Thread by @ThomasJPaddock

Really scary sounding story about #ambulance provision in England today.

Closing 57 of ambulance stations?! :O

Why it's not actually as bad as you first think - a thread by a #paramedic. (1/15)

In the 1970s/1980s, ambulance services were simple; every town had a station, with more ambulances than the town needs.

If you called 999, one of the crews would come, take you to hospital, and then go back to their station to clean, restock, and play pool til next call. (2/15)

Whilst really easy to understand - it only works when you have more ambs than you need, and when it's busy, your two ambulances might both be 'on a job ' and if you call 999, one of the two crews in the next town will have to come - which might be 20 miles away! (3/15)

In the 1990s, someone realised having 2 free ambs in the town and no free ambs the city wasn't sensible; so something called the "System Status Plan" was born - complex maths, but really simple idea of moving free ambs around so the cover is better, and hence amb quicker. (4/15)

Through the 2000s & 2010s, the system started seeing way more calls - started to go straight from hosp to the next call.

The days of the little town's ambulance staying in the little town were pretty much over - from hosp, likely to stay in the city, or go to another town (5/15)

This isn't the disaster for the town you started in that you'd initially think, btw - because of the SSP, a crew from somewhere else will be on standby at your little ambulance station whilst you're off on tour, so if you call 999, you still get an ambulance quickly (6/15)

However - as things got busier (in the 2010s), people started going job-to-job.

Start in town, blue light straight into the city, spend the whole day everywhere except your town, and then finish either at the hospital, or in another town and drive back for a late finish (7/15)

The issue with that is - if I finish in Hospital at finish time, I'm now out the system until I drive back to the town ambulance station (let's say 30 mins).

But remember - in the 1970s, we had time to restock and fuel between patients. But we haven't been back all day. (8/15)

Now the oncoming crew need to restock and refuel before they can go anywhere - let's say another 30 mins or so.

We've got two shifts a day, so now the Littletown amb is only available for 22 hours a day.

(30 mins late off is generous btw, often 30-90 mins, sometimes hrs) (9/15)

We're now in the mid 2010s; someone realises that this is becoming really inefficient - we only get 22 hours of ambulance out of a 24 hour station.

And we are paying very expensive highly trained professionals OT to drive back to station and count bandages and mop floors (10/15)

The "Make Ready Centre" is born.

A dedicated team refuel, clean, mop, restock and check every amb, so you just turn up and go - and then put the amb back into the system at shift end to be "made ready" for someone else.

And it's 5mins from hospital too - so not late off!(11/15)

Whilst this does mean an ambulance doesn't start/finish in every town any more, because of SSP, one of the crews will still come and standby in the town whenever they can.

Even if they're driving 30 mins at the start/end to do so, it's still an extra hour of amb for town (12/15)

Now this Hub & Spoke model is up and running, every little town having a proper ambulance station with stores, showers, garages, car parking, drugs room, fuel pump etc doesn't seem very sensible; that's a lot of money on estates that we aren't really getting much from (13/15)

Enter a new idea - the ambulance room in a community fire station. A room costs less than a station - and we can pick the fire/police/GP practice/community hospital/whatever which is best to respond from, rather than being confined by where we built stations in 1970s! (14/15)

In conclusion, it sounds really odd - but closing your local ambulance station is actually better (and cheaper, so you get more ambulances!)

Sorry for the very long thread! (15/15)

TL;DR:

-Closing local amb station =\= losing your amb cover
-Local amb crew don't spend very much time in your local area these days anyway
-Large Make Ready hubs more efficient than lots of little stations
-When station is closed, ambs use fire stations etc to cover your area.