Doing more: How the fire service can create healthier communities

Surrey, B.C., is one of four sites in the Heart Outcomes Prevention and Evaluation 4 (HOPE-4), a Canadian-based, international study that is evaluating the benefits of using non-physician health workers (NPHWs) as part of a cost-effective program to identify, treat and control cardiovascular disease (CVD) around the world. CVD accounts for nearly half of all deaths from non-communicable diseases worldwide. HOPE-4 aims to reduce CVD deaths and events through a multi-faceted community-based intervention.

In Surrey, HOPE-4 is following a group of about 50 residents enrolled in the program by Surrey Fire Service members who were trained as NPHWs to identify risk factors for CVD, perform basic screening tests, and provide prevention counselling. Supported by mobile health (mhealth) technologies, the fire services also make specific health care suggestions to participating health care providers.    

“The training of firefighters as non-physician health workers is a great example of optimizing an existing resource to improve health outcomes,” said Surrey Fire Service Deputy Chief John Lehmann. “Firefighters are respected professionals who are in regular contact with citizens through our day-to-day duties and community outreach work. If we can help point those at risk of cardiovascular disease in the right direction, we could have an even greater impact on the health of the community we serve.”

The pilot sites
Launched in 2014 by the Population Health Research Institute in Hamilton, Ont., HOPE-4 targets low- to middle-income countries as well as lower-income/high-risk populations in higher-income countries.

Surrey is a city of about 500,000 in Metro Vancouver that – like most large urban centres – has citizens and neighbourhoods with a range of income levels. The same is true of the other Canadian pilot site, Hamilton, which is similar in size to Surrey. Individuals with no background in health care were trained as NPHWs for the Hamilton pilot, while the other 30 communities  in Malaysia and Colombia trained high school graduates, research assistants and existing community health workers with no formal training in cardiovascular care.

In its early stages, HOPE-4 developed an NPHW training curriculum tailored to the needs of the target community. For example, in higher-income countries such as Canada, HOPE-4 focuses on identifying high-risk individuals and connecting them to existing services and programs. In countries where access to medical care is more limited, NPHWs play a stronger role in the management of CVD, coupled with free access to proven medical therapies.  

Honed with feedback from the four sites, the refined curriculum has been adapted for the World Health Organization (WHO) Global Hearts Initiative, launched in September 2016 to increase prevention and control of CVD around the world. The training of  primary health workers and NPHWs is one of the initiative’s measures intended to strengthen services at the primary health care level.

While the HOPE-4 curriculum has been adapted and rolled out through the WHO, the study team in Canada continues to collect and analyze the data coming in from the four sites.

Initial results
Surrey’s 50 study participants live in the same apartment block and were signed up for the study in 2015 after four firefighters completed training and testing in basic chronic disease assessment and management, including identifying CVD risk factors such as smoking and poor diet, performing screening tests such as measuring blood pressure and hip/waist ratios, taking medical histories, and providing counselling on treatment options and lifestyle changes. In the field, the firefighters were equipped with a tablet computer to guide them through the assessment process, and equipment to conduct blood pressure tests.

Results from the Canadian pilot projects are still being assessed, but what has already become apparent is that the firefighter resource is best used for front-end screening and referrals, rather than follow-up and ongoing monitoring. With the appropriate training and tools, firefighters out in the community could be helping to identify CVD and other potential health issues and steer at-risk individuals towards local health services.  

“Firefighters are trained to handle medical situations and we’re already out in the community, so the HOPE-4 project seemed like a natural fit.” said Mike McNamara, president of Surrey Firefighters’ Association (IAFF Local 1271). “As well, as firefighters we’re always looking for opportunities to do more to improve the health and safety of our community.”

The whole society approach
The concept of increasing the capacity of firefighters is not new to Surrey. The city’s fire service has continually pushed the boundaries of traditional firefighter work as a way of maximizing the resource and providing greater benefit to the community. In 2005, for example, Surrey firefighters began taking part in public safety inspections of residential marijuana grow operations as part of the city’s Electrical & Fire Safety Inspection initiative, which has reduced both the associated safety hazards (including fires) and number of grow operations in the community.

Another example is Surrey’s HomeSafe program, winner of a 2013 Community Health and Safety Program Excellence Award from the International City/County Management Association (ICMA). Through HomeSafe, on-duty career firefighters go door-to-door in neighbourhoods identified as fire hotspots, where they speak to residents, provide fire-safety information, and offer to install a free smoke alarm or conduct a free confidential fire-safety inspection. The program has significantly increased smoke alarm activations and reduced fire spread and size in HomeSafe neighbourhoods.

The re-examining of traditional emergency responder roles is happening more and more across the country and around the world, part of a growing “whole-of-society” approach to community resilience.

The need to redefine fire services within this context was discussed at a September 2016 meeting of the Fire Community of Practice, a body of Canadian public- and private-sector fire leaders and experts established by Defense Research and Development Canada’s Centre for Security Science in 2012 to identify problems in public safety and security and contribute to science and technology solutions.

The report on the meeting, Canada’s Fire Service in the Context of Community Safety, pointed out the potential benefits of re-examining the current emergency management approach, to both reduce service overlaps and cost, and to ensure communities can meet growing demands for service – including the high-impact events that exceed the existing response model’s capacity.

Further afield, another example of a “whole-of-society” approach can be found in the United Kingdom, where the Well North program of the Manchester Academic Health Science Centre is exploring a collaborative community leadership approach to improve the health and wellbeing of low-income individuals in northern England.

At a time when traditional firefighting work is declining due to improved safety practices and building technologies, and when communities are struggling to meet increasing demands for service and accountability, it is critical that decision-makers consider the untapped potential of the fire service for improving service-delivery efficiency and effectiveness as well as health and safety outcomes.

Details about the HOPE-4 clinical study are posted at www.phri.ca/hope4.

Information about the Surrey Fire Service and its programs can be found at www.surrey.ca.

Len Garis is the Fire Chief for the City of Surrey, B.C. Contact him at LWGaris@surrey.ca
JD Schwalm completed his MD and residency at McMaster University. Contact him at schwalj@mcmaster.ca