Shetland to retain second ambulance as government looks to copy the concept

Shetland is to keep its second emergency ambulance permanently following the success of its first year in operation. The Scottish Ambulance Service confirmed the decision today and pledged to complete the medical emergency training for its recruits which has so far not been carried out.

In a first for the UK, the back-up ambulance is manned out-of-hours by a pool of retained crew members who mainly have other jobs during the day. The concept has attracted interest from the Scottish government and is seen as a possible cost-effective model for other parts of rural Scotland.

But one year on the retained crews are still going to 999 calls, including car crashes, without having been medically trained. The pool members, understood to number around six, have had only a few days’ medical training to a minimal level called “first person on the scene”, which was only meant to be a stop-gap until full training yielded a properly qualified team. Driver training was completed more than a year ago.

An SAS spokesman said the lack of training was to be remedied. He said it took longer to fit people into the extensive technician training courses down south if they also have other jobs in Shetland. It is understood the training takes around 10 weeks full-time and those who pass then have to work hundreds of hours under supervision to qualify fully.

In most emergencies in Shetland the main ambulance attends with its crew of one fully trained paramedic – a so-called green suit – and one blue suit, an ambulance care assistant with only a few days’ training as a first responder plus a course in ambulance driving. During the day the second ambulance operates with the same crewing arrangement.

After 5pm two retained personnel take over the second ambulance, mainly attending less serious calls and taking patients to be flown south in the air ambulance. But occasionally they are exposed to 999 emergencies when the regular ambulance is on another call-out – which is exactly the kind of situation that the Shetland community wanted a back-up ambulance for but with a fully trained crew.

The retained crew members are paid up to £2,500 a year plus an hourly rate when on duty.

The SAS spokesman said more training was in the pipeline: “All retained staff will continue their training to technician level, assuming that they pass the relevant entry criteria and previous learning standards required to be accredited as an ambulance technician.

“This process is likely to take longer for retained staff who are part-time and have to fit training into their outside commitments than it would for full-time ambulance staff.

“Accreditation and entry selection for the technician course has recently been strengthened to ensure that appropriate benchmarks for standards of care are maintained. An access course is being developed for those staff who need further support to meet these standards.”

Shetland’s back-up ambulance was quickly deemed a success due to a cut in response times to 999 calls and it is set to stay, albeit that the brand-new ambulance that was expected to operate it has not materialised. The vehicle in use is seven years old.

The SAS spokesman said: “The pilot to introduce retained ambulance staff alongside full-time crews in Shetland has successfully improved the quality of care for the wider community, achieving improved response times. This is the first initiative of its kind in the UK and the success of the scheme means that it now operates permanently.”

Scotland’s deputy First Minister, Nicola Sturgeon, the cabinet secretary for health and wellbeing, said in her national annual review that she would be “very interested to be kept updated on this service and the robust evaluation that will be undertaken to inform any future roll-out of similar schemes”.

The second ambulance came after a powerful show of feeling from the community and a series of incidents in which no ambulance was available to convey sick and injured people to hospital during life-threatening incidents. Over 2,000 people signed a petition and the Shetland MSP raised the matter in Edinburgh, hastening the SAS and Shetland NHS to put their plans for a back-up service quickly into action.

The final straw was when an oil worker who had a heart attack had to be taken from the rescue helicopter to hospital in a rental van after having waited half an hour for the ambulance to appear. It followed just two weeks after a sick baby and his mother had to wait many hours for an ambulance to take them to the air ambulance to fly to Aberdeen.