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Last Updated: Tuesday, 11 December 2007, 07:33 GMT
The beginning of the end for ambulances?
By Nick Triggle
Health reporter, BBC News

Ambulance
The modern ambulance service has come a long way
The modern ambulance service was born in 1946 when local authorities were given responsibilities for transporting patients to hospital.

But the emphasis was very much on the ferrying as they were not expected to provide medical treatment for another 20 years.

But the origins of the service actually date back much further.

Indeed, there are reports showing the injured and hurt were carried on horses during Norman times to places where they could be helped.

But the birth of any sort of system started in Victorian London.

The capital is believed to have had the first full-time service when in 1897 the Metropolitan Asylums Board began transporting patients.

Initially this was done by a horse-drawn carriage, but later steam and electric vehicles were introduced, before the petrol-powered motor became popular.

By 1930, the organisation had a fleet of 150 ambulances and six large ambulance lorries.

Patchwork

And they were also joined by a London police ambulance service.

Elsewhere, particularly in cities and towns, a patchwork of ambulance services began to emerge.

These were loosely run by town hall administrators with the help of the British Red Cross.

And it was this system that served Britain so well during the German bombing campaign during the Second World War.

AMBULANCE TIMELINE
1897 - The Metropolitan Asylums Board start transferring patients to hospitals in one of the first schemes of its kind
1946 - 1946 National Health Services Act requires councils to provide ambulances "where necessary"
1964 - The Millar report recommends ambulances provide treatment as well as transport
1974 - Ambulance services transferred to NHS control

Hundreds of lives were saved as volunteers dragged the injured from the rubble of bombed-buildings and took them to hospital.

The success persuaded the Atlee government to set up a national ambulance service at the same time it was creating the NHS.

The 1946 National Health Services Act required councils to provide ambulances - albeit with the caveat "where necessary".

This continued until 1964 when a government-commissioned report called for ambulance services to provide treatment.

Soon it became common-place for life-saving procedures such as haemorrhage control, neck and back injury care, heart resuscitation and oxygen to be given in the back of ambulances.

By the mid 1970s, the medical aspect had developed at such a pace that it was felt necessary to hand control of the service to the NHS.

And then as technology developed even further so did the form of ambulances. The first air ambulance was launched in Cornwall in 1987.

And then in the early 1990s ambulance cars, staffed by one paramedic, became popular in London in response to a shortage of staff. Other areas soon followed.

Solo-response cars

This period also saw a change in the nature of calls ambulance services began to receive.

Unison official Sam Oestreicher said: "Increasingly, people began dialling 999 for things that were not life-threatening.

"I think there were a number of reasons for this - people becoming more demanding of the NHS and problems with seeing doctors during out-of-hours."

This in itself demanded a different response from ambulances with more call to treat patients at the scene.

Again, this allowed policy-makers to put the case for the solo-response cars.

Increasingly, people began dialling 999 for things that were not life-threatening
Sam Oestreicher, of Unison

But their use is now becoming even more widespread as bosses grapple with ways to hit ever-more ambitous response times under the Call Connect target.

From next April, ambulance services will have to answer the most serious calls within eight minutes.

To do this, many are splitting up their two-manned ambulance crews and putting more solo-reponse cars on the road.

The move prompts the question: Is this the beginning of the end for ambulances?

No, not quite, says Mr Oestreicher.

"There will always be a place for the traditional ambulance. Solo-responder need them as back up and some patients will need to be transported to hospital.

"The ambulance service is just evolving."



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