Welcome to kewrail transport media
home to all things transport related in the British Isles
The work of the modern ambulance service in the United Kingdom is well highlighted with the popularity of reality television shows. The vehicles featured are modern and well equipped, and crewed by highly trained paramedics and technicians. The history of the ambulance, however, can be traced back hundreds of years. That this article requires a short introduction is perhaps indicative of its content. Condensing over a century of information into a manageable read for a blog has required a great deal of compression and, therefore, there is much detail omitted. Most of the information that has not formed part of this somewhat abridged history has been put aside and will form the basis of future, and more specific, articles regarding the wide range of specialised vehicles that have served with ambulance providers over the decades. The development of the ambulance as a vehicle has been inextricably linked with the historical events, developments in healthcare, and political decisions that have surrounded it. It is with that in mind that this article is not limited to the transport based element in order to give the reader some supporting context. Perhaps the earliest record of an "ambulance", derived from the Latin "ambulantum" (to walk), can be traced to circa 900AD. These were little more than a canvas secured to a cart chassis and were used to transport, and not particularly willingly for the most part, people suffering from conditions which we would now associate with mental health disorders.
It was not until the 15th Century that an ambulance was used in an emergency context. The Spanish army deployed horse drawn wagons to collect casualties from battlefields but this was not until the battle was over and most soldiers were already dead by the time the ambulance arrived.
Although its introduction was nearly a century later, the modern “Star of Life” was created as an international symbol of medical care for all organisations who were not entitled to display the red cross.
A horse-drawn ambulance was kept at a state of readiness and, by 1889, had attended some 44,000 calls. Rapid technological development, brought about largely by the Industrial Revolution, saw horse drawn ambulances giving way to steam, and in turn, petrol powered vehicles. The Royal Army Medical Corps (RAMC : British Army) commissioned the manufacture of a number of ambulance vans which were built by a Bristol company, Straker-Squire, based on a shortened version of their double-deck bus platform produced for the London bus market. As tensions grew throughout Europe in the early part of the 1900's, the British government planned for war. Casualties on an unprecedented scale were anticipated and secret meetings were held with the managers of Britain's railway companies to prepare designs for ambulance trains. On the 4th August 1914, when war was finally declared, carriage builders began construction.
Further experiences gained during the First World War led to the introduction of the first dedicated ambulance services throughout the United Kingdom. Managed by local hospitals this was far from a national service and worked in conjunction with local police forces providing drivers. ABOVE: Ford Model T "Sympathy" Ambulance operated by St John Ambulance Image: St John Ambulance Museum Although many of the vehicles were, by now, purpose built with many based on Ford's 1908 Model T chassis, the interior had changed very little from their horse-drawn carriage predecessors. They were often windowless and equipped with no more than wooden benches upon which a canvas stretcher could be placed. The development of first aid, driven by the treatment of World War 1 combatants, lead the voluntary aid societies to begin working with coach-builders such as Grose (Northampton) and Lomas (Wilmslow) to produce vehicle designs which, even today, would be readily identifiable to the public as ambulances.
displaying "ambulance" in white text with either a blue or black background. Electronically operated bells for attracting attention also become a standard feature.
two ambulances and a mobile canteen. By 1945 the ambulances had transported 681,531 casualties, most of which during 1940-1941.
On the morning of the 8th October 1952, a major incident was to change ambulance services in the United Kingdom forever. At 8:19am an express train passing through Harrow & Wealdstone station collided with a local train stood at the platform. A few seconds later, another express heading in the opposite direction, ploughed into the wreckage from the first collision. Of the 35 coaches involved, 16 were completely destroyed with 13 being compressed into a compact heap 45 yards long, 18 yards wide, and 6 yards high.
The reports following the incident, whilst not critical of the care given at the scene, highlighted the need to develop the ambulance services to become "mobile hospitals" rather than simply a way to convey the sick or injured. In the months and years that followed, studies placed pressure on the British government to improve emergency care in general, including the care provided by ambulance services.
