The Scottish Ambulance Service () 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.
History 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.
St. Andrew's First Aid, the trading name of St. Andrew's Ambulance Association, continues as a voluntary organisation and provides first aid training and provision in a private capacity.
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.
Structure
Emergency Medical Service Capabilities 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.
Ambulance Control Centres The Scottish Ambulance Service also maintains three command and control centres in Scotland, which facilitate handling of 999 calls and dispatch of ambulances; a further 350400 staff employed as call handlers and dispatchers fulfil this role across three locations: Edinburgh, Glasgow and Inverness. These three centres (which, through use of software, operate as one integrated unit) have been in use since 2004 and handle over 800,000calls per year. The Advanced Medical Priority Dispatch System (AMPDS) is used for call prioritisation, and provides post-dispatch instructions to callers, allowing medical advice to be given over the phone, before the ambulance arrives. Clinical staff are present to provide clinical oversight and tertiary triage. Co-located with the Ambulance Control Centres (ACC) are patient transport booking and control services, which handle approximately 1million patient journeys per year.
Advanced Paramedics
Critical Care
Scottish Ambulance Service Advanced Practitioners in Critical Care (APCC) are based at Raigmore Hospital, Newbridge Ambulance Station in Edinburgh and Glasgow Airport. They are considered a Yellow level response in relation to the trauma network. They carry injectable medications not usually available to Scottish Ambulance Service paramedics.
They can undertake a number of advanced interventions, including:
DC cardioversion Transthoracic pacing Sedation Surgical airway Thoracostomy Advanced clinical assessment Advanced decision making Point of care ultrasound Paediatric intubation
Urgent and Primary Care Advanced Practitioners in Urgent & Primary Care (APUC) are located more widely across Scotland. Specifically at the following ambulance stations: Lerwick, Kirkwall, Stornoway, Benbecula, Lairg, Inverness, Lochcarron, Elgin, Aberdeen, Oban, Pitlochry, Callander, Perth, Dundee, Campbeltown, Paisley, Glasgow (Castlemilk fire station), Kilmarnock, Hamilton, Stranraer, Newton Stewart, Dumfries, Biggar, Melrose, Prestonpans, Edinburgh, Livingston, Falkirk, Stirling, Dunfermline, Cupar and Leven.
Retrieval Practitioners Scottish Ambulance Service employ a number of Specialist and Advanced Retrieval Practitioners as part of the ScotSTAR service.
Role within the Scottish Trauma Network 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.
Volunteer Resources
BASICS Scotland 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.
Community First Responder 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.
Highland Prehospital Immediate Care and Trauma (PICT) Team 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 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. It has a fast response car, but relies on the Scottish Ambulance Service sending a driver to the hospital in order to attend 999 calls. The usual composition of the team is an emergency medicine consultant with a middle grade doctor, with one or two emergency nurses. They attend around three patients a month. In 2020 Medic One declared their intention to cease operations and it was noted that their training and governance was unlikely to meet current standards.
Scotland's Charity Air Ambulance (SCAA) The Scottish charity air ambulance is a Scottish charity which since 2013 has worked to provide additional air ambulance resources to support the work of the ambulance service. They transport around 1 patient a day. The helicopter is crewed by 1 or 2 paramedics and a pilot.
Tayside Trauma Team The Tayside Trauma Team is an enhanced care team working out of Ninewells Hospital, Dundee. They attend around six patients a month. The team is made up of staff from the Emergency department, however they have no team capability to drive on blue lights, so need to be given a lift from another agency. This results in a variable mobilisation time: average time from 999 call to the team leaving the hospital is 25 minutes, with a range of 6 minutes to 1 hour 40 minutes. In 2020 the Tayside trauma team stated they would soon cease to operate and it was noted that their governance and training could be deemed inadequate by current standards.
+ Tabulated prehospital workload by resourceTrauma ResourcePrehospital patients seen each monthNotesPICT †150Data from January 2022EMRS Team †12Data from 20152015TTT †5.6Data from 2009MEDIC 1 *3Data from 1980 to 1990BASICS Scotland Volunteer *2-3Responder on the Outer Hebrides
† NHS Funded * Charity Funded
Fleet, equipment and uniform
The Scottish Ambulance Service maintains a varied fleet of around 1,500 vehicles.
Emergency response vehicles include ambulances, and single-response vehicles such as cars and small vans for paramedics. There are also patient-transport ambulances, which are adapted minibuses, lorries and support vehicles for major incidents and events, and specialist vehicles such as 4x4s and tracked vehicles for difficult access. The service also has three bicycles, which are only utilised during events at which Scottish Ambulance Service crews are present.
The geography of Scotland includes urban centres such as Edinburgh and Glasgow, areas of relatively low population density such as Grampian and the Scottish Highlands, and inhabited islands. Thus the fleet provision has to be flexible and include different kinds of vehicle. In the past, 4x4-build ambulances on van chassis were used in more rural areas, and traditional van conversions in more urban areas.
When a large fleet upgrade project was commissioned in 2016, the business case was made to move to a solely box-body on chassis build, to provide some flexibility and more resilient parts procurement. Most of these replacement ambulances have been based on either Mercedes or Volkswagen chassis, with a mixture of automatic or manual transmissions. The equipment used on board Scottish Ambulance Service vehicles broadly falls in line with NHS Scotland and allows for interoperability in most cases. Equipment is standardised nationally and replaced at regular service intervals; for example, high-cost items such as defibrillators are costed and changed every seven years according to clinical need.
The uniform is in line with the NHS Scotland National Uniform standard, which is in keeping with the uniform standard described by the National Ambulance Uniform Procurement group in 2016. Amongst cost and comfort considerations, all Scottish Ambulance Service Staff now wear the national uniform which comprises a dark green trouser/shirt combination. Personal protective equipment (boots, helmet and protective jackets) is issued to all staff and denote rank/clinical rank by way of epaulette and helmet markings.
Organisation
The national headquarters is located at Gyle Square, South Gyle, on the west side of Edinburgh.
There are five divisions within the service, namely: