Scottish Ambulance Service

Scotland's public ambulance services

The Scottish Ambulance Service (Seirbheis Ambaileans na h Alba) is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health and Social Care Directorates of the Scottish Government. It is the sole public emergency medical service covering Scotland's mainland and islands; providing a paramedic led accident and emergency service to respond to 999 calls, a patient transport service which provides transport to lower acuity patients, and provides for a wide variety of supporting roles including air medical services, specialist operations including response to HAZCHEM or CBRN incidents and specialist transport and retrieval.

In 1948, the newly formed Scottish National Health Service (NHS) contracted two voluntary organisations, the St Andrew's Ambulance Association and the British Red Cross, to jointly provide a national ambulance provision for Scotland, known then as the St Andrew's and Red Cross Scottish Ambulance Service. After British Red Cross withdrew from the service in 1967, the service was renamed the St Andrew's Scottish Ambulance Service. In 1974, with the reorganisation of the Scottish health services, ambulance provision in Scotland was taken over by the Scottish NHS, with the organisational title being shortened to the current Scottish Ambulance Service. The organisation was established as a NHS trust on 1 April 1995 when it legally became known as the Scottish Ambulance Service National Health Service Trust. The trust was dissolved on 1 April 1999 and at the same time constituted as a special health board known as the Scottish Ambulance Service Board.

The Scottish Ambulance Service now continues in its current form as one of the largest emergency medical providers in the UK, employing more than 5,000 staff in a variety of roles and responding to 740,631 emergency incidents in 20152016 alone. The service, like the rest of NHS Scotland, is free at point of access and is widely used by both the public and healthcare professionals. Employing almost 1,300 paramedic staff, and a further 1,200 technicians, the accident and emergency service is accessed through the public 999 system. Ambulance responses are changing in Scotland and are now prioritised according to patient needs: a traditional, double crewed ambulance, a single response car or a paramedic practitioner may attend different kinds of emergencies.

The Scottish Ambulance Service coordinates the pre hospital and inter hospital transfer elements of the Scottish Trauma Network. This response comes from the Scottish Ambulance Service and a number of partner agencies. These are sometimes categorised as Red, Yellow and Green resources; of these, Medic One and BASICS Scotland are registered charities. The use of Yellow and Red categorisation is also applied to the enhanced skills offered by different teams or clinicians.

The service also uses a number of volunteer responders in conjunction with BASICS Scotland and the Sandpiper Trust. These responders are doctors, nurses and paramedics who volunteer their time to respond on behalf of the ambulance service and help the sick and injured. Equipment is provided to these responders by both the ambulance service and BASICS Scotland, with assistance from the Sandpiper Trust. These responders may be able to offer enhanced "Yellow" skillsets and advanced interventions to assist the other emergency services. Such skills offered by BASICS Scotland responders may include: endotracheal intubation, procedural sedation, advanced analgesia, nerve blocks, cardioversion and thoracostomy with or without drain insertion.

There are also a number of Community First Responder schemes across Scotland which support the ambulance service. These are voluntary responders with basic medical training who are deployed to 999 calls, mostly cardiac arrests.

The Highland PICT Team is based at Raigmore Emergency Department, Inverness and respond to a round 150 patients a month. It was formed in 2016 to address a lack of physician led pre hospital care in the Highlands. It uses a doctor and advanced practitioner model, providing advanced care and extending the capabilities of the Scottish Ambulance Service. They were winners of the Highland Heroes award in 2022, with the team's founder and clinical lead receiving an international award for his work in rural pre hospital medicine in 2021. One of the team's advanced nurses was also nominated for a Scottish Health Award for his part in the care and rescue of a child with traumatic injuries from a mountain.

Medic One is a charity team formed in 1980 which deploys from the emergency department in Edinburgh. In 1998 a charitable trust was set up, aligned to the Medic One team, to facilitate learning and development of Edinburgh hospital staff. The helicopter is crewed by 1 or 2 paramedics and a pilot.

The Patient Transport Service carries over 1.3 million patients every year. This service is provided to patients who are physically or medically unfit to travel to hospital out patient appointments by any other means so that they can still make their appointments. The service also handles non emergency admissions, discharges, transport of palliative care patients and a variety of other specialised roles. Patient Transport Vehicles come in a variety of forms and are staffed by ambulance care assistants, who work either double or single crewed. They are trained to look after patients during the journey, and to provide basic emergency care.

The service has the only government funded air ambulance service in the UK, operated under contract by Gama Aviation. The fleet consists of two Airbus H145 helicopters and two Beechcraft B200C King Air fixed wing aircraft, which provide emergency response and transfers of patients to and from remote areas of Scotland. The two previous H145 helicopters were operated under sub contract by Babcock Mission Critical Services Onshore until May 2020. In 20152016, the air ambulance crews flew 3,849 missions. One helicopter and one King Air are based at a Gama Aviation facility at Glasgow Airport. The other operating bases are Inverness Airport (helicopter) and Aberdeen Airport (King Air). The aircraft based in Glasgow are regularly used by the Emergency Medical Retrieval Service (EMRS). The air ambulance service was occasionally featured as part of the Channel 5 television documentary series Highland Emergency.

