Is this a gamble with people's lives?

ON a freezing, fog-shrouded night in Upper Weardale, more than 200 people turned out to a public meeting. The reason why so many people left their firesides and headed out into the bitter cold was concern about the future of rural ambulance services. To put it bluntly, people fear that changes to ambulance services could mean delays in transferring loved ones to hospital in the event of a serious stroke or heart attack.

In the firing line were senior officers from the North-East Ambulance Service (NEAS), attempting to explain changes which they believe will improve services to rural and upland corners of the region which are far from major hospitals.

Judging by the response across the region - and the unanimous show of hands by those against any change at the St John's Chapel meeting - the ambulance officials have a big job to do before proposals will be widely accepted.

Plans to modernise ambulance services in rural parts of the North-East first surfaced this summer, with the announcement of public consultation exercises in areas affected, including Weardale and Teesdale.

In a nutshell, NEAS bosses argue that the only way to meet tough national targets of attending at least 75 per cent of life-threatening 999 calls within eight minutes is to scrap the current system of asking off-duty crews at rural ambulance stations to answer 'blue-lamp' calls during the night.

Apart from concerns about the European Working Time Directive, the question of whether it is safe to rouse ambulance staff from their beds and expect them to deal safely with a medical emergency is still a live issue.

Encouraged by the results of experiments in places like East Anglia and Staffordshire, NEAS is thinking of replacing the permanent standby crews with a new type of highly-trained ambulance officer working on their own. Known as 'community paramedics' (CPs), they would not be permanently stationed in rural areas but would provide a mobile, flexible service across a wide area. Trained to deal with life-threatening emergencies such as heart attacks and strokes, the CP would be on duty 24 hours a day on a shift basis.

Contrary to speculation that CPs would be in a car or even a motorbike, the new breed of ambulancemen or women would drive a scaled-down ambulance carrying what would virtually be a mobile clinic.

The idea is that community paramedics would respond to 999 category "A" calls and use their enhanced diagnostic skills to stabilise a heart attack or stroke victim while the nearest available emergency ambulance was despatched to provide support.

Unlike the current arrangements, which mean that the single ambulance crew based at St John's Chapel can be away from the area for several hours while transporting a patient to Bishop Auckland General Hospital or Darlington Memorial Hospital, the new system would mean the CP would remain in the dale to answer any further calls. If the CP establishes that the patient does not need to be taken to hospital, the supporting ambulance is stood down .

But what is really novel is the notion that while CPs are waiting for 999 calls, they can be deployed across regional areas to support the work of GPs and district nurses. If the scheme gets off the ground it could result in community paramedics collecting blood samples from people's homes or helping to immunise babies or elderly people.

As well as the ambulance station at St John's Chapel, those in Barnard Castle and Middleton-in-Teesdale would also be affected. The proposals have been criticised by Barnard Castle Town Council and led to a 1,000-strong petition by those opposed to the changes in Teesdale.

Douglas McDougall, out of hours development manager for the NEAS took part in the St John's Chapel meeting. He has taken part in more than 30 similar meetings across Durham and Northumberland and believes the message is getting through.

"The main thing driving all of this is to improve patient care," says Mr McDougall. "The biggest advantage in introducing community paramedics will be to get a trained officer to the patient much quicker."

Because rural ambulance stations are relatively quiet, the changes would make the best use of staff time, he says. "We need to train up our people to give them more diagnostic skills. We need to cut down on unnecessary trips to hospital and give more support to primary care."

John Shuttleworth, county councillor for Weardale, represents a formidable obstacle to the ambulance service plans. Having taken an early interest in rural ambulances when he was elected in 1995, he has no intention of letting it drop.

"They were not manning the ambulance station in St John's Chapel at that time so I wrote to them about it," recalls coun Shuttleworth, who arranged for most homes in upper Weardale to be leafleted for last week's meeting.

"Then someone had a heart attack and died. A few days later it happened again and somebody else died. Only then did they find the money to staff it."

He can't see any reason to change the current arrangements. "The current system works. They are talking about moving the nearest ambulance to Stanhope down the dale. But if they do that, they will struggle to get to places over the top of the dale like Sparty Lea or Blanchland."

The current arrangement means that the St John's Chapel ambulance can get up to Lane Heads in 20 minutes and down to Stanhope in 20 minutes.

"All they are doing is gambling with people's lives," says coun Shuttleworth.

He suspects that the move is to allow the ambulance trust to meet its targets by concentrating on answering calls from the majority of people who live further down the dale. "If this community paramedic idea is so good, why don't they do it everywhere?" he asks.

Certainly, the packed meeting at St John's Chapel threw up a number of thorny issues. John McCutcheon, who lives in an isolated farmstead near Westgate, has already survived one heart attack and fears a second.

"When I had my heart attack they were there within 16 minutes and I was in hospital in 50 minutes where I had a clot-busting drug. If that happened again in February what would happen? I will get the clot-busting drug but if the nearest ambulance is parked outside Bishop Auckland hospital we are looking at a one and a half hour wait before getting to hospital," says Mr McCutcheon.

Retired GP Dr Jennifer Holden expressed sympathy with ambulance crews who are on standby through the night. "I was a GP for 30 years. I am aware of the destructive effect of being on duty for long periods out of hours, the impact on marriages and families."

But she expressed concern about ambulance crews from outside the area answering calls. "When I broke my hip, it took two hours to reach me. They had no idea where I was."

Mr McDougall is under no illusion about the task on the ambulance trust's hands, but he believes that attitudes are changing and the proposals are getting a more sympathetic hearing.

Yet coun Shuttleworth says: "I called for a show of hands at the meeting. No-one was in favour. If they won't listen to that they won't listen to anybody."

* Firm proposals for changes to rural ambulance services are expected to be announced shortly. They will be subject to full public consultation before any changes are made.