The trade union, Unite Scotland, today, 9 September) called on the Scottish Ambulance Service to declare a ‘major incident’ status at all hospitals with Accident and Emergency Units where turnaround times exceed 30 minutes. 

The demand has been made by the trade union to protect the public who have made 999 calls in the community, amid patient safety concerns due to 6 hours on average waiting times. 

A ‘major incident’ is any occurrence that presents serious threat to the health of the community or causes such numbers or types of casualties, as to require special arrangements to be implemented.  The status is currently ‘normal’ but if the Scottish Ambulance Service elevate the status to ‘major incident’ then other public health bodies are required to immediately assist. In practice, this means that NHS Scotland or community health workers may be required to attend to a patient in the community, which could involve the setting up of clinical tents until paramedics are able to attend.

Unite has made the call due to substantial delays in patients being admitted to major Accident and Emergency Units across Scotland arising from the significant pressures on NHS Scotland. This is directly resulting in ‘excessive’ patient waiting times to 999 calls in the community.  On average an ambulance response to a 999 call can take between 55 minutes, and 1 hour and 10 minutes, from call to completion. However, ambulance responses are now taking 6 hours on average due to ‘system overload’.  In real terms, this means an ambulance misses three 999 calls while located at a hospital waiting for patient discharges.  

Unite understands that there have been several ‘adverse clinical events’ over the last 72 hours arising from the delays, and that hospital turnarounds peaked at 7 hours on Tuesday night (7 September) with some patients waiting over 24 hours for a bed. Unite has also raised concerns over the potential risk to patients over clinical decision making due to fatigued ambulance staff. 

Jamie McNamee, Unite Convenor at the Scottish Ambulance Service, said: 

“Unite has asked the Scottish Ambulance Service to declare a major incident status arising from excessive hospital turnaround times due to the significant impact on all outstanding 999 calls. The reality is that there are excessive waiting times for paramedics to attend to a patient in the community as they are being held up at hospitals.

“On average the waiting time taken for an emergency call out to a 999 call has grown from around 1 hour to 6 hours to complete. Due to the system overload in NHS Scotland, there is the potential for adverse clinical events to happen to patients in the community. It’s essential that we elevate the status immediately because having ambulance crews tied up for extensive periods and subsequent fatigue, due to the long hours, is a known public safety issue. Lives of both the public and the crews are being put at risk.”

A  new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.

The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.

One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with seven per cent reporting the longest stay to be more than 48 hours.