Medical crises slip through agreement

Fire bosses say staff attend all emergencies where possible

Firefighters did not respond to emergency calls for a choking child and a person with heart attack symptoms, despite requests from ambulance staff, a union report has revealed.

The New Zealand Professional Firefighters Union ( NZPFU) is concerned that the problem has been caused by rules which can prevent firefighters without high- level first aid training from attending some lifethreatening cases.

The union report also highlighted “significant delays in waiting for a patient’s condition to deteriorate before responding”.

In some cases, a life- threatening call could sit pending for 10 minutes, waiting for the patient to deteriorate to the most serious category, the report said.

If the call was not upgraded, ambulance staff often “pleaded” with firefighters to respond.

The report gave examples of a child choking and another of a person with shortness of breath.

“These are incidents where NZFS could make a difference,” the report stated. “In the example above, we could wait until the child becomes unconscious and unresponsive before responding or we can choose to initiate a response early to save time.”

It’s not clear if the patients listed as examples survived.

Fire bosses yesterday said firefighters attended all medical emergencies where possible, but the union said further investigation was required about the workings of a Memorandum of Understanding between Fire and Emergency NZ ( FENZ) and St John Ambulance which is based on a colour- coded patient triage system.

Under the agreement, fire centres must dispatch the closest available staff for “immediately lifethreatening ( cardiac/ respiratory arrest)” purple calls.

However, only highly trained first responders are supposed to go to red calls, which are “immediately lifethreatening or time critical”.

First responders are firefighters trained to a higher level of first aid and can deal with emergencies without assistance. Staff without this training, known as co- responders, provide lifesaving treatment in conjunction with paramedics and only attend purple calls.

The choking child and potential heart attack incidents were categorised red calls by ambulance 111 call centre staff, and were in areas where FENZ did not have first response units. In both cases the re- sponding ambulances were farther away than available co- responders but the firefighters were not sent.

FENZ national operations manager Paul Turner said if St John confirmed a co- response would help the patient, then “Fire will send a coresponse unit, if available”.

He said this response existed in protocol in the communication centre which allowed them to work on a case- by- case basis. “We believe the Memorandum of Understanding is working well to protect New Zealand communities and save lives.”

Of 26,000 emergency call incidents since January 1 last year to June this year, released to the Weekend Herald under the Official Information Act, 3367 calls were not responded to.

Of those, more than 1000 requests for assistance by ambulance staff were declined by fire communication centres because there were no first responders.

In 21 of the red calls there were delayed response times of between 10 and 29 minutes.

NZPFU national secretary Derek Best said he would investigate whether co- responders should formally attend red calls but said training and workloads had to be considered.

Best acknowledged there was a gap in the service and said the irony of the situation was that red call patients had a better chance of being saved by earlier treatment than a patient triaged purple.

“I’ve got no doubt that sooner or later members in the main provincial and metropolitan areas will be dealing with red calls because the ambulance simply can’t cope with the situation.”

St John assistant director of clinical operations Dan Ohs said there were several circumstances where FENZ might not have an appropriate resource and this was different to refusing help.

Lynette Blacklaws, of First Union which represents paramedics, said if co- responders were free, paramedics wanted the help.

“I’m sure it would be a much appreciated assistance.”

The MOU will be reviewed in December.

Firefighters union national secretary Derek Best