Playing with fire: Why some volunteer firefighters refuse to offer medical service, amid health-care shortages

This story is part of Situation Critical, a series from CBC British Columbia reporting on the barriers people in this province face in accessing timely and appropriate health care.

In his 22 years of service with the Peachland Fire Department, Fire Chief Dennis Craig has rarely seen so many calls for medical service.

His department, consisting of 34 volunteers, has offered first responder service since before Craig joined. In 2021, it fielded 352 calls from residents in the District of Peachland, located just southwest of Kelowna, B.C. 

Of those, 168, or just under half, were for medical assistance, a sharp spike from where the department was nine years ago when, according to the chief, medical calls accounted for just under 40 percent of the department's responses.

"My concern is being tied up on a medical call and not being able to respond to a fire," said Craig, 48. "Once our truck is committed to a medical call, it's committed until we can hand it off to the same level of care — or higher." 

Craig notes that, in some rare instances, his crews have waited between 20 and 30 minutes for an ambulance to arrive.

As communities across British Columbia struggle with a shortage of both ambulances and paramedics, many volunteer fire departments find themselves filling in the gaps, providing emergency medical services to small towns often situated an hour or more away from the nearest hospital.

But while departments like Peachland are prepared to keep offering their current level of medical service, crews in some neighbouring communities have been reluctant to expand the scope of their work, citing concerns around training, resources and volunteer burnout.

Dan Derby, the president of the Fire Chiefs' Association of British Columbia (FCABC), believes that while the majority of the province's fire departments are involved in some level of first responder services, recent challenges, including the opioid crisis, wildfires and the COVID-19 pandemic, have left some crews wanting to reduce them or re-evaluate the medical offering entirely.

In early August, volunteer firefighters in the village of Ashcroft, an hour's drive west of Kamloops, B.C., responded to a call for an 84-year-old man who had suffered a heart attack. 

According to Ashcroft Mayor Barbara Roden, Fire Chief Josh White informed the caller that Ashcroft's firefighters are volunteers and not trained as medical first responders.

"That's not something that they're trained to do. It's not something that they signed up to do, and that is going to take a huge toll on our volunteer firefighters," said Roden.

Roden tells CBC that White, who has received first aid training, attended the scene and performed cardiopulmonary resuscitation (CPR) with an automated external defibrillator from the fire hall. 

His efforts were unsuccessful, and the man died while waiting almost 30 minutes for the ambulance to arrive. 

CBC requested an interview with White, but he declined.

In a statement, B.C. Emergency Health Services (BCEHS), which oversees the delivery, co-ordination and governance of out-of-hospital emergency health services in the province, extended condolences to the patient's family.

It also noted that it has voluntary agreements with many fire departments throughout the province, in which BCEHS notifies firefighters of a wide array of medical emergencies, including high priority "Red and Purple calls," less urgent "Orange and Yellow calls," as well as calls that require fire departments technical expertise and equipment, such as motor vehicle incidents, hazmat scenes or potential drownings."

Meanwhile, B.C.'s Ministry of Health said in a statement that it "is aware there has been increasing demand on volunteer firefighters to respond to medical emergencies" and that "increasing BCEHS staffing, especially in rural communities in B.C." is a priority for the NDP government.

'False sense of security'

While it's unclear whether the Ashcroft man could have been saved with a faster response from paramedics, his death has served as a stark example of what can happen when small-town residents lack immediate access to emergency health resources.

Ashcroft resident Nick Lebedoff helped perform CPR on the 84-year-old before fire crews arrived. He thinks every small town should have a dedicated ambulance service.

"I worry because I live by myself," said Lebedoff, who had open heart surgery in 2014 after going into cardiac arrest. "What's going to happen if I phone 911 and I have to wait half an hour? It's too late."

Peachland Mayor Cindy Fortin feels the province is "playing the odds" when it comes to public health, leaving small-town residents with a "false sense of security."

"[The province] is saying it's staff shortages … but this has been going on for a long time, so, for me, that's not an excuse."

According to BCEHS, Ashcroft has one ambulance staffed by eight regular paramedic positions and one full-time "irregular" position, which is described as "a permanent but irregular position, much like a floater, to cover off on holidays, sick leave, etc."

Peachland also has one ambulance staffed by eight full-time regular paramedic positions, one irregular paramedic position and on-call staff.

In both communities, BCEHS said in a statement, the ambulance and paramedics can be tasked with work in other areas. 

In Ashcroft, this area includes Lytton, Clinton, 100 Mile House and Logan Lake.

Peachland's region includes a section approximately halfway to the stations in West Kelowna, Summerland, to the Okanagan Connector, Highway 97C (half-way to Merritt) and some backcountry and forest service roads.

Medical training may deter volunteers

Tom Moe, the chief of the Cache Creek Fire Department, which is comprised of 18 volunteers, said his team has been asked to respond to medical calls, even though they are not currently qualified or trained to handle them, with only "a few" having completed their Level 1 first aid.

"None of our members are interested in doing medical calls at this time," said Moe, who has 31 years of volunteer firefighting experience in Cache Creek.

"We joined the fire department to be firefighters and not paramedics." 

Specifically, Moe said his members, who work a regular 40-hour work week on top of their firefighting commitments, are not interested in the liability or mental stress that can accompany medical calls.

He estimates he has lost six people to burnout in the past two years.

At the same time, he said, he has felt pressured by BCEHS dispatchers and B.C. Ambulance recently to increase the department's medical services.

"We're putting huge amounts of effort into just keeping our [firefighter] training up," he said.

"If they start pushing toward first responders, it's going to cost a lot more money and a lot more hours on our part to get trained to where we need to be … adding medical would be a big deterrent."

Can calls be better triaged?

In the days following the Ashcroft man's death, B.C. Health Minister Adrian Dix said the province has made "dramatic changes" in funding for BCEHS and B.C. Ambulance, with only mental health and addictions seeing a more significant increase.

"Since 2021, we have added more than 500 new full-time and part-time permanent paramedic positions in rural and remote areas to work at 24 new rural stations across British Columbia …

"Approximately 75 per cent of all permanent positions at BCEHS are filled, and we have a robust national recruitment campaign underway to fill vacant positions," a ministry spokesperson said in a statement.

However, firefighters interviewed by CBC said staffing is only part of the equation. Triage and public education around which calls require emergency services and which don't may also strengthen British Columbia's health-care system.

"We have to look at the whole system holistically to see where we can gain efficiencies and better prioritize calls," said Peachland Fire Chief Dennis Craig.

FCABC, meanwhile, believes that local governments and fire departments should be the ones determining their level of pre-hospital emergency care.

In a position paper presented to a pre-hospital care committee, which includes the Ministry of Health, BCEHS, B.C. Ambulance and others, the association, writes, "Local governments and fire first responders understand local characteristics and are positioned to provide input to patient comfort and care delivery models."

"The FCABC position is that communities should be determining how their respective resources will be utilized regarding the delivery of First Responder services."