Memorandum submitted by the Ambulance
Service Association (March 2002)
1. The Ambulance Service Association is
the representative body of the NHS Ambulance Service. Its members
include all 32 ambulance trusts in England together with the national
services in Scotland, Wales and Northern Ireland. Public ambulance
services in Guernsey, Jersey and the Isle of Man are also members.
2. Ambulance services are an integral part
of the National Health Service and represent its front line response
to any terrorist incident. This "public safety" role
as one of the three principal emergency services is widely recognised
and they make a vital contribution to local emergency preparedness.
3. They have also been regularly called
upon to respond to a range of major incidents so liaison and co-operation
with other agencies at local level is generally excellent. The
local approach to emergency planning remains an important foundation,
but the type of events seen on 11 September and immediately thereafter
clearly calls for greater emphasis on a national approach. The
Association has some real concerns regarding the existing co-ordinating
mechanisms at a national and cross government level.
4. In recent years emergency planning in
the NHS has increasingly become a public health responsibility.
Whilst that has a number of obvious advantagesparticularly
in respect of biological issuesthe public health function
is not particularly well connected on a day to day basis to those
more operational parts of the NHSsuch as ambulance serviceswhich
are responsible for front line delivery.
5. Although unintended, we believe events
since 11 September highlighted a significant failure within the
NHS to rapidly involve the Service at national level or provide
it with the kind of timely and specific information and national
guidance that were clearly needed by front line crews.
6. The Association's members are not arguing
that ambulance services should not be included in the NHS's emergency
planning system. But the very nature of their front line position,
operational role and well defined links to other emergency partners
needs to be better recognised within the Government's planning
for terrorist threats and the specific issues related to the initial
response and pre-hospital care better addressed.
7. The Association welcomes the fact that
the London Ambulance Servicean active member of the ASAwas
involved in some of the wider and more strategic cross-government
discussions from the outset. That is fully justified given that
the particular threats and operational requirement in London are
not typical. But for that very reason the views and issues of
all ambulance services need to be better represented and capability
outside the capital also assessed.
8. Health, Home Office and DTLR Ministers
have recently confirmed their expectation that all three "blue
light" emergency services must develop more common approaches,
joint training and operational procedures. The ASA fully supports
that view and will be working as an equal partner with the Association
of Chief Police Officers and the Chief and Assistant Chief Fire
Officers Association to develop and maintain that capability.
In return it would expect equal representation on all relevant
committees and national working groups so that our views can be
put directly and considered in the same way as those of our partners.
9. A major area of continuing operational
concern is around staff protection and Personal Protective Equipment.
Delays in producing a national specification for PPE meant that
most Services had very little available and few if any staff trained
to operate in hazardous environments in the immediate aftermath
of 11 September. Some of those deficiencies are slowly being remedied
but from the Association's point of view those who are actually
going to be the most at risk must have more involvement in the
discussion and choice of equipment. As a result there is a lack
of operational confidence amongst staff and comparatively little
real capability outside those few areas that had received funding,
training or equipment from earlier initiatives.
10. The same situation applies in respect
of decontamination capability and in both areas it is critical
that national programmes of training and national operational
procedures are developed to ensure a safe and consistent response.
Joint command training, to ensure effective joint working between
the police, fire and ambulance services, is also of paramount
11. The ASA welcomes the recently agreed
Memorandum of Understanding between the Department of Health and
the DTLR to facilitate effective co-operation between the fire
and health services in dealing with incidents where mass decontamination
may be required. But the triage and treatment of those who are
ill or injured remains a health responsibility and the capability
to deal with smaller numbers needs to be developed and maintained.
12. ASA believes that events since 11 September
have shown the need for improved high-level information sharing
and national co-ordination amongst the various agencies and organisations.
This is critical to our ability to provide an adequate local response.
We are aware of outline proposals to develop improved co-ordinating
mechanisms and as a front line responder believe that ambulance
services should play a direct and integral part in developing
13. In common with other parts of the health
service, ambulance services face competing priorities and limited
resources. The ability to organise and then maintain the capability
to respond to such incidents will require initial and on-going
investment, particularly in staff training. Given day-to-day financial
pressures that must be recognised at national level and specific
investment should be made available to achieve and maintain preparedness.
14. ASA believes that more specific ambulance
involvement at national level is essential if the UK is to be
and how that contribution might benefit the whole system. This
Association and its individual Ambulance Trust members are ready
and willing to play a full and equal part but can only do so if
we are properly involved, consulted and funded for what are clearly
15. The Association would be pleased to
clarify or expand upon these points if the Committee would find