Having spent 14-years as a volunteer in Cork City Civil Defence, Peter Bowles got the bug for the emergency medical service from an early age and allowed his training and experience from the civil defence be a stepping stone to a career in the ambulance service.
In 2011, he moved to London and worked in the private sector, but he was always on the hunt for a job as a paramedic, something he is passionate about. That break came in 2014 when he moved to Birmingham to begin a student paramedic contract. Peter qualified as a Paramedic with the West Midlands Ambulance Service in 2016.
Report by Declan Keogh
Peter Bowles is very active on Twitter @wmaspeterbowles and provides a good insight to his followers into the operational, training and personal aspect to being a Paramedic in the West Midlands.
WMAS Paramedic Peter Bowles. (Photo Declan Keogh / Emergency Times)
In an interview with Peter at the EMS Gathering in Cork earlier this month, I started by asking him about the differences between the NHS Ambulance Service in the UK and the HSE National Ambulance Service in Ireland. “Within the UK there are so many services that do their own thing, some will focus more on urgent care, some will focus more on emergency care, some will offer different scopes and levels of clinical practice while others regions wont focus on those and direct their funds into that so it’s up to the individual ambulance services to focus their funds into either urgent care or emergency care.”
In Ireland, the National Ambulance Service supply services from 102 locations and operates a wide range of fleet including emergency ambulances, intermediate care vehicles, rapid response vehicles and a range of specialised support vehicles. The NAS has also invested significantly in the purchase of new vehicles and a fleet maintenance programme over the past number of years.
HART – Hazardous Area Response Team
Having served as a paramedic in the West Midlands Ambulance Service (WMAS) over the past four years, Peter subsequently progressed into his current role as a paramedic in the WMAS’ specialist unit HART – Hazardous Area Response Team. HART provides paramedic care to patients within a hazardous environment that would otherwise be beyond the reach of NHS care. This can include working at height, collapsed structures or within confined or contaminated environments. HART staff can also operate within the Warm Zone of a firearms incidents to triage, treat and extricate patients.
“Working in HART is excellent. Paramedics in HART receive extra training and skills which enables us to have the ability to work within the hot zone and warm zones of different types of incidents and major incidents, things like HazMat, CBRN, heights, confined space, MTFA scenarios and so on” says Peter.
Ireland’s terror threat level
Thankfully, the threat level to Ireland is quiet low, however, while there is always the risk of such an event occurring in Ireland and the Principal Response Agencies are continually working to reach a level of preparedness, competency and training in dealing with the threat of, potential for or an actual terror related incident in Ireland.
An Garda Síochána and the Defence Forces regularly carry out tactical training exercises to prevent or deal with terror related incidents, some on their own and some jointly.
In its 2016 Operational Report, the National Ambulance Service outlined plans to provide specialist response teams to lead or support the Health Service’s response to maritime, public health (e.g. Ebola Virus Disease), public order, Hazardous Material (HAZMAT) and Chemical, Biological, Radiological or Nuclear (CBRN) incidents and the NAS carry out regular training exercise on these scenarios.
HSE National Ambulance Service exercise. (Photo: NAS)
Bowles believes there are some factors which might challenge the establishment of a HART type unit in Ireland. He said, “I do see potential benefits for the National Ambulance Service to take on a role like Hazardous Area Response Team, certainly some of the training, but I think there are certain challenges in Ireland that are not necessarily present in the UK such as the population, the workload, roads network and so on.”
Terror related incidents which occurred across the UK have undoubtedly challenged the police and emergency services; operationally, mentally and financially. However, from dealing with those horrific incidents, it has made those people and services on the frontline more resilient and more prepared for future attacks or incidents.
“The UK has learned from those incidents but what we do in the UK is look at systems that happen outside the UK and apply them to the UK system to see would we be able to cope with that. In turn I think Ireland could benefit from doing the same thing even though the terror threat level may not be as high in Ireland as it is in the UK, there is still a chance there so there is an opportunity for them to learn even more, have shared learning with the UK, see how the UK responds and see the types of challenges that they encounter with those significant incidents that have unfortunately occurred.”
The annual EMS Gathering which is held in Cork provides a platform for emergency medical service personnel from different corners of the world to develop their skills and learn new ideas and see how things are done elsewhere. Some of the paramedics who to Ireland to attend the EMS Gathering may not have realised the considerable travel times for conveying patients to hospital, the significant waiting times at different parts of Ireland, both in the response of an ambulance arriving and the waiting time in A&E, and that’s not seen that much in the UK.
Peter Bowles observing ‘terror incident’ exercise at EMS Gathering in Cork. Top Photo (EMS Gathering), Bottom Photo (Declan Keogh / Emergency Times)
Having met with paramedics and trainee-paramedics at EMS18 from Coventry and other places in the UK, one of the big differences I found for paramedics who travelled over to Cork is that they get to see how the services operates here, it gives them a greater appreciation for the distances which crews must travel to reach patients and then convey them to hospitals.
Peter Bowles believes it is important for paramedics to see what other people are doing outside their own country. “In terms of visiting the EMS Gathering here, it is important for paramedics to come outside the UK and for paramedics within Ireland to see what happens outside their country. There is lots of exciting research in other countries that will inevitably impact your own clinical practice in the country you’re in at some stage.
Dr. Jason Van der Velde guiding ambulance personnel from National Ambulance Service in Ireland, South East Coast Ambulance Service in Surrey and students from Coventry University Paramedics in the UK. Photo (Declan Keogh / Emergency Times)
I think it’s important to see what other people are doing because while they may be ahead of the trend in one aspect, you may be able to show them that your ahead of the trend in another aspect and that we can all learn. It’s about shared learning and a shared awareness about where we’re going as a profession globally.”
In England, people are used to having a regionalised system, regional trauma networks and regional assets where groups of hospitals will designate specialities in one hospital and other specialities in another, that is the norm in the UK, but not so much here, in Ireland its more of a District Hospital approach.
From voluntary to the frontline
Voluntary Services such as the Civil Defence, Order of Malta, Irish Red Cross, St. John Ambulance, and even the Garda Reserve and Reserve Defence Forces have all provided many volunteers and members with the knowledge, training, skills and learning tools to progress their careers further, as a stepping stone from volunteer to the frontline, and in Peter’s case, Cork City Civil Defence was that stepping stone.
Peter is still an active volunteer with the civil defence and returns to Cork regularly for duties and training sessions. I asked Peter about good interoperability and working relationships with other services, principal or voluntary, and what skills he learned from the Civil Defence and how it helped him to where he is today.
Volunteers at Cork City Civil Defence. (Photos: via Twitter @cc_civildefence)
“For me the Civil Defence was a great stepping stone into the frontline services, first of all it gave me an insight into the various services and I met people that were already volunteers with civil defence that were also in frontline services, but also through exercises and emergency call-outs we’d get to see more of the job, I think that’s important that there is some interoperability between the voluntary sector and the frontline sector because inevitably a lot of people begin in the voluntary sector and progress to the frontline, and those frontline paramedics can then give back to the voluntary services and that’s a good circle to come around, from the voluntary into the frontline.”