Stopping turf war between firefighters, paramedics
Carleton University professor Susan Braedley has spent years documenting the expanding role of firefighters across Canada in responding to medical emergencies. As Queen’s Park contemplates a proposal from the Ontario Professional Fire Fighter’s Association (OPFFA) to increase their medical responsibilities, Braedley offers advice on how to diffuse the turf war between firefighters and paramedics.
What’s causing the tension between firefighters and paramedics?
911 rates have gone up . . . and paramedic services have not experienced the kind of growth that one would expect from those stats. Fire services are assisting as first responders to meet the demand, and paramedics are worried about this, in terms of, first of all, being the wrong service and, second of all, in terms of their own jobs. Neither of those concerns is completely justified, but I understand the reasons for both.
From a fire point of view, fire is already there. They’re involved, and they have the possibility of being involved. They are already in our communities. Expanding scope of practice to do more in emergency medical response costs us very little and seems to make sense. Thus, the fight ensues.
You’ve said that you’re not a fan of amalgamating fire services and paramedics, like in Winnipeg, because of differences in culture, unions and funding models. But you speak highly of the effect of “service integration” in that city. How does that work?
In Winnipeg, we see a primary care paramedic who is cross-trained as a firefighter on every fire apparatus. That means that everything in terms of medical assessment can get started the minute they arrive. The pressure is off paramedics in terms of their response rates. They don’t have to be as fast. Paramedics do not have to go to every call.
This has value added for the public in that they get the right care and the right time and that they don’t get more than they need. It has tremendous benefits for taxpayers in terms of the use of tax dollars and it also allows paramedics to specialize and really advance their practice.
How has technology helped bridge the divide in Winnipeg?
Fire service goes in (first) with a tablet. While the firefighter/primary care paramedic is doing the assessment, another firefighter is entering the data on the tablet. When the paramedic and ambulance service arrives, the info they have taken is transferred by Bluetooth technology to (their) tablet so they have the data right in front of them.
All that data gets transferred back to respective services for statistical analysis. So there is a seamless process where technology is used for information exchange that really facilitates care. I saw it over and over again. It also supports trust between the two services.
What do you think of the OPFFA’s proposal for firefighters to receive more medical training and be able to administer some medications?
What they’re proposing is pretty mild stuff. To me, it makes sense. What I wish were included is more training on dealing with people with mental illness, people who are very upset or volatile, because in my work with fire services I see many, many instances where these skills are necessary. The other thing I would love to see is consultation between the OPFFA and the paramedics’ association. I think if those two groups ever get together and collaborated on service integration, we would see some tremendous system improvement.
If the problem is that we need more medical responders, why not focus instead on decreasing hospital wait times to free up more paramedics?
We have to work at multiple levels of scale at one time. You can’t say we’re going to decrease wait times at emergency rooms and have people waiting for care on the street until that happens. Firefighters are there now. We’ve already paid for them. This makes perfect sense. I don’t think it’s an either/or proposition.