Lowering the bar

In the world of policing we have, over the last 10 years or so, been besieged by targets. You must make this many arrests each month, you must issue this many tickets for this offence and you must submit this much intelligence. We’ve also had targets that have been set for us for by us to reduce crime. We have proudly announced targets stating we will reduce burglary in an area to a certain percentage… sometimes using no evidence base whatsoever to dream up a figure.

If you haven’t read Intelligent Policing by Simon Guilfoyle then I implore you to do so. He covers all this ground and a lot more. One area he writes about is why, if we aspire to excellence, do we think reducing burglary in a area to a certain percentage is good and to be boasted about? Surely, he argues, if we are to have a target at all then it should be zero burglaries. That is what we should aspire to. Interestingly, and as a comparison, do you know about the Below 100 campaign? It seems very bizarre to me that the purpose of this group is to reduce preventable LODD’s (Line of duty deaths) to below 100 in the USA. What will they do when they reach 99? Will this be a time of celebration? One death of a police officer in the line of duty is not acceptable so why is the target to get below 100? Surely to God, however unachievable it may be, reducing LODD’s to zero must be the objective?

What some organisations, campaign groups, governments and others seem to do when setting targets like this is compromise. Instead of aspiring to a target that is the absolute 100% best outcome they settle for second best. They understand that reducing burglary to zero may never be attainable. They recognise that getting LODD’s to zero may be an impossible dream. So instead of accepting these difficulties and aiming for zero regardless, they compromise.. because let’s face it how can you ever claim to be a success if you never EVER reach your goal? Achieving a reduction is something to be pleased about. Your efforts are showing positive results and moving in the right direction but it is not the ideal outcome. Cancer Research UK have a vision;

“Our vision is to bring forward the day when all cancers are cured.”

Note how it says “all” cancers are cured. Not some or a percentage but all. They strive to cure all cancers and will not settle for something that is pleasingly achievable. Second best is not even a consideration.

 A couple of weeks ago the North West Ambulance Service announced a collaboration with Greater Manchester Fire and Rescue Service. Firefighters, using their fire engines, will attend suspected cardiac arrests. Firefighters will be directed to these calls by the ambulance service if they are free and within 3 miles of the call. They will provide basic life support and be equipped with defibrillators to provide potentially life saving intervention until trained paramedics arrive. This in many regards is similar to the Community First Responder programmes that are already up and running around the country. Such collaborations are not new. The East Midlands Ambulance service have had a trial running with several fire services since May.

This was always going to be a difficult blog to write. Community first responders are volunteers and doing the best they can, with the kit they have to make a difference and save lives. The fire services around the country that are taking on this role are doing exactly the same. To be honest, if you or I were having a heart attack I don’t imagine for one minute that we would complain if the responder walking through the door with first aid skills and a defibrillator was in wellies, a green paramedic uniform or jeans and trainers. The whole purpose of the projects both fire and community first responders is to provide trained hands, with kit, as fast as possible that could be the difference between life and death. It has to be a win for the patient.

That is a very tough point to get past. How can I argue against a program that has a sole purpose of trying to save lives?

Consider a scenario. You are having a heart attack. Three responders arrive at the same time;

  1. A firefighter in a fire engine with 4/5 other firefighters and a defibrillator
  2. A local resident in her own car with a defibrillator acting as a community first responder
  3. A fully trained advanced life support paramedic in an ambulance and all the kit that comes with it

Who would you choose? Who is the best person to help you? You could argue that you would take all three. I’m told that an arrest needs at least four pairs of hands, preferably six to be done correctly. So maybe taking all of them is a good choice. But put that aside for one moment. I think you would all agree that option 3 is the person you need. An out and out medical professional with all the advanced skills, equipment, drugs and experience to save your life and an ambulance to then put you in and whisk you away to A&E. Whilst the other two options may well assist in saving your life and could very well succeed, the best, first choice option is the paramedic.

If we agree on that final point then we can move forward. Why do we need community first responders? Why do we need firefighters acting as ambulances? Again the argument can be raised they could be nearer and faster than the ambulance crew and therefore make a difference. Tough to argue against. However what it shows to me is a shortfall in our ambulance provision. We should have an ambulance service that has sufficient resources to respond to all the calls they receive. A service that in the case of a “Red 1” (cardiac arrests, respiratory failure etc) will not need a fire fighter or a CFR because they are nearer, will be there quicker and a far better qualified and trained to save your life.

