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Dual Duty: January 2014

I was writing this column in late November when coverage of the 50th anniversary of the JFK assassination permeated newscasts.

The coverage made me think about the secret service and the roles its members play – protecting the president and performing high-risk, high-pressure work in difficult surroundings. Sound familiar?

In previous columns, I have explained that in Alberta, fire departments are truly all-hazards responders, with most of our calls being medical emergencies. As the Alberta government continues to build its provincial EMS system, fire departments are becoming secret services in the truest sense: we’re protectors who answer all types of calls and we cover for the inadequacies of the new provincial EMS model while remaining an enigma to Alberta Health, which, to my mind, has failed to recognize the role of fire in emergency medical care.

According to a joint IAFF/Ontario Professional Fire Fighters Association report in 2011 called Enhancing Emergency Medical Response Through the Fire Service, 90 per cent of fire departments in North America deliver some level of emergency medical care. The report says this makes firefighters the largest group of providers of pre-hospital care in North America.

Often, patients need more than just medical care – they require extrication or specialized protection from hazards. The fire service is uniquely equipped to address all of these needs.

Because of Alberta’s new so-called borderless EMS system, ambulances can be sent out of district, often for long periods of time. When a code-red occurs – meaning there are no ambulances available in a particular region – it is the fire service that steps up and responds to the 911 calls. These types of situations are occurring increasingly and are straining volunteer resources, thus creating retention and morale issues in the province’s volunteer fire departments.

A recent discussion paper by Alberta Municipal Affairs noted that training and increasing workloads for fire services that provide medical response are top issues. Despite pressure from fire chiefs, health-care decision makers have turned a blind eye and denied funding and support for the valuable medical first response that the fire service provides. Recently, a task force was set up to address these issues.

Several groups – the Alberta Fire Chiefs Association, the Urban Municipalities Association of Alberta, and municipal and county districts – have said they are concerned that medical services are being offloaded to municipalities through medical first response. Fire services often bear significant costs for medical first response, including training and supplying equipment; in addition, there is a strain on volunteer responders in small communities.

In my opinion, Alberta Health Services does not fully recognize the extent of the capabilities of medical first response providers in some communities. Firefighters willing to assist with patient transport to the hospital often cannot get back to their homes within a reasonable time because that particular ambulance is thrust back into the system and ends up hours away from the home community.

Emergency workers in Alberta have had to adjust to a new delivery model for health care, specifically because EMS care was officially recognized as part of the health-care system. Previously, each community, city or town in Alberta was responsible for managing, funding and supporting its EMS delivery model; Albertans who needed transport to hospital were looked after by a variety of private, municipal, volunteer and dual fire/EMS systems, each of which was customized for its specific regional domains.

In my opinion, Alberta Health’s new EMS system is tightly controlled by a strict mission statement that starts from the desk of the health minister and filters down onto the front-line workers. It appears mandated that a borderless, province-wide system is not to be challenged. The downside of a “We are One” mission statement is that it removes communities’ ability to regulate specific regional needs and response strategies.

Some communities have chosen to stop providing the service: the City of Lacombe, for example, has said it will not dispatch fire units to medical first response calls until the province steps up with assistance such as supplies and training.

Many studies have identified the improved patient outcomes as a result of fire personnel arriving quickly to a scene, but how can we achieve the necessary support for this service? Fire-service leaders across Canada must work with health ministries to build partnerships that put patients first. There must be a clear understanding of which agency is ultimately responsible for medical first response when ambulances are delayed or unable to respond. Alberta Health must support first-responder models and ensure that safe, standardized care is provided to patients. Studies have shown that using fire/medical response saves taxpayers one-third of the cost of adding more ambulance crews into the system. Ultimately, the solution is the provision of financial support to municipalities for medical first response training, equipment and supplies.

It is clear some decision makers believe that EMS within the fire service is unworkable: this could not be further from the truth. All players must open borders, create seamless transitions and realize that conflicting agendas only harm patient outcomes. Failing to use the strength of fire department medical aid truly makes fire a secret service that fails to safeguard those we’ve sworn to protect.

Until next time, advocate for your patients, and be safe.

Lee Sagert is a career paramedic/firefighter with the City of Lethbridge in Alberta and a volunteer lieutenant with Coaldale Emergency Services. Contact him at leesagert@shaw.ca