Emergency medical services in the United Kingdom: Wikis

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An NHS ambulance outside Broomfield Hospital

Emergency medical services in the United Kingdom, to provide immediate care to people with acute illness or injury, are predominantly provided by the four publicly-funded health care systems: the National Health Service (for England), Health and Social Care in Northern Ireland, NHS Scotland and NHS Wales.

Contents

Role of the ambulance services

Public ambulance services across the UK are required by law to respond to four types of requests for care,[1] which are:

  • Emergency calls (via the 999 system)
  • Doctor's urgent admission requests
  • High dependency and urgent inter-hospital transfers
  • Major incidents

Ambulance trusts and services may also undertake non-urgent patient transport services on a commercial arrangement with their local hospital trusts or health boards, or in some cases on directly funded government contracts.[2] This is an area where an increasing amount of private firms are taking business away from the trusts.

Emergency ambulance work in all NHS bodies and most voluntary and private firms is based on the guidance published by the Joint Royal Colleges of medicine Ambulance Liaison Committee (JRCALC).

Public ambulance services

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England

Crest of NHS ambulance services in England

Emergency medical services are provided through local ambulance services, known in England and Wales as trusts. Each service in England is specific to a one or more local authority areas, and so the country is divided across a number of ambulance services, in a similar way to the Police.


In England there are twelve ambulance 'Trusts', with boundaries generally following those of the regional government offices.[3]

The ambulance services across England have been increasingly busy, with a significant increase in calls in the last two decades,[3] as shown in the table below:

Year Emergency Calls Source
1994/5 2.61 million [3]
2004/5 5.62 million [3]
2006/7 6.3 million [4]

Following consultation, on 1 July 2006, the number of ambulance trusts fell from 29 to 13.[3] The reduction can be seen as part of a trend dating back to 1974, when local authorities ceased to be providers of ambulance services. This round of reductions in the number of trusts originated in the June 2005 report "Taking healthcare to the Patient", authored by Peter Bradley, Chief Executive of the London Ambulance Service, for the Department of Health.[5]

Most of the new Trusts follow government office regional boundaries, exceptions to this are the Isle of Wight (where provision will remain with the Island's Primary Care Trust), and South East and South West England which are both split into two Trusts. This has led to a number of old trusts ceasing to exist. Staffordshire ambulance trust had a temporary reprieve, but became part of the West Midlands ambulance trust on 1 October 2007. The new Trust structure is as follows:

NHS Ambulance Service Trusts
Ambulance Service Headquarters[6] Local Authority Areas Covered[6]
East Midlands Ambulance Service NHS Trust Nottingham Derby, Derbyshire, Nottingham, Nottinghamshire, Lincolnshire, North Lincolnshire, North East Lincolnshire, Leicestershire, Rutland and Northamptonshire
East of England Ambulance Service NHS Trust Norwich Luton, Bedfordshire, Cambridgeshire, Hertfordshire, Norfolk, Suffolk, Peterborough, Southend-on-sea, Thurrock and Essex
Great Western Ambulance Service NHS Trust Chippenham Bath and North East Somerset, Bristol, Gloucestershire, South Gloucestershire, North Somerset, Swindon and Wiltshire
Isle of Wight Primary Care Trust Newport Isle of Wight
London Ambulance Service NHS Trust London Greater London
North East Ambulance Service NHS Trust Newcastle-upon-Tyne Darlington, Durham, Hartlepool, Middlesbrough, Northumberland, Redcar and Cleveland, Stockton-on-Tees and Tyne & Wear
North West Ambulance Service NHS Trust Bolton Blackburn with Darwen, Blackpool, Preston, Cheshire, Cumbria, Greater Manchester, Lancashire and Merseyside
South Central Ambulance Service NHS Trust Wokingham Berkshire, Buckinghamshire, Hampshire, Milton Keynes, Oxfordshire, Portsmouth & Southampton
South East Coast Ambulance Service NHS Trust Banstead Brighton and Hove, Kent, Medway, Surrey, East Sussex and West Sussex
South Western Ambulance Service NHS Trust Exeter Bournemouth, Cornwall, Devon, Dorset, Plymouth, Poole, Somerset and Torbay
West Midlands Ambulance Service NHS Trust Brierley Hill Herefordshire, Shropshire, Staffordshire, Telford & Wrekin, Warwickshire, West Midlands and Worcestershire
Yorkshire Ambulance Service NHS Trust Wakefield East Riding of Yorkshire, Kingston-upon-Hull, North Yorkshire, South Yorkshire, West Yorkshire and York