Prior to the report, the only qualification required to be an ambulance attendant was a first aid certificate (issued by a recognised voluntary aid society) although this was not always mandatory as a condition of employment. The training proposed by Millar became the first national training standard, lasting 8 weeks, the successful candidates receiving the Ambulance Services Proficiency Certificate upon completion and presented with the Millar badge for their uniform. Initially a round black badge with a silver laurel wreath and bow, traces of the design still forms part of the national ambulances services crest displayed on the vehicles. Commonly referred to as the "Millar Certificate", the syllabus laid the foundations for the later "Ambulance Technician", and more recently "Emergency Care Assistant", qualifications; so much so that the Institute of Health Care & Development (IHCD) were still using a revised version of the course training manual (the Green Book) some 4 decades later. Throughout the 1960's, and in no small part induced by the mass production techniques of the personal motor vehicle, some coach-builders began to specialise in the production of specialist vehicles. The 2 most prominent companies to emerge as ambulance manufacturers in the United Kingdom at the time were Lomas and Wadham Stringer. Bedford platforms, the exception being after the introduction of the Land Rover in the mid to latter part of the decade. company manufactured ambulances on multiple types including Bedford, BMC, Morris, and Ford. Internally, the standard of ambulance equipment had improved dramatically. Purpose built stretchers and loading systems were now standard, along with carry chairs, “Minuteman” resuscitators, light rescue equipment, and more extensive first aid and "nursing" supplies in line with the Millar training. Most designs featured darkened glass on the side and rear of the vehicle and, externally, roof mounted blue flashing lights had been introduced. ABOVE: Typical 1960's ambulance interior Image : Jonathan Tomlins/Flickr BELOW: Nurses being shown inside the ambulance circa 1965 Video : The Kino Library The latter part of the decade also saw the introduction of early specialist response vehicles. The Ambulance Heritage Society owns one such example in the form of a 1966 Vauxhall Victor estate car that was operated by Nottingham City Ambulance Service. By the 1970's, there were 142 separate ambulance services operating throughout the United Kingdom, all of which were still under local authority control. The Conservative government, led by Edward Heath, introduced the National Health Service Reorganisation Act : 1973. This act formed 53 county ambulance services under the auspices of 14 regional health authorities in 1974. On the 4th March 1971 a total of 6 ambulancemen, all based at Brighton Ambulance Station, started their shifts as the United Kingdom's first Paramedics. The previous 6 months, under the guidance of cardiologist, Dr Douglas Chamberlain, had been spent receiving extended training in the interpretation of ECG's, administration of four key drugs believed to be important in the management of cardiac emergencies, and the invasive treatment of airway obstruction and of pneumothorax. ABOVE: First paramedics in the United Kingdom photographed in 1971 Image : College of Paramedics This pilot scheme marked the birth of the first paramedic unit in England (and indeed Europe), and immediately began making a difference to patient survival in the pre-hospital setting. Despite being very well-received by the public, GP's, and unions alike, the Department of Health (DoH), upon hearing about it in 1976, said the paramedic unit had no proven value and promptly shut it down. It was not until 1979, after giving keynote speeches at a conference in Harrogate about emergency treatments, that Dr Chamberlain and his colleague, Dr Peter Basket (who was also teaching ambulance staff in Bristol the importance of looking after the airways) convinced the DoH how important and necessary their work was. Once approval had been given by the DoH for the scheme to be restarted, the extended training was rolled out nationally. Soon thereafter, addition subjects were added to the paramedic syllabus including advanced resuscitation, drug administration, intubation, and emergency child-birth procedures.
modern body design resulted in the company supplying 60% of the NHS fleet well into the 1980's. The 1970’s were a troubled time in the United Kingdom. Throughout the decade there were 32 terrorist attacks on the mainland, 27 of which attributed to the Irish Republican Army (IRA). A spill-over from the conflict in Northern Ireland, dubbed “The Troubles” by the media, the IRA maintained a persistent bombing campaign which would last into the 1990’s. The frequency of the attacks led to the early development of what might be recognised today as major incident planning; with ambulance services recognising the need for pre-planned responses to mass casualty incidents. Whilst the command and control for such responses was still very much based on rank structure at this early stage, the Millar Certificate syllabus was updated to include guidance for those “first on scene”. It would be another decade, after the Broadwater Farm riot of October 1985, that the Gold-Silver-Bronze (plus Platinum where COBRa involvement is required) would be introduced.
