Will we answer Maggie’s Call?

Andrew Clarke is a DUP Councillor in Mid and East Antrim.

Maggie Black died on 1st December 2021. Maggie was just five years old, and her sudden passing shocked the entire community around Glenarm. Shocking too, is this statistic: while the ambulance took 70 minutes to arrive, the local fire station was only seven minutes away.

In medical emergencies speed is of the essence. For cardiac or oxygen incidents, each minute can make a crucial difference to survival, and to subsequent quality of life.

In memory of their daughter, the Black family have called for the implementation of ‘Maggie’s Call, a policy whereby firecrews are alerted to an emergency ambulance callout. A petition supporting the idea rapidly reached over 20,000 signatures and was unanimously backed by Mid and East Antrim Council last week.

Firecrews are not a replacement for the ambulance service, nor does the policy try to make them so. But they are professionals, trained in emergency medical response, with the ability to use defibrillators and oxygen. Their timely presence could save lives.

One reason for the quicker response time of the fire station is the different spread of our firestations, often putting firecrews physically closer to the scene. So too is their local knowledge. The media recently reported on the sad passing of Ignatius McGahon in Tyrone, with the family believing that the ambulance “took the longest possible route that they could to get there”. The McMahon family called for an update to ambulance navigation systems. Maggie’s Call would help address this problem: the tendency for firecrews to be community recruited suggests a good knowledge of local roads, especially in rural areas.

At any rate, a wide body of expert opinion looks favourably on such a move. The 2002 Bain Report into UK Fire & Rescue Service recommended the expansion of the Fire Service as first responders to medical emergencies. A 2006 UK Select Committee Report on Fire and Rescue Services recommended the development of a national co-response protocol, concluding they “were convinced of the life-saving benefit of co-response schemes”. In 2015 the National Joint Council for Local Authority Fire and Rescue Services began trialling co-responding schemes (as did firefighters in Lurgan). Interestingly, one of the most enthusiastic participants was the Greater Manchester Fire and Rescue Service – headed by Peter O’Reilly, now Chief Officer of the Northern Ireland Fire and Rescue service.

Hertford University was tasked with analysing the results of the trials, and produced a follow-up report, Broadening Responsibilities. Collating results, the report found of fire crews:

“In time-critical incidents, such as cardiac arrests, they arrive sooner than ambulances in 93% of cases”.

They also found that:

“International examples demonstrate the effectiveness of using the fire and rescue service for medical response”.

Overall, Broadening Responsibilities concluded that:

“Appropriately trained and equipped firefighters co-responding to targeted, specific time-critical medical events, such as cardiac arrest, can improve patient survival rates” (pg.8-9).

Much of politics is just posture: politicians make demands for more spending (or ‘investment’, as we are now obliged to call it) in full knowledge that the cupboard is bare, and with no suggestions as to how Mother Hubbard might be enriched. Maggie’s Call is different: it is not a demand for an ambulance in every village or an A&E in every town. It is a targeted way of using existing resources more intelligently.

Of course, there are likely to be some costs and a need for planning. If fire crews tend to be at incidents more quickly, it is likely that their defibrillator use – and associated maintenance costs – will climb (though ambulance use would then decline). Unions will emphasize the Hertford study finding of an 8% increase in firecrews needing counselling, and some provision should be made for an increase in callouts for retained officers.

Yet Maggie’s Call is likely to improve NHS finances. Broadening Responsibilities analysed financial costs and benefits (such as reduced long term care or gain of quality adjusted life-years (QALYs)), and estimated “a conservative net benefit of between £1,985 and £4,091 per incident, or a return on investment of between £5.67 and £14.40 per £1 invested” (pg. 37).

A separate analysis of the same data by New Economy was carried out in November 2017. Its methodology is aligned to that of HM Treasury and suggested the slightly lower, but still substantial figure of £4.41 per £1 of expenditure. It also forecasts a paypack period for return within the first year of implementation (pg.6).

However, we package the details, it is clear that Maggie’s Call is a serious proposal with a substantial prize. It demands the serious and speedy attention of our Health Minister. We can only hope the upcoming elections focus, rather than diminish that attention.

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