Scotland

Whilst ambulance cover in Scotland was originally provided by a combination of the British Red Cross and St Andrews Ambulance until 1974,[7] the Scottish Ambulance Service is a Special Health Board funded directly by the Health Department of the Scottish Government.[8] In 2006 the service responded to over 520,000 emergency calls. Scotland also has Britain's only publicly funded Air Ambulance service, comprising of two Eurocopter EC 135 Helicopters (based in Glasgow & Inverness) and two Beechcraft B200C King Air fixed-wing aircraft (based at Glasgow & Aberdeen).[9]

In financial year 2006–2007, the service employed 3,973 staff across six divisions and attended to 569,372 accident and emergency incidents.

The national headquarters are in Edinburgh and there are five divisions within the Service:

  • North division covers the Grampian, Highlands, Orkney, Shetland and the Western Isles of Scotland. A total area of 16,792 square miles (43,490 km2)[10]
  • East Central division covers Fife, the Forth Valley and Tayside, a total area of 4,421 square miles (11,450 km2).[11]
  • South East division covers Edinburgh, the Lothians and the Borders, a total area of 2,457 square miles (6,360 km2).[12]
  • West Central division covers Greater Glasgow and Lanarkshire, an area of 1,054 square miles (2,730 km2).[13]
  • South West division covers Argyll, the Argyll islands, the Clyde islands, Ayrshire, Dumfries-shire and Galloway for a combined area of 6,670 square miles (17,300 km2).[14]

Northern Ireland

The Northern Ireland Ambulance Service (NIAS) is the ambulance service that serves the whole of Northern Ireland, and was established in 1995 by parliamentary order.[15] As with other ambulance services in the United Kingdom, it does not charge its patients directly for its services, but instead receives funding through general taxation. It responds to medical emergencies in Northern Ireland with the 270 plus ambulances at its disposal. The Service employs approximately 1,044 staff based across 32 stations & sub-stations, four Control Centres and a Regional Training Centre.[15]

Wales

The Welsh Ambulance Service NHS Trust (also called Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru) was established on 1 April 1998, and has 2,500 staff providing ambulance and related services to the 2.9 million residents of Wales.[16]

Its headquarters is located at H.M.Stanley Hospital, St Asaph, Denbighshire and it is divided into three regions:[17]

  • Central and West Region based at Ty Maes Y Gruffudd, Cefn Coed Hospital, Cockett, Swansea
  • North Region based at H.M.Stanley Hospital, St Asaph, Denbighshire
  • South-East Region based at Vantage Point House, Ty Coch Ind Est, Cwmbran

Measuring performance

The performance of every Ambulance Trust is measured by the government. Commonly called 'ORCON',[18] after the consultancy used to formulate them, they are more properly called NAPS - New Ambulance Performance Standards. The Government's targets are to reach 75% of Category A (life-threatening) calls - as decided by the computerised AMPDS (except the Berkshire Division of South Central Ambulance where CBD (Criterion Based Dispatch) is used) - within eight minutes. A number of initiatives have been introduced to assist meeting these targets, including Rapid Response Vehicles and Community First Responders.

Measuring performance and criticisms

The performance of the Ambulance service is measured by the government, as part of a system called 'ORCON'.[19] The Government's target is to reach 75% of Category A (life threatening) calls within eight minutes, as recorded by the computerised AMPDS. A number of initiatives have been introduced to assist meeting these targets, including Rapid Response Vehicles and Community First Responders.

