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Why can’t firefighters double as paramedics?

We have fewer and fewer fires, and ambulance services are under huge strain. There’s only one problem: the Fire Brigades Union

12 September 2015

9:00 AM

12 September 2015

9:00 AM

As a nation, we are learning to accept that our firemen are more and more redundant. The Fire Brigades Union fights austerity at every turn; its spokesmen say that every reduction in station numbers or jobs is a threat to public safety. One of their campaign posters even showed David Cameron and George Osborne alongside the words, ‘They slash. You burn.’

But the statistics undermine the union’s manipulative language of doom. The cuts have been matched by a continuing decline in dangerous fires. According to figures released at the end of last month, the fire brigades attended 495,000 incidents in the year 2014–15, a decrease of 42 per cent compared with ten years ago. But of these incidents, only 31 per cent were actual fires: 44 per cent were false alarms, with other operations like floods, road traffic and animal rescue making up the rest. In 2014–15 there were 258 fire deaths in England, 16 fewer than in the previous year and 30 per cent lower than ten years ago.

It is now clear that a heavily staffed fire service is an anachronism, so things will have to change radically. One unorthodox proposal just put forward by the Local Government Association was that underemployed firefighters should become quasi-social workers. Among the roles envisaged for this new breed of hose-and-care operatives are running courses to encourage overweight children to become fitter, checking families for signs of domestic abuse, and ‘helping babies and toddlers sleep safely by distributing cots and Moses baskets’.

There is a far more sensible solution. Instead of half-baked social workers, firefighters should become fully fledged paramedics, helping to relieve the tremendous, growing pressures that the ambulance service is facing. The brigades should merge with ambulance crews to create a proper, effective emergency and rescue service. That is what happens in most other European countries — and the system works well, precisely because it is geared to real public needs rather than outdated working practices.


Our ambulance services are grossly overstretched. The number of emergency calls to ambulance switchboards in 2014–15 reached 9 million, an increase of 515,000 on the year before. That deluge of calls resulted in 4.7 million emergency patient journeys, most of them involving Category A (the most serious, urgent) cases. The demand on ambulance crews is up to ten times that on the fire brigades. Which partly explains why so many paramedics are leaving their jobs: 1,015 of them quit in 2013–14, up from 593 two years earlier. One of them, Michelle Sanderson, reflected on the stresses that had driven her into premature retirement: ‘There is very little time for a lunch or a toilet break. There was no respite. As soon as you came back from one call, you had to go out and do another.’

Firefighters face nothing like this constant strain. Indeed, a 2013 report from the former London fire commissioner Sir Ken Knight produced the remarkable statistic that the average firefighter now attends just 43 fires a year, less than one a week. The endless strikes called by the FBU in disputes over pensions and cuts have had little impact: in what other public service could regular walkouts by key professionals go almost unnoticed? During one recent bout of industrial action in London, it was a revealed that a third of striking firefighters had additional occupations. Among them were three mortgage brokers, a chiropodist, two butchers, a private investigator, a male model and two undertakers. One fireman even worked as a film extra on the Hollywood hit movie Prince of Persia.

Absurdly, the fire brigades actually have more staff than the ambulance services. Last year, there were about 45,000 fire service employees, including around 37,000 firefighters. By contrast, the ambulance workforce in England comprised of just under 19,000 qualified crew members and 14,000 support staff, a total of 33,000. Worse, underworked firefighters tend to be paid much better than overworked ambulance crews. The basic salary for a qualified firefighter is now £29,054, while a trained ambulance practitioner can only earn up to £22,236. Even senior paramedics start on £26,041.

In his 2013 report, Sir Ken Knight argued that fire authorities ‘now need to transform themselves to reflect the entirely different era of risk’. The best way to achieve that transformation is to require fire crews to train as paramedics and perform ambulance duties when they are not engaged in rare moments of firefighting. Some authorities are moving in that direction, through the creation of joint operations and join control rooms. A pioneering project in Long Sutton between the Lincolnshire Fire Brigade and the East Midlands Ambulance Service has seen patients taken to hospital by the nearest emergency vehicle available.

What we need, however, is a co-ordinated overhaul to bring the two services together. That is precisely what the FBU, desperate to defend its cushy vested interests, has long ferociously opposed. ‘Vital fire prevention work will be compromised,’ claims Matt Wrack, dismissing plans for firefighters to work as paramedics. But even the union now recognises that the fall in fires makes its blanket opposition untenable. Earlier this year the FBU Executive agreed to review its policy on medical emergencies, admitting there is ‘real scope’ for the fire service to ‘expand its role’.

What we do not need, however, is for the fire brigades and the FBU to use makeshift medical work as just an added extra to support the current structure. That is what has happened in parts of the USA. The economics professor Fred S. McChesney has written, ‘Firefighters have touted themselves as “first responders” who can answer a medical emergency faster than paramedics in an ambulance. But when they arrive without training or equipment to deal with severe medical emergencies, they are of little use.’

A truly integrated service, as exists in France with the Sapeurs Pompiers, is the real answer. Reformers should pay no heed to the FBU leaders, who have destroyed their credibility with their crude blackmail.


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