Scottish Ambulance Service: Difference between revisions

Scottish Ambulance Service
Seirbheis Ambaileans na h-Alba
Area served by the Scottish Ambulance Service
Type	Special health board
Established	1 April 1995 (1995-04-01)
Headquarters	Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB
Region served	Scotland
Chair	Tom Steele
Chief executive	Pauline Howie
Staff	5,291 (2019–20)
Website	www.scottishambulance.com

The Scottish Ambulance Service (Scottish Gaelic: Seirbheis Ambaileans na h-Alba) is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health and Social Care Directorates of the Scottish Government.

It is the sole public emergency medical service covering Scotland's mainland and islands; providing a paramedic-led accident and emergency service to respond to 999 calls, a patient transport service which provides transport to lower-acuity patients, and provides for a wide variety of supporting roles including air medical services, specialist operations including response to HAZCHEM or CBRN incidents and specialist transport and retrieval.

History

In 1948, the newly formed Scottish National Health Service (NHS) contracted two voluntary organisations, the St Andrew's Ambulance Association and the British Red Cross, to jointly provide a national ambulance provision for Scotland, known then as the St Andrew's and Red Cross Scottish Ambulance Service.

After British Red Cross withdrew from the service in 1967, the service was renamed the St Andrew's Scottish Ambulance Service. In 1974, with the reorganisation of the Scottish health services, ambulance provision in Scotland was taken over by the Scottish NHS, with the organisational title being shortened to the current Scottish Ambulance Service.

St. Andrew's First Aid, the trading name of St. Andrew's Ambulance Association, continues as a voluntary organisation and provides first aid training and provision in a private capacity.

The organisation was established as a NHS trust on 1 April 1995 when it legally became known as the Scottish Ambulance Service National Health Service Trust. The trust was dissolved on 1 April 1999 and at the same time constituted as a special health board known as the Scottish Ambulance Service Board.

Structure

The Scottish Ambulance Service now continues in its current form as one of the largest emergency medical providers in the UK, employing more than 5,000 staff in a variety of roles and responding to 740,631 emergency incidents in 2015–2016 alone.

The service, like the rest of NHS Scotland is free at point of access and is widely utilised by the public and healthcare professionals alike. Employing almost 1,300 paramedic staff, and a further 1,200 technicians, the accident and emergency service is accessed through the public 999 system.

Ambulance responses are evolving in Scotland and are now prioritised on patient requirement; a traditional, double-crewed ambulance, single response car or a paramedic practitioner may attend emergencies of differing dispositions.

The Scottish Ambulance Service also maintains three command and control centres in Scotland, which facilitate handling of 999 calls and dispatch of ambulances; a further 350–400 staff employed as call handlers and dispatchers fulfil this role across three locations - Edinburgh, Glasgow and Inverness. These three centres (which, through use of software operate as one integrated unit) have been in use since 2004 and handle over 800,000 calls per year. The AMPDS system is used for call prioritisation, and provides post-dispatch instructions to callers allowing for medical advice to be given over the phone, prior to ambulance arrival. Clinical staff are present to provide clinical oversight and tertiary triage. Co-located with the Ambulance Control Centres (or ACC) are patient transport booking and control services, which handle approximately 1 million patient journeys per year.

Volunteers

BASICS Scotland

The service also utilises a number of volunteer responders in conjunction with BASICS Scotland and Sandpiper Trust. These responders are doctors, nurses or paramedics who volunteer their time to respond for the ambulance service and provide assistance to sick or injured individuals. Equipment is provided to these responders by both the ambulance service and BASICS Scotland.

Community First Responder

A number of Community First Responder schemes also exist across Scotland to support the ambulance service. These are voluntary responders with basics medical training who are deployed to 999 calls, mostly cardiac arrests.

Medic One

Medic One is a charity team deploying from Edinburgh from the emergency department. It has a response car, but relies on the Scottish Ambulance Service to obtain a driver to attend calls. They attend around 3 patients a month.

Fleet, equipment & uniform

A New Mercedes-Benz Sprinter Box Ambulance of the Scottish Ambulance Service

The Scottish Ambulance Service maintains a varied fleet of around 1,500 vehicles.

Emergency response vehicles include ambulances, single-response vehicles such as cars and small vans for paramedics. There are also patient-transport ambulances which come in the form of adapted minibuses, lorries and support vehicles for major incidents and events, and specialist vehicles such as 4x4s and tracked vehicles for difficult access.

