CHAT column, January 2019

First published in John O’Groat Journal in January 2019

I would like to thank Graham Cormack and Steven Gorman from the Scottish Ambulance Service (SAS) for their help in giving me this insight into how the Emergency Ambulance Service operates in Caithness.

Following significant investment in 2018 Thurso and Wick now both have an Ambulance on 24/7 cover with two additional Ambulances on a varying shift system.

Emergency Ambulances are staffed by Technicians who can administer a wide range of drugs, provide Intermediate Life Support and have good knowledge of human anatomy and physiology.  They usually work alongside Paramedics who have wider knowledge of the human body and additional skills so can give enhanced pain relief, provide clot busting treatment during a heart attack and deliver fluids through your veins.  Ambulance drivers are now a thing of the past.

It’s a great relief when an Ambulance arrives but a few people have told me they’ve experienced a delay, sometimes waiting a considerable length of time before an Ambulance came.

When a 999 call is made it is quickly assessed; for example if the patient is not breathing this is known as Immediately Life Threatening (ILT) and will take priority over any other call.  This may increase the time you need to wait if your emergency is not as serious.

Those 999 calls that are not emergencies are passed to NHS24 for more appropriate care keeping the emergency ambulance available.

When an ILT call is received the SAS now have technology that identifies where the call originates and as the call is in progress an Ambulance will be dispatched.

The caller will be given instructions what to do by the call handler and if the patient is not breathing the caller will be talked through how to perform CPR.

SAS know where all registered defibrillators are situated so if there is one nearby and someone available, they will ask them to go and get it.

Some ILT calls may need a number of responders to attend which can include a second ambulance or other medical support. Serious road accidents may well need all available Ambulances in attendance.

If circumstances dictate, SAS have the option to deploy volunteer Community First Responders to appropriate emergencies. Thurso already has a team of First Responders who can be called upon and any community interested in starting one up should contact the SAS.

The SAS also undertake Inter-Hospital Transfers making sure people who need care are taken safely to more specialist units. There are over 500 transfers a year from Caithness and they can happen day or night.

To maintain Emergency Ambulance cover additional ambulances can be brought in from outwith the county.

Ambulance crews can call for additional resources like the Air Ambulance helicopter or fixed wing plane. The helicopters based in Inverness or Glasgow can now operate during the hours of darkness. The planes operate from  Aberdeen and Glasgow. The Coastguard Helicopter can also be requested if the condition is life threatening and it also has the capability to transport expectant mothers.

When required SAS can deploy its Scottish Specialist Transport and Retrieval Service (ScotSTAR), a national service that provides safe transfer for some of the sickest patients within Scotland. The clinical teams transport patients, from babies to adults, by road and air. The expert teams include doctors, nurses and paramedics.

The combination of a highly trained crew and a very well equipped Emergency Ambulance (they are virtually mobile A&E departments) means a far better outcome for patients. Technology is also used; for example a heart attack victim will be connected to a monitor, the crew obtain a heart tracing (ECG) which is sent to a specialist who can assist with diagnosing. If appropriate, the crew can administer a clot busting drug. This procedure has allowed a huge number of patients to make a far better recovery.

More patients are now being treated and stabilised in their own homes by Ambulance crews so there is not the same need for them to go to hospital.

Obviously some patients will still require hospital treatment so they will be stabilised and then taken to Caithness General or, if necessary, straight to specialist care units. Incidentally, Caithness General A&E dept. has consistently been amongst the top rating A&Es in Scotland.

So if you have to make a 999 call for an Ambulance it is really important that you answer the questions the best you can and then be assured that when you hear the siren coming, the patient will soon be in very safe hands.

Ron Gunn
Vice Chair Chat