place for some of its RDS/OnCall stations will be responding to purely Cat 1s, so people in Cardiac Arrest. In the vast majority of occasions, this will be due to an MI and by default, will be to those north of 40, but more likely 50+. They will be unconscious not breathing so it’s your basic bread and butter OP/NP airway or even IGEL (this is NOT intubating) compressions/O2 and defib if prompted that any CA would require we would come across conventionally.

If your station serves a relatively rural location, where any ambulance response is plus 10 mins away, your direct involvement will save lives, no question about it.

The best people to speak to though, and the ones with all the info are your local crew.

Best of luck pal.

[OscarTango]

Gone to them and done what? Without current level of training, equipment and personnel availability? As I've been in that situation many a time and felt as useful as a Braille text message.

As things stand now, Red/Cat1s is all we can do to make a meaningful difference to patient outcomes (and that's what matters at the end of the day, not what makes the fire service look busy to avoid cuts). 

For things to be different we would have to drastically expand our scope of practice to Tech/ECSW level, and realistically, be able to convey people to hospital. If we can 12 lead ECG, cannulate, medicate and convey then you are right, we can prevent that Cat 2 call becoming a full cardiac arrest.

But what the hell would the fire service look like for that to be the case? No way in hell could we do that with current levels of manpower and funding. We can barely discharge our core duties of fire service provision as it is. We can't train enough drivers and ICS, let alone paramedics. 

All that said, I know you are someone who has given a hell of a lot of thought to the subject and I value your thoughts on the matter. 

How could/should it be done? How should fire service medical response look and how do we get there?

Quote removed as its a direct of the post above. Please see FAQ

Edited August 7, 2022 by Carl

[Percy]

22 minutes ago, OscarTango said:

Gone to them and done what? Without current level of training, equipment and personnel availability?

Well in the three examples I gave… provide an epinephrine pen, salbutamol and high strength aspirin and/or GTN would likely prevent at least the first two Cat/Red 2s becoming Cat/Red 1s, there are too many variables with the MI scenario to say for definite and these are examples that I actually went to on numerous occasions (resulting in a meaningful patient outcome… aka, they didn’t deteriorate to full CA and/or die but did go to hospital when the paramedics arrived with greater knowledge, skills, drugs and equipment at their disposal) when Surrey trialled their version of Co Responding.

I could also say the same if they went into CA and we just went to Cat/Red 1s…And done what? Defib/resus provide O2 how? In both cases their airways and whole respiratory system would have been compromised to the point of exhaustion and/or acidosis they actually went in to CA. You could ineffectual BVM them all day and even defib them but unless the primary reason for them going into CA is addressed it’s not going to do anything is it? 

The ‘Surrey’ version of the Co Responding trial would do me. Registered with the local ambulance authority to provide 7-8 drugs (none IV) that you have the cards for in JR Calc and administer via permission from the clinician on the phone in EOC. No ECG interpretation needed, no cannulation, just rapid intervention of some simple meds and skills that can prevent Cat 1.

Funding for this is a separate debate - we did it once, for 18 months and extremely successfully as mentioned in the Royal College of Surgeons report. I have a feeling that UK FRS not providing EMR will not be the status quo for much longer anyway but the biggest hurdle to this currently is appropriate remuneration which is all part an parcel of the next few acts of the play that seems to have already started.

[Jono]

When I was doing Co-responding before they trained us up to FREC 3-4, you could also do an additional drugs admin but it was for minor drugs like salbutamol, fentanyl etc, you also had to cover an additional amount of calls at one level before they gave you further training in order to develop your skills for the more in depth fault finding like cat 2 etc,  I think it was stations in Lincolnshire that had the “F ambulance” as it was known, but I don’t know wether that worked or is a successful campaign, 

[Percy]

‘Minor drugs like fentanyl’  😮

Did you actually mean fentanyl?, as a Ff in the UK you were cleared to and registered to administer fentanyl? 

[Rory-495]

Can't comment in FF, but as a reservist infantry soldier I'm also trained to use Fentanyl and administer it. It was maybe 10min of a 5 day course. Used instead of morphine now on a lozenge

[Jono]

Should of cleared that up a bit, MOD FF co-responder Not via injection it was lozenge, and not straight off the back, you had to cover a fair wack well before you were aloud anywhere near it, plus 100% on yearly drugs exam for obvious reasons, like I said you would start on a a level 2 basic course, then FREC 3, then bolt on courses to up skill and then FREC 4 with more bolt on courses 👍