Ambulances

[MOCAŠ]

It was reported this week that ambulance driver Paul Bex, who was delivering a transplant organ, faces a ban and possibly the loss of his job after being caught by a camera on the A1 at 112mph.

http://www.cambridge-news.co.uk/Hom...rgan-to-patient-facing-court-for-speeding.htm

The press reaction has been fairly uniform: is this the thanks he gets for helping to save someone's life. His professional association points to the fact that the laws governing ambulances and how they may be driven are a mess and need to be updated and consolidated. A Facebook page has also been set up to support him.

So why is the law so confused? Well, it all comes down to what constitutes an 'ambulance'. A police car or fire engine is easily defined, and will only ever be driven in an emergency by a member of the police or fire services. An ambulance, on the other hand, could be anything from a glorified taxi for the elderly to an essential high-speed conveyance between accident scene and hospital. It could be operated by the NHS or by an entirely private company, and its driver may or may not have received any specific high-speed training. Even coroners' vans are sometimes described as ambulances.

I've summarised the relevant parts of the legislation below, but the conclusion I draw from this current case is that Mr Bex was in the invidious position of knowing that he was not allowed to exceed the speed limit without, say, a police escort, but decided to risk prosecution in order to get the organ delivered on time, in the hope that no court would convict him with such strong mitigation.

There is some precedent for the courts acting leniently in such cases, provided it can be established that the driver was responding to a genuine emergency and did not take undue risks. The trouble is that on each occasion, this needs to be tested by the courts, involving considerable public ependiture and no doubt a very stressful time for those being prosecuted. On the other hand, the police can't just turn a blind eye to any vehicle being driven in excess of the speed limit just because it says "ambulance" on the side - it has to be established that the speed was justified by the circumstances under which it was being driven. Without casting any aspersions at Mr Bex, it would also need to be established, perhaps by examination of tachograph records, that the driver had not made any unnecessary stops or detours that directly resulted in his need to exceed the speed limit in order to compensate.

Seems to me that what is required is a review of the relevant legislation to ensure that it is flexible enough to cope with the way emergency vehicles are used today, and perhaps some way for every emergency call to be logged with the authorities by the despatcher at the time, so that there is a definitive record or who is driving; the vehicle being used; the nature of the call; where they are travelling from and to; any deadline they have been requested to meet. This could then be checked in the event of a speeding camera being triggered, and if the vehicle was seen en route by the police they would be able to decide instantly whether to pull the driver over or provide an escort.

The legislation

A little research reveals that the law in this matter sits within four separate pieces of legislation, with inconsistencies or omissions in the wording used:

Vehicle Excise and Registration Act (VERA) 1994

This determines whether a vehicle can be registered as an ambulance for taxation purposes. To qualify, the vehicle must be "constructed or adapted for no purpose other than the carriage of sick, injured or disabled people to and from welfare centres or places where medical or dental treatment is given" and be "readily identifiable as a vehicle used for the carriage of such people by being marked 'Ambulance' on both sides."

Apparently these requirements have remained unchanged since they were first introduced with the formation of the NHS in 1946, and on that basis, Mr Bex's vehicle could not have been registered as an ambulance.
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The Road Vehicles Lighting Regulations (RVLR) 1989

These regulations determine which vehicles may be fitted with emergency blue lights. Originally introduced in 1962, they essentially use the same definition of an ambulance as VERA, but with a later concession for "vehicles used for the transport of Human Tissue, including, Blood and Human Organs for Transplant."

However, that only covers the use of lights, not sirens (see below), and it has been pointed out that under this legislation, vehicles such as solo-reponse cars and paramedic bikes that are routinely used as emergency medical vehicles are not covered by the definition and are therefore technically illegal.
​

The Road Vehicles (Construction and Use) Regulations 1986

These regulations cover the fitting of 'Audible Warning Instruments', including two-tone horns or sirens. They obviously allow for such instruments to be fitted to an ambulance, but they do not define what an ambulance is - so the restirctive definition laid down in VERA would apply in the event of any court case. Upshot: an ambulance may only be fitted with a siren if it has been constucted or adapted solely for the purporse of carrying sick, injured or disabled persons.
​

Road Safety Act (RSA) 2006

This covers exemption from standard traffic regulations (speed limits, red lights, etc) for vehicles responding to an emergency, in which respect it supersedes the provisions made in the Road Traffic Regulation Act (RTRA) 1984.

The RTRA wording stated that "vehicles being used for fire and rescue authority, ambulance, police or Serious Organised Crime Agency purposes are not subject to any statutory provision imposing a speed limit if observance of the limit would be likely to hinder their use for the purpose for which they are being used on that occasion."

The RSA added a provision for the Secretary of State to prescribe further classes of vehicle (by regulation) to which this exemption would apply, and states that any such exemption does not apply unless the vehicle is being driven by a person who has satisfactorily completed a course of training in the driving of vehicles at high speed provided in accordance with regulations under the new section (or is driving the vehicle as part of such a course).
​

 

[davidjpowell]

Not a lot changed since 2003 then.