The Scottish Ambulance Service was criticised in a case where a technician attended a call out within four minutes — well within the eight minute target — but not a paramedic who alone could administer certain cardiac drugs.[20]

Private ambulance services

Private ambulance services are becoming more common in the UK, performing a number of roles, including providing medical cover at large events, either alongside, or instead of the voluntary sector providers. Some organisers use a private firm instead of a voluntary ambulance service because of wider availability during the week (sometimes difficult for a voluntary service to cover) or for a wider range of skills, such as provision of qualified Paramedics.

The most common type of private ambulance provider is in the Patient Transport role, with many trusts and hospitals choosing to outsource this function to a private company, rather than use the NHS service, although the policy differs from trust to trust.

Some companies have been contracted to provide additional emergency crews and vehicles to supplement the core NHS staff at busy times, with a quarter of the UK ambulance trusts contracting private companies to front line work.[21]

Another type of private ambulance are those operated by funeral directors, who generally favour black vans, with the words "PRIVATE AMBULANCE" printed discreetly on the vehicle.

Voluntary ambulance services

St. John Ambulance emergency/multi-purpose ambulance.

The main voluntary ambulance providers are the British Red Cross and St. John Ambulance, which have been providing emergency medical cover in the UK for many years, including active service in both World Wars (pre-dating the existence of any government organised service), and along with St Andrews Ambulance (now St Andrews First Aid, which no longer provides an ambulance service]]) ran statutory ambulance services in the United Kingdom under contract to the government until a reorganisation in 1974.[7] The primary activity of both organisations in relation to ambulances, is the provision of covers at events as an extension of their first aid contract.

Depending on their agreement/s with their local ambulance service trust (known as a "Memorandum of Understanding" or MOU), they may treat and transport certain categories of patient to hospital, although for more serious incidents, such as cardiac arrest it is likely that they would be expected to summon the assistance of the statutory ambulance service.

Both organisations also provide "reserve" or "support" cover to some, though not all, of the ambulance trusts , dependent on the local MOU, where ambulance crews from one of the organisations (who are usually volunteers, but in some instances may be paid staff) will attend 999, GP Urgent or PTS calls on behalf of the ambulance trust, with the organisation receiving recompense from the trust. This service is most often called on during major incidents (e.g. the 7 July 2005 London bombings), when there is a high level of staff absence or when there is an unusually high call volume, although in some areas, voluntary crews are regularly used to supplement full time trust cover.

Both organisations have also provided cover for the public on the very rare occasions when unionised NHS ambulance trust staff have taken industrial action.[22]

