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Published: 31/10/2002, Volume II2, No. 5829 Page 14 15

The firefighters'strike has been postponed, but is the NHS prepared for future eventualities? A decision by one trust to ban toasters in the event of industrial action hardly addresses the key issues.Daloni Carlisle reports

It is off - but, many industrial relations pundits believe, not for long. A few weeks down the line, industrial action by firefighters may take place and paramedics may be called on to cut the victims of road traffic accidents free from the wreckage in place of fire crews. And how would the service go about cutting its own health and safety risks in the event of a strike?

University Hospital Birmingham trust has a plan: toasters would be banned for the duration of each strike.'They are the most common cause of fires, ' a spokesperson explains.

Cleaners would also pay special attention to the prompt removal of rubbish.

The NHS is unwilling to reveal many details, beyond blanket reassurances that preparations have been made and that the service will be able to cope. And that same line is followed, from the Cabinet Office, through the Department of Health and down to individual trusts.

Take this typical comment from a spokesperson at Guy's and St Thomas'Hospital trust in London.

'Planning has been going on for some time and we hope we have got it right. 'We have reviewed all our policies and procedures, done an evacuation training programme for key staff and worked closely with the police and London Ambulance Service.'

Every department now has a safety checklist to complete each week, there are more security patrols in areas where there is a higher risk of fire, and notices on the walls ask staff and visitors to be vigilant.

But with the original schedule of 36 days of action in the period to Christmas eve now planned to start from November 6, how well will the NHS really cope?

Deputy prime minister John Prescott has admitted that the military would provide a slower, more basic service than the fire brigade can, revealing government nervousness about public safety. The Fire Brigades Union has said it will provide cover in the event of a major incident such as a terrorist attack or rail crash, but still has to define what constitutes 'major' and work out how to contact members.

NHS planning began back in August when the DoH sent out guidance to trusts, ambulance trusts and primary care trusts in England. More guidance was issued in September in England, with the Scottish Executive following suit the same month.

Northern Ireland's health department was slower off the mark, issuing its guidance to trusts on October 16 - just 13 days before the first planned walk-out.

As a result, hospitals in Northern Ireland were still working on their plans late last week as the strike loomed closer.

The guidance asks all NHS facilities to review their policies and procedures and do as much as possible to reduce the risk of fire and false alarms. Automatic links to fire stations should be taken off line during strike days, with emergency calls routed through the 999 system instead. Hospitals should look at their capacity to treat burns as well as respond to chemical or biological incidents.

Trusts have also been asked to set up 'fire response teams' that would check out any fire alarm, try to bring small fires under control and act as support for the armed forces.

But staff may find themselves taking on new roles, too. The guidance asks trusts to look at how to rescue trapped casualties - for example, people caught in their vehicles after a road traffic accident. That could either mean ambulance crews or nursing staff cutting casualties free or, where that is not possible, setting up roadside clinical support and surgical teams.

It is this aspect of NHS staff freeing trapped casualties that may cause problems.

The London Ambulance Service is very wary, saying in a statement: 'We will not put our staff at unacceptable risk... Crews will not be expected to deal with situations for which they are not trained, or for which they do not have the equipment.'

Training seems to be sporadic.

'The information we have shows there is no co-ordinated move to train ambulance crews or provide them with equipment, ' said a Unison spokesperson.

The union is in a delicate position, not wanting to see its members effectively strike-break by carrying out firefighters' duties but at the same time understanding the need to save lives.

The union has not issued a blanket instruction to members ordering them not to help extract casualties where it could save lives, but it has warned them to make a risk assessment and take into account their own safety.

A question for many NHS managers is what would happen if there was a major fire at an NHS hospital? History may have something to teach us.

On the first day of the last national firefighters' strike in November 1977, a fire broke out at St Andrew's Hospital in east London. Smoke from a paper store filled wards on three floors and the army, with no breathing equipment, was unable to reach trapped patients. Two dozen union members left their picket, packed their breathing equipment into their own cars and set off to the rescue.

As one picket reportedly said: 'I am human.We cannot let people die.' Does this spirit live on? The next few weeks may tell.