There is sufficient international evidence to demonstrate that first responders, including professional firefighters, improve patient outcomes, especially from out-of-hospital cardiac arrest (Ho et al, 1997; Hollenberg et al, 2009; Hoyer and Christensen 2009). With demonstrated improvement in cardiac arrest outcomes by using first responders, this has led to a move in recent years to have automatic external defibrillators (AEDs) placed in prominent locations where large numbers of people congregate so that the response time to defibrillation is as short as possible (public access defibrillation (PAD)). This policy has proved to be successful in decreasing the response time to the person and subsequent defibrillation, albeit with small numbers in the studies compared to other ‘first responder’ programmes (Colquhoun et al, 2008; Fleischhackl et al, 2008).
Training professional firefighters as first responders means their downtime can be put to a better public good and will assist the ambulance service in decreasing the time it takes to respond to a medical or non-medical emergency. Professional firefighter first responders have demonstrated better response times to medical (including cardiac arrest) and non-medical emergencies compared to the ambulance service (Boyle et al, 2010).
In a study by Boyle et al (2010), ambulance response times showed a steady increase over time where the fire service response times remained constant over the same time period. Even though the study by Boyle et al (2010) investigated metropolitan firefighter first responders, there is no reason why professional firefighters in rural towns cannot be trained to first responder level to assist the ambulance service in these towns.
Drugs such as midazolam and adrenaline are used by members of the public for managing potentially life-threatening conditions in family members with no immediate life support equipment available, should they require it. Therefore, it is difficult to argue against professional firefighters being trained to use drugs such as intranasal midazolam for patients with continuous seizure activity (Fisgin et al, 2000) and lingual adrenaline for the management of anaphylaxis. The argument that midazolam can and does cause respiratory depression and should not be used by non-paramedics is archaic, given professional firefighter first responders are trained to resuscitate people, including the use of AEDs. Drugs that can be administered via a non-intravenous route would be appropriate for professional firefighter first responder use as it removes the sometimes difficult task of intravenous cannulation and negates the issue of needlestick injury.
Paramedics may be concerned with the introduction of professional firefighter first responders, about them encroaching on ‘their turf’, and being not sufficiently trained, which is a narrow and baseless view. The introduction and use of professional fire fighter first responders should be seen as part of a policy of improving access to healthcare earlier, with responders appropriately trained for the role. This is difficult to argue against given the weight of positive scientific evidence.