Ambulance bosses in Yorkshire have come out fighting following suggestions they are putting patients' lives at risk because of a lack of trained paramedics. STEPHEN LEWIS reports.

If you had a heart attack while walking along the street, would you prefer to see an ambulance crewed by two highly-trained medical technicians arriving within minutes, or no ambulance at all because a paramedic was off sick?

That is the choice Yorkshire ambulance bosses face in the one in ten cases where a 999 call comes in and there is no paramedic available to respond.

"If my heart stops, I want an emergency response with somebody who can save my life," says John Darley, Yorkshire Ambulance Service's director of operations.

"A response in terms of a double tech crew an ambulance crewed by two technicians, rather than a technician and a paramedic is certainly better than me dropping that shift because a paramedic is off sick."

Ambulance bosses have come out fighting following claims earlier this week that they may be putting patients' lives at risk because of a lack of fully-trained paramedics.

Only 48 per cent of the service's frontline response staff are paramedics, with the remaining 52 per cent being emergency medical technicians.

According to a report in one Sunday newspaper, those figures ranked the Yorkshire service 11th out of 12 services in the country in terms of the proportion of paramedics it employs.

Wrong, Mr Darley responds, the service ranks eighth out of 12.

The man or woman in the street might think that is still not that great. And because of the comparatively low proportion of highly-trained paramedics, while the aim is always to send out ambulances crewed by one technician and one paramedic, inevitably sometimes there is no paramedic available.

In those cases, an ambulance crewed by two technicians is sent out instead.

That happens in just over one in ten emergency calls, Mr Darley accepts, usually because of sickness.

But he won't accept any suggestion that an emergency medical technician is unfit to deal with emergency call-outs.

Technicians are all trained in emergency driving, and also have 80 per cent of the clinical training of a paramedic, Mr Darley stresses.

That includes training in all the essential life-saving skills, such as use of a manual defibrillator to restart the heart, resuscitation, and treatment of abdominal pain, bleeding, seizures and allergic reactions.

There are on the Yorkshire ambulance service's staff many emergency technicians who are experienced and capable, Mr Darley says.

"It is insulting and inaccurate to depict a technician as being anything other than a highly-qualified member of staff," he says.

So if you collapse in the street with a heart attack, are you in safe hands if a technician responds?

"They have all the essential life-saving skills, and that includes using a defibrillator to start your heart," Mr Darley said. "A technician will do that to save your life."

UNISON, the union which represents paramedics, has gone on record as saying the research carried out for ITV's Tonight With Trevor McDonald programme which led to claims patients' lives were being put at risk bordered on "scaremongering".

The union said that deaths in Yorkshire attributed to the lack of a paramedic on board an ambulance were few and far between.

Nevertheless, there have been some.

In Knaresborough 18 months ago, Bruce Cartwright choked to death. A paramedic was available, but was not sent out. The technicians who responded were not trained in the use of forceps, which might have removed the blockage from Mr Cartwright's throat.

Mr Darley said he could not discuss that case because a complaint had been made and it was being investigated.

But it had involved airway management, an area in which paramedics are trained, but emergency medical technicians are not.

In the rare cases that a "double tech" crewed ambulance reached an emergency and felt they could not cope, they would immediately call for a paramedic as back-up, Mr Darley said.

All very well. But why is the proportion of paramedics to technicians so low in the first place?

If the aim is always to try to send out an ambulance with one paramedic on board, why not have enough paramedics to do that, even if someone is off sick?

It is partly a historical reason, Mr Darley said. In the past, ambulance staff were recruited and trained as technicians, and could then go on to qualify as a paramedic if they wanted to.

But some did not want to, perhaps because they were happy with the skills they had and did not want extra responsibility.

"It was up to them. We would not say to a technician I'm ordering you to become a paramedic'," Mr Darley said.

All that is about to change.

Over the next two years, the service will be recruiting a significant number of paramedics - and training technicians to become paramedics - to boost the ratio to something more like two paramedics to every technician.

That should guarantee every ambulance responding to an emergency has a paramedic on board, while also increasing the number of ambulance cars crewed by a single paramedic, Mr Darley said.

That ties in with a Government drive to increase the responsibility of paramedics, launched two years ago following a report by London Ambulance service chief executive Peter Bradley.