See also

References

  1. ^ "Ambulance Service Definition". http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=529&sectionId=21958. Retrieved 2007-06-15.  
  2. ^ "NHS Ambulance Trusts Description". http://www.nhs.uk/England/AuthoritiesTrusts/Ambulance/Default.aspx. Retrieved 2007-06-15.  
  3. ^ a b c d e "NHS Information on Ambulance Services". http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=529. Retrieved 2007-06-14.  
  4. ^ "Emergency ambulance calls 'peak'". BBC News. 21 June 2007. http://news.bbc.co.uk/1/hi/health/6227034.stm. Retrieved 2007-06-22.  
  5. ^ "Taking Healthcare to the Patient". COI Communications for the Department of Health. June 2005. http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=2256&Rendition=Web. Retrieved 2007-06-15.  
  6. ^ a b "NHS Ambulance Trusts List". http://www.nhs.uk/England/AuthoritiesTrusts/Ambulance/list.aspx. Retrieved 2007-06-15.  
  7. ^ a b "St. Andrew's Ambulance - Our History". St Andrews First Aid. http://www.standrewsambulance.org.uk/history.htm. Retrieved 2009-08-05.  
  8. ^ "Scottish Ambulance Service Website". http://www.scottishambulance.com/index.asp. Retrieved 2007-06-15.  
  9. ^ "Scottish Ambulance Service Air Wing". http://www.scottishambulance.com/what_we_offer/air_wing.asp. Retrieved 2007-06-15.  
  10. ^ Locations - North scottishambulance.com, accessed 11 February 2009
  11. ^ Locations - East Central scottishambulance.com, accessed 11 February 2009
  12. ^ Locations - South East scottishambulance.com, accessed 11 February 2009
  13. ^ Locations - West Central scottishambulance.com, accessed 11 February 2009
  14. ^ Locations - South West scottishambulance.com, accessed 11 February 2009
  15. ^ a b "Northern Ireland Ambulance Service Trust". http://www.niamb.co.uk/home.htm. Retrieved 2007-06-15.  
  16. ^ "Welsh Ambulance Services NHS Trust". http://www.wales.nhs.uk/sites3/home.cfm?orgid=136&redirect=yes. Retrieved 2007-06-15.  
  17. ^ "Welsh Ambulance Services NHS Trust Contact Details". http://www.wales.nhs.uk/sites3/page.cfm?orgid=136&pid=816. Retrieved 2007-06-15.  
  18. ^ Nicholl, Jon; Coleman, Patricia; Parry, Gareth; Turner, Janette; Dixon, Simon. (1999). "Emergency Priority dispatch systems - a new era in the provision of ambulance services in the UK" (PDF). Pre-hospital Immediate Care 3 (71-75). http://www.firetactics.com/PDS.pdf.  
  19. ^ Nicholl, Jon; Coleman, Patricia; Parry, Gareth; Turner, Janette; Dixon, Simon. (1999). "Emergency Priority dispatch systems - a new era in the provision of ambulance services in the UK". Pre-hospital Immediate Care 3 (71-75). http://www.firetactics.com/PDS.pdf.  
  20. ^ 'Tea break' paramedic criticised BBC News, 22 September 2008
  21. ^ Donnelly, Laura (2009-02-21). "NHS bosses send 'il-trained' private ambulance crews to 999 calls". The Telegraph. http://www.telegraph.co.uk/health/healthnews/4739836/NHS-bosses-send-ill-trained-private-ambulance-crews-to-999-calls.html.  
  22. ^ "Ambulance Staff strike over pay". This is Cheshire. July 20, 2006. http://archive.thisischeshire.co.uk/2006/7/20/274227.html. Retrieved 2007-06-14.  

External links


Simple English

Emergency medical services in the United Kingdom are provided by one of the four National Health Services through local ambulance services, known in England and Wales as trusts. Each service in England is based on one or more local authority areas, and so the country is divided across a number of ambulance services, in a similar way to the British Police.

, West Yorkshire.]] In England there are twelve ambulance 'Trusts', with boundaries generally following those of the regional government offices[1]. Scotland, Wales and Northern Ireland have one ambulance service each; the Scottish Ambulance Service (a Special Health Board), the Welsh Ambulance Service, and the Northern Ireland Ambulance Service.

Contents

Job of the Ambulance Services

NHS ambulance services must by law answer four types of requests for care[2], which are:

  • Emergency Calls (via the 999 system, or the 112 Europe-wide number)
  • Doctor's urgent admission requests
  • High dependency and urgent inter-hospital transfers
  • Major incidents

The ambulance services have getting more and more busy. There has been a big increase in the number calls in the last two decades,[1] as shown in the table below:

Year Emergency Calls Source
1994/5 2.61 million [1]
2004/5 5.62 million [1]
2006/7 6.3 million [3]

Ambulance trusts may also undertake non-urgent patient transport services on a commercial arrangement with their local hospital trusts, or in some cases on directly funded government contracts. The pateients do not pay for this service. The hospital does.[4] In some place private firms do this job instead, but it can be a big source of money for the trusts.

Ambulance Trusts and Services

England

Before 1974 local councils used to run the ambulance service. Since then NHS regions and now ambulance trust have. On 1 July 2006 the number of ambulance trusts fell from 29 to 13[1][5] .