ABOVE: Leyland National "Lifeliner" operated by Derbshire Ambulance Service Image : Steve Powell/Flickr With the developing paramedic programme within the ambulance service, Doctors across the United Kingdom began to take a greater interest in pre-hospital care. In 1967 a GP in Yorkshire, Dr Ken Easton, formed a network of 34 medical colleagues covering a 1000 square miles. The group, named the Road Accident Care Scheme, responded to incidents on and around the A1 corridor. This initiative stimulated the emergency services in turn to appraise their roles at road accidents and saw a new stimulus for training to work co-operatively. Following Dr Easton’s efforts, and frequently as a result of personal contact, doctors elsewhere began to set up similar schemes. Among them was Dr Kenneth Mourin in Coventry, Somerset based GPs Dr David Rawlins and Dr Donald Thomson (assited by Mr James Kennard whose wife had been involved in a road accident) and Dr Neville Silverston MBE in East Anglia to mention only a few.
care. So much so that, in 1977, with the support of the Royal College of General Practitioners, Dr Easton established the British Association of Immediate Care Schemes (BASICS). Whilst capturing the interest of his counterparts and ambulance services alike, the organisation failed to impress its benefits on government and, to this day, remains a charitable organisation. Today, BASICS are still the umbrella organisation behind numerous Doctor led first responder schemes across the country and has been renamed British Association for Immediate Care to reflect the much wider, multi-disciplinary, scope of its membership including those in voluntary roles. The association has expanded to include a pre-hospital care education service in both civilian and military fields and has become a recognised authority with senior members advising within a number of governmental and non-governmental projects ranging from pandemic flu to civil resilience. The Resuscitation Council (UK) started life as a sub-committee of the Association (the Community Resuscitation Advisory Committee) and today the strong links remain as they do with the Faculty of Pre-hospital Care at the Royal College of Surgeons of Edinburgh.
service provision in 1967 and the name became “St Andrew’s Scottish Ambulance Service”, remaining so until 1974. The world of motor-sport, and particularly rallying, was to see the introduction of a new ambulance type during the 1970’s. Rally cars themselves were becoming increasingly more powerful and faster and, after a number of fatal accidents in the early part of the decade, the organising bodies recognised the need for specialist ambulances that were also capable of rapid access extrication of casualties. Being dubbed “Rescue Ambulances”, the volunteer crews received both ambulance aid and fire service type training. ABOVE: Motorsport Rescue Units Image : Emergency Mobile Medical Unit (EMMU) / Stuart Westbrook The vehicles, although based on standard road ambulances for the most part, were (and are still) something of a hybrid. Whilst having a single stretcher giving the capability to transport a patient, half of the vehicle was kitted with road accident type rescue equipment as used by the fire services. Whilst accidents in the sport were still common, the ability to perform extrication of casualties without needing to wait for the fire service to arrive, saw the number of fatalities reduce considerably.
workers particularly was extremely low and recommended a pay increase of 25.8%. Despite this, there was still considerable disparity in pay between ambulance and other emergency service workers leading to industrial action in 1981 resulting in Constabularies across the United Kingdom providing emergency cover. In response, a new salary scale was agreed in 1985 linking the pay of ambulance workers with that of firefighters.
match Ford and, in concert with losing its military contracts to Leyland Trucks, ceased production of its commercial vehicles entirely in 1986.
The Hanlon tooling was sold to bus manufacturer, Reeve Burgess of Chesterfield, the following year. As bus manufactures, Reeve Burgess were well established and had themselves been acquired by the Plaxton group in the early 1980’s. ABOVE: St John Ambulance Dennis Dart built by Reeve Burgess Image : emdjt42/Flickr With previous experience of supplying mobile treatment and command & control vehicles to ambulance operators, Reeve Burgess employed a small group of former Hanlon workers to help with the new fibre-glass based products from the Irish manufacturer. The product range, “Hi-Line” tooling for Ford, Mercedes-Benz, and Leyland platforms, and interior conversions for the Renault Master van, was rebranded “Reebur” and manufactured at a factory in Tibshelf (Derbyshire). Wadham Stringer, having foreseen Bedford’s withdrawal, had already started production on bodies for offerings from other manufacturers. Like Hanlon, Wadham Stringer’s range included platforms from Ford, Land Rover, Leyland, Renault, Mercedes, the Italian manufacturer Iveco, and American GMC. Their “Pioneer” range of off-road ambulances were proving to be very popular (especially with the British Military whose Land Rovers from the 1960’s and 1970’s were becoming very outdated internally) offering a patient treatment area that was comparable with the standard ambulance body albeit somewhat less spacious.
