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Vehicles
WITH the passing of the National Health Service Act, 1946, Lancashire County Council, like other local authorities, had to inaugurate a comprehensive ambulance service. The principal cities and towns in Britain had for long been running well-organized services, but the more remote places had mostly been 41:pendent upon voluntary organizations or services run on an agency basis, great amount of work was therefore necessary to obtain the needed vehicles, their depots and staffs, and in the arrangement of an operational system which would ensure the instant availability of ambulances at all hours.
The. first report on the service (Special Report of the County Medical Officer of Health on the Operation of the Ambulance Service in the Administrative County of Lancashire) covers the period from July 5, 1948, until March 31, 1950. Lancashire has a population of over 2m., is 110 miles long and between 20 miles and 50 miles wide. Whilst the coalfields have a density of 27 persons per acre, there are large rural districts where it is less than one person per acre.
Accident Potential The county has ports and airfields, and, with the heavy traffic between Liverpool and Manchester, there is a great road-accident potential in addition to the industrial risk. The task of providing a comprehensive ambulance service was also complicated because of tho hilly districts.
Before the passing of the Act, and the consequent unification of the service, there were over 109 separate county districts with a variety of arrangements. Some operated ambulances from fire stations, some from council yards, others from local garages, and
B16 so on There was little to form the nucleus of a new service; even ill:: vehicles were nearly all worn out. Seventy-four of the 126 'ambulances taken over were more than 10 years old. nine of them having given 20 years' service.
It was appreciated that once the free nature of the service became known, the demand would increase. In considering the extent of the probable demand, it is sometimes taken for granted that only one or two people may be involved in an accident. Evidence of the opposite is given in the report. When a double-decker hit a coach, 34 people were injured and 30 had to be taken to
hospital. 3 Again, at a dye works a quantity of hypochlorite of soda was accidentally pumped into a tank containing hypochloric acid. A strong concentration of chloride gas was produced and 19 people were taken away by ambulance and three more by taxi.
Such incidents make it clear that there must be a closely integrated service capable of concentrating ample forces at one point at .any time, yet leaving sufficient strength 91sewhere to deal with normal routine.
Certain hospitals and industrial concerns arranged an appointment system, so that out-patients attended in groups in 15-minute periods. In some 987
attendances, 6,416 hours have been saved, representing a saving of 6i hours per patient.
Frequent conveyance of patients over long distances is one of the peculiar needs which must be met. Carrying a patient from the north of the county to one of the Liverpool or Manchester hospitals may involve a return trip of some 200 miles.
To meet these needs it was decided to obtain special vehicles which would be suitably disposed over the county area. The requirements included a wheelbase of such length that the patient, on a stretcher bed, should lie within the wheelbase, and provided for soft springing with double-acting shock absorbers and low-pressure tyres.
To meet this specification, Commer 03-type ambulance chassis were chosen and fitted with bodies panelled externally in light alloy and internally with cream coloured Perspex. Clayton Dewandre heating equipment was fitted. Each ambulance was equipped with beds, with Dunlopillo 6-in, mattresses. that could be adjusted to any position, also two armchair seats provided with headrests. All necessary surgical and toilet requisites are included in the equipment of the vehicles.
Moderate Power
The supply situation presented a serious initial problem. The St. John Ambulance Brigade rendered valuable help by placing its facilities at the county council's disposal. Realizing that the vehicles to be transferred to the county authority would be inadequate, both in numbers and in quality, the health committee in 1947 prepared a specification for vehicles to meet its particular needs. It was decided that as most of them would operate in built-up districts and over comparatively limited areas, the engines should be of moderate power and therefore economical.
No sooner had this specification been drafted than urgent demands were received from hospitals and county
eistricts for aid in obtaining new vehicles. The council decided to invite tenders from nine distributors for the supply of five ambulances without restriction as to type or specification. This produced an offer to supply five vehicles over a period of 14 months.
The general shortage of new vehicles and the demand for ambulances made it necessary to go farther afield. As the council wished to standardize the fleet and as it was obviously better to buy vehicles to the desired specification, is was decided to direct inquiries to that end.
There were three types of chassis on the market which provided full forward control, one of the makers—Karrier Motors, Ltd.—supplying as standard an ambulance which clossly approximated to the council's requirements. This type, with certain modifi cations, was already giving good service in Birmingham. An order was placed for 40 vehicles to be supplied within the ensuing 12 months. An order for another 40 for the succeeding year was also given.
Appreciating that special ' vehicles would also be needed for the transport of sitting cases, the council considered the type of machine which would be the most suitable. It was found that thestandard Hillman Minx utility fully met requirements and 30 were ordered for the first financial year, with 30 to follow in the next 12 months.
By February 25, 1950, the council had a fleet of 216 ambulances and cars, of which 147 were reasonably new. The higher roadworthiness of the fleet made the provision of an efficient service possible.
Particular attention was given to the introduction of a comprehensive and regular maintenance system, and arrangements were made with the Rootes organization to contract for servicing the vehicles at its depots. Each vehicle is withdrawn from service four times every year for a detailed check. " Minor attentions are carried out by the ambulance staffs.
The report criticizes the accident record of the fleet. The average mileage per accident for ambulances is 11,069, and for sitting-case cars 24,086. The health-service cars, driven exclusively by district nurses and midwives, show a figure of 28,324 miles per accident.
The petrol-consumption rate of the Ka rrier ambulances averages 15.5 m.p.g., with a weekly mileage of 205. The Hillman utilities show a figure of 25.9 m.p.g., with a weekly mileage or 250. The all-in cost per mile is 3s. 10d. for each ambulance and Is, for each car. Although the figures are reasonable, having regard to the exacting nature of the services performed, they indicate the high cost to the Nation of sickness, disease and accident.
In this connection, the report records some interesting facts. The total number of patients moved in 12 months was 26,206. Of these, 8,877 were accident cases—nearly a third of the total, The greatest percentage of street accidents involved persons between 21 and 30 years of age, and the worst time for these accidents was 5-6 p.m.
The average.time taken throughout the courtly from the receipt of an emergency .call to the attendance at the scene was 8.4 minutes, over a period of 12 months. whilst the average time from receiving the call to delivering the patient at the hospital was 24.61 minutes.
Co-operation between the authorities and the vehicle suppliers assisted greatly in attaining such efficiency.