The Ambulance Service: what it ought to be

The title of this brief comment was the final part of my inaugural Larrey Lecture given in London on 13 July 2016. It represents only an opinion; hence, some disagreement is naturally expected, and indeed, welcomed. Honest debate can stimulate progress.

Whilst physical maps and individual knowledge of local areas allow paramedics to find their way to critical locations, the use of satellite navigation is still used in the vast majority of tactical operations through the on-board vehicle mounted communications systems. What's more, the use of GNSS is likely to become even more integral to everyday missions. Oulu in Finland recently linked a monitoring system between the town's CCTV and central traffic light system with GNSS tracking. This enables emergency vehicles to be ‘green lighted’ through the main urban intersections to an incident anywhere in the municipal area, vastly improving the efficiency and effectiveness of the emergency response call-outs.

I have had a major interest in resuscitation since 1966, when Jude, Knickerbocker and Kouwenhoven reminded us of the value of external chest compression (Jude et al, 1966). Their paper triggered a chain of ideas that led to modern cardiopulmonary resuscitation (CPR). A dramatic but sad event in 1970 led me to teach an ambulance attendant on-scene how to perform CPR. His rapidly acquired skill prompted me to introduce the ‘extended training’ for ambulance crews into Europe in 1970–71, which included defibrillation and drug administration. Dr Peter Baskett had already taught ambulance personnel the use of entonox. Progress thereafter was a joint effort that led to the creation of a group we now call paramedics.