Another milestone was to be reached during the 1980’s with the introduction of the first emergency Air Ambulance Service. The first civilian air ambulance flight in the United Kingdom had actually taken place 5 decades earlier, in November 1933, from Wideford aiport on Orkney (Scotland), and the military had been using aircraft for medical evacuation purposes as early as 1917. The use of air ambulances in motorsport had started by the 1970’s, the Isle of Man TT motorcycle races being amongst the first. This was followed shortly after, in 1971, by the addition of a helicopter rescue service for riders competing in the Manx Grand Prix (MGP) after fundraising efforts by the Manchester Motorcycle Club led by Ian Bradshaw. BELOW: MGP Helicopter Fund promotional material Image : Manchester Motor Cycle Club
It was on the 1st April 1986, however, that the United Kingdom’s first dedicated public Air Ambulance, callsign “Helimed Zero-One”, took to the sky on its first mission. Initially funded by the local Health Authority, and working in partnership with Bond Helicopters, the Cornwall Air Ambulance began operations providing a critical care medical service and rapid transport for Cornwall and the Isles of Scilly with a German built MBB Bo105 helicopter.
In response to the incident, the Lancaster Royal Infirmary (LRI) introduced a “Flying Squad” to respond to major incidents with a Land Rover 110 providing all terrain capability. The vehicle went on to operate with the motor-sport rescue team “EMMU” (Emergency Mobile Medical Unit) based in Morecombe after the LRI acquired a Peugeot for their medical response team.
London was once again to be the scene of a major incident when, on the 18th November 1987, a fire broke out underneath one of the wooden escalators at Kings Cross underground railway station. The first notification came at 19:30 after an unknown passenger pushed the emergency stop button at the concourse end of the stairway. An officer from British Transport Police went to investigate and saw a small flame. As there had been some 400 similar incidents recorded in the previous 3 decades, the officer returned to the ticket hall, where he was able to use his radio, to make a routine call to the London Fire Brigade and the station continued to operate as normal with the escalator in question taped off at each end. 9 minutes later the police, as a precautionary measure, evacuated the station, a decision which would later prove to have saved many lives.
started as early as 1985, London HEMS was not to take delivery of its first helicopter, an Aerospatiale (now Airbus) AS365 Dauphin (callsign Helimed 27), until a year after the Kings Cross fire in December 1988. Shortly after 19:00, on the 21st December 1988, a loud explosion was heard in the skies above the small town of Lockerbie, Scotland. Moments later the remains of Pam-Am flight 103, a Boeing 747 flying between London Heathrow and Detroit, rained down on to the town and surrounding countryside. The explosion, caused by an explosive device hidden in the hold, punched a hole in the side of the aircraft causing it to enter a steep dive and disintegrate mid-air. All 243 passengers and 16 crew members perished along with 11 people on the ground as properties were struck by the falling debris. ABOVE LEFT: ABOVE RIGHT Remains of the Pan Am 747 near Lockerbie Scene of the Kegworth Air Crash Image : The Mirror Image : BBC A month later, with the Lockerbie bombing still fresh in everyone’s mind, another aircraft crash immediately roused suspicions of another terrorist attack. At 20:24 on the 8th January 1989, a British Midland Boeing 737 struck the embankment next to the M1 motorway within yards of East Midlands airport where the pilots were attempting an emergency landing. Of the 118 passengers on board, 39 were killed outright in the crash and 8 died later of their injuries. All 8 members of the crew survived along with 79 passengers, most of whom suffered serious injuries. The first person to arrive at the scene to render aid was a motorist, Graham Pearson, a former Royal Marine who remained on scene assisting the emergency services for over three hours. The investigation that followed found the crash to be the result of engine failure combined with pilot error, caused by confusion from new instrumentation, leading to the shutdown of the working engine.
As the 1980’s came to a close, the fire brigades union (and police) secured favourable pay settlements breaking the pay link agreement with the ambulance service and, by 1989, ambulance workers were paid 11% less than firefighters.
