Ambulance

Some thoughts from EMS2016 keynote speaker Professor Douglas Chamberlain
Ambulance in use in Odense in 1919. Such horse-drawn
ambulances were used in some provincial cities right up
until the beginning of the 1940s. Source unknown.
this was indeed the case. The creation of
the European Society of Cardiology (ESC)
led to major improvements in this regard
and continues to do so. Within resuscitation
medicine, a breakthrough came when the
Laerdal Foundation invited members of
national groups from many countries to
a meeting in Stavangar where we met
each other for the first time. International
meetings then became commonplace. Not
only did we learn from each other, but a
consensus on best practice was passed
on from a new international committee
(ILCOR) to regional bodies that used them
to create guidelines suitable for local needs.
Our own regional body, within Europe, was
conceived initially as a working group of
the ESC, but fortunately this did not work
out and instead the European Resuscitation
Council (ERC) was formed. This body
has considerable relevance to ambulance
services because it issues important and
definitive advice on the management
of prehospital as well as in-hospital
emergencies. But its remit does not include
organisation.
The question arises as to whether we
need an international group devoted
to ambulance services that may help
them learn from each other in terms of
organisation, scope, and objectives. One
pattern will not suit all, but there will still
be ideas that can be shared to the benefit
of many. Meetings need not be frequent
but occasional direct contact is essential
Red Cross ambulance from the Holbaek approx. 1950.
Source: The Danish Museum of Science, the Zonen
Collection.
so that colleagues from other countries
will be known and indeed friendships built
up. We do already have some national
and local groups but these may have their
own agendas that may not represent views
of the majority of providers. It would be
worth exploring the feasibility of individual
administrative units having membership,
despite large variations in size across nations.
Whilst the intention should not be
pressure to harmonise the types of service,
discussions would have an influence in the
medium or long term. Some principles are
worth mentioning. In all advanced countries,
services should be rapidly available to all
through a common national or international
phone number. Only one service should
exist within any one region. Whilst high
degrees of clinical expertise should be
available, patient transport without the
requirement for immediate treatment
must also be provided. These leave room
for other differences some of which will
depend on other aspects of health care
outside ambulance services; here there is
room for evolution. In some areas of the
United Kingdom, we have practitioners with
advanced training in critical care and others
in domiciliary care. How many levels of
expertise are optimal? Would it be useful
to discuss the criteria for non-conveyance,
the maximum time on scene for different
heart rhythms, the need for widespread
use of emergency ultrasound, the use of
mechanical compression or the availability
of ECMO? In particular, we need additional
Ambulance care in the UK began to develop rapidly in the
late 1970S
emphasis on immediate or retrospective
feedback on compression quality, liaison with
community first responders, the necessary
skills of dispatchers, and the immediate
availability of medical or other advice. The
list of course does not end there.
We do have an opportunity to discuss
these matters at the up-coming EMS2016
Congress in Copenhagen in late May. This is
particularly appropriate in that colleagues in
Denmark have shown not only how rapidly
progress can be made but demonstrated
too the impact on benefit to patients.
We can all learn from each other. Let us try
harder to do so.
Pre-hospital cardiac care is now far more advanced
Electrocardiograph patient with technician, c.1929
Medical students watching an operation in theatre,
c.1950-1960
Book your place at EMS2016 now at: www.ems2016.org
Professor
Douglas
Chamberlain’s
keynote address entitled: The
History of EMS will take place at
10.30am on Monday 30th May and
will open EMS2016.
Spring 2016 | Ambulancetoday
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