Our
Battle To Retain Rescue
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Our
Battle To Retain Rescue
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On 3rd September the NSW State Government announced that it was closing eight metropolitan Ambulance Rescue Stations and handing this rescue role over to the NSW Fire Brigades. Regrettably those Paramedics concerned found out about this decision the night before when it was ‘leaked’ via text message on their mobile phones; with the same Officers required to relinquish their rescue role a mere 36 hours later.
The Government announced that of the 181 paramedic land rescue operators, 88 staff would relinquish their rescue roles and be ‘re-deployed’ to general ambulance duties. The Government justified this decision in a media release that set out a number of key arguments. The five main points were that:
1. The Ambulance Service of NSW is the only ambulance service to have rescue
Ambulance Rescue has been one of the early pioneers of rescue in NSW. As Ambulance Rescue has developed so have rescue services in NSW. It is a unique situation that has evolved over a long period of time. Over that time there have been advances in rescue vehicles, equipment, techniques, training, communication – and every step of the way our Rescue Paramedics have been there. We are not the ‘new kids on the block’ trying to wrestle rescue services away from firemen to establish a new direction within ambulance services, we are the veterans taking our rightful place in rescue.
Our strong experience base gives us the edge. We have had plenty of time to develop our skills base through rescue education and training, plenty of time to develop local knowledge within our local rescue response areas, and plenty of time to get out there and to practice rescue. Until recently, Ambulance Rescue had an active rescue role –we were the primary rescue response in our rescue areas. In some areas, this represents over 45 years of continuous rescue service to the community. And not just to our local community. We are a state resource. We service the NSW community and may be called to assist with major incidents anywhere in NSW (like the Thredbo Landslide), as well as interstate (like the Victorian bushfires).
2. There is duplication and overlap of rescue resources as the Fire Brigades already have ‘enough specialised equipment and personnel to provide the services previously provided by the Ambulance units’
As previously discussed the Ambulance Service of NSW was integral in the establishment of rescue services in NSW. If there is a ‘duplication’ of this service it is the Fire Brigades that have duplicated it. They have been allowed to ‘stockpile’ resources and staff into areas where they have initially not had a primary rescue role, they have then achieved a secondary role in rescue and then made political moves to take over ambulance rescue services. On September 3, this political lobbying paid dividends and rescue services in eight metropolitan areas were handed over to the Fire Brigade.
The NSW Fire Brigades is administered by Government under the banner of Emergency Services. They receive the majority of their public funding under a direct tax to the insurance industry known as the Fire Services Levy. Only 14 per cent of their total operating budget comes directly from the Government purse.
One could ask firstly, why the duplication of resources has been allowed to occur. If rescue is a public service provided by government then is it appropriate for the Fire Brigades to have used public money to duplicate a service. One could ask, secondly, why this public money allocated for rescue has been given to the Fire Brigades rather than any other agency. And lastly, one could ask why a tax on insurance, passed on to the consumers of insurance products, is being used to inject large amounts of money into the Fire Brigades so that they can expand their rescue empire while other agencies like the Ambulance Service (administered by government under the ‘health’ banner) have their rescue services axed.
3. The Head Review reported that the workload of Rescue Officers was ‘only 11 per cent of their total workload’.
The focus of public safety is prevention – we want less people requiring rescue services, but when that person does need the service we want them to receive the best care. The average rescue workload will be the same regardless of which agency is responsible for rescue services. Fortunately, Rescue Paramedics do not respond exclusively to rescue jobs. If only 11 per cent of their workload is rescue work then the residual 89 per cent must be medical work. So for the majority of the time they respond to medical calls for help, assess and treat patients and then request a transport vehicle if required. They essentially operate as ‘rapid responders’ working out of a rescue truck. And unlike the general ambulance vehicles they do not get caught up in ‘bed block’ at hospitals as they do not transport, which means that once they are relieved by an ambulance they can respond to the next call.
4. ‘Sending two ambulance crews…. is clearly a duplication of resources’, where the Rescue truck is responded to incidents along with a general ambulance crew
If sending two vehicles to an incident is a ‘duplication of resources’ then the Service’s dispatch system PROQA frequently ‘duplicates’ resources by sending more than one car to an incident. If sending two vehicles to an incident is a ‘duplication of resources’ then a ‘rapid response’ vehicle that can respond, assess and treat, but then not transport the patient is ‘duplicating’ resources when it requests a car to transport the patient. And when it comes to ‘duplication’ doesn’t that mean ‘an exact copy’? But Rescue Paramedics have a specialist role, if they are at a motor vehicle accident and another ambulance arrives on scene then the role of the Rescue Paramedic and their Paramedic colleagues is not identical, they are complementary – the responsibilities within the team will be shared, but the Rescue Officer’s primary role is rescue and the Paramedic’s primary role on scene is medical.
5. Re-deployment of Ambulance Rescue Officers will boost frontline services, particularly through rapid response vehicles
These Officers are currently employed as ‘frontline’ officers providing a ‘frontline’ service - putting them in a different uniform and asking them to drive a different vehicle will not ‘boost’ services. They will be absorbed into the general ambulance system; a system that is chronically short-staffed. There is no ‘boost’ to rosters that are currently so short they cannot cover staff on annual leave, maternity leave, long service leave and workers comp.
The Officers have been told that they can staff a ‘rapid response’ vehicle – they can work out of a vehicle by themselves and can operate this vehicle without transporting patients to hospital. The use of a ‘single officer’ response has a few inherent problems, first and foremost Paramedics may be personally at risk when attending to violent patients or dangerous scenes, and secondly the patient receives care from only one person. Obviously when a patient is critically ill you want the patient to receive prompt treatment and transport (not just a ‘rapid response’). The treatment from one Paramedic in a non-transport car when compared with two Paramedics in an Ambulance equipped for transport is not best service delivery.
The bottom
line is that we wouldn’t need a rapid response vehicle if we had enough staff
and there wasn’t ‘bed-block’ at hospitals.
The Government is so keen to introduce and expand a ‘rapid responder’ service because one of its key performance indicators (KPIs) is response times. Our service is measured by the amount of time it takes the Service to take a call, dispatch a car and for that car to arrive on scene. The care that that person receives by Paramedics is secondary to the Government. Perhaps the Government should recruit more staff and then develop KPIs that focus on service delivery as a whole, and not response times. Maybe then our rescue services would have some value to Government – it already does to our patients.
So why is the State Government so keen for the NSW Fire Brigades to assume responsibility for rescue services in NSW?
The short answer: Funding.
The long answer: the decision to increase the Fire Brigade’s rescue responsibilities impacts little on the funding arrangements that the Government has with the NSW Fire Brigades because the costs will be borne by the private sector through the Fire Services Levy. This Levy accounts for 73.7 per cent of funding for the NSW Fire Brigades. Local governments contribute 12.3 per cent and the State Government just 14 per cent.