For the first time since the late 1970’s, the British military, along with voluntary aid societies, were operating in 18 ambulance service areas to answer 999 calls. Whilst the military were, if begrudgingly, accepted the same could not be said of the volunteers from the British Red Cross and St John Ambulance. That they were willing to work for free during the strikes left some ambulance workers feeling very bitter towards them for many years after the strikes ended. The government eventually relented on the 23rd February and a mutually acceptable pay rise of 16.9% over two years was agreed with the addition of a £500 per year bonus to ambulance crew members with additional medical training and a further 2% pay rise in services that could offset the cost through efficiency savings. There is much more that could be said about the tactics and antics that were deployed during the industrial action, on both sides, but that is perhaps best left for those pages of a political nature. Despite still having a healthy order book, parent company Plaxton decided the Reeve Burgess operation was no longer viable and the factory was closed in 1991 with the loss of all jobs, Bus orders and manufacturing were moved to the Plaxtons' Scarborough site and the entire ambulance range, along with the tooling, was scrapped. The last of the traditional ambulance manufacturer names, Wadham Stringer, was to disappear 2 years later after the company was purchased by the Universal Vehicle Group (UVG) in 1993. UVG were to become the last company to manufacture the tradition resin-formed fibreglass bodies that had been the mainstay of ambulance production since the 1970’s.
By far the more successful model for UVG was another of Wadham Stringers designs, the “Premia”, which was unveiled at the AMBEX trade show in Harrogate in 1996. Displayed under the banner of WS Coachbuilders, the launch customer was the Mersey Regional Ambulance Service (MRAS) which had previously operated the Wadham Stringer “Samaritan” Ford Transit van conversions, as the Mersey Metropolitan Ambulance Service, prior to a restructuring in 1991 that had merged the Merseyside and Cheshire services. BELOW Gallery : Mersey Metropolitan Ambulance Service Wadham Stringer Samaritan Click to enlarge One particular MRAS Premia was to achieve national notoriety after becoming flooded on a beach near Southport. The crew, who were on standby, reportedly fell asleep and failed to notice the incoming tide. By the time they did, the vehicle was stuck in the sand and had to be abandoned; it was later recovered by Southport Coastguard using WWII DUKW amphibious vehicles! ABOVE: UVM Premia demonstrator at AMBEX The Premia range, which was originally available on the LDV or Ford platforms, was soon expanded to include Renault, Mercedes, and Volkswagen. The design proved popular and robust with many examples finding their way into service with voluntary ambulance providers after disposal from NHS fleets. With the older names in ambulance design and production all but gone, a number of other companies, some of which were to be very short-lived, began to appear during the 1990’s. One of the earliest were the Mountain Range Group who were based in Crewe. First appearing during the late 1980’s the company enjoyed some degree of success, perhaps because of distinct similarities with the familiar Hanlon and Wadham Stringer designs, with London and South East based services. Initially based on the CF2 platform, and fitted with the 3300cc engine, the company later moved to the Ford Transit. The Ford based vehicles were more popular but were not enough to keep orders flowing and the company was eventually bought out by UVG. One of the more unusual range of vehicles, and among the first “Box Body” ambulances to be used in the United Kingdom, were supplied by a very established manufacturer. Although unfamiliar to the British public, the Wheeled Coach Company was already a well known name in the United States.
Vehicle manufacturers themselves also saw an opportunity, especially with the ongoing development of the paramedic programme. Vauxhall were among the first to directly target the market with their “Frontera Paramedic”, a badge-built version of the Isuzu MU Amigo. Vauxhall, competing with the already well established Land Rover Discovery, received minimal orders. ABOVE: Publicity brochure for the Vauxhall Frontera Paramedic Image : brian/Flickr This was followed a year later by the “Monterey Paramedic”, another badged Isuzu product, but that too was unable to compete favourably with the Land Rover range. Their “Corsa” and “Astra” models, whilst fairing better perhaps in part of their use with British police forces, did not see widespread use.
The early 1990’s saw the French vehicle conversion company Collet (now part of the GIFA group) supplying ambulances to Yorkshire, Teeside, and Staffordshire ambulance services, some through importers O&H based in Goole.
