Clinical Quality and Patient Safety
Information for GPs and Clinicians
Accident and Emergency Personnel
Ambulance Technicians
Certificates of accreditation in ambulance aid are obtained by ambulance personnel on completion of a
one year period of in-service training and work based assessment by qualified instructors and managers.
Technicians begin their first year by completing a thirteen week intensive training course. During this
period they will have received instructions and practiced the techniques of ambulance aid in accordance
with standards which apply across UK ambulance services.
Paramedics
Paramedics have progressed from technicians and have received additional training in patient
assessment and specific clinical skills. The following procedures are performed in addition to those of a
technician:
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tracheal intubation
needle criothyroidotomy
needle thoracocentesis
many of the Technicians in East Division also provide intravenous access
LMA (Laryngeal Mask Airways) (both Paramedics and Technicians have this skill)
Oropharyngeal and naso ralhyngeal airways (both Paramedics and Technicians have this skill)
intravenous and intra-osseous vascular access
intravenous fluid therapy and volume resuscitation
needle chest decompression
the use of: aspirin*; GTN*; salbutamol*; glucose and glucagon*; adrenaline, atropine, lignocaine,
naloxone; morphine; diazemuls; benzyl penicillin; frusemide; syntometrine; metocloprimide;
hydrocortisone; chlorphenamine
pre hospital thrombolysis
*also administered by technicians
All paramedics are required to be registered with the Health Professions Council. In order for paramedics
to maintain their qualification they must update their skills regularly and prove their competence through
examination.
Paramedic Supervisors / Clinical Support Officers
Paramedic Supervisors / Clinical Support Officers are paramedics with supervisory responsibilities for
staff and specific functions. Some managers also hold a paramedic qualification eg Assistant Divisional
Officers. They respond to emergencies when on call and have additional skills in the management of
major incidents.
Emergency Care Practitioners
Emergency Care Practitioners (ECPs), are paramedics with additional training in injury assessment,
diagnostic skills and advanced wound care. ECPs are based in the community and provide on the spot
emergency treatment to patients, helping to relieve pressures on the emergency ambulance service and
dealing with patients more effectively in their own home without transporting them to accident and
emergency departments. Some ECPs have a BSc (Hons) in Emergency Care.
When a 999 call comes into ambulance Control, the patient’s injuries are assessed and an ECP
contacted if appropriate. They can treat minor injuries (wounds, burns, muscoskeletal injuries) and minor
illnesses (falls, blackouts or blood loss) which would normally go by ambulance into accident and
emergency departments. ECPs are also able to call upon other agencies such as social services,
occupational therapy, physiotherapy or mental health organisations in order to provide the best possible
care for the patient. They can also refer patients to community hospitals for assessment and treatment or
for rehabilitation, eg after a patient has had a fall in the home. This allows the Trust to provide a patient
centred model of care with community-based clinical assessment.
Others Involved in Delivering Emergency Care and Urgent Transport
Urgent Transfer Care Assistants (UTCAs)
UTCAs are trained in basic life support and are able to use a defibrillator. They are trained to drive under
emergency conditions. They may respond to an emergency when other resources are occupied.
Responders
The Trust uses first responders to respond to specific life-threatening emergencies (for example
suspected cardiac cases) in advance of the ambulance’s arrival, providing the best opportunity of survival
for patients, particularly in rural areas. First responders comprise of off duty Trust staff, fire and rescue
co-responders, police, RNLI, beach rescue co-responders and community volunteers and are all trained
in basic life support and carry equipment which allows them to manage airways, give oxygen therapy and
use an automated external defibrillator. The scheme is operated using an automatic paging system. This
means first responders are automatically paged by the accident and emergency Control on receipt of an
emergency in their operating area. If they are available they contact Control, either by radio or by using a
specific telephone number designated as an emergency line. The Trust is keen to involve healthcare
professionals as ambulance responders. Please contact the Lead Community Engagement Manager on
01392 261500.
Accident and Emergency Vehicles
A number of ambulance resources may be utilised to attend an emergency call.
These include:
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ambulances (with two personnel)
rapid response cars (with one crew member)
urgent transfer vehicles (used for long distance and inter hospital transfers and urgent calls with two
crew members)
paramedic motorcycles
paramedic/technician bicycles
the Cornwall, Devon or Dorset & Somerset air ambulances
ambulance boat (Isles of Scilly only)
South Western Ambulance Service emergency ambulances are equipped to a high specification standard
inventory. Emergency ambulances all carry defibrillators and our staff are trained to use them in
accordance with pre-determined protocols laid down by the Resuscitation Council.