Call to lift speed limit for transplant drivers | Society | The Guardian

Case against speeding transplant driver dropped - Health News, Health & Families - The Independent

 

[MOCAŠ]

Indeed - the British Ambulance Society (BAS) has been lobbying the government about this issue for years, but have largely been met with inertia. Apart from the revised provisions in the 2006 Act, the official view seems to have been that no court would convict an emergency driver if he/she could demonstrate just cause.

BAS president Don Williams has also highlighted the inconsistency that exists amonsts the different police forces in the way they apply the law, particularly in this emotively-written (and undated) paper on the subject:

BRITISH AMBULANCE ASSOCIATION​

P.O. Box 100, Paignton, Devon, TQ3 1YE​

To whom it may concern.

Ambulance / Medical Transport Legislation :- Trusts Contracted to the NHS - Private Services - Voluntary Organisations.

Before commencing with the overall view of legislation relating to ambulance / medical transport I wish to make it perfectly clear that there is no legislation which discriminates between the owners or operators of ambulance / medical services. All legislation is applicable to all operators and services. Therefore any references mentioned below apply equally to any services providing ambulance / medical transport services. The only legislation which mentions ambulances operated by the NHS is the vehicle and excise registration act 1994. This clearly states that ambulances operated by the NHS must register and tax their ambulances in the same class as all other ambulance operators and cannot use the classification “HNS vehicle”.

Additionally, section 60 of the NHS and Community Care Act 1990, which removed NHS bodies, including ambulance trusts from the protection of crown immunity, and ended any discrimination that may have existed prior to that date.

I am sorry to say that the whole area of / Ambulance / Medical Transport Legislation is in such a sorry state that virtually all of it is open to interpretation, or so out dated as to be virtually useless.

As an Association, we have been fighting for the introduction of Legislation, or even indeed, a review of the current legislation, to no avail.

We have sought the assistance of the Police Federation, the BMA, the Royal College of Nursing, the DVLA, the DETR, the CPS, the Prime Minister, the Secretaries of State for Health and Transport, the NHS Executive to name just a few.

The main problem appears to be that when we quote a case in point, although it may be technically an offence in Law, the various bodies recognise that it is an offence, BUT appear to say, “Yes, we know that the law needs updating, but there is no way that anyone would prosecute you for that offence anyway, so it isn’t really important”. However prosecutions are taking place in many areas of the Country.

Although it would not afford any legal standing, it can also be said, that the Prime Minister, the various Secretaries of State, probably the majority of the government who have been made aware of the total inadequacy of Ambulance legislation, and have chosen to do nothing about it, have in fact allowed these matters to persist.

Could it therefore be said that the offences are permitted by the Prime Minister and the Government, who having been informed of the situation, have chosen to ignore it.

One thing I can say is that only a minority of cases actually get to Court. In most cases, the ones that appear in Court do not succeed, showing the waste of time money and effort, instituting the process in the first instance

The Crown Prosecution Service have advised me that where an offence has been committed, their first step is to determine whether it would be in the ‘Public Interest’ to institute Court proceedings. I can assure you that the publicity that would be attracted to a prosecution for some of the cases in question would cause far more than a ‘public outcry’.

The most serious aspect of this, is a possible alternative charge. Let us say the driver, not wishing to break the Law, knows that the Police in the area he is in will prosecute him for speeding. He decides to abide strictly by the Law, does not exceed the speed limit, and as a result of the delay, the Organ is rendered useless, or the intended recipient dies before the organ is delivered.

Could there now be a case of negligence against that driver ??. Would a Coroner accept that the reason the driver failed in his professional responsibility, was simply because the Police may have prosecuted him for speeding.

Next I will try and deal with “Medical Transport”, although it is somewhat difficult to keep Ambulance transport separate. If I may take first the Transport of Human Tissue / Organs.

Forty some years ago, no one had ever heard of an Organ Transplant, or in reality any form of “medical transportation” other than normal ‘Ambulance’ requirements.

The definition of an Ambulance was laid down, and in spite of the enormous changes in the Medical / Ambulance requirements of today has basically never altered. The definition is as follows, and is an exact “cut and paste” from the DVLAs letter to me asking for confirmation of the latest / current definition :-

An ambulance is defined in Schedule 2 of the Vehicle Excise and Registration Act (VERA) 1994 as a vehicle which: -
a) is constructed or adapted for no purpose other than the carriage of sick, injured or disabled people to and from welfare centres or places where medical or dental treatment is given.
b) Is readily identifiable as a vehicle used for the carriage of such people by being marked “Ambulance” on both sides.

As you will see a strict observation of that definition, does not include the transport of Human Tissue / Organs.

BUT we should ask who is responsible for that particular task. Even though in the world as it is today, no one in government seems to acknowledge that this task is carried out many, many time a day all over the Country. Yet, they do not see fit to introduce legislation to cope with it.

In many