In late 2010, a charity, Scotland's Charity Air Ambulance (SCAA), was founded to provide a further air ambulance, based at Perth Airport to work alongside the state funded aircraft. SCAA commenced operations in May 2013 with a MBB Bo 105 helicopter. Since November 2015, SCAA has operated a Eurocopter EC135. The EC135 was previously operated by the state funded service, until they replaced the fleet with H145 aircraft. The helicopter is crewed by Scottish Ambulance Service paramedics, tasking is from the SAS ambulance control centre at Cardonald. In April 2018, it was announced by the charity that a drive was underway to raise funds to secure a second helicopter. This aircraft is now operational at Aberdeen Airport.

On 19 May 1996, a Britten Norman BN 2 Islander aircraft operated by Loganair for the Scottish Ambulance Service crashed short of the runway at Lerwick/Tingwall Airport in Shetland while turning to final approach at night during strong and gusting winds. The pilot was killed, and the physician and flight nurse were injured. There was no patient on board at the time. On 15 March 2005, a Britten Norman BN 2 Islander aircraft operated by Loganair crashed into the sea while descending toward Campbeltown Airport in western Scotland. The aircraft was operating an air ambulance flight on behalf of the Scottish Ambulance Service. The pilot and paramedic both died in the crash.

The SORT service is similar to the Hazardous Area Response Team in other parts of the United Kingdom. SORT paramedics have the same scope of practice as a regular paramedic, however have an enhanced scope of practice in relation to Personal protective equipment and other rescue equipment. This £4.3million initiative was to provide additional preparedness to be able to respond to large scale hazardous incidents, such as those that might involve chemical, biological, radiological or nuclear material. The work was in concert with the UK government. as of 2017 there are five SORT teams; three full time based in Edinburgh, Glasgow, and Aberdeen, and two on call teams in Inverness and Dumfries. These teams provide a specialist response to major incidents, and provide paramedic care in hostile environments. The team provides capability in arenas such as water rescue, safe working at height, search and rescue including the use of breathing apparatus, and confined space working. The SORT teams also provide a full time emergency decontamination and inner cordon capability.

With the remote towns and villages in Scotland often being hours away from advanced medical treatment, Scottish Specialist Transport and Retrieval (ScotSTAR) was setup incorporating paediatric and neonatal retrieval and transfer teams and the two adult Emergency Medical Retrieval Service teams (EMRS). Initially, the service provided aeromedical cover to six isolated hospitals within Argyll and Bute. 14 retrieval practitioners, and 4 registrars, carrying out around 1000 missions every year. The facility has purpose built classrooms, lecture theatres, syndicate rooms and a clinical simulation area that recreates a 16 bed hospital ward and Accident & Emergency department allowing realistic interaction with other trainee healthcare professionals. From 1996 until April 2011, the service used its own dedicated training college located at Barony Castle in Eddleston near Peebles. Set in of formal gardens and woodlands, Barony was a residential training and conference centre with 78 bedrooms that allowed the service to carry out all its training in house. Between 1985 and 1996 it used the former Redlands women's and children's hospital in Glasgow's west end and prior to that the training school was based at Bangour Hospital before moving to Gartloch Hospital.

In 1999 it emerged that the Financial Director of the Scottish Ambulance Service had previously been jailed for fraud. In 2017 the ambulance service was criticised for using an ancient fleet of ambulances, with nearly half having over 100,000 miles on them. In 2018 it was revealed that frontline staff had been working "dangerously long hours", with one staff member working a 36 hour long shift. This was described as a national scandal at the time. In 2020 both the Tayside Trauma Team and Medic 1 announced their continuing existence was unsustainable and the services would be terminated, removing this physician led resource from the ambulance services capabilities. 2021 saw the Scottish Ambulance Service struggle to staff frontline ambulances; seeking help from firefighters, the military, and non medical trained drivers to crew ambulances attending 999 calls. A number of tragic stories emerged highlighting the personal cost of this crisis, including one patient who died after waiting 40 hours for an ambulance, and an elderly man who died on his driveway after waiting four and a half hours for an ambulance. In the same year it was also revealed that a number of senior NHS managers from the ambulance service were running a camper van hire business during work hours, while planning for the COP26 international conference. Research published in 2022 demonstrated that four out of five Scottish paramedics were considering quitting their jobs. It also revealed that 87% of staff do not feel valued by the Scottish Ambulance Service. The same report highlighted a third of staff working shifts lasting 15–20 hours. The same year, a story was published in which a member of the public was asked to perform CPR on their relative, alone in the back of the ambulance without help from the ambulance crew while en route to hospital. In the summer of 2022 it was claimed that an ambulance service senior manager was suspended as a result of requesting that a member of control room staff leave their post and collect him (and his family) from Glasgow Airport. In 2022 it also came to light that EMRS have been deploying as a “Red Team” for the Scottish Ambulance Service without a Consultant on board.