Ambulance service moves to tackle call-out problem
By ROSALIND GRIFFITHS
AMBULANCE chiefs have reacted swiftly to the problem highlighted by The Shetland Times recently of there being only one ambulance to serve the Shetland Mainland by setting up networks of volunteer medics.
Scottish Ambulance Service is to start two community “first responder” schemes, one in the north and one in the south – if successful they will be rolled out to other areas. These schemes will comprise trained volunteers in specially equipped vehicles providing a quick initial response to 999 calls.
The volunteers will be the first on the scene in the “vital first minutes” following an emergency call-out, and will be dispatched by the ambulance service, although they are not a substitute for the ambulance.
Advertisements for people to train as responders placed in country shops have attracted much interest since they appeared on 29th December. They ask people to “help your community in its time of need,” offer medical training and explain that the ambulance cannot always get to country areas quickly but trained responders can, thus helping to save lives. The initiative is expected to go live within six weeks.
The move follows the incident revealed by this newspaper last month of Sandwick heart attack victim Alan Woodworth being driven to hospital by a porter – one hour after his wife made two 999 calls. The Mainland’s only ambulance was busy and the lone out of hours GP serving most of the Mainland was an hour’s drive away.
Ambulance bosses are due in Shetland soon and public meetings will be held in Brae and Sandwick to explain the role responders, which bosses say are “more than first aiders”. As the first people on the scene at a possible life-threatening emergency they will be trained in operating defibrillators, delivering oxygen, airway management and control of bleeding.
The volunteers will be expected to manage unconscious patients and stabilise conditions such as heart attack, stroke, asthma and diabetes. They will also be trained in trauma care and paediatrics, but will not be sent to road traffic accidents, maternity cases or incidents of a violent or domestic nature.
First responders will manage but not treat a patient – management will take the form of keeping the airway clear, giving oxygen and putting the patient in the recovery position.
They will not make a diagnosis or a clinical decision and will not administer drugs. Neither will they be allowed to transport patients to hospital.
Community resuscitation development officer for the ambulance service Alan Knox said the scheme was “badly needed” in Shetland and would make “such a difference”.
He said it would be implemented quickly and “there will be no hanging about”. Two Ford Fiesta vans are already on order – they will bear the SAS crest and be fully insured by the service.
Mr Knox claimed the training and equipment would be “bullet proof”.
He said: “It can’t go wrong. The scheme will provide cover in the first vital minutes before the ambulance arrives.” During this time they would be in constant touch with paramedic advisers.
However, critics say there would still be only one ambulance serving the Mainland – what was needed was a standby vehicle and crew.
First responders would be there to offer comfort until the ambulance arrives, one critic said, but could not be “expected to do the impossible”. Volunteers would not be able to diagnose certain conditions whereas an ambulance staff could start treatment straight away by confirming the diagnosis and administering drugs.
The critic said: “An ambulance is an A&E service on wheels. It needs to be at the patient’s house quickly. They [ambulance chiefs] can’t get away from the fact the ambulance can’t be in two places at once.”
The issue of the single ambulance has been taken up by MSP Tavish Scott, who became involved after Mr Woodworth’s experience. Mr Scott, who will meet ambulance chiefs when they visit Shetland, gave a qualified welcome to the first responder proposals.
He said: “It is a small step forward but not the complete solution to Shetland’s blue-light ambulance cover. I would like to see a full 24-hour station in Shetland, properly staffed and with an additional ambulance and crew.”
Mr Knox rejected the suggestion that the two Shetland schemes were a cheap alternative to providing another ambulance. He said they would be a positive development in the two community areas, not necessarily a final development.
Putting another ambulance in was not necessarily the answer, Mr Knox said, because of the problem of “skills decay” and possible lack of demand. But he did promise that “exciting new models” were being considered. “We are working more closely with communities than ever before.”
Meanwhile, first responders would assist in filling a “therapeutic vacuum”, which would be an enhancement of the existing service.
Mr Knox said that he has already had a “fantastic initial positive response” from people enquiring about the Shetland initiative, even before the presentations.
He said that recruitment had never been a problem in previous schemes, but Shetland was proving exceptional. “I have never seen such interest”.
At least six people would be needed in each location, and Mr Knox is hoping for up to 20. The schemes will cost £15,000 for the van and initial training in each location and he said the fact that the SAS was fully funding the scheme showed its commitment to Shetland – some communities had had to provide funding themselves.
The aim was not to turn volunteers into “mini-doctors,” he said, but to provide a “link in the chain”. In previous schemes involving 400 first responders there had never been any problems.
Volunteers, who would be subject to enhanced Disclosure Scotland checks, will have “intensive training”, initially over two days, with a further half day of written and practical examinations. Advances in medical technology mean that interventions can now be made by people with less training than previously.
Training will be enhanced by refresher courses and re-assessment every six months. It will be fully accredited by the Institute of Health Care and Development approved by the faculty of Royal College of Surgeons in Edinburgh, and trainees can progress to SVQ level and undertake placements with the ambulance service or the health board.
Similar initiatives are being set up in Orkney.
Mr Woodworth, who had his heart attack in October, welcomed the initiative. He said: “It sounds good. It’s what the people need. I’m hoping it does work and it gets better as time goes on.”
*The community first responder initiative was pioneered in England and Wales. Since being launched in Scotland, the Scottish Ambulance Service has seen over 50 schemes established, with 35 being set up in the north of Scotland since 2003.
Anyone interested in setting up a scheme in the Brae, Mossbank or Sandwick areas should call Mr Knox on 07785 724316 or email firstname.lastname@example.org or call Lerwick Ambulance Station team leader Peter Smith on (01595) 695344.
Public meetings have been arranged for: Monday, 19th January at 7.30pm in the Brae Community Hall; and Tuesday, 20th January at 7.30pm in the Carnegie Hall, Sandwick.