Most of the new Trusts follow government office regional boundaries. But on the Isle of Wight the local hospitals will keep running the ambulances. Also South East England and South West England were split into two Ambulance Trusts. This has meant that a lot of old trusts disappeared. The new Trusts are:

NHS Ambulance Service Trusts
Ambulance Service Headquarters[6] Local Authority Areas Covered[6]
East Midlands Ambulance Service NHS Trust Nottingham Derby, Derbyshire, Nottingham, Nottinghamshire, Lincolnshire, North Lincolnshire, North East Lincolnshire, Leicestershire, Rutland and Northamptonshire
East of England Ambulance Service NHS Trust Bury St Edmunds Luton, Bedfordshire, Cambridgeshire, Hertfordshire, Norfolk, Suffolk, Peterborough, Southend-on-sea, Thurrock and Essex
Great Western Ambulance Service NHS Trust Chippenham Bath and North East Somerset, Bristol, Gloucestershire, South Gloucestershire, North Somerset, Swindon and Wiltshire
Isle of Wight Primary Care Trust Newport Isle of Wight
London Ambulance Service NHS Trust London Greater London
North East Ambulance Service NHS Trust Newcastle-upon-Tyne Darlington, Durham, Hartlepool, Middlesbrough, Northumberland, Redcar & Cleveland, Stockton-on-Tees and Tyne & Wear
North West Ambulance Service NHS Trust Bolton Blackburn with Darwen, Blackpool, Preston, Cheshire, Cumbria, Greater Manchester, Lancashire and Merseyside
South Central Ambulance Service NHS Trust Wokingham Berkshire, Buckinghamshire, Hampshire, Milton Keynes, Oxfordshire, Portsmouth & Southampton
South East Coast Ambulance Service NHS Trust Lewes Brighton & Hove, Kent, Medway, Surrey, East Sussex and West Sussex
South Western Ambulance Service NHS Trust Exeter Bournemouth, Cornwall, Devon, Dorset, Plymouth, Poole, Somerset and Torbay
West Midlands Ambulance Service NHS Trust Brierley Hill Herefordshire, Shropshire, Staffordshire, Telford & Wrekin, Warwickshire, West Midlands and Worcestershire
Yorkshire Ambulance Service NHS Trust Wakefield East Riding of Yorkshire, Kingston-upon-Hull, North Yorkshire, South Yorkshire, West Yorkshire and York

Scotland

The Scottish Ambulance Service is a Special Health Board funded directly by the Health Department of the Scottish Government[7]. In 2006 the service answered over 520,000 emergency calls.

Scotland also has Britain's only publicly funded Air Ambulance service. It has two Eurocopter EC 135 Helicopters (based in Glasgow & Inverness) and two Beechcraft B200C King Air fixed-wing aircraft (based at Glasgow & Aberdeen).[8]

Northern Ireland

The Northern Ireland Ambulance Service (NIAS) is the ambulance service that serves the whole of Northern Ireland, and was set up in 1995.[9]

As with other ambulance services in the United Kingdom, it does not charge its patients directly for its services, but is funded through general taxation.

To answer medical emergencies in Northern Ireland, NIAS has over 270. The Service employs approximately 1044 staff based across 32 stations & sub-stations, 4 Control Centres and a Regional Training Centre.[9]

Wales

The Welsh Ambulance Service NHS Trust (Welsh:Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru) was set up on April 1, 1998 and has 2,500 staff providing ambulance and related services to the 2.9 million residents of Wales.[10]

Its headquarters are at the H.M.Stanley Hospital, St Asaph, Denbighshire and it is divided into three regions [11]:

  • Central and West Region based at Ty Maes Y Gruffudd, Cefn Coed Hospital, Cockett, Swansea
  • North Region based at H.M.Stanley Hospital, St Asaph, Denbighshire
  • South-East Region based at Caerleon House, Mamhilad Park Estate, Pontypool

Private Ambulance Services

Private ambulance services are becoming more common in the UK. They often providing medical cover at large events, either with, or instead of the voluntary sector providers. Some organisers use a private firm instead of a voluntary ambulance service because of wider availability during the week (sometimes difficult for a voluntary service to cover) or for a wider range of skills, such as provision of qualified Paramedics.

The most common use for private ambulances is for Patient Transport. Many trusts and hospitals choosing use a private company, instead of the NHS service. Private ambulances do not answer emergency (999) calls. Sometimes a private ambulance company is used as a follow-up, for stretcher transport or going non-life threatening calls. Recently, some companies have been contracted to provide additional emergency crews and vehicles to supplement the core NHS staff at busy times (such as New Year).

All ambulance companies and the NHS Ambulance trusts must follow the same laws, so a private ambulance must have the same equipment and the people working in it be as qualified as the same type of NHS ambulance.