The geography of Scotland, which includes urban centres such as Edinburgh and Glasgow, areas of relatively low-population such as Grampian and the Scottish Highlands, and the island communities mean that fleet provision has to be flexible and include different approaches to vehicle construction. In the past, 4x4-build ambulances on van chassis have been used in more rural areas, and traditional van-conversions in more urban.

When a large fleet upgrade project was commissioned in 2016, the business case was made to move to a solely box-body on chassis build, to provide some flexibility and more resilient parts procurement. Most of these replacement ambulances have been based on either Mercedes or Volkswagen chassis, with a mixture of automatic or manual transmissions.

The equipment used on board Scottish Ambulance Service vehicles broadly falls in line with NHS Scotland and allows for interoperability in most cases. Equipment is standardised nationally and replaced at regular service intervals; for example, high-cost items such as defibrillators are costed and changed every seven years according to clinical need.

The uniform falls in line with the NHS Scotland National Uniform standard, which is in keeping with the uniform standard described by the National Ambulance Uniform Procurement group in 2016. Amongst cost and comfort considerations, all Scottish Ambulance Service Staff now wear the national uniform which comprises a dark green trouser / shirt combination.

Personal protective equipment (boots, helmet and protective jackets) are issued to all staff and denote rank / clinical rank by way of epaulette and helmet markings.

Organisation

Former Renault Master van ambulance pictured in 2008

Map of the five regional divisions within the Scottish Ambulance Service.

The national headquarters is located at Gyle Square, South Gyle, on the west side of Edinburgh.

There are five divisions within the service, namely:

Scottish Ambulance Service Divisions

Division	Covering	Area	Divisional HQ
North	Highlands, Western Isles, Grampian, Orkney, Shetland	15,607 square miles (40,420 km2)	Inverness
East Central	Fife, Forth Valley, Tayside	4,421 square miles (11,450 km2)	Dundee
West Central	Greater Glasgow, Lanarkshire	1,054 square miles (2,730 km2)	Motherwell
South East	Edinburgh, Lothian and Borders	2,457 square miles (6,360 km2)	Edinburgh
South West	Argyll, Argyll islands, Clyde islands, Ayrshire, Dumfries and Galloway	6,670 square miles (17,300 km2)	Ayr

A PRU (Paramedic Response Unit). A Honda CRV 4x4

Patient transport

The Patient Transport Service carries over 1.3 million patients every year. This service is provided to patients who are physically or medically unfit to travel to hospital out-patient appointments by any other means so that they can still make their appointments. The service also handles non-emergency admissions, discharges, transport of palliative care patients and a variety of other specialised roles.

Patient Transport Vehicles come in a variety of forms and are staffed by ambulance care assistants, who work either double- or single-crewed. They are trained to look after patients during the journey, and to provide basic emergency care.

Air operations

Aberdeen (AS & Ch)

Perth (Ch)

Glasgow (AS)

Inverness (AS)

class=notpageimage|

Air ambulance bases in Scotland
Key: Ch=Charity AS=Ambulance Service

Beechcraft King Air

G-SASN - A previous Babcock-operated H145, with the callsign 'Helimed 02'

The service has the only government-funded air ambulance service in the UK, operated under contract by Gama Aviation. The fleet consists of two Airbus H145 helicopters and two Beechcraft B200C King Air fixed-wing aircraft, which provide emergency response and transfers of patients to and from remote areas of Scotland. The two previous H145 helicopters were operated under sub-contract by Babcock Mission Critical Services Onshore until May 2020. In 2015–2016, the air ambulance crews flew 3,849 missions. One helicopter and one King Air are based at a Gama Aviation facility at Glasgow Airport. The other operating bases are Inverness Airport (helicopter) and Aberdeen Airport (King Air).

The aircraft based in Glasgow are regularly used by the Emergency Medical Retrieval Service (EMRS). The air ambulance service was occasionally featured as part of the Channel 5 television documentary series Highland Emergency.

Charity-funded air ambulance

In late 2012, a charity, Scotland's Charity Air Ambulance (SCAA), was founded to provide a further air ambulance, based at Perth Airport to work alongside the state-funded aircraft. SCAA commenced operations in May 2013 with a MBB Bo 105 helicopter. Since November 2015, SCAA has operated a Eurocopter EC135. The EC135 was previously operated by the state-funded service, until they replaced the fleet with H145 aircraft. The helicopter is crewed by Scottish Ambulance Service paramedics, tasking is from the SAS ambulance control centre at Cardonald.

In April 2018, it was announced by the charity that a drive was underway to raise funds to secure a second helicopter. (SCAA holds assets and funds in excess of 12 million pounds.) This aircraft is now operational at Aberdeen Airport.

