Co-responding is the name given to the fire and rescue service response to medical emergencies in the United Kingdom (UK). The scheme is relatively new, and to fully understand it, it is important to appreciate the recent history and structure of fire and ambulance services in the UK, which have similarities and differences from those in the United States.
Each fire and rescue service in the UK is a function of local government. Each has a chief fire officer as the executive head of the service who is responsible to an authority consisting of democratically elected councillors. The services generally are delivered at a county rather than a city level, except in London.
Consequently, fire and rescue services in the UK generally are larger organizations than in the United States. However, unlike the United States, these services in the UK are governed by national legislation that sets out in law the role and responsibilities of the service and the local authorities that are responsible for them. In addition, central government expectations of what the fire and rescue service will deliver is set out in a national framework document. So while this is a local service, it works within quite a rigid national legislative and organizational framework. This is reinforced by a financial regime where approximately 50 percent of the financial resources for the service is provided through a central government, which gives the government considerable influence over what we can afford to do.
UK FIRE/RESCUE AND EMS SERVICES ARE SEPARATE
Unlike the fire and rescue service, the ambulance service in the UK (comparable to EMS services in the United States) is a function of the central government, part of the National Health Service. However, delivery of the ambulance service is at a local level with each organization usually covering a number of counties. It is, therefore, funded and administered in a completely different way from that which exists for the fire and rescue service. This creates problems for the fire and rescue service, as there is no easy way to match available funding to the work being undertaken.
Co-responding was introduced in the UK in 1997 in my own county of Devon. It was introduced in recognition of the fact that in large rural areas it was extremely difficult for existing ambulance services to provide rapid medical aid to victims suffering from cardiac arrest. However, many relatively small rural towns have a fire station from which it was felt a response could be made to sustain life while awaiting the arrival of a qualified paramedic from the ambulance service.
CO-RESPONDING IS A VOLUNTARY SYSTEM
Co-responding works on a voluntary basis. Firefighters are not required to undertake the role. Nevertheless, there is a huge desire on their part to be involved. Firefighters who undertake the role of co-responder have to undergo a criminal records check. This is a legal obligation in the UK for those who might have contact through their work with the disabled, elderly, mentally ill, or young people. Once cleared, these responders have to undertake a training program determined by our local ambulance service, ride along with a qualified ambulance crew, and pass the necessary skills assessment.
Co-responding is implemented in the following manner: All emergency medical calls are routed through to the ambulance control center. If the call is in a location where a fire and rescue service co-responder station is located, and no paramedic response is nearer, the call will be passed over to the fire and rescue service control center to dispatch first responders. A paramedic response also will be mobilized. A fire and rescue co-responder attendance is never made alone. Firefighter co-responders, once on scene, will attempt to maintain life until the arrival of qualified paramedics, who will then take over care of the victim.
Firefighter co-responders attend the following type of medical incidents:
- Chest pain.
- Unconscious or unresponsive.
- Severe breathing problems.
- Trauma with penetrating injuries to the head or trunk.
- Anaphylactic shock, seizure.
- Severe obstetric hemorrhage.
Since the launch of co-responding in 1997, Devon Fire and Rescue Service has combined with Somerset Fire and Rescue Service to create one of the largest fire and rescue services in the UK, providing services to 1.6 million people across southwest England. We deliver our services through 82 fire stations spread across 4,000 square miles. The largest city in Devon and Somerset counties is Plymouth, with a population of about 250,000, followed by Torbay and Exeter, each with approximately 120,000 residents. The remaining population is spread across a range of small- to medium-sized towns and villages with populations ranging from just a few hundred to 75,000.
Since 1997, the co-responder scheme has expanded to include 18 fire stations spread across Devon and Somerset. Each station receives between 35 and 325 co-responder calls each year, currently amounting to about 2,100 across the service (this has grown from 170 calls in 2000-2001).
UK FIREFIGHTERS UNION OPPOSES CO-RESPONDING
The Fire Brigades Union (FBU) is the principal firefighters union in the UK, representing the majority of full-time (career) firefighters. The FBU has had a policy of opposition to firefighters carrying out co-responding duties for many years. That remains the case, and only now is there an early sign of a willingness on the part of the FBU to reconsider its policy.
This policy of opposition was recently put to the test in a court case. Two fire and rescue authorities tried to impose co-responding duties on firefighters, claiming that it was part of their role and within the demands of their employment contract. The FBU mounted a successful legal challenge to this directive. The court found that the limitations of the defined role of a firefighter excluded co-responding. However, the case has not prevented firefighters from undertaking co-responding duties on a voluntary basis. This is currently the case in my organization; consequently, the scheme has been unaffected by the court case. Advocates of co-responding are hoping that the case prompts a dialogue between the FBU and the national representatives of fire and rescue authorities with a view to reaching an agreement.
So what does the future hold for the role of the UK fire and rescue service in terms of medical response?
It has to be said that the possibility of combining the fire and rescue service with the ambulance service to create a single organization seems remote. Unlike the United States, local politicians in the UK are not in full control of the agenda regarding these vital functions. In addition, each service comes under a different central government department with different government ministers in control. Consequently, there are significant political influences at work that are likely to resist combination.
Nevertheless, it seems likely that there will be a growing demand from the public for an ever-improving emergency medical response. The public does not care which emergency service arrives first, as long as it keeps the victim alive once there. In my view, the resistance to co-responding in the UK eventually will be overcome. All of us have a duty to save lives, and the life saved by the fire and rescue service responding to a medical emergency is worth every bit as much as one saved from a fire.
PAUL YOUNG is chief fire officer of Devon and Somerset Fire and Rescue Service in the United Kingdom. He joined the London Fire Brigade in 1973. In 1985 he moved to Devon as a divisional commander and in 1990 to Somerset to take up the post of deputy chief fire officer. In 1992, he was promoted to chief fire officer. He has served as chief (during two tenures) for 15 years, making him the longest-serving chief in the UK. In 1998, he became the international president of the Institution of Fire Engineers and is a past chairman of the Association of Principal Fire Officers. He achieved a postgraduate degree in management research in 1996 and a master of philosophy research degree in 2001. On April 1, 2007, he became the first chief fire officer of the newly combined Devon and Somerset Fire and Rescue Service. Young was made an Order of the British Empire (OBE) in the Queen’s Birthday Honours list in June 2001.