Additionally for North Yorkshire Ambulance Service were some vehicles based on the LDV Convoy platform. Unlike its predecessor (Leyland Freight Rover) that had been supplied with the Rover V8 engine, these were fitted with turbo diesel engines. ABOVE North Yorkshire Ambulance Service LDV Convoy Collet Whilst inherently more efficient, they proved to be under-powered compared with those from other manufacturers and LDV dropped the Convoy model from their range, after just 10 years production, in 2006. Founded in 1988, O&H not only provided ready-built vehicles but also undertook the pre-conversion electrical work and fitting of ramps to, primarily, Renault vans. By 1993 the company had also begun to build their own Patient Transport Service (PTS) vehicles but it would be another decade before their own emergency ambulances would be manufactured. First established around the mid 1990’s, ambulance services across the UK began to work in conjunction with Community First Responder (CFR) schemes. With a couple of exceptions, most schemes were (and still are) volunteer led by charitable organisations working in concert with local NHS ambulance trusts. Provided with extended first aid training, and responding to local emergencies (usually in private vehicles and not under response conditions), the scope of calls to which the volunteers are deployed varies greatly between areas. The objective, however, is consistent throughout; to enable immediate care to reach a critical life emergency as quickly as possible. ABOVE Showing how CFR's are dispatched Video : St John Ambulance Today there are some 2,500 CFR schemes operating across the United Kingdom with an estimated 11,000 volunteers. 1995 was to see changes in Northern Ireland with the formation of the Northern Ireland Ambulance Service (NIAS). An amalgamation of 4 separate authorities, NIAS was split into 5 operational areas (Belfast, South Eastern, Western, Northern, and Southern) serving a combined 1.8 million people and based across 46 stations. As with services across the United Kingdom, the new service logo featured the laurel but omitted the crown and staff and double-snake in the centre rather than the wheel design. Two significant legislative changes effecting ambulance construction and operation were to occur during the 2000’s. The first, the introduction of the CEN Regulations in 2007, sought to standardise the manufacture of PTS, emergency, and intensive care transfer ambulances throughout Europe; ultimately to the extent that they would be similar enough that crews from different member states could easily work in any vehicle. Whilst the regulations have never truly achieved the full ambition, perhaps owing to them being voluntary for the most part, they did bring about changes in ambulance design. It would not be unreasonable to claim that, up until the early 2000’s, ambulances in the United Kingdom were a “patchwork” of design and standard. Although statutory ambulance services using the most current vehicles had, by and large, kept up with modern concepts the same could not be said of the voluntary aid societies (VAS).
from the NHS with Hanlon and Wadham Stringer vehicles being commonplace. In the extreme, some small remote divisions commissioned local companies to convert vans or minibuses for use as ambulances. Whilst it would be unfair to say that these vehicles were unfit for purpose, many fell short of the standards which were becoming expected of a modern ambulance.
The implementation of the Crusader 900 led directly to SJA, again in collaboration with ATT Papworth, beginning a 20 month project with Nissan UK to improve their off-road response capability. The resulting vehicle, launched in 2002, was the “Challenger” which was based on Nissan’s “Patrol” platform with an extended roof giving additional storage capacity and encompassing the blue light arrays. BELOW ATT Papworth Challenger Along with improving standards internally, the CEN regulations also made recommendations for the visual identity of ambulances and introduced a departure, for the United Kingdom, of the traditional white base colour. Introducing “Euro Yellow” (RAL1016) as the replacement, as it was considered easier to see in all light conditions and by those with colour blindness, the regulations also went on to include reflective green & yellow markings along the body.
Changes were also made to the active warning systems used on emergency ambulances. The use of the compressed air driven “two-tones”, whilst already falling out of favour with manufacturers, was removed by the CEN regulations which specified the electronic wail/yelp system with defined standards for sound pattern and volume. Lighting systems were also addressed with the new regulations mandating that the lights must be blue and visible for 360 degrees around the vehicle. Volvo were very quick to target the United Kingdom ambulance market when the new regulations were proposed. Already very well established with the police services, with various models, as roads policing vehicles across the country, Volvo Special Vehicles introduced their car-based Nilsson bodied ambulance built on their S80 estate platform in 2001 which complied fully with the CEN specifications.
