It’s 6:50 a.m. An elderly man awakes with crushing chest pain and dials 911. As he fights to catch his breath and cope with the pain, nothing is more important to him than receiving aid; he needs help now and he needs it fast. The 911 dispatcher advises him that help is on the way; the medical system has been set in motion. What this patient does not know is that minutes prior to his call for help, another emergency had occurred nearby and now there is no ambulance available in town to respond. The patient will have to wait until an ambulance from a neighbouring community arrives. When a situation like this occurs in Alberta, the way it is handled can mean the difference between life and death. Community first responders (usually local fire departments) play a key role in the medical system. Sadly and surprisingly, some communities still fail to recognize this valuable life-saving service.
The issue of community first response appears to be burning once again. An analysis of recent activities in Alberta may provide some insight for other provinces, in hopes of advancing patient care. After all, the sick and injured should be a top priority.
Since the Alberta government assumed ambulance care in 2009, there have been many changes – both good and bad. Some cities and towns quickly handed over their EMS systems, while others fought to maintain the ambulance services they had built with pride. Improvements were witnessed with the launch of province-wide patient treatment protocols. This standardized care placed all responders on the same page. Attempts to centralize dispatch centres and regulate response levels created tension among government leaders, emergency service chiefs and front-line medics. It was evident that Alberta Health Services was trying to apply a standardized vision of EMS care. With every citizen deserving the same level of care, We are one seemed to be the new slogan. The idea of a province-wide system was met with questions from all levels, especially the integrated fire/EMS departments. It was soon realized that a cookie-cutter approach was failing in some areas. It became evident that Alberta was an incredibly diverse province with unique needs in different regions. Long-serving EMS and fire systems that had been tweaked to excellence through local requirements were suddenly altered . . . some for better, and some for worse.
Front-line emergency workers and municipal governments began to speak out through the mainstream media and social media. Response times and community coverage made headlines. Some areas experienced reduced coverage and required neighbouring communities to forfeit ambulances. As everyone was adjusting to these changes, the fire service was responding with medical care when the ambulance system was stretched. Certainly, ambulances were dispatched and front-line paramedics did their best. However, when ambulances were delayed, Alberta’s fire departments were sure to answer the call and respond quickly to the sick and injured. So the question was asked: where do local fire departments fit into the medical response system? Fire chiefs are still waiting for an official answer.
The equal level of care that was projected did not come without a price. With the vision of borderless EMS service also came a new protocol. System status management (SSM) meant that, theoretically, code-red events – when no ambulances are available – would not exist. SSM ensured overall area coverage, and rapid chute times were the only true measurement. Priorities stretched, as did response times. When multiple 911 calls are stacked, EMS units are sent, no matter what. But the response can come from a great distance and the system could potentially result in a community being without an ambulance for hours. When a serious call comes in, a community’s ambulance may be on a call, or covering other busier response areas, and patients may wait longer for an ambulance to arrive.
Luckily for some towns, for years, fire departments have been initiating care prior to ambulance arrival. Studies show that early medical aid by local fire-rescue crews directly impacts patient outcomes. Larger cities have used full-time fire-first response for years. Overlooked within this new EMS system was the increased call volume for volunteer departments that already struggle with recruitment and retention issues. Volunteers are being called away from their jobs at an increasing rate, and Alberta Health Services must rethink funding, training and compensation for this critical service. It is clear that community first responders are a needed service in a growing system, but they remain overlooked, underfunded and unrecognized.
Remember the patient with chest pain? He requires help urgently; therefore, the ultimate objective is early arrival. Alberta Heath Services shares several goals for improving health for Albertans. Pushing forward with a strategy of community first response using local fire services is one reliable way to achieve these goals. Recognizing this valuable resource with province-wide standards, simultaneous dispatching, adequate training, and funding, will ensure the best care for Albertans. A group of concerned stakeholders has rallied and started the Rural Emergency Direction (RED) group. Go to www.ruralcommunityfirstresponders.com to view the presentations and strategies. EMS leadership must place fire into the chain of survival. By giving clear direction and quality assurance to fire chiefs, planning, budgeting and staffing can be outlined. The added value to citizens will result in better patient outcomes and community satisfaction.
Be an advocate for your patients. Do no harm and, most of all, be safe.
Lee Sagert is a career paramedic/firefighter with the City of Lethbridge in Alberta and a volunteer lieutenant with Coaldale Emergency Services. Lee is a former flight paramedic with S.T.A.R.S. and has trained at Oregon Health Sciences University in Portland. He resides in Coaldale, Alta., and enjoys photography and spending time with family. Contact him at
Dual Duty - January 2013
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