Co Responder Initiatives

A Partnership for Life

There is now a huge amount of irrefutable evidence that proves beyond doubt that Co-Responder schemes are effective and save lives.

It has been accepted by all informed parties that there are very few negative aspects and in general terms, properly managed schemes provide benefits to the Ambulance Service, Fire Service, operational staff and the communities they protect.

The points detailed in the FBU position statements are quite wide ranging and completely uninformed and out of date. The points are listed below with our position which is endorsed by CFOA, the ODPM, and the Ambulance Service Association (ASA).

Co-Responder initiatives are vitally important if people suffering a life threatening emergency are to stand a better chance of survival.

The Fire Brigades Union (FBU) is vehemently opposed to cooperation between Fire and Rescue Services and Ambulance Trusts to enhance service delivery. Their position statement is very negative and critical and is divided into the following headings. We have used the same headings to explain the RFU’s position.

History

Most of the statements in the FBU document contain a reasonable degree of accuracy, however they are frequently quoted out of context, additionally there is a considerable amount of new research that demonstrates that 4 minutes is the maximum amount of time available to achieve an effective resuscitation. The 2004 Fire and Rescue Service Act places new duties on all FRS, Co-Responder schemes fall into the scope of the act.

Operational Implications

  • Saving Lives – It is an unfortunate fact that achieving reliable quantifiable scientific data on patient outcomes derived from co responder scheme intervention is virtually impossible.

  • All data therefore has to be subjective, this is often miss-quoted in an attempt to minimise the benefits derived from Co-Responder schemes.

  • On average each scheme saves 5 lives per year, with as many as 10 others that could be defined as possible saves. There is a huge benefit to very worried relatives when responders arrive; reassurance is often 80% of the treatment given!

  • Even in the worst case where a resuscitation attempt has failed, the relatives are comforted by the fact that everything possible was done to save the patient.

  • If a patient has an obstructed airway they will be dead within 4 minutes, Co-Responders do not need paramedic skills to save a life. A highly skilled, qualified paramedic equipped with £ 60,000.00 of the latest equipment can not do anything for a patient who has not been breathing for more than 4 minutes.

  • Perhaps in an ideal world everyone needing a paramedic should get one in less than 4 minutes, however if the world was that ideal we would not need any of the emergency services.

  • Many areas that do not have ideal Ambulance Service cover may have a fire station; these are ideal bases for Co-Responder schemes.

Fire Cover

  • Many Co-Responder schemes have been in operation since the late 1990s, thousands of Co-Responder calls have been attended. There have been very few instances of simultaneous demand and even fewer where these actually caused any difficulty.

  • All services have effective back up arrangements; these easily cover a rare event of simultaneous house fires occurring in the same station area.

  • If a serious life threatening call occurred whilst a Co-Responder call was in progress, locally agreed protocols will cover most eventualities.

  • Modern and professional control operators should be able to determine the correct response to any incident that could occur.

  • In an extreme circumstance the Co-Responder response could be stood down and redirected to a life threatening fire/rescue emergency as the Paramedic response is always mobilised when the call is received in Ambulance control.

  • The FRS Act 2004 places a statutory obligation on fire and rescue services to attend any emergency, not just fires.

  • Co-Responder schemes are a valuable and effective extension of service delivery that enhances the protection any FRS can offer to the communities it covers.

Training

  • There is no suggestion that firefighters participating in a Co-Responder scheme should be trained as paramedics, this would be impossible due to training and skill maintenance implications.

  • However moderately enhanced first aid skills save lives ever day, often simply by maintaining the patients airway.

  • Training for Co-Responders is usually delivered by the Ambulance Service to ensure that the correct treatment protocols are in use. This also helps to build a better understanding of both services operational priorities and working arrangements.

  • This has the added benefit of increasing the operational efficiency at incidents where both services are in attendance leading to better treatment for the patient.

  • All Co-Responders benefit from the enhanced training provided by the Ambulance Service staff. Additionally, frequently working together with local paramedics leads to a greater confidence in each others abilities, indeed, most Co-Responders are now on first name terms with paramedic staff.

Competence

  • It is true that initially, early schemes were only intended to be sent to cardiac related calls; however it quickly became apparent that other categories of call could be attended with some additional training.

  • Several more call categories have been added into most schemes, fundamentally they are all dealt with by utilising basic lifesaving skills.

  • As Co-Responders are only utilised for immediately life threatening calls, the specifics of the medical emergency are often irrelevant as management of the patients’ airway, breathing and circulation take priority.

  • All Co-Responders are regularly reassessed as part of on-going clinical governance by the Ambulance Service.

Liability

  • The FBU’s position on Co-Responder liability is well known, it has been repeatedly proven that the vicarious liability insurances provided by all Ambulance Trusts are reliable and robust.

  • It is interesting that the FBU’s position statement actually confirms that even if the Ambulance Service cover was to be insufficient, the FRS insurance would cover the Co-Responders.

  • All Ambulance Trusts provide insurance for their Co-Responders; FRS Co-Responders are only one of a wide selection of lay responders utilised.

  • As FRS responders are mobilised by their respective FRS, the Firefighters Pension Scheme will still apply whilst the responders are carrying out Co-Responder calls.

The points above address directly the negative and dogmatic stance of the FBU as detailed in their out of date position statement.

The RFU fully supports involvements in Co-Responder initiatives, especially in rural areas. The benefits accrued by existing schemes are many and varied: -

  • Improved appreciation of the local station by the community it serves

  • Increased call volume, often on very quiet stations

  • Increased income generation which preserves retention of staff and encourages recruitment

  • Improved first aid skills

  • By raising the profile of a fire station within the community, Co Response enhances recruitment

  • Greater feeling of value amongst fire station crew, especially after saving a life.

  • Greater cooperation between firefighters and paramedics at incidents, this leads to better treatment for the patient and generates a better understanding of FRS and ambulance service roles

Whilst it is often stated that the use of fire service Co-Responders will lead to a reduction in ambulance cover, the reality is that statistical information derived from Co-Responder schemes is frequently used to increase the provision of Ambulance resources.

There is a wide variety in operational procedures for carrying out Co-Responder duties, generally the best methods should be determined by an assessment of Co-Responder call volume, existing station workload, availability of retained staff and local demographics.

Operational response can be made in a number of ways: -

  • Use of Fire Appliance

  • Use of light vehicle with 2 crew – in some cases supplied by a local benefactor or by fundraising

  • Crew responding in own vehicles

  • Crew responding alone

The RFU has concerns about lone responding, two responders as a minimum crew provides a better level of protection for the responders from any allegations that may be made or difficulties that could be experienced.

Any new schemes should be subject to Criminal Records Bureau checks on all staff involved in the scheme.

The provision of a Co-Responder service is an additional level of cover provided by both services; a full paramedic response will always be made as usual, even though the Co-Responders may be able to reach the patient more quickly.