V70 estate faired considerably better being used by a number of services as rapid response vehicles. Being identical to the police variant, it had a proven reliability record, excellent load capacity, and powerful T5 engine. The other major change to effect ambulance services followed the introduction of the Care Quality Commission (CQC) on the 1st April 2009. The CQC, which had been created in shadow form in October 2008, replaced 3 other statutory bodies and had wide reaching implications across the healthcare sector as a whole. NHS services, which from 2006 had been amalgamated into 13 Trusts across Britain and Wales plus 3 services covering Northern Ireland, Scotland, and the Isle of White (Isle of Man and Channel Islands operate independently of the United Kingdom NHS), complied to most of the new legislation from its introduction and were able to incorporate any remaining changes relatively simply. For non-statutory providers the new legislation brought about considerable changes, not least of which was the requirement for any organisation or company who wished to provide regulated ambulance services and clinical procedures to be registered with, and monitored by, the Commission. Whilst regulation of the statutory ambulance services was maintained by the Healthcare Commission, Commission for Social Care Inspection, and the Mental Health Act prior to the introduction of the Commission in 2009, there was little to no system in place to regulate non-NHS providers. Any individual or organisation could purchase an ambulance, be it new or second hand, and offer pre-hospital care services to the public and event organisers. For the most part, these private and voluntary providers conducted themselves professionally and adhered, as best they could, to the same practices as their NHS counterparts. However, it was discovered that this was not always the case and, in extreme cases, presented themselves in such a way that was deliberately misleading. To counteract such practices, the CQC brought about legislation that required all operators who provided services beyond that of basic first aid and the transportation of the sick and injured be subject to the same standards and inspection regime as the NHS providers. By 2013 the CQC stated that 97% of private and third sector providers had achieved a “good” rating although 25 had been issued with improvement notices by the time a report was published in 2017 over the safety of care delivered. It would be fair to say that, although the new regulations all but eradicated those private operators who posed an immediate risk to the public, things have not always gone smoothly for the NHS services either. It is not the intent of this article to scaremonger, or indeed stir up old news, but it is worth noting that the inspection process did lead to some stark findings with some NHS Trusts being forced to address serious concerns in recent years. The early 2000’s were to see another new concept introduced to improve response times to critically ill patients. Tom Lynch, a former BMX champion and Emergency Medical Technician (EMT) with the London Ambulance Service, was becoming increasingly frustrated with the delays delivering care caused by the dense city traffic. He recognised that he could weave his way through the city on a bicycle far quicker than even motorcycle responders and put forward his idea to the service. Despite initial scepticism, Tom eventually received approval for the trial of an Ambulance Cycle Response Unit (CRU), initially in London’s West End, and put together a package marrying the best cycle available with life-saving equipment; the whole ensemble weighing some 50lbs (23kg). On his first day, Tom responded to 5 calls within the first hour and they continued to come thick and fast. Along with dramatically reducing the response time, he noted that he had been able to stand-down some of the normal ambulances as the patient did not always require transport to hospital following the care delivered on scene. ABOVE Tom Lynch, creator of the London Ambulance Service Cycle Response Unit Image : cyclefit.co.uk Although the scheme had immediate positive outcomes, Tom had to overcome a number of hurdles in order to expand the service. Thanks to his perseverance London now has some 100 personnel, which includes reservists and volunteers, operating the CRU on Rockhopper mountain bikes fitted with blue lights and sirens. The scheme has also been introduced by other NHS Trusts extending the service across the major cities of the United Kingdom and St John Ambulance have established their own CRU which can be deployed at public events. In January 2002 UVG were to change name and began trading as UV Modular, dropping all references to Wadham Stringer in the process. The new company initially focused on the production of just three body designs; the “Modular” and “Premia” emergency ambulances, and Treka for PTS and mini-bus applications.
Whilst offering considerably less space than the “Modular” model, the weight of the “Cura” was kept within the 3500kg weight limit permitted for those with only the standard driving license. This enabled the service to recruit those without the C1 / D1 category which, in 1996, had been amended to cover vehicles between 3500kg and 7500kg and included the larger ambulances such as the “Modular”. By the end of the decade UV Modular was to close with an administrator called in to begin proceedings on the 3rd February 2010. A report in 2004, commissioned by the Ambulance Service Association (ASA) and Department of Health (DH), was to assess the feasibility of paramedics working within the inner cordon of major incidents. The result of that study culminated in the introduction of the Hazardous Area Response Team (HART) across Britain, Wales, Northern Ireland, and the Isle of Man. Scotland introduced a very similar system under the acronym SORT (Special Operations Response Team).