His report, Taking Healthcare To The Patient, envisaged paramedics as a kind of mobile medical service instead of simply a high-powered emergency taxi.

The aim is for crews to offer treatments such as administering clot-busting drugs, diagnosing patients, and deciding en route which hospital to take them to.

Some Yorkshire paramedics are beginning to do such tasks, paramedic and Yorkshire Ambulance Service union rep Glean Gears told The Press recently.

According to UNISON, the biggest danger to patients now is not the so-called shortage of paramedics, but the proposal to replace technicians with ambulance health care assistants.

This is another drive that originates with Government, Mr Darley admitted.

Some ambulance services - though not, so far, Yorkshire - now employ "emergency care assistants". These are ambulance crew-members who have a lower level of training than technicians.

Ultimately, it is likely that all ambulances will be crewed by a paramedic teamed with a health care assistant.

Exactly what level of training such assistants will have has yet to be thrashed out with the unions. But the move has nothing to do with saving money, Mr Darley stressed. It is about finding the right balance of skills and training for an ambulance crew.

The money to train up and recruit new paramedics had already been ring-fenced.

The ambulance service was there to save lives, Mr Darley said. And that was what it intended to do.

What a turbulent ten years the ambulance service in North Yorkshire has had...

June 1997: The Galbraith inquiry slammed the harsh and inflexible management style and the culture of bullying and intimidation at the then North Yorkshire Ambulance Service. Chief executive Mike King had already retired on the grounds of ill-health. Chairman Murray Naylor resigned following publication of the report.

February 1999: Health Secretary Frank Dobson approves the merger of North Yorkshire ambulance service with the Cleveland and East Yorkshire services to form the Tees, East and North Yorkshire Ambulance Service (TENYAS).

June 2001: Ambulance boss David Craig quits after response times in North and East Yorkshire fail to meet Government targets. It was reaching only just over half of emergency calls within the required eight minutes.

October 2001: New ambulance boss Trevor Molton is credited with a turnaround which sees ambulances reaching emergency calls within eight minutes 75 per cent of the time. Molton, who was seconded to North Yorkshire from West Yorkshire Metropolitan Ambulance Service and served for a while as joint chief executive of both, was last year jailed for three years for conspiring to defraud the West Yorkshire service of £250,000. Former West Yorkshire finance chief John Miners was also jailed.

June 2002: Plans emerge to merge TENYAS with ambulance services in West Yorkshire and the North East to form a new super-trust.

September 2003: Outgoing chairman David Taylor says TENYAS has come through "unsettled times" and faces a bright future after the proposed merger with two other ambulance services was shelved.

September 2005: TENYAS could merge with ambulance services in West Yorkshire and South Yorkshire under Government plans to reduce the number of ambulance services, it emerges.

November 2005: The merger would make the ambulance service less accountable and less responsive to local need, warns Vale of York MP Anne McIntosh July 1, 2006: The Yorkshire Ambulance service is set up following the merger of the North and East Yorkshire service with those of West and South Yorkshire.

December 2006: The Press reports how paramedics are beginning to take on a higher-profile and more responsible role, including administration of clot-busting drugs to heart-attack patients, and deciding which hospital to take patients to.

April 17, 2007: Yorkshire Ambulance Service is ranked eighth out of 12 services in the country terms of the proportion of qualified paramedics on the frontline staff.

Paramedic vs Technician: how they stack up

Emergency medical technician
Nine weeks clinical training, plus a three-week emergency driving course.

Technicians then spend one year as trainees on the job, during which they should always be supervised. During that year they also have four extra days of training.

When fully trained, technicians are equipped with the full range of life-saving skills. These include:

* Use of a manual defibrillator to restart the heart.

* Resuscitation.

* Clearing airways and assisting breathing.

* Treatment of abdominal pain, bleeding, seizures and allergic reactions.

* Administration of oxygen and some pain relief.

At the moment, staff at Yorkshire ambulance service can only go on to train as a paramedic after serving two full years as a qualified emergency medical technician.

Their additional training then includes:

* Six-weeks in-house' training.

* A six-week placement at a hospital accident and emergency department.

Like emergency medical technicians, paramedics have the full range of life-saving skills. Their additional training includes:

* Administration of a much wider range of drugs, including clot-busting drugs and pain relief.

* Fluid replacement.

* Airway management.