This is our gold standard. The service we as the public should expect and the ambulance service should aspire to. Yet we don’t. Financial reasons more than anything else are squeezing the ambulance service as much as they are the police. They are meeting increased demand with fewer resources and they cannot cope. The response, and there is much back patting going on, is to push out responsibility to volunteers and the fire service. How can that be right? These people will do the best they can and will save lives. They will also see that there was nothing they could do and the casualty was as good as dead when the call came in. The volunteers should be praised highly for their compassion and desire to make a difference. Calls to the fire service are reportedly down by 40% and these collaborations look to me like an organisation that needs to increase its workload, does not want to lose any staff/resources and is therefore looking for ways to help that will portray them in a positive light. Whichever way you look at it, (and no disrespect to the CFR’s and fire fighters) they are not the gold standard. They are second best.

These collaborations are a compromise. We cannot guarantee to put the right resource in the right place at the right time to attain the best possible outcome. Therefore we will employ volunteers or give the fire service something to do in order to “make do” until we can get the paramedic there. I’m sure in city locations the ambulance service may turn out the fire service and the paramedic still gets there first. If you live in a particularly rural area you may as well forget it. You need the CFR who lives in the village or the person from three doors down who grabs the defib from the village shop because neither the ambulance service nor the retained firefighters are going to get to you in time. Whilst in the case of the latter you will, as said above, accept whoever turns up to assist, you are accepting these responders as second best because of failings within the ambulance service.

Now before all my paramedic friends jump up and down about that last sentence. You do a great job. You work from start of shift to end of shift, often non-stop and you make a difference. You save lives and I hold you in the highest regard. The failings are down to senior mangers and government funding that means there are simply not enough of you to provide the gold standard. The standard that we should aspire to but cannot achieve. Therefore we haven’t found a solution and solved the problem. We have propped it up in the best way we can to keep the wheel on. Hardly acceptable is it?

Maybe this is a stop gap. Maybe the fire service bosses already know that with a 40% drop in calls that redundancies are inevitable. The police are in a time of transition and we cannot get away from it. The fire service need to change and adapt too but the bottom line remains. If your house is on fire you want a fire fighter. If you’re having a heart attack you want a paramedic. If you’re being attacked in your home you want a police officer.

The solution to me is quite simple. If we need more paramedics.. get more paramedics. The hard bit, if we need less firefighters then lose firefighters. Don’t give them other jobs to keep them busy where they are second best. Let’s not send them to jobs that sound like a cardiac arrest but are actually something else they are totally unprepared to deal with. Jobs that could leave them exposed to complaints, litigation or prosecution.

Firefighters are fire fighters. Paramedics are paramedics and police are the police. We can all have basic crossover skills. I have administered first aid and put small fires out but I’m not a specialist in these areas. We need specialists in times of emergency.

If we have a cardiac arrest then let’s send two ambulances and one RRV from the ambulance service. Five pairs of hands and all the skills and equipment to do everything they can to save that persons life. Let’s not send, 2 ambulances, an RRV, a fire engine and a community first responder. Maybe up to 12 pairs of hands and 5 vehicles. Hardly efficient is it?

Collaboration between the emergency services has gone on for years. I suspect it will increase in the future but it needs to be done in a smart and intelligent way. We cannot and should not be merging and

 morphing roles of specialists to make it work. A jack of all trades is a master of none. A line I have heard many times.. “If all else fails.. lower your standards”. Why settle for mediocrity when we should aspire to excellence?

We as society should expect and demand a gold standard from our emergency services. Why would you want anything less?

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5 thoughts on “Lowering the bar”

  1. Needs to be a clear distinction between HEART ATTACK (where a coronary artery becomes block or narrowed, causing reduced oxygen flow to the heart and usually – but not always – chest pain) and CARDIAC ARREST (where there is complete cessation of respiratory and cardiovascular activity).

    Normally, chest pain incidents are coded as Red1 and cardiac (or respiratory) arrests are coded as Red2.

    🙂

    1. Chest pain calls are red 1, and Cardiac arrests red 2? No idea which service you work for pal but that needs to be addressed!

      Great article, half the problem and I know we go on about it but we are registered as an essential service, not emergency. This then impacts of funding and operability. As well as the fire service we should be more worried about these private companies who are now starting to tender for 999 contracts (Plymouth was the beginning). These are often ungoverened and strive to make profit, much like our own service but without the NHS umbrella and pension.

      It’s not something I am looking forward too, considering I have 42 years left in the service!

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