Special Operations Response Team (SORT)

The SORT service is similar to the Hazardous Area Response Team in other parts of the United Kingdom.

In 2010, the service established three teams of specialist accident & emergency ambulance personnel who were given specialist training. This £4.3 million initiative was to provide additional preparedness to be able to respond to large-scale hazardous incidents, such as those that might involve chemical, biological, radiological or nuclear material. The work was in concert with the UK government.

As of 2016 there are five SORT teams, three full-time and two on-call. These teams provide a specialist response to major incidents, and provide paramedic care in hostile environments. The team provides capability in arenas such as water rescue, safe working at height, search and rescue including the use of breathing apparatus, and confined space working. The SORT teams also provide a full-time emergency decontamination and inner-cordon capability.

ScotSTAR

With the remote towns and villages in Scotland often being hours away from advanced medical treatment, Scottish Specialist Transport and Retrieval (ScotSTAR) was setup incorporating paediatric and neo-natal retrieval and transfer teams and EMRS. The ScotSTAR service was set up on 1 April 2014 and transported 2,654 patients 2014–2015. The service uses multiple vehicles, either owned by the ambulance service or other organisations: specialist ambulances and cars, five air ambulances and HM Coastguard helicopters. The service is based in Glasgow.

EMRS was started in 2004 by ten emergency medical consultants from Glasgow and Paisley. Providing aeromedical cover to six hospitals within Argyll and Bute. The ten consultants only had £40,000 worth of funding for medical equipment. In its first year the service transported 40 patients. In years to follow the clinical crew began to gather evidence for the lifesaving and cost effectiveness of the service. In 2010, the service was opened up to the whole of the country, thanks to backing by permanent funding. The service is staffed by 27 part-time consultants, two full-time registrars and seven critical care practitioners.

Training academy

The service has its own dedicated training academy within the campus of Glasgow Caledonian University, which opened in June 2011. The facility has purpose built classrooms, lecture theatres, syndicate rooms and a clinical simulation area that recreates a 16-bed hospital ward and Accident & Emergency department allowing realistic interaction with other trainee healthcare professionals.

From 1996 until April 2011, the service used its own dedicated training college located at Barony Castle in Eddleston near Peebles. Set in 25 acres (100,000 m²) of formal gardens and woodlands, Barony was a residential training and conference centre with 78 bedrooms that allowed the service to carry out all its training in house. Between 1978 and 1996 it used the former Redlands women's and children's hospital in Glasgow's west end and prior to that the training school was based at Gartloch Hospital.

Facts and figures

In year ended 31 March 2020, the service:

• Responded to 542,213 accident and emergency incidents.
• Carried out 606,015 non-emergency patient journeys.
• Flew 3,732 air ambulance missions.

Controversy and Challenges

Scottish Ambulance Service has not been free from controversy over the years:

In 1999 it emerged that the Financial Director of the Scottish Ambulance Service had previously been jailed for fraud.

In 2017 the ambulance service was criticised for using an ancient fleet of ambulances, with nearly half having over 100,000 miles on them.

In 2018 it was uncovered that frontline staff had been working "dangerously long hours" with one staff member working a 36 hour long shift. This was described as a national scandal at the time.

2021 saw the Scottish Ambulance Service struggle to staff frontline ambulances; seeking help from firefighters, the military, and non-medical trained drivers to crew ambulances attending 999 calls. A number of tragic stories emerged highlighting the personal cost of this crisis, including one patient who died after waiting 40 hours for an ambulance, and elderly man who died on his driveway after waiting four and a half hours for an ambulance and The same year it was also revealed that a number of senior NHS managers from the ambulance service were running a camper van hire business during work hours, while planning for the COP26 international conference.

Research published in 2022 demonstrated that 4 out of 5 Scottish paramedics were considering quitting their jobs. It also revealed that 87% of staff do not feel valued by the Scottish Ambulance Service. The same report highlighted a third of staff working shifts lasting 15-20 hours. The same year story was published where a member of the public was asked to perform CPR on their relative, alone in the back of the ambulance without help from the ambulance crew while en route to hospital. In July 2022 a story broke where a senior ambulance manager requested a colleague leave their 999 dispatcher job, to give them and their family a lift home from the airport after a family holiday.

See also

• Air ambulances in the United Kingdom
• Ambulance services in the United Kingdom

Other Scottish emergency and non-emergency services:

• NHS 24
• Police Scotland
• Scottish Fire and Rescue Service

External links

• Official website
• Inspection reports from Healthcare Improvement Scotland