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Tuesday 17 November 2009

Well a girl can dream.....

...... there have been a lot of rainbows around lately and I always make a wish upon them, of course. Anyway I awoke this morning, looked out the window and thought "Ooooh my wish has come true!" Standing in my field at the back of the house was A Man in Uniform...... but before I could rush out to see if he was also carrying chocolate, I got a phone call from my neighbour to explain. My hopes were dashed before the end of the call as it appears the chap was connected with the Scottish Ambulance Service (SAS) prospecting for landing sites for the Air Ambulance in case of future medical evacuations. Oh well - it was still good to see the pilot in the field - even if it was just because it means we are able to get procedures in place for medical evacuations.

I've been meaning to report our recent training as "First Responders" by the Scottish Ambulance Service. This scheme is set up to enable communities to deal with emergencies while waiting for trained paramedics or doctor to arrive. So a Community First Responder will be on call to immediately attend an emergency and provide assistance during that crucial "golden hour".

We had Day 1 of our training a couple of weeks ago (sorry been too busy to report!). About fourteen of us on the island attended the course and learned basic procedures for the recovery position, CPR as well as using a defibrillator. We are yet to have Day 2 training and then we go "live" (interesting term). We will have a rota on the island with two people being "on duty" and carrying bleepers, as well as having "First responder" uniforms (yellow reflective jackets and waterproof trousers - let's hope it's not "one size fits all" or it could be interesting!). We will also be given our medical pack with defibrillator and other equipment.

The procedure will then be that once someone on the island phones 999 or NHS24, the First Responders will be alerted and go to the scene. Now on Graemsay as soon as there is any emergency, word is passed around the island and folk turn up to lend assistance. There have been several medical evacuations in recent years, and being an island this can bring certain challenges. One evacuation was via a helicopter in a gale and so help was needed to get the stretcher into the helicopter. On another occasion a stretcher had to be taken down to the pier and put onto the boat. So, as I say, folk just turn up when word goes round to see what help may be needed.

However none of us has medical experience and as it would take a minimum of probably 45 minutes to get paramedics onto the island through the usual route (Blue flashing light ambulance from Kirkwall to the harbour (20 mins), load equipment onto boat and then sail across (probably another 20 mins) and then into car to patient) we felt we wanted to be able to do more than just hang around anxiously. So, in conjunction with our GP surgery in Stromness and the SAS (no not that one, the Scottish Ambulance Service) we've started training.

The provision of "First Responders" has been controversial in other parts of the UK, and indeed in Orkney. This is partly as it is feared that the "target response time" will now be taken as having been achieved when a First Responder arrives on the scene rather than when an ambulance/paramedic arrives on the scene. The NHS is keen on targets....... Also on other islands the fear is that their medical service will be downgraded. A number of Orkney islands still have resident GPs as well as nurses. This is a costly service to provide and there have been controversial attempts to not replace GPs when they leave, and require nurses to provide more provision. However on Graemsay we don't have *any* medical provision on the island. Our nearest GP surgery is in Stromness across the water. Now - the Stromness GP surgery is fantastic. We can't praise them highly enough for all that they do, and they have a great understanding of the needs of our community. However - they are across the water, and out of hours provision is via NHS Orkney which has a limited number of doctors "on-call" who could be on another island when there is an emergency. So one GP in particular has been helping us organise the training as "First Responders".

And back to the helicopter pilot at the beginning of this post..... he's out looking for landing sites and my field has been selected as a potential site - it's flat, no overhead power cables nearby, easily identified (there's a great big lighthouse next to it) and close to a road. So the plan is we will be issued with landing lights which we would place in the field when we are alerted that the helicopter will be needed. And that brings me to the next controversy - Orkney used to have its own "air ambulance" which was a plane stationed at Kirkwall Airport. However this service was withdrawn due to cost and instead the air ambulance is a helicopter which has to fly up from Inverness. As you can imagine this has caused concern about time delays. However on Graemsay a regular plane could not land (no landing strip) and the same is true for a couple of other islands so we have always had to rely on a helicopter, or evacuation via the ferry.

Evacuation via the ferry - I hear some of you ask why not the lifeboat? Well actually the ferry is much better geared to medical evacuation as it is more easily accessible (well apart from a stretcher needing to be winched off and on - yip really...... in the cattle box as that is the safest way) and there is more space on board for medics to be able to attend to the patient on the journey back to Stromness. And the MV Graemsay can get up speed too when it chooses! However with our interim ferry, the Golden Mariana we would need to rely on the Lifeboat as it would not be possible to get a stretcher inside on the wee boat.

Anyway we are a little nervous about the prospect of being "called out", but as someone with several chronic medical conditions, it is comforting to know there will be *some* assistance on the island!

Note: we have a "community hospital" in Kirkwall which can deal with certain emergencies, but most major emergency cases are airlifted south either to Aberdeen or specialist hospitals in either Glasgow or Edinburgh. And yes that makes patient visiting practically impossible!


  1. It all sounds pretty well organised up there.

    First Responders do a marvellous job. We have them in our village, here in rural Hampshire. We are a bit remote, but nothing like you are!

    Good luck with the training and here's hoping you won't be needed too often.

  2. Wow...tremendous. I'm still trying to get to grips with the organisation needed with so many small inhabited islands. What a shame about your own air ambulance... they are costly indeed; they’re forever trying to raise money for the Devon one.

    But good on you and here's to you all and your patients...I know you'll be excellent.

  3. Martin - yes I think we are all hoping we won'tbe needed too often too!

    Paula - In some ways our challenges are not disimilar to any other rural area in the UK, but in others, that short stretch of water between us and the Orkney Mainland and the Scottish Mainland make a whole lot of difference. And I had NO idea just how different until I moved here.