• Home
• Used vehicles
• Product news
• Dealer news
• Compliance
• Buying advice
• Archive

Co-ordination Improves

Part I Ambulance Efficiency 0 NE of the features of British life is the way in which great public services come into existence with so little fuss that the man in the street hardly notices any change. No better example could be quoted than the establishment of a nation-wide ambulance service as a result of the National Health Service Act, 1946.

• Like so many of our laws, this statute established a principle and left the formulation and implementation of policy to the local authorities. County and county borough councils were made responsible for providing ambulance services and were given almost a free hand in the methods of doing so. When they came to tackle the job, they immediately found themselves confronted with a difficult and curious situation, in that whilst they are responsible for organizing the service and have to pay half of its cost (the balance coming from the Exchequer), they have little control over its use.

The demand comes from the hospitals and from general practitioners, and arises because of accidents. A further complication is that the "catchment areas" of hospitals are not in any way related to local government boundaries, and the hospitals themselves are organized in two different ways. What are called the teaching hospitals are controlled by Boards of Governors appointed directly by the Minister of Health whilst all other hospitals are grouped under 14 Regional Boards, each individual hospital having its own management committee.

Before the Act came into force on July 5, 1948, there were four bodies in Birmingham providing ambulances. The police dealt with all street accidents; the Public Health Department handled infectious diseases, tuberculosis and mental patients; and there was a voluntary hospital car service run by the Red Cross. The bulk of the normal hospital removal work (as it is called) was, however, handled by the Birmingham Hospitals Contributory Association.

This body had about 250.000 members who, with their dependants, were entitled to a free ambulance service which was thus within reach of most of the city's inhabitants. The Public Health Department, apart from their direct responsibilities, also acted as agents for the Ministry of Health in transferring patients between hospitals in different parts of the country.

Birmingham City Council decided to take direct operational responsibility for the service, acting through the Health Committee but entrusting the day-to-day working,to the chief officer of the lire brigade. An Ambulance or no Sub-committee was established representing both the Health and the Fire Brigade Committees.

There were obvious advantages in this scheme, notably in its making available td the ambulance service the maintenance facilities of the fire brigade, the use of the fire stations at strategic points, the possibility of establishing a central control side-by-side with the central fire control, and the likelihood of a saving in senior staff. On the financial side, this arrangement has been as big a success as it has operationally; it is estimated that if the ambulance service had been entirely separate from the fire brigade its costs for the year 1952-53, instead of being about £180,000, would have been little short of Lim.

When 1 mention that the fire service was returned to local control only on April 1, 1948, it will be realized that some smart work was done in transferring the various ambulance fleets and personnel on July 5 of the same year without disrupting the service. The previous authorities had operated 82 vehicles, of which 72 Were taken over. Included was a mobile surgical unit, which has been returned to the charge of the accident hospital as being too specialized for a general service of this type.

The previous owners had the common post-war difficulty of finding suitable vehicles and by the end of 1953, 63 of the transferred vehicles had been scrapped either because of age or as non-standard. The present fleet totals 107, including two old vehicles for Civil Defence purposes and two others not used for patients, An early decision had to be made on vehicle policy and it was decided to aim at the establishment of a uniform fleet in two main classifications: (a) a type chiefly for stretcher work but adaptable for any type of case (the "dual-purpose ambulance "); and (b) a type for sitting cases. Consideration was given to using a commercial 2-3-ton chassis of one of the makes already in the fleet, but it was felt that commercial vehicles were not the ideal for ambulance work involving stretcher cases, because of the chassis height, the heavy springing, the tyre pressures and the often noisy transmission, . In the interest of patients, therefore, the commercial vehicles, as they are due for renewal, are being replaced by high-powered private-car chassis, It is considered that the higher initial cost is counterbalanced by the longer life (eight years as against five) and the lower fuel consumption:.

The dual-purpose fleet now consists of 34 l'■/eh idles on private-car chassis—eight Humber Pullman, six Daimler and 20 Austin Sheerline; and 44 on commercial chassis-20 Austin Welfarer, 13 Commer Q25, 10 Morris-Commercial and one Bedford. These vehicles have a fitting for a stretcher to slide in on the near side with sitting accommodation for three or four on the off side. This seating, which is longitudinal, can be converted in a few seconds to take another stretcher if necessary. Originally, dual-purpose vehicles had a single door in the middle at the back, but this necessitated an awkward movement to get the stretcher in and out. The newer bodies have two doors at the back, so that the full width of the vehicle is available when they arc open and stretchers can go straight in and out.

Sitting-case ambulances involve different considerations. The problem is to give comfort whilst at the same time making up loads which will show the maximum economy in the use of the vehicles. Each of these ambulances makes a round, picking up or setting down patients. There is a fairly low limit to the number that should be accommodated on any one journey. It would disorganize a hospital's reception arrangements if a large number of patients arrived at one time, whilst the psychological effect on the patients might be bad if a journey had to be made all round.the city picking up and setting down a number of times.

