Ambulance service – how can we help you?

Published on Monday 22 June 2009 22:52

THE Scottish Ambulance Service (SAS) is about to embark on its most extensive consultation, asking the public and organisations to tell it how its service can improve in the future.

The exercise will cover everything from provision in remote and rural areas to the idea of the service helping to teach first aid to schoolchildren to give them skills for the future.

But one major issue the SAS wants to tackle is dealing with the surges in demand they see caused by alcohol.

Pauline Howie, acting chief executive of the service, contends that more needs to be done to tackle the burden placed on the whole of the NHS by alcohol misuse, and she says her organisation is trying to do more to cope with spikes in demand for ambulances caused by alcohol.

Last month was particularly busy for the ambulance service, with crews responding to 38,920 call-outs. This compared with 34,962 responses in May and 37,608 in January, which, because of New Year celebrations, is traditionally one of the busiest times of the year.

It is thought that the Scottish Cup final, end-of-season football matches and the good weather could be behind the surge in demand as a result of people drinking more.

Ms Howie says: "If you look at our demand during the week, it is pretty stable Monday to Friday. Then on Friday night and Saturday morning it kicks off; particularly after 10pm on a Saturday night to 3am on Sunday morning it really spikes up.

"We see the big bulge in activity once the pubs and clubs close in the city centres."

To cope with the weekend demand, mobile units have been used in Glasgow and during busy periods in Edinburgh to treat drunk patients without the need to send them to accident and emergency – a system that could be extended to other areas in future.

But Ms Howie says there is also a need to offer people help earlier to reduce alcohol-related harm, an approach that has seen ambulance staff increasingly refer patients for further support.

"I think it is part of a wider alcohol strategy because it is very reactive," she explains.

"There is much more we need to be doing to try to educate the public about the adverse effects of their behaviour.

"We are contributing to the government's alcohol strategy and trying to help in terms of intervention work, making sure we can refer people to appropriate agencies early, because we do find it is the same groups of people presenting in that way."

She continues: "We think there really is more we need to do as a country, in terms of education, but also in terms of treating people in the most appropriate way, rather than taking them to A&E and getting them clogged up in that system."

The ambulance service has faced a difficult year following the departure of former chief executive Kevin Doran and Grace Kennedy, the operations director, amid allegations of bullying and harassment.

Staff surveys have also revealed problems with morale and job satisfaction at the service.

Despite this, Ms Howie claims that the SAS has come a long way in recent years.

"We finished the last year in a very strong state," she says. "We are getting to more life-threatening calls faster than ever before."

Recent figures show that the SAS reached 77.4 per cent of life-threatening calls within the eight-minute target, with an average response time for mainland Scotland of 7.2 minutes for the whole of last year.

"We are really proud of that, and obviously the patients who really need us are telling they want a really quick and suitable response," she says.

To get to some of Scotland's remotest and most rural areas, the service is testing different methods, including using retained staff who are not full-time but called upon when their help is needed. More than 50 "first-responder" schemes are also already running, with volunteers given basic training to help patients while an ambulance is on its way.

Ms Howie says it is not feasible to have more fully crewed ambulance stations in more areas, as the staff would suffer "skills atrophy" – not using their skills enough to keep them useful and up-to-date.

Other methods could include getting a trained ambulance driver to work with a community nurse.

Another would be having a community paramedic working in primary care when not needed for emergencies.

Ms Howie believes the service could also have more of a role in educating people about the most appropriate place to go for their health needs. This may not always mean phoning an ambulance, but using services such as NHS 24 or speaking about their problem to their GP instead.

Ms Howie points out that the SAS staff are already involved in first-aid training in some schools. Research has suggested teaching children these skills can reduce deaths in their communities in the future, as they are able to offer help when someone becomes ill.

"We will be asking if there is a wider role for us in this," she says. "It's not what you would expect traditionally from an ambulance service, but we are in all the communities.

"We are across the country, 150 stations and over 4,000 staff."

She adds: "We have got a very local presence and we have got the skills."