People suffering from heart attacks are ringing 111 to ask for help from firefighters instead of an ambulance because the response is quicker in some rural parts of New Zealand.
Volunteer firefighters have been called out to help single-crewed ambulance officers lift heavy patients or drive the ambulance in non-urgent cases. Medical calls make up 9 per cent of the workload for fire crews - meaning it has nearly doubled in the past decade - as ambulance services struggle to keep up with demand.
The pressure has led to plans for a prototype "Fire-Ambulance" to be trialled in mid-2013, which will weigh seven tonnes and be as long as a traditional fire truck.
The design will have a space for two people in the cab, pump and fire equipment stored in the middle and room for a single stretcher clinic in the back with seating for two more crew.
National Commander Paul Baxter said in October that the "fire-ambulance" may be of more practical use to volunteer brigades for which most of their calls are medical emergencies. "We believe it will provide the patients with an appropriate and more comfortable treatment space and give the firefighters easier access to their medical equipment and supplies. It will also be a relatively safe environment for the patient until an ambulance or helicopter can arrive to take them to hospital."
Since the announcement the Fire Service has released documents about the medical emergency workload to the Weekend Herald under the Official Information Act.
Mr Baxter said the submission to a health select committee inquiry into ambulance provision in 2007 was a good summary of the Fire Service's position. The inquiry led to the creation of the National Ambulance Sector Organisation and Government funding for an extra 100 paramedics.
The same year St John and the Fire Service signed a memorandum of understanding in which St John can dispatch "first responder" fire trucks from 32 brigades to emergencies when there are no available ambulances.
This was in response to the fact that the number of medical calls for firefighters doubled to more than 4600 between 2004 and 2007. That figure has increased to more than 6000 - 9 per cent of the workload.
In the 2007 inquiry submission released to the Herald, Fire Service chairwoman Dame Margaret Bazley said the true figure could be much higher because calls to help ambulance staff lift patients did not go through the 111 system.
She said fire crews had always worked closely with ambulance staff in emergency situations, such as a car accident, but were increasingly being asked to respond to medical emergencies such as heart attacks.
"Most worryingly, the public in some communities where the ambulance service has relocated - perhaps as much as half an hour away - have taken to calling 111 and asking for the Fire Service, in the knowledge they will get a prompt response."
Dame Margaret also felt strongly about volunteers called to assist single-crewed ambulance staff to lift heavy patients or drive the ambulance if need be. She said these were planned transfers, often arranged days in advance, which was a commercial operation for St John.
"We will always respond. We're concerned because we believe it's symptomatic that ambulance isn't always able to respond, but the reality is in a country like ours, particularly when we get into remote, small towns, it makes common sense for the Fire Service to do this," Dame Margaret told the committee. "And it may well be in the future Fire Service will always provide the service in those very small towns and, likewise, it may well be in the future that we see fire trucks up and down the streets, getting to people with heart attacks in that golden five minutes or so, when an ambulance isn't close by."
The Herald revealed in September that ambulances will no longer be sent to minor 111 calls as part of sweeping changes to help stem St John's $15 million-a-year loss. Under the new system, "non-urgent" 111 calls will include abdominal pain, allergies, animal bites, assaults, back pain, falls, headaches, exposure to cold, lacerations, and feeling sick.
Such calls will be redirected to a GP or other health care, or a St John officer will be sent in a car - not a double-crewed ambulance.
An increasing number of elderly people with chronic illnesses has paramedics struggling to cope with an annual 4.5 per cent increase in demand. Last year, the ambulance service received a record 337,000 emergency callouts. Response times to 111 callouts have also deteriorated - particularly in urban areas - and will continue to do so unless the service's cash shortage is addressed by the Ministry of Health and ACC, said St John operations manager Michael Brooke.
"There's a brick wall coming," he said in September. "But that's true of the health sector in general."
Of the "fire ambulance", he said keeping volunteers in remote and rural regions was difficult and the joint venture would make it easier to provide high-quality emergency cover.
• A combined fire-ambulance vehicle like the one pictured above is expected to be on New Zealand roads by the middle of next year
• The fire-ambulance is designed mainly for rural communities, where ambulances are often scarce
• Fire crews already respond to about 6000 medical calls a year - 9 per cent of their workload