Hot-air Heating

It has been found that a light commercial chassis is suitable for this work and 16 Morris-Commercial and five Bedford vehicles are employed. The first vehicles with specially designed bodies were fitted with five seats for patients facing forward, but the latest model has seven. The upholstery is extremely comfortable. An interesting point is that whereas the stretcher ambulances are heated by hot air, the sitting-ease vehicles are heated by hot-water tubes. It was found that the continual opening and shutting of the doors nullified the value of the hot-air system. Three Austin 16 h,p. cars are also available for sitting cases. A Bedford coach provides a useful amenity far expectant mothers desiring pre-natal treatment. There is a hospital for this at Marston Green, on the extreme eastern boundary of the city, to which access by public transport is not easy. The coach makes five or six trips a day (Mondays to Fridays) to this hospital, starting on the Outer Circle bus route at Yardley and calling at two other points convenient for ransferring to and from frequent bus services.

A woman entitled to use the service is given a ticket either )y her doctor or by the hospital and is notified of the time the coach she is to travel on. In addition to the vehicles idonging to the ambulance service, use is still made of the 'oluntary hospital car service of the Red Cross, and this is valuable addition to the publicly owned facilities. The trivate-ear drivers who lend their vehicles for this work are kaid 7d. per mile.

Three Sections

The 103 operational vehicles of the ambulance service are ivided into three sections: accident, infectious diseases, and ospital removals'. In the first section there are eight chides—two at the central fire station and one at each Of x other fire stations. These vehicles—now all Humber ullmans—are those which normally arrive in response to 999 telephone call; they are manned by firemen. The ifectious diseases and tuberculosis hospitals are situated ose together at Little Bromwich and Yardley Green, on te east side of the city, and are served by eight vehicles Imanently based there under a leading driver. During the iytime, a small number of vehicles from the hospital movals fleet is stationed at the general and accident ispitals but works under central control.

Ambulance control is one of the four operational sections the service for which (as a whole) the deputy chief officer the fire brigade, Mr. A. J. Probert, is responsible to the ief officer, Mr. H. W. Coleman. The other three sections e the depot organization, the ambulance staff office and 3 accident service. The last mentioned has already been rationed as entirely under fire-brigade station officers. le depot organization under the depot superintendent, r. W. James, comprises all the staff at the main depot Henrietta Street and the sub-depot in Ladywood Road, 1 the drivers, attendants and midwives. It maintains and

operates the ambulance fleet and carries all the traffic except that dealt with by the hospital car service and the accident service.

The detached unit at the infectious diseases hospital is included in the depot superintendent's responsibilities. The ambulance control is located in a room next to the fire control room at the central fire station, with sub-controls at the accident and general hospitals. The ambulance staff officer, under Mr. 0. Fahy, co-ordinates the work of the depot and the control and prepares the necessary statistics and records.

An important member of this section is the hospital liaison officer, whose duty is to foster and develop good relations between the service and the hospitals. The necessary administrative work (personnel, finance, stores. buildings, etc.) is handled by the appropriate sections of the fire brigade organization and, as has already been said the central workshop for the fire-fighting equipment deals also with the ambulance fleet.

Reference has been made to the depot. At the take-over. the ambulances were, naturally, scattered among seven or eight garages, none altogether suitable for the working of a highly organized fleet and all lacking in amenities for the staff. Eventually a bomb-cleared site was found in Henrietta Street, nearly half a mile from the central fire station, and there a single-storey building has been constructed to accommodate 65 ambulances, with room for extension if necessary.

Chequered History

In addition to parking space, there is an office block with stores, canteen and recreational facilities. Among the premises taken over was a garage in Ladywood Road which has had a chequered history as a transport centre for some 30 years. It has been in the hands of several hauliers, and at the time of the take-over the Birmingham Hospitals Contributory Association were garaging 22 vehicles there. In view of its proximity to the accident hospital, it has been retained as a sub-depot to house the 13 vehicles which are attached to that hospital for day work.

Although for the most part vehicles operate only within the city boundaries, frequent journeys are made to sanatoria and convalescent homes which, although situated at a distance, are affiliated to hospitals in the city. How to deal with patients requiring transport for treatment at hospitals many miles outside the city and not under the Midland Regional Board was an early problem. Every effort is made to cut down long-distance journeys and extensive use is made of the facilities provided by the railways where these are really suitable. This has been a recent development and it has required much tact and propaganda to divert traffic from road to rail.

Authorities in other parts of the country have co-operated admirably and no difficulty has been experienced either in arranging for the conveyance of patients from the station at the farther end of the journey or in recovering equipment sent with patients. In the first six months of the new service in 1946, only eight cases were sent from Birmingham by rail; in 1952 the figure was 653. On occasion, for extreme journeys (e.g. to Ireland), air transport has been used.