Equipment carried on all emergency ambulances and urgent transfer vehicles includes:
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12 lead ECG with telemetry
immediate aid response kit (containing: resuscitation bag/valve with adult and child masks, hand
held suction, airways, burns gel packs, assorted dressings)
portable oxygen therapy set with a range of face masks and portable ventilator
battery operated suction unit
pulse oximeter
manual sphygmomanometer and stethoscope
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defibrillator with accessories
drugs packs, intravenous fluids and cannulae
entonox giving set
rigid neck collars of various sizes
long spinal board, orthopaedic stretcher
vacuum splints and fracture splints
moving and handling equipment, pillows, blankets and carrying chairs
universal precaution equipment including
disposable gloves, face masks, aprons, waste bins
and sharp boxes
maternity pack and blankets
tissues and incontinence pads
Routine Ambulance Journeys
Patient Transport Service
The Trust’s Patient Transport Service (PTS) conveys non-emergency, non-urgent patients who do not
require an emergency or urgent response, but, due to their medical condition, are unable to use public
transport and need planned assistance to attend NHS appointments. Bookings are matched to patient
needs - all PTS ambulances have easy access for patients, in addition to walking patients, they have
been designed to carry wheelchair and stretcher patients in safety and comfort.
Ambulance Care Assistants
PTS ambulance crews usually consist of two trained ambulance care assistants (ACAs). ACAs are
trained in first aid and to assist and care for patients who may have special needs. They are trained in
basic life support (including defibrillation) and first aid including oxygen therapy.
Volunteers
Unpaid volunteers work on the voluntary ambulance car service (VACS) and take patients, who require
minimal assistance to walk and with a small amount of hand luggage, to treatment centres. Some
voluntary ambulance cars can accommodate personal patient wheelchairs but these have to be folded
and placed in the boot. Volunteer car drivers are not expected to carry out manual handling operations
such as lifting patients or heavy luggage, and so if the patient is unable to manage stairs at their home
they are unsuitable for a voluntary car.
Changes to the co-ordination of VACS are differing stages across the operational area of South Western
Ambulance Service NHS Trust.
More details can be obtained from Operational Lead Manager, Graham Smart on 01392 261500.
Escorts for Non-Urgent Patients
Some patients may need to be provided with a medical or nurse escort by the hospital unit. South
Western Ambulance Service will do its best to return clinical escorts to their base after completion of the
ambulance journey, but for operational reasons this may not always be possible. Requests to PTS
Control for non-medical escorts should only be for the following categories of patient:
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children under 16
patients with loss of senses (eg hearing, speech or sight)
mentally confused patients
patients undergoing traumatic treatment sessions
Please advise PTS Control at the time of booking of the need for an escort, so that an ambulance seat
can be allocated. Please remember that each escort will occupy a seat that might otherwise be used by a
patient.
Requesting Patient Transport Services
Patients must have a medical need to receive NHS transport.
Click here for the arrangements for booking PTS transport in each area.
Bookings can normally only be accepted from authorised hospital sources (such as referral centres) or
GPs. They should be made at least 48 hours before the patient’s journey is required. In the event of a
cancellation please inform the relevant Control immediately to save a wasted journey which will be
charged to the relevant contract holder.
PTS generally operates between 1000 and 1500, Monday to Friday. Patients should ideally be given
appointment times which allow their journey to be completed within these times. Local agreement with an
individual trust may exist to accommodate attendance at specialist centres.
Please inform patients using Voluntary Ambulance Car Services transport that a cost will be incurred
unless exempt from the charges.
When Making a Booking, Please:
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allow at least 48 hours notice (late notice bookings may sometimes be accommodated however the
Trust can not guarantee this will be possible due to demand on services)
include the patient’s full address (including postcode) and telephone number
tell us the patient’s destination (eg hospital and clinic, ward. Outpatients is insufficient)
state the category of transport (see below)
advise if a child seat is required
advise if the patient has any mobility aids which need to travel with them
advise of any infectious diseases (eg MRSA)
advise if the patient is potentially violent
advise if escorts are authorised to travel with the patient (for medical need only: children under 16,
patients with loss of senses, mentally confused patients, patients undergoing traumatic treatment or
injury)
advise of any additional special needs (eg oxygen therapy)
So what does the jargon mean?
Car One (C1) - the patient can travel sitting in a car and move with the assistance of one person, without
a requirement to be ‘lifted’.
Car Two (C2) - the patient can travel sitting but needs the assistance of two people to walk or may need
to be helped into the ambulance or up stairs.
Stretcher (Str) - the patient needs to travel lying down on a stretcher in the ambulance and needs to be
carried up and down any stairs. A stretcher patient takes the same room as three C2 seats.
Wheelchair (w/c) - the patient is required to travel in their own wheelchair due to medical reasons.
Electric or other model wheelchairs are booked as three seats.