Within Northern Ireland’s stretch of 5,500 square miles is a culmination of complex history, raw beauty, and mythological wonder. Despite being a relatively small country, the geography offers a range of challenges to emergency ambulance response with many remote locations.
Tourists explore the vast countryside of “Glens of Antrim” and the famous North Coast “Giant’s Causeway,” a stepping-stone rock formation dated back 60 million years. Villages such as Strangford or Islandmagee are located on peninsulas, and the historical site of Dunluce Castle is perched on the edge of a cliff. Visitors are drawn to the stony stories of the Derry walls with their battle-filled history, and “The Dark Hedges,” described as an avenue of beech trees, have become ever more popular for their ethereal setting in the Game of Thrones series.
Living among these fascinating landmarks are 1.9 million people served by the Northern Ireland Ambulance Service (NIAS), which originated in 1995 and has grown in impact while remaining small. Only 100 employees handle 230,000 emergency 999 calls per year.
The NIAS Emergency Ambulance Control (EAC) room is based in Knockbracken Healthcare Park, just outside of Belfast. They have a fleet of over 300 ambulance vehicles, including mini buses (especially used in palliative care transport), support vehicles, rapid response vehicles (RRVs), and Accident and Emergency (A&E) ambulances to dispatch into the wide community.
The formal title “Northern Ireland Ambulance Service Health and Social Care Trust” denotes a broader focus, including sponsoring programs to meet the public’s general health care needs. For instance, their Volunteer Car Service (VCS) enables patients to be transported to non-emergency health care appointments and visits with the help of volunteer drivers.
Providing the best care for their patients is evident in the NIAS’ desired goal of maintaining their Accredited Center of Excellence status, which was first attained in 2017. However, re-accreditation felt unobtainable when the Covid-19 pandemic catapulted widespread repercussions throughout the world.
Exceptional demands in the emergency services meant the NIAS communication center had to prioritize support within their Control Room, putting the QA/QI processes on the backburner for a time. The team rapidly incorporated several new EMDs working alongside individuals with over 30 years of experience, creating a diverse dynamic.
EMDs were given little feedback or learning opportunities while surviving the upheaval of both their professional and personal lives in the face of the pandemic. Yet within a year of adaptation through adversity, the NIAS was ready to get back on track with their center’s high ambitions.
Re-evaluation and rebuilding
Hannah Maxwell, Emergency Ambulance Control Continuous Development Manager, said confidence was a key component as the NIAS re-evaluated efforts to achieve re-accreditation. Their resources were extremely limited with a small ambulance service and an even smaller Audit and Training Team. But the personal dedication of the entire staff to “be the best they can be for their patients” inspired the EMDs to respond positively to feedback and lean into training opportunities offered once again.
“Rebuilding the audit volume required for re-accreditation was difficult,” Maxwell said. “We took small steps to gradually increase our workload as we expanded our team and brought the National Ambulance Service (Republic of Ireland) Audit Team on board to help.”
With guidance, the internal Audit Team worked tirelessly to provide detailed call review, often dedicating long hours to support and encourage the EMDs and promote understanding.
“We tried to keep this simple,” Maxwell said. “We trusted the audit process and the MPDS® standards, as they are proven to work. This, coupled with the attitude of our staff and high-quality feedback from our auditors, ensured we could focus on stability and consistency.”
Jonny McMullan, IAED™ EMD Mentor Board of Curriculum Member, noted the exceptional quality of leadership and teamwork that made re-accreditation possible. “Hannah’s leadership of the Control Training and Quality Improvement Unit (CTQIU), including the Audit and Training Team, has been fundamental in NIAS achieving the re-ACE designation,” McMullan said. “The team’s ethos, local camaraderie—including their unique sense of humor—and focus have been critical in achieving the re-accreditation and continuing the excellent standard of care delivered.”
Recognition
By November 2021, the NIAS had achieved all areas of accreditation, except for audit volume and compliance levels. With focus on the remaining components, by September 2022, the center’s non-compliant volume had gone from 15% to 5% in the space of six months, finally achieving the required audit volume and ACE compliance levels.
The team’s unity and morale clearly flourished through recognition. In October 2022, the NIAS reinstated their local award program to recognize EMDs for high compliance calls and excellent customer service.
“We shared compliments received from service users on the electronic noticeboard within Emergency Ambulance Control, we nominated staff members for Dispatcher of the Year at UK NAVIGATOR, and we have since installed a ‘Tree of Life’ to recognize the lives saved by our EMDs,” Maxwell said.
In January 2023, the NIAS received confirmation that their portfolio had officially passed accreditation standards. Immediately, celebration plans commenced.
The Senior Management Team, Medical Director Dr. Nigel Ruddell and Assistant Director Steven Carson, approved funding for a grand event with a key focus on including all members of the NIAS EAC team, ensuring everyone was recognized for their dedication to delivering high quality patient care in the face of an ever-growing call volume and health service pressures.
In September 2023, the NIAS hosted a re-accreditation appreciation celebration with two identical sessions to allow all staff to attend while maintaining coverage in the Control Room. Invitations went out in July designating the chosen venue, and award cards were included for those individuals who would be highlighted for making a notable impact (e.g., those who successfully resuscitated a patient or delivered a baby over the phone). The event was even extended to family members of the EMDs to join in celebration of both personal and professional achievements.
Several teams pitched in their collaborative, creative efforts to make the event special. Decorative signage and a balloon arch were contributed by the Audit and Training Team. Visitors from the IAED and PDC™ included Jerry Overton, Brian Dale, Louise Todd, and McMullan. Overton presented the ACE plaque to NIAS Chief Executive Michael Bloomfield, and EMDs who received awards were invited onstage with the medical director and chief executive detailing their achievements.
All staff members received gift boxes stuffed with ACE-logo merchandise, including travel mugs, notepads, pens, coasters, pin badges, lanyards, and mobile phone holders. Though the NIAS had never had a celebration of this nature before, many staff members expressed appreciation for recognizing their efforts.
“It is an event we would like to continue as an annual occurrence,” Maxwell said. “It’s important to take a step back, to thank our EMDs, and to spend time with each other as a team outside of the Control Room.”
Confidence in the future
For those hesitating on the brink of accreditation, Maxwell has one question: “What are you waiting for?” Her tips are simple: “First, do it. Second, ask for help (e.g., the IAED, other services, and experienced colleagues who have been down that path), and make the most of it.”
The success of obtaining a multifaceted goal such as ACE is met with worthy satisfaction, but the reality of its reach comes down to the individual.
“Ultimately, it is about our patients,” Maxwell said. “Accreditation means we have confidence that the patient care we are providing within NIAS is the best it can be. We are using the protocol correctly and providing a high standard of customer service. Not only can our patients have confidence in us, but we can have confidence in ourselves.”