Many Headaches To the public, the take-over on July. 5, 1948, went off smoothly but for the officers of the ambulance service the ensuing weeks and months provided a good many headaches. Not the least of these arose from the multiplicity of sources from which orders were received, and because Birmingham has within its borders about 40 hospitals, mostly serving a much wider area than the city, orders were being received from different departments of the same hospital, causing duplicated running; some hospitals, for example, separately ordered cars for sitting patients and ambulances for stretcher cases when a dual-purpose vehicle could have handled both.

There was also a strong suspicion that the service was being abused by being called on to give free rides to people who could well have used public transport. In the past two or three years there has been a marked improvement through the appointment in each hospital or group of hospitals of an ambulance liaison officer, who is now the only normal channel of communication between the hospital and the central control.

The concentration of the bulk of the West Midland hospitals in Birmingham threatened at an early stage to impose an unfair burden on the city ambulance service, and consequently the Birmingham ratepayers, as the responsibility for conveyance lies with the authority in whose area the need for transport arises; in other words, once patients had entered city hospitals it was theoretically Birmingham's responsibility to get them home again.

Discussions were held with the surrounding local authorities and a reasonable compromise was reached. If a patient has to be moved within three months of his reception into a Birmingham hospital, it is now the responsibility of his home authority to take him back. If a longer period than three months elapses, Birmingham takes him home. As a natural development of this, a mutual-assistance arrangement is now in force which works something like a goods clearing house in providing back loads to save waste mileage.

"Removal Section"

Co-ordinating the demands on the service is the work of the control section, which started with the benefit of the experience of the fire brigade. The "removal section," although located in the next room to the fire brigade control, is worked quite separately with different telephone numbers and switchboards. There are 12 exchange lines and private wires to hospitals, fire stations and depots. In the same mom is a telephone for the use of the emergency bed bureau, which is an organization under the Regional Hospital Board, partly staffed by voluntary workers. Ambulance control staff are trained to handle this work as well in an emergency.

Accident calls (mainly through 999) are actually dealt with in the fire control. Immediately a call is received, two operators go to the instrument; one takes the message and repeats the information aloud to her colleague. As soon as the location is given, the second woman refers to a large revolving drum on which every road in Birmingham is listed in alphabetical order with a note of the nearest fire and ambulance station. The appropriate station is contacted by the second operator and, should the ambulance stationed there be out, reference is made to a record card which gives the next nearest, and so on through the whole list.

For the " removal " cases all the main hospitals in the city are supplied with cards of two different colours. One is for patients for whom transport has to be provided both ways and the second is for one-way-only journeys. There is a third type of card completed in the control for priority cases. The jssue of cards by the hospitals covers 60 per cent. of the cases and for the others (which arise mainly

from doctors') cards are made out by the control staff.

The main feature of the control room is a large board divided vertically into the four main headings of clinics, admissions, transfers and discharges, these being again subdivided into time zones. Each column is slotted from top to bottom to take cards and against each slot is a hole into which can be plugged a token which, by its shape and colour, indicates the type of vehicle that has been sent; this token also bears the fleet number of the vehicle.

A card remains against the vehicle plug until the driver telephones to say that he has done the job; the card is then filed. Cards made out by hospitals are collected each afternoon and sorted by the control staff ready for the next day. A case book for each vehicle is made out with sufficient work to start the men off promptly in the morning. When these calls have been worked through, the drivers telephone for further instructions.

Now that the organization has been working for nearly six years, the staff have had time to settle into a routine and to develop an esprit dc corps. How to integrate the staff into the fire service was one of the major difficulties in 1948 because of the differing conditions under which they had been employed. These took some time to iron out, especially as many of the transferred employees were ineligible or unwilling to accept fire brigade conditions.

The ambulance staff, therefore, work under terms and conditions laid down by the West Midland Joint Industrial Council for local authorities non-trading services. All new entrants are given a fortnight's basic training and then have to work for three months under supervision before being regarded as fully qualified. Hours of work are arranged to allow for the concentration of traffic during the day-time.

Staff Rotas

Thus, of approximately 150 men and women on the " removals " staff, 50 are always engaged on day work. The others are on an eight-week cycle to cover day and night. In all stretcher cases, two men are sent with each dualpurpose ambulance and in all maternity and certain other cases a midwife or female attendant as well. Drivers are kept as far as possible to the same vehicle, although, obviously, with some on shift work this cannot be done in every case.

The present establishment of the service is 262, but the actual staff is only 245. At the depot there is a superintendent and his deputy, six garage foremen, 10 leading drivers, 158 drivers and attendants, 12 midwives, a storekeeper, four depot assistants, two clerks, 13 ambulance cleaners, and six cooks and cleaners The staff office has a staff officer, a hospital liaison officer and two clerks. In control are a duty officer, seven senior operatives and 19 operatives.