Background

To understand the complex rescue situation in NSW, a little background is required.

Until the early 90s there were no special rules for who performed rescue in NSW, how they did it or what equipment they would use. The NSW Fire Brigades (NSWFB), Police, Ambulance Service, State Emergency Service (SES) and the Volunteer Rescue Association (VRA) all had a hand in the role, with no defined areas of response.

This lead to many problems where two or more services would attend the same incident to perform the rescue. With different ideas, training and egos it was not a good system and it sometimes turned ugly.

So the government of the day, in their wisdom, decided to divide the state up into areas and allocate the areas to the various services. By doing this, they removed the chance of different rescue services attending the same job and it kept everyone reasonably happy. The downside was that you still had a state with 5 different rescue services, duplicating training and management structures.

Due to their close positioning, metropolitan areas have only primary units with the next closest unit covering if the area's primary unit is committed. Rural areas (due to the large distances involved) usually have both a primary and secondary provider in each town.

That's how it's been now in NSW for the last 15-odd years. There have of course been changes to areas over that time, with the most common of these changes being the NSWFB gradually assuming responsibility for more and more areas in the state. Currently (October 2008), the state is divided approximately as follows:

To summarise the above table: The NSW Fire Brigades do most rescue in metropolitan areas and major country centres, with the SES and VRA doing most rescue in country towns (with backup provided by the NSW Fire Brigades). The Police and Ambulance also have minor roles.

Withdrawal of Ambulance Rescue

In late 2008, the NSW health minister announced that the Ambulance Service of NSW would withdraw from rescue in metropolitan areas and that the NSW Fire Brigades would take over in those areas. Naturally, the operators from the Ambulance service were none too happy with this outcome and have been making a great deal of noise in order to have their role reinstated.

However, it has been a long time coming, with several inquiries and reports recommending the withdrawal dating back up to 8 years. Read the NSW Fire Brigades' submission to the latest inquiry here. Let's look at some facts in relation to the Ambulance service doing rescue:

• Even before the metro withdrawal, the Ambulance service only provided rescue services to 14 areas of the state. The NSW Fire Brigades already provided rescue to over 150 areas of the state, so the addition of 8 ambulance areas is a drop in the ocean.
• The NSW Fire Brigades have about 2,000 qualified rescue operators. The Ambulance Service have about 180.
• The vast majority of rescue services in Australia and around the world are provided by the Fire Brigade.
• The Fire Brigade are the only rescue service who are able to perform rescues in fire and hazardous material situations.
• The Fire Brigade are the only rescue service with large hydraulic ladders and lifting capabilities.
• There is no other Ambulance service in Australia that provides rescue services.
• There are very few Ambulance/Paramedic-trained services in the world who provide rescue services.
• Paramedics will still attend every rescue where someone is injured to perform their medical role

Why does / should the Fire Brigade do rescue?

There are a number of reasons why the Fire Brigades provide most rescue in NSW and around the world:

Vehicles: Fire engines are large vehicles and already have the capability to carry the most commonly used rescue equipment. Specialised heavy rescue vehicles are located strategically However ambulances are designed to carry patients and cannot carry any rescue equipment, so Ambulance services need a large number of dedicated rescue vehicles relative to the fire brigade. The fire brigade also have a fleet of hydraulic ladders and platforms for rescues from heights, and several specialised Urban Search and Rescue vehicles.

Experience: Every firefighter is trained to use rescue tools, rope and abseiling equipment as part of their basic training. It is not part of Ambulance basic training, as their primary role is clinical care.

Rescue is not medical: Rescue is the (mechanical) act of removing a person or animal from actual or threatened harm. The medical role is completely separate, and is performed by paramedics. Eg: If you are trapped in a car wreck after an accident, would you prefer the Paramedics were monitoring your health or setting up the hydraulic tools?

Efficient Use of Resources: With their existing vehicles, stations, experience, training and the economies-of-scale of being such a massive rescue service, having the fire brigade provide rescue is highly efficient compared to the Ambulance model.

Why shouldn't the Ambulance Service do rescue?

The theoretical argument is that the primary role of the Ambulance service is clinical care of the sick and injured. Rescue does not fit that role. Rescue is the (mechanical) act of removing a person or animal from harm, not the treatment of that person. It simply isn't possible for a paramedic to concentrate on clinical care while they are attempting to cut away a wrecked car, set up abseiling rope or lift a train. Plus, having 2 highly trained paramedics getting a cat out of a tree while someone is having a heart attack down the road is not an efficient use of resources.

NSW is the only place in the world where paramedics are/were diverted from patient care to operate rescue tools.

The practical argument, in addition to the above, is that the health budget is under pressure. Ambulance response times need improvement and there is a shortage of Ambulances. By redeploying Ambulance Rescue staff to regular Ambulances, there should be an improvement in response times.

What if I'm trapped and injured? I'd rather have Paramedics than firefighters treating my injuries.

And that's exactly what you'll get. Contrary to what you may have been lead to believe. Ambulance paramedics will still attend every car accident and rescue to provide medical care.

The Ambulance service also have a team called SCAT (The Special Casualty Access Team). A group of paramedics trained to access patients who are trapped or confined, such as down a cliff or in a train wreck. Their role will not change, and they will still be the ones accessing patients who need medical care.

What has changed is that instead of the paramedics spending an hour cutting their way into the train wreck, or setting up the abseiling ropes, the Fire Brigade will be doing that work for them, leaving the paramedics to focus completely on patient care.

"If it aint broke, don't fix it":

The problem, is that it was 'broke'. The Ambulance budget is stretched, Rescue was taking a disproportionate amount of money to operate, and the NSW Fire Brigade was constantly being asked to cover for unavailable Ambulance rescue units.

Over the last few years, the Ambulance service have struggled to staff their rescue vehicles, and keep them operational. Between October 2005 and May 2008, the NSW Fire Brigades provided rescue coverage in Ambulance areas on over 170 separate occasions because the local Ambulance rescue unit was unavailable due to a lack of staff or equipment failure. Sometimes the standby period extended for several months.

What about the other claims on the Save Our Rescue website?

Understandably, the Ambulance rescue officers are upset and are trying hard to get their role back. But there is some truth stretching going on, and in the interests of forming a balanced opinion, I will provide some answers to their comments and insinuations on a page-by-page basis here.