Developing alternative ambulance response schemes: analysis of attitudes, barriers, and change.

OBJECTIVES: Alternative response schemes for emergency calls are being set up by many UK ambulance services. The barriers to such developments from the perspective of ambulance service staff have not been formally investigated. The aims of this study are to identify attitudes and barriers to the development of alternative response schemes and ways of easing the transition as they are implemented.
METHODS: South Yorkshire Ambulance Service crews and control room staff were interviewed, using South Yorkshire's paramedic practitioner (PP) scheme as a model of an alternative response scheme.
RESULTS: 55 ambulance crew and 17 control staff were interviewed. Most (97%, n = 70) thought that the PP scheme was a good way of dealing with patients who call 999 but may not need urgent transport and hospital treatment. The perceived effect of the PP scheme on traditional ambulance service duties was equally divided between a third who thought there had been no effect, a third who perceived an improvement, and a third a deterioration. Recurrent difficulties with the scheme were found relating to the AMPDS methodology of ambulance dispatch, and ambulance service performance targets.
CONCLUSIONS: Flexibility of AMPDS and dispatch targets will need to be reviewed to permit the successful implementation of alternative responses to 999 calls. Careful consideration needs to be given to communicating the aims and value of such schemes to all staff and ensuring a common understanding of, and commitment to, a shared vision. The effect of implementation on the remaining service function must be well planned.