during the attack with 56 (including the 4 terrorists) fatalities. The aftermath brought about vital lessons, many of which were to shape the evolution of the specialist HART service. The first units being introduced in 2006, the concept of HART has developed considerably since its inception and teams are now deployed to a wide range of incidents. Typically, these would include calls to CBRN, hazmat, collapsed buildings, patients at height or in confined space, water rescue, flooding, firearms incidents, and explosions. Incorporated towards the end of 1984, Cheshire based MMB International had quickly built a considerable reputation for the supply of specialist ambulances with one of the most unique being a Ford Transit supplied to ICI in 1989. Designed to respond to large chemical incidents, the vehicle was able to deliver oxygen to 6 patients simultaneously and could convey 3 patients.
Wadham Stringer “Pioneer” range but was noticeably wider. Receiving numerous technical upgrades, and client driven specification in terms of windows and interior, the basic design endured throughout its build lifetime.
ATT Papworth, who had entered the market in 1995, continued to supply a variety of ambulances well into the late 2000’s. Alongside their range of van and box-body conversions, the company also supplied a number of response type off-road vehicles based on the design developed for St John Ambulance. With the Nissan based model well established, an adaptation of the design was fitted to the Mitsubishi Shogun (Pajero) for the Gloucestershire Ambulance Service in 2003, a first for the Japanese manufacturer. The company was also to produce a limited number of vehicles based on the Volvo V90 platform which, like the Nilsson bodied version, saw limited service with NHS operators. Despite their success, and with a number of large contracts completed the company was to receive an order of court order to wind up at the petition of South Cambridgeshire District Council, creditors for the company. The company was declared insolvent and ceased to exist in 2013. With a large portfolio in a wide range of industries, the Babcock Group were to purchase the Walsall based S MacNeillie & Son in 2010. MacNeillie had started as luxury vehicle converters in 1912 and were still doing so well into the 1990’s.
The vast array of vehicles produced by the Babcock group arguably makes them the largest of the manufactures in the United Kingdom but it is O&H Vehicle Technologies that hold the distinction of being the longest serving. Their first emergency ambulances being produced in 2006, the company has now been in existence for over 30 years. With emergency ambulances being predominantly van conversions to the Fiat Ducato platform, the company also offers a range of PTS ambulances and RRV’s; the most recent based on the Skoda Kodiaq. Another new addition to O&H’s portfolio is the “Venari”. Dubbed “Project Siren” and developed over 9 months in partnership with Ford, the Venari is of box body construction on the Transit platform but weighs just 3500kg. ABOVE: Ford Transit with O&H Venari body Image : O&H Moving towards the next decade will see a number of challenges with the commitment by the British Government to end the sale of new petrol and diesel vehicles by 2030. Whilst this poses more of a problem for the base vehicle manufacturers, the ambulance conversion companies have already begun exploring concepts for the new range of electric vehicles (EV’s).
GNAAS explained that the flying paramedic will be armed with a medical kit, with strong pain relief for walkers who may have suffered fractures, and a defibrillator for those who may have suffered a heart attack. With the initial trials undertaken in the Lake District, where access to casualties is problematic, the driving element behind the concept is that of speed. The use of the jet suit potentially means that what might have taken up to an hour to reach a patient may only take a few minutes in the future. Advances in the telecommunications industry are also having a direct impact on the care delivered by ambulance crews. The “5G connected ambulance” provides an innovative new way to connect patients, ambulance workers and remote medical experts in real time, thanks to a collaborative trial between Ericsson, University Hospital Birmingham NHS Foundation Trust (UHB) and King’s College London. Through a live 5G network in Birmingham, managed by British Telecom, healthcare workers have performed the UK’s first remote diagnostic procedure and could possibly transform how future healthcare is delivered, enabling crucial efficiencies and reducing the need for some patients to visit A&E. All images, illustrations, or video © Kewrail Transport Media unless otherwise indicated
1 Comment
12/26/2022 04:21:10 am
Nice Information! One good way to generate high-quality leads is to build a content strategy that provides valuable information to people who might want to buy insurance. This attracts the right people to your website who have confirmed their interest based on the fact that they have engaged with your insurance-related article.
Reply
Leave a Reply. |
Archives
December 2021
Categories
All
|