Who will respond to your call

NWAS has a wide range of ambulance resources that are capable of dealing with patients with varying illness acuity.  The table outlines the resources in a traffic light approach, from lowest acuity to highest acuity.

Resource Crew Patient Acuity
Patient Transport Service 2x Patient Transport Staff

Transport only (no clinical intervention during journey)

Urgent Care Service

2 x Urgent Care Service Care Assistants

Low-Medium Acuity

Volunteer Ambulance Service

(includes St.John Ambulance & British Red Cross)

Patient Transport/Emergency Transport qualified staff combination (2 x staff)

Low-Medium Acuity generally, but this will be determined by crew combination.

Intermediate Tier

EMT2/Ambulance Technician or Paramedic working with a Urgent Care Service Staff member or EMT1.

Medium-High Acuity

Paramedic Emergency Service

EMT1 or EMT2/Ambulance Technician with a Paramedic or a combination of these.

High Acuity

When booking, you should identify the minimum level required to deal with your patient (as we can allocate this or above as resources become available to deal).  Paramedic Emergency Service resource requests should be reserved for the highest acuity patients.

Crew Qualifications and Skill Mix

Urgent Care Service Care Assistant

This ambulance consists of two Urgent Care Service (UCS) Care Assistant staff which will undertake an assessment of the clinical and personal requirements for a specified range of medical and trauma related patient conditions.  This will include ensuring accurate recording of patient observations and the delivery of pre-determined interventions and therapies.  They are able to deliver emergency care skills in the event of sudden patient deterioration, including the use of medical emergency warning scoring systems.

The UCS will deliver effective treatment and safe transportation of patients between their homes/treatment centres and locations as identified, whilst providing the appropriate standards of clinical and personal care within the pre-hospital environment.  These skills include:  

  • BLS and AED equipment (including portable oxygen, bag valve mask, oropharyngeal airways, suction techniques)
  • Vehicle based oxygen provision (including variable & non re-breathing masks)
  • Obtaining a patient history and performing a primary and secondary patient assessment.
  • Wound & bleeding management
  • Clinical observations -blood pressure, pulse-oximetry, blood glucose, tympanic thermometer
  • Orthopaedic stretcher/scoop stretcher
  • Basic fracture management (e.g. box splint) and basic immobilisation skills
  • Drug administration: Oxygen, Entonox
  • Supporting the Paramedic (e.g. assisting with IV cannulation and endotracheal intubation)

This level of ambulance will drive vehicles under normal road speeds, in a safe and competent manner.  They are not blue-light response capable.  This resource will only transport a child if there is a suitably qualified escort (e.g. Registered Nurse) accompanying the child. 

Volunteer Ambulance Service Staff

This includes the St. John Ambulance and British Red Cross Society.  These provide a valuable supportive role to the Trust in both routine operations and times of operational demand.  Their skills are commensurate with the UCS, but can provide additional clinical skills to support Paramedic Emergency Service operations.  There are two skills levels: VAS 1 and VAS 2

VAS-1 is commensurate with the UCS in respect to skill level and service provision. 

VAS-2 offers a range of patient assessment and clinical skills for a wider range of medical and trauma related patient conditions. 

Both levels will deliver effective treatment and safe transportation of patients between their homes/other treatment centres, other incidents and locations as identified, whilst providing the appropriate pre-determined level standards of clinical and personal care within the pre-hospital environment. 

Additional VAS skills include:

  • Fracture Immobilisation (including box, vacuum and traction splinting)
  • Cervical collar and spinal immobilisation skills
  • Drug administration: Oxygen, Entonox, Aspirin, Oral Dextrose, Paracetamol and Epipen (pre-prescribed)
  • Supporting the Paramedic (e.g. assisting with IV cannulation and endotracheal intubation)

This level of ambulance will drive under normal road speeds, in a safe and competent manner.  They are not currently blue-light response capable.   On occasion, an EMT2/Ambulance Technician or Paramedic may crew a VAS resource.  On such occasions, the resource will be classed as an Intermediate Tier resource and will be able to offer Intermediate Tier resource skills.  Their skill provision is currently under review.

Emergency Medical Technician Level 1 (EMT1)

EMT1'swill assist in the delivery of high quality and effective pre-hospital clinical care and patient transportation, respond to 999 emergencies under blue light and normal traffic conditions, inter-hospital transfers, urgent hospital admissions and other allocated patient interventions commensurate with the role and responsibilities.  They will work as a crew to initiate appropriate care and effective treatment to patients in both hospital and pre-hospital environment, selecting and applying appropriate skills and equipment safely and within their level of training, competency and scope of practice.  They offer similar skills to UCS and VAS-2 level, except can undertake emergency driving.

