Cycle responders from the ambulance, police and fire and rescue service in the US have been established for over two decades (Becker, 2008). The International Police Mountain Bike Association (IPMBA) was founded in 1992, providing the foundations for uniformed services responding to calls and patrolling on bicycles in the US (IPMBA, 2012). In the year 2000, in the UK, the London Ambulance Service (LAS) developed a pilot trial of responding on bicycles, led by LAS emergency medical technician and Team GB BMX World Champion, Tom Lynch MBE which later was developed into the Cycle Response Unit (CRU), as it is known today (Figure 1). Lynch independently set up the CRU alone and joined with IPMBA in 2004 to develop an affiliated course to equip emergency services personnel with the skills to respond and patrol safely and efficiently, this being known as public safety cycling (PSC) (Figure 2), which was founded in 2005 (IPMBA, 2012).
The process
To be a UK ambulance service cyclist, completion of a five day PSC course is mandatory. Prior to attending the course, prospective subscribers can acquaint themselves with the many patrol skills within the pre-course workbook. The 36-page workbook covers the various skills required to be an efficient, safe cyclist representing your organisation while remaining in the public eye. The workbook is informative with good visual aids and useful knowledge checks to prepare the student for the course, irrespective of previous cycling experience. Over the five-day course the student must successfully complete an aerobic fitness test, anaerobic fitness test, written paper, road assessment, skills assessments and bike maintenance test (Box 1).
| Aerobic fitness test (patrol test) | The student must cycle 2.5 kilometres at 80% maximum heart rate in a time frame adjusted for age, but typically within 5-6 minutes |
| Anaerobic fitness test (sprint test) | The student must cycle 1 kilometre in a time frame adjusted for age but typically between 105- 135 seconds. |
| Workforce stamina test (cycle road assessment) | A continual assessment throughout the course in which the student cycles the speed and distance set by the instructor to demonstrate the level of fitness required for the job. Normally at a speed of 15 mph over a distance of 1 kilometre safely to national standards level 3 for cycling. |
| Written test | Constitutes of 25 multiple-choice questions (not negatively marked) based on the pre-course workbook and the Highway Code. To pass, the student must achieve 75 % or higher. |
| Skills assessments | Slow speed skills such as the offset serpentine, the ten-foot box and the lock to lock. |
| Bike maintenance test | The student must demonstrate a cycle maintenance test such as removing a wheel, changing a tyre or fixing a puncture. |
The students are taught various skills that they need to perform at slow speed, including the ten-foot box, offset serpentine and lock-to-lock. All the skills require the rider to complete a circuit with tight corners in a small space involving continual cycling where the rider’s feet are not permitted to touch the floor. Throughout the course there are plenty of opportunities to practice with instructor support until the assessment and the skills have been mastered.
Over the duration of the course, obstacle clearing skills and the bike safety checks (ABC Quick Check) are taught and practiced. The student also has a kit familiarisation, so, upon reaching the call, they already have had an introduction to the various pieces of equipment they will be required to use when in the field. The course also involves practising group riding as CRUs are often used at large events and in order to portray a professional image this skill must be practiced—furthermore a night ride forms part of the PSC course which prepares the students for the subtle differences when cycling in the dark hours. Students who successfully complete the PSC course are given five shifts with an experienced CRU rider until they are confident and are then permitted to travel as solo CRU riders. This is not the end of the training however, as annually the CRU riders have to successfully undertake a Cycle Certification Test, involving a fitness test to ensure that they are maintaining the standards required to undertake their CRU duties.
Environmental benefits
One of the fundamental benefits of the CRU is the huge reduction in the carbon footprint. Often, the CRU is sent before a fast response unit (FRU) or an ambulance or as the only resource thereby significantly reducing the carbon footprint. In the LAS, a 216 tonne reduction in the amount of carbon dioxide emitted has been estimated for each year (Lynch, 2010b).
Furthermore, when a CRU proves to be the only resource used on a call-out, a large economical saving is also made. This is not only due to the initial outlay for the resource so ~£4500 for a fully equipped cycle compared to ~£53 000+VAT for a fully equipped FRU or ~£24 000+VAT for a motorcycle and ~£122 000+VAT for an ambulance, but also in the fuel savings, service, maintenance and other road usage costs. The estimated saving annually in Londonby using the CRU is ~£1 012 500 (Lynch, 2010b; LAS, 2012).
As healthcare practitioners we often provide health advice and actively promote a healthy lifestyle. The CRU is an excellent way to illustrate the non-hypocritical commitment we make to our health and fitness while undertaking our duties. The additional benefit of having a paramedic in the public eye, could be considered to be contributing to the community involvement aspect to provide health advice (Lynch, 2010a). Moreover, the CRU offers a dual purpose clinically, as they often arrive first on scene and are in a position to cancel further resources and manage their patients autonomously and use the appropriate care pathways (ACPs). Likewise, they can also provide early life saving interventions and deliverearly care to the critically unwell medical or trauma patient.
The CRU assists the core motor vehicle feet of responding to calls within the response times in congested and highly pedestrianised areas. Due to the large number of calls managed alone, there are, therefore, an increased number of mobile resources available to respond to other patients. This can benefit the ambulance trust with regard to funding as more calls can be met within the target with appropriate use of the CRU.
The National Cycle Response Unit Group (NCRUG) is an advisory group who set and maintains the standards, policies and guidelines surrounding emergency services CRUs, their role can be defined as:
‘The purpose of the National CRU Group established by the National Directors of Operations Group [NDOG] is to standardise UK practices of cycle response units to mitigate risk, provide a sustainable nationwide programme, protect staff and their wellbeing and with an absolute focus on ensuring the best possible service to the public’ (NCRUG, 2012).
It is clear that CRUs offer a large additional benefit to ambulance trusts, police forces, fire and rescue services and the voluntary aid societies. With regard to the ambulance services, the CRU can only be effective with an appropriate dispatch system. Previously, on occasion, CRUs have not been dispatched appropriately—possibly due to lack of understanding in emergency operations centres, issues with computer aided dispatch systems or a host of other factors. Senior operational managers and emergency medical dispatch staff must understand the optimal methods of CRU use, otherwise the full benefit of the unit will not be realised.
The CRU can benefit a paramedic’s career by offering a different perspective to patient care, and would suit a large number of clinicians who are confident and enjoy working autonomously and using ACPs. Additionally, where clinicians enjoy keeping ft or wish to increase their fitness and health, the CRU offers a fantastic opportunity. Typically in areas where gaining access with a FRU or ambulance would be challenging, congested areas with human traffic or motor vehicle traffic the CRU would be best used, hence, it is not applicable everywhere.
Conclusion
In conclusion, the CRU offers benefit in a number of means to the paramedic, it is an invaluable resource to a large number of UK ambulance trusts and ultimately benefits the patient. If a paramedic has the appropriate skills to offer, then the CRU can offer the paramedic an exciting and rewarding element to frontline work.