Ambulance services in Europe: Great Britain

Legal basis

The basis for the Ambulance Service in Great Britain which, like almost all medical services, falls within the sphere of the National Health Service (NHS), the public health body, is the National Health Service Act of 1977. This requires the local and regional health authorities to provide adequate medical, dental and ambulance services.

Organisation

The Ambulance Service is in principle divided into the Emergency and Urgent Ambulance Service and Non-Emergency Ambulance and other NHS Patient Transport).

The Emergency and Urgent Ambulance Service includes emergency cases (any kind of emergency call made by dialling "999"), urgent cases (requested by doctors, dentists and midwives, incl. urgent interhospital transport) and other emergencies. Non-Emergency Patient Transport (PTS) usually involves transporting patients to and from treatment centres.

The emergency and urgent ambulance services are under the direct authority of the local and regional health authorities.

According to the standards of the National and Patient Charter, the times taken to reach patients vary from 8 minutes in urban areas to 19 minutes in rural areas depending on the kind of emergency. Every ambulance should also be manned by at least one fully trained paramedic. Every ambulance is equipped with a defibrillator which can be operated by members of staff.

Control centres

Great Britain is divided into about 37 historically evolved ambulance service regions which each have a control centre. The control centres can be reached by calling the national emergency number 999. The state-run control centres operate with specially trained staff (no doctors) in their own premises and they often have technically advanced equipment. Since they in many cases provide the possibility of communication with other health services, they are often also referred to as communications centres.

Involvement of doctors

In Great Britain, there is no emergency doctor system such as exists on the Continent. The ambulance services usually have a large number of paramedics who are well trained in a wide range of procedures, so that it is not considered very necessary to involve doctors in the Ambulance Service.

Air ambulance service

The first civilian air ambulances in Great Britain were brought into service on the Cornwall peninsula in April 1987. A second base was established a year later at the Royal London Hospital. The helicopter stationed there alone made 1700 emergency flights up until May 1998. Up until now, it has also been the only one to have a doctor as a permanent member of its crew. Air ambulances now operate from twelve bases in England and Scotland, although usually only for ten hours during the day up until the onset of darkness. In order to be better able to co-ordinate operations, guarantee the same technical standards and ensure the financial support which is largely dependent on donations, the National Association of Air Ambulance Services (N.A.A.S) was established in 1997. In April of this year, the AA, the automobile club with the biggest membership, entered into a 14 million pound sponsorship contract with the NAAS. This means that seven more helicopter ambulances should be in use by the year 2002 and seven-day-a-week availability should be guaranteed.

Staff / Training

British ambulance service training is provided in three stages in regional schools (Regional Training Schools) on the basis of training programmes drawn up by the National Health Service which is also responsible for this area.

1. 96 hours of basic training to become an ambulanceman/woman

2. 360 hours of training (requirement 1 year‘s experience as an ambulanceman/woman) to become an Emergency Medical Technician (EMT) (cf. Rettungssanitäter in Germany)

3. 320 hours of training + 2 years‘ experience in the ambulance service + a 6-month period of training in an operating theatre or coronary care unit (requirement:  EMT) to become a paramedic (cf. Rettungsassistent in Germany). The paramedic examination has to be repeated every three years.

Finance

The finance for the Ambulance Service in Great Britain comes from the national budget. The finance for the Air Ambulance Service largely depends on donations. Only three Scottish air ambulances and HEMS London receive State support.