Emergency Medical Technician Level 2 (EMT2)

EMT2's are able to respond to the full range of emergency, urgent and routine calls under blue light and normal traffic conditions.  Paramedics will work on emergency ambulance and rapid response vehicles.  EMT2's will be the lead clinician when working with UCS, EMT1 and Student Paramedic staff.  EMT2's have the following additional clinical skills (above other levels):

  • BLS with automated and manual defibrillation skills, including the use of a bag-valve-mask and oropharyngeal airway (OPA), Nasopharyngeal airway (NPA) and Laryngeal Mask (LMA)
    • Recognise a range of clinical conditions and injuries and administer the appropriate treatment including the use of the following drugs:
  • Oxygen
  • Entonox
  • Aspirin
  • Oral Dextrose Gel
  • Glucagon (IM)
  • Adrenaline 1:1000 for anaphylaxis (IM)
  • Naloxone (IM)
  • Salbutamol (NEB)
  • GTN (S/L)
  • Ibuprofen
  • Paracetamol
  • Obtain a 4 and 12 lead Electrocardiograph (ECG) and be able to recognise abnormalities and a range of rhythms including Ventricular Fibrillation (VF), Pulseless Electrical Activity (PEA), Asystole, ST Elevation Myocardial Infarction (STEMI) and Left Bundle Branch Block and other ECG abnormalities.
  • Be able to recognise patients who are suitable to be streamed to specific care pathways (e.g. PPCI, CVA rapid access) or alternative care pathways or left at home using clinical support tools, such as Paramedic Pathfinder, Community Care Pathway and Self-Care Pathways
  • Following a thorough clinical assessment, be able to arrange for an alternative transport provider such as UCS, VAS, and Intermediate Tier or Planned Care resource.
  • Be able to recognise death and manage the bereavement with relatives.
  • Be able to use triage systems such as the Manchester Triage system or pre-hospital early warning scores to identify urgency and mode of transport.

Paramedic

Paramedics provide assessment, treatment and diagnosis at point of first contact by attending to patients in a variety of clinical & non-clinical settings, according to patient needs.  Paramedics will work on emergency ambulance and rapid response vehicles.  They provide treatment in accordance with Joint Royal Colleges Ambulance Service Liaison Committee (JRCALC) guidance, Health Profession Council (HPC) and local ambulance service procedures.  Paramedics will evaluate clinical information from examination & history taking and initiate appropriate treatment and/or referral.  This will include signposting appropriately to other services, referring patients to appropriate care settings and discharge or treat, as appropriate and within their scope of professional practice.

Paramedics will provide all the previously mentioned skills and: 

  • Full Advanced Life Support
  • IV Cannulation
  • Endotracheal intubation
  • Needle cricothyroidotomy and needle thoracocentesis
  • Manual defibrillation
  • Obtaining a 4 and 12 lead Electrocardiograph (ECG) and be able to recognise abnormalities and a wide range of rhythms including Ventricular Fibrillation (VF), Pulseless Electrical Activity (PEA), Asystole, ST Elevation Myocardial Infarction (STEMI) and Left Bundle Branch Block and other ECG abnormalities.
  • Prescribe and administer a wide range of pharmaceutical therapies for acutely sick and injured patients, including:- 
  • Adrenaline 1:10,000 (for cardiac arrest) and 1:1000 (for anaphylaxis)
  • Amiodarone (IV)
  • Aspirin
  • Atropine (IV)
  • Benzyl penicillin (IM/IV)
  • Chlorphenamine (IV)
  • Dextrose 40% Gel
  • Diazepam (PR and IV)
  • Entonox
  • Glucagon (IM)
  • Glucose 10% (IV)
  • GTN (Buccal)
  • Heparin (IV)
  • Hydrocortisone
  • Ibuprofen
  • Ipratropium Bromide (Neb)
  • Metoclopramide (IV)
  • Morphine Sulphate (IV)
  • Naloxone Hydrochloride (IV/IM)
  • Oxygen
  • Paracetamol
  • Sodium Chloride 0.9% infusion (IV)
  • Syntometrine (IV)
  • Tenectaplase
  • Enoxaparin (Cumbria only; for use with Tenectaplase only)