Care with Lights and Sirens: Firefighters, Equity and Welfare State Change
Principal Investigator: Dr. Susan Braedley
About the project
Care with Lights and Sirens is a research project which explores the questions in two sub-projects and the relationships between them.
The sub-projects are:
A. Fire-Based Emergency Medical Response: Residual Welfare at Work
B. Equity Shifts: Promising Practices at Protective Services
A. Fire-Based Emergency Medical Response: Residual Welfare at Work
In 2007, I was at a rooming house in Toronto, accompanying three firefighters who were responding, as the first responders, to a 9-1-1 emergency medical call. We had trouble finding George, a man in his late 50s or early 60s, who was laying on his bed in an old house that had been cheaply and badly renovated to cram in as many tiny bedrooms as possible in its three stories. When we finally found him, George was groaning with pain. He told Ed, the captain of this crew, that he had broken his leg badly some months ago, that it hadn’t healed properly and sometimes he couldn’t handle the pain. He said when he went to the hospital, they gave him pills and told him to get the leg looked at. But he didn’t have a phone or email, and when he called the medical clinic, he just got message machines. He told us his family was in Slovakia, that his wife had left him and he didn’t have anyone else who could help. He said he could handle the pain, most of the time. Just not today.
Nine years later, on another 9-1-1 response with another firefighting crew, I met Greta, a frail elderly woman who lived alone in a room in another run-down boarding house in a medium sized Canadian city. The firefighters told me she seldom went out and suffered from some mental health issues. I noticed that she struggled to walk and sitting down and getting up were painful and difficult. On this day, she seemed both falsely cheery and confused, her smiles incongruent with her inability to say what day of the week it was or what city she was in. Mostly, Greta sucked on a piece of candy and looked around. Other candies were stuck on her hair and sweater like some kind of avant-garde fashion statement. A firefighter noted that her electric tea kettle was hot and had boiled dry. There was no smoke detector.
George and Greta are just two of many people whose lives I observed for brief moments while on “ride-alongs” with professional fire fighters. Between 2007 and 2015, I observed, interviewed and otherwise immersed myself in firefighters’ work, concerns and culture in nine Canadian cities while also spending time in neighbourhoods that generated high rates of 9-1-1 calls. While George was a new face for the crew that day, firefighters told me that they saw a lot of Greta. She called 9-1-1 when she was feeling lonely, confused and disoriented. Firefighters and paramedics were dispatched to her home due to the potential risks associated with her disorientation and confusion. They talked with her, determined whether she needed medical care, calmed her down. In one year, these services responded to Greta over 100 times. She is involved with other service providers as well, but, according to the firefighters and paramedics, these providers have deemed that Greta is well enough to “manage on her own”. While Greta was one of this city’s more notable cases, she and George are not unusual. Most emergency services in Canadian cities have cadres of regular service users as well as escalating numbers of one-time only 9-1-1 calls. These increases are much higher than those anticipated as a result of growing populations and population ageing.
This is care with lights and sirens. What emergency services provide is not enough care to support health, but it is enough care to prevent death. How did this happen? Why are fire fighters and paramedics – and even police – responding to people who are struggling to cope with daily life while suffering from mental illness, disabilities, chronic diseases, addictions and/or infirmities, and, very often, poverty? How has serving this population become such a large part of what urban emergency services do each day? Where are the families, neighbours, social workers, health care and other public and charitable services that have historically worked to provide care and support for people? And why is it that this population seems to be growing disproportionately in many Canadian cities? What are emergency services doing when they respond to these calls and how do these workers, and the organizations they work for, deal with it? Does it do any good, or is this a waste of public services and tax payer dollars?
This project aims to address these questions through an examination of the emergency service that seems the least likely candidate for involvement in this work: firefighting. Professional fire services in most Canadian jurisdictions respond to calls regarding medical and social care needs as much as half – and often much more – of their call volume. Firefighters receive very little medical training and virtually no training to address social care needs. Yet, as firefighters themselves often say, “we are the ones who have to come when you need help the most”. Fire services’ involvement in health care related responses have ebbed and flowed through history. Indeed, given the development of provincially funded professional Emergency Medical Services (EMS) in the last half century, staffed by a professional cadre in a new occupation – paramedicine – with roots in both ambulance and military medic services, one might expect that fire services involvement in these emergency responses would be in decline. However, fire services have never been busier in this service area, and, despite regular internecine battles with EMS and paramedics’ unions, in 2016 this trend remains strong.
B. Equity Shifts: Promising Practices at Protective Services
This project was funded by an Insight Development Grant (2012-2015) from the Social Sciences and Humanities Research Council of Canada.
Research Assistance on this project has been provided by Graham McDonald, Ashley Clarkson, Fiona Meyer Cook and Prince Owusu
Pressures for employment equity in firefighting have escalated as scandals around sexual harassment and issues regarding public sector hiring practices have received public attention. Fire fighters are not only almost entirely white men, but the culture, rituals, equipment, rules and expectations are deeply imbued with heterosexual masculine norms that reflect Canada’s mainstream white working class masculine culture. As one fire fighter put it, “Firefighters? We’re just a bunch of hockey players who couldn’t make it to the big leagues”. In most fire services, team cohesion, composed of equal parts camaraderie, required togetherness and cooperative action, is central to effectiveness, safety and firefighters’ work satisfaction. But in building and maintaining this team cohesion, fire services have relied upon already existing commonalities related to gender, race and class among this relatively homogeneous group.
Despite movement toward employment equity in the military, policing and EMS, fire services are the least integrated labour force in Canada. Further, when hired, women and visible minority workers often don’t stay long. Affirmative action is actively rejected by many fire services and municipalities, while at the same time pledges to recruit and hire more women and visible minority group members have been made by the same services and cities.
Challenged by both their emergency medical response care work and by employment equity pressures that challenge who is deemed “fit” for fire fighting jobs, resistance to change from the rank and file, as well as from as from some in higher ranks, is not surprising. But firehouse masculinities are changing, as new generations of firefighters enter the field. In cities where there has been significant hiring, either due to expansions or retirements, there are some big shifts in culture as GenX and millennial firefighters join the ranks. Further, some fire services are leading the way, addressing both who becomes a firefighter and how to better serve diverse communities through innovation in hiring and retention strategies.
This discussion of masculinity, employment equity and care raises more questions. Is it a good thing that white men, and masculinized public services, are now getting more involved in addressing care need? Does this shift in work support equity in care work, perhaps leading this work and those who do it to become more valued and recognized? On the other hand, is doing this work eroding the value and status of firefighting work, as some firefighters worry? Will this make firefighting less appealing to those who have traditionally entered the field? To what extent is the value and prestige of a job based in the overall dominance of the groups who do the work? How are public policies shaping who gets firefighting jobs, and what firefighting looks like as a job? And how are firefighters, themselves, dealing with all this change?
Publications
Susan Braedley Pulling Men into the Care Economy: The Case of Canadian Fire Services Competition and Change January 2015
Susan Braedley (2015) Promising Practices in Fire-Based Emergency Medical Response: Lessons from Winnipeg . Published at: http://www.winnipeg.ca/fps/
Susan Braedley (2012) The Masculinization Effect: Neoliberalism, the Medical Paradigm and Ontario’s Health Care Policy Canadian Women’s Studies/cahier des femmes 29/3 Spring/Summer. pp.71-83.
Media Coverage
July 25, 2015 How to stop the turf war between firefighters and paramedics-Toronto Star