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Dual Duty: April 2011

Coming together is a beginning. Keeping together is progress. Working together is success.” –Henry Ford

The above quotation reflects the culture and direction of Canada’s integrated fire and EMS systems. For many communities, this dual approach to saving lives is ingrained and deeply rooted, with a rich history that continues to succeed today.

People have ever-increasing expectations of emergency services. Fire services have had to expand their toolboxes with high-angle rescue, heavy rescue, hazmat and water rescue/dive teams. EMS has grown, with new protocols, an expanded scope of practice, superior equipment and additional services. With ever-tighter budgets, emergency services are expected to find efficiencies in everything they do. The adage doing more for less applies to today’s emergency services. Lethbridge Fire and Emergency Services (LFES) in Alberta is among several Canadian departments that have addressed this issue and realized efficiencies by cross-training staff to be firefighters and EMS providers – one crew, many jobs.

At any time in Lethbridge, the crews on duty may be dispatched to a cardiac arrest call, or to assist a family with a CO alarm; it’s all part of the daily duties for firefighter/paramedics who have been delivering EMS and fire services since 1912. Next year, the department celebrates 100 years of continuous EMS provision. LFES is the oldest dual-role service in North America. All Lethbridge’s trucks are staffed with paramedic and EMT personnel who are cross-trained as firefighters. Four stations cover a population of 86,000, with call volumes of 10,000 EMS runs and 1,300 fire/rescue runs a year. Each station staffs ALS ambulances and ALS engine/rescue trucks. Additionally, Lethbridge is responsible for a rural fire protection zone, inter-facility patient transfers, specialized rescue teams and a fire prevention bureau.

In an integrated department, it is not unusual for an engine company to arrive first to a medical call – if it is the closest unit – and provide immediate advanced life support care. The value of this care is emphasized with the ability of the first-arriving paramedic to accompany the patient in the ambulance to the hospital. This is truly a seamless transition. Some of the efficiencies are:

1. Everyone has the same training.
2. Staff can change roles when needed.
3. There are always trained medical personnel and equipment available on every scene to which staff respond.
4. Continuity of care for patients – the first paramedic/EMT on scene can do initial assessment/care and transport patients to the hospital.
5. The tax base has to fund only one employee group (this is more fiscally responsible). Separate fire and EMS systems rely on the tax base to fund two employee groups.

Although EMS calls make up the bulk of emergencies in Lethbridge, fire calls are handled the same way. Lethbridge’s firemedics carry turnout gear and breathing apparatus on the ambulances and are simultaneously dispatched with fire units. Often arriving first, they are trained to provide a scene size-up and report findings to the first-arriving officer. Working within the incident command system on all call types, the role of the firemedic can be assigned as needed. On a fire scene, those assigned to the ambulance can act as firefighters, care for fire victims or set up rehab tasks. When asked why this system works so well, many say that being housed in a station together as a team allows joint training, team building and a general sense of collective direction to any emergency.

“The fact that our leaders have worked all levels of the system only strengthens the team,” says Lethbridge firefighter/paramedic Todd Walker.

Helping people, regardless of the type of incident, is the forte of Canada’s integrated fire and EMS systems. When demands call for community health care, crews assist with injury prevention in youth, blood-pressure and flu-shot clinics. Or, crews may be called to check smoke alarm batteries or perform home inspections for the community. The system eliminates the need for multiple agencies to deal with emergencies. Leaders of these dual-role departments have big challenges as they supervise such a variety of objectives but bring them together to work as one. Although this structure works smoothly, this all-in-one system has its challenges, including:

• maintaining proficiency and experience on a multitude of equipment
• higher call volume – stations struggle to balance training versus calls
• fulfilling EMS benchmarks and procedures
• for legislated provincial standards (chute time versus response time and their effect on patient outcome – these may not match local department standards)
• working to rotate staff through ambulance duty and fire duty to maintain competence in both specialties
• co-ordinating responses to best serve the public
• sorting out the various custodians of EMS – municipal or provincial governments, federal or municipal, and urban versus rural challenges

In upcoming issues of Canadian Firefighter and EMS Quarterly we’ll look at those challenges to help open up discussion on various EMS delivery models.

The delivery of emergency care in Canada varies from community to community. Private ambulance services, provincially run ambulance systems, integrated departments and stand-alone fire services all deal professionally with EMS. However, a team approach that focuses on one goal strengthens public confidence. The goal is to care for the community and there is no better exercise for your heart than reaching down to help somebody up.

Lee Sagert is a career paramedic/firefighter with the City of Lethbridge 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. Contact him at leesagert@shaw.ca