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British paramedic shadows Summit County Ambulance Service

by Kathryn Corazzelli
Summit Daily News
Summit Daily/Kathryn Corazzelli
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Most people go on vacation to escape from their work life. When Emma Toose was planning her trip to Summit County, she willingly penciled in a day of work.

Toose is an ambulance technician and avid skier from Bracknell, England. She visited Summit County five years ago for vacation, and loved it so much she decided to come back. Only this time, she wanted to observe the American equivalent of her job, which she has been doing for 10 years.

“Ambulance work was something I have always been interested in,” she said. “Pursuing it as a career was an ambition come true.”



Toose contacted the Summit County Ambulance Service about six months ago, and spent Friday shadowing a crew to see how things work. Toose said she was interested in how protocols were different, what kind of jobs they get sent to, how they man their vehicles, and what kind of qualifications are put on their ambulances.

“I was intrigued how they operated,” she said. “It’s very different in the UK.”



She said in England, police, fire and ambulance are all separate, while here they sometimes work together.

“This is a good exchange,” said Marc Burdick, director of Summit County Ambulance Service. “We’re as interested in hearing how things work for her at home as showing her how things work here.”

Different countries, different systems

In the United Kingdom, every citizen pays into the National Health Service – the world’s largest publicly funded health service – through their taxes. All citizens are covered. Toose said the payments are “marginal compared to what the national service offers for the people.” When an ambulance is called, it is paid for through the NHS.

In Summit County, the ambulance service is entirely supported by patient billing. There is no direct public support of the ambulance. The service is run like as business inside of the government; no tax dollars are taken out, and they infuse money back into the government.

Another one of the biggest differences between the UK’s system and ours is the way they handle emergency calls. Toose said calls either come through 999 (the UK’s 911), or NHS direct, a non-emergency number. The ambulance service -or even a general practitioner (GP), depending on which number is called – shows up to the patient’s home and decides if hospital care is needed. Toose said she often calls the patient’s GP to consult about care. Doctors might go out to see the patient, or tell Toose to bring them to the hospital. She said they often see patients they don’t transport.

“If we don’t see that it’s fit to go to a hospital, we can tie it to an alternative pathway,” Toose said. “We can either get back in touch with their doctor, send them to their local minor injury unit, or take them ourselves.”

Toose said the UK’s highest level of emergency personnel, emergency care practitioners, work alongside the call centers to decide what kind of care is needed.

“It sounds like these guys connect a little bit more with the patient’s private doctors than we do,” Burdick said. “We pretty much don’t have much of a relationship with the patient’s physicians, because all of our control comes out of the emergency room here.”

Burdick said having physicians in the field would be a more cost-efficient way to run things.

“That’s really something that’s not built in the United States that’s common in other areas,” he said. “That really works to keep low emergencies out of the emergency department.”

Toose said this was a recent change because of cramped emergency rooms. Ambulance technicians were given further training so they could decide if hospital care is needed.

“There’s a big swing on trying to keep patients at home to try and free up emergency care rooms,” she said.

James Woodworth, deputy director at the Summit County Ambulance Service, said the UK ambulance service is “almost opposite” to ours.

“We try to minimize our on-scene time, whereas (they) try to maximize it,” he said.

“We don’t have that protocol,” Burdick said. “We tend to take everyone to the hospital, which creates a lot of problems. That’s much more integrated health care. I think it’s something we need to head towards in the United States, primarily because it’s way more cost efficient to run health care that way.”

Toose said the areas assigned to ambulance services are smaller in the UK, which makes it easier to go to the hospital or call a doctor to the scene if the hospital isn’t needed.

“I think the difference here is the geography,” she said. “You’re so remote; you’re so vast in what you cover.”

In both countries, it seems the basics are the same. The same equipment is used, and skill levels of emergency personnel seem to be similar. Skill levels here consist of: EMT, EMT intermediate, paramedic and critical care paramedic. Both services are also required to bring patients to the hospital if they insist.

Toose said she was excited, and a little nervous, for her ride along on Friday.

“I was a little bit nervous because I didn’t know what to expect, but it’s really nice to see how things work in a different country and see what the different protocols are,” she said.

Both Burdick and Woodworth said they were happy to have Toose visiting for the day. Woodworth said he can’t wait for his chance to shadow in the UK.


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