Another type of private ambulance are those operated by undertakers, who generally favour black vans, with the words private ambulance written discreetly on the vehicle. They are used for taking bodies between hospital, embalmer and chapel of rest, rather than use a hearse.

Voluntary Ambulance Services

The main voluntary ambulance providers are the British Red Cross and St John Ambulance in England/Wales, Northern Ireland & The Islands, and St Andrew's Ambulance Association in Scotland. The Order of Malta Ambulance Corps. can sometimes be found in Northern Ireland also. These groups have been providing both emergency and non-emergency medical cover in the UK for over 120 years, including active service in both World Wars. This is before any government organised service.

The main activity of the organisations apart from training and education, is providing ambulance cover at events, as an extension of their First aid contract.

Depending on their agreement, or agreements, with their local ambulance service trust (known as a Memorandum of Understanding or MOU), they may treat and transport certain categories of patient to hospital, although for more serious incidents, such as cardiac arrest it is likely that they would be expected to summon the assistance of the statutory ambulance service.

Both organisations also provide 'reserve' or 'support' cover to some, though not all, of the ambulance trusts (dependent on the local MOU), where ambulance crews from one of the organisations (who are usually volunteers, but in some instances may be paid staff) will attend 999, GP Urgent or PTS calls on behalf of the ambulance trust. In these cases the organisation is paid by the trust. This service is most often called on during major incidents, when there is a high level of staff absence or when there is an unusually high call volume, although in some areas, voluntary crews are regularly used to supplement full time trust cover.

Both organisations have also provided cover for the public when NHS ambulance trust staff have held strikes or walk outs.[12]

Big White Taxi Service

Big White Taxi Service is nickname sometimes used by NHS ambulance staff in the United Kingdom.

They use it because the 999 emergency number is often misused by people who do not need an emergency ambulance, but could go to their own local General Practitioner.[13]

Other pages

References

  1. 1.0 1.1 1.2 1.3 1.4 "NHS Information on Ambulance Services". http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=529. Retrieved 2007-06-14. 
  2. "Ambulance Service Definition". http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=529&sectionId=21958. Retrieved 2007-06-15. 
  3. "Emergency ambulance calls 'peak'". BBC News. 21st June 2007. http://news.bbc.co.uk/1/hi/health/6227034.stm. Retrieved 2007-06-22. 
  4. "NHS Ambulance Trusts Description". http://www.nhs.uk/England/AuthoritiesTrusts/Ambulance/Default.aspx. Retrieved 2007-06-15. 
  5. "Taking Healthcare to the Patient". COI Communications for the Department of Health. June 2005. http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=2256&Rendition=Web. Retrieved 2007-06-15. 
  6. 6.0 6.1 "NHS Ambulance Trusts List". http://www.nhs.uk/England/AuthoritiesTrusts/Ambulance/list.aspx. Retrieved 2007-06-15. 
  7. "Scottish Ambulance Service Website". http://www.scottishambulance.com/. Retrieved 2007-06-15. 
  8. "Scottish Ambulance Service Air Wing". http://www.scottishambulance.com/helpoffered/airwing.asp. Retrieved 2007-06-15. 
  9. 9.0 9.1 "Northern Ireland Ambulance Service Trust". http://www.niamb.co.uk/home.htm. Retrieved 2007-06-15. 
  10. "Welsh Ambulance Services NHS Trust". http://www.wales.nhs.uk/sites3/home.cfm?orgid=136&redirect=yes. Retrieved 2007-06-15. 
  11. "Welsh Ambulance Services NHS Trust Contact Details". http://www.wales.nhs.uk/sites3/page.cfm?orgid=136&pid=816. Retrieved 2007-06-15. 
  12. "Ambulance Staff strike over pay". This is Chesire. July 20th 2006. http://archive.thisischeshire.co.uk/2006/7/20/274227.html. Retrieved 2007-06-14. 
  13. "Meetings with destiny". The Guardian. http://www.guardian.co.uk/society/2005/jul/13/attackonlondon.terrorism. Retrieved 2007-12-29. 

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