Posted by: ayrshirehealth | August 21, 2013

The Professionalism of the Paramedic Service by @davidgarbutt1

Ambulances have been around for hundreds of years, usually as conveyances for military casualties, but in the UK It was not until the1946 National Health Services Act that local authorities were required to provide ambulances “where necessary


Surprisingly it took until 1964 for the Miller Report to recommend that ambulance services should provide treatment as well as transporting patients and thus began the professionalisation of the service. Paramedic Wordle The early care attendants began to provide a range of clinical services, which were supported by an ever increasing range of training, eventually leading to the State Registration of Paramedics, a new breed of autonomous practitioners who provide treatments and diagnostics without seeking authorisation from doctors. The development of the profession was soon followed by the production of national clinical guidelines produced by the Joint Royal Colleges Ambulance Liaison Committee known throughout the UK as the JRCALC guidelines.

More recently we have seen the development of the College of Paramedics, which will help to develop the professionalism of the service further. A wordle of their membership rationale makes quite powerful reading –

Remote and Rural

This short review of the history of the service is important as it describes the context within which these highly skilled professionals have developed their expertise, a fact still frequently overlooked by many colleagues within other sectors of the medical profession. The fact is that paramedics in Scotland are providing an ever widening range of services, from anticipatory care, the provision of community paramedic services, dealing with out of hours responses, supporting community responder schemes and working in hospital environments as well as emergency response and the associated early critical care. Throughout Scotland they are providing clinically safe and sustainable services in a cost effective way. There is considerable scope for these services to be extended, in partnership with other NHS Boards, to the benefit of patients, particularly in remote and rural locations. The key is in that word ‘partnership’. If you look at the Strategic Options Framework (SOF) which was developed by the Remote and Rural Implementation Group, in partnership with the Scottish Ambulance Service, you will see it outlines the responsibilities of the various organisations for Emergency and Urgent response, sets standards to be achieved and gives a framework of the types of response which might be available to the various geographical and clinical service configurations.

Kilchoan, Ardnamurchan

Lets take an example of that effective partnership in action. Kilchoan is a thriving community in the Ardnamurchan peninsula.

ArdmurchanAccess is by single track road and the nearest Doctor and Ambulance are at least one hour distant, assuming that they are immediately available.

Nursing provision in the area was changing due to impending retiral and the community needed a sustainable, and clinically safe, solution. In partnership with NHS Highland and the Scottish Centre for Telehealth and Telecare an emergency responder model was developed which provides a resident SAS ambulance technician, together with six emergency responders working on a rota system.

The system was developed with the local community and the model provides for a higher level of training and skills for each of the emergency responders. We have also installed a telehealth unit in the community, which links directly to consultants at Aberdeen Royal Infirmary. The emergency responder team can activate this system through the Ambulance Control Centre and, within minutes, patients can be in contact with a specialist resource in another part of the country. This has been well received in the community and is a model that could be utilised in other appropriate locations.

This example demonstrates the changing nature of the services that the ambulance service can provide and we continue to build on these capabilities.

Scottish Specialist Transfer and Retrieval Services

Another example of the changing face of the service happens in April next year when ScotSTAR, the Scottish Specialist Transfer and Retrieval Services, will be co-ordinated by the SAS as a single service.

SAS Helicopter

This will bring together the highly skilled teams who provide the Emergency Medical, Paediatric and Neo-Natal Response Services. The new service will have the support of specialists, employed on a sessional basis from partner boards, and also critical care paramedics who have developed additional higher level skills. ScotSTAR will be supported by our Air Ambulance Service, which consists of two fixed wing aircraft and two helicopters crewed by SAS paramedics. New helicopters will arrive in spring next year and they will provide much better patient care facilities.

A third helicopter, provided through a charitable trust (Scotland’s Charity Air Ambulance) is also tasked by the SAS and crewed by our paramedics. Again the staff crewing these aircraft have additional skill sets.


We are also progressing change through the introduction of technology and recently demonstrated our new traponin test equipment which is ambulance based, and is a world first, to the Cabinet Secretary. TraponinThis equipment provides a blood analysis in 15 minutes allowing paramedics to determine treatment and the need for transfer to specialist centres. The use of other diagnostic tools for conditions such as Diabetes and Sepsis will also enhance our early diagnostic capability

GCU LogoAll of our training and development is supported by our new academy at Glasgow Caledonian University where developments pathways leading to degree and masters levels will be available for appropriate paramedics. Again partnership is key and much of the initial training programmes are completed in conjunction with nurses also undergoing programmes at the university.

In short we have come a long way since 1964. Paramedics provide a vital, and growing, service to patients and their role will develop. The key, as I mentioned earlier, is partnership and we would welcome the opportunity to work with colleagues on future initiatives which would benefit everyone but most of all our patients. We are ready to help and look forward to hearing from you.

Our blogger this week was @davidgarbutt1 is Chairman of the Scottish Ambulance Service

Next week @sandywatsonNHST , Chairman of NHS Tayside, rounds of our months of blogs by chairman of NHS Scotland Boards.


  1. […] Garbutt, Chair of the Scottish Ambulance Service, wrote about recent developments in The professionalism of the paramedic service on the  Ayrshirehealth blog this week. Scotland has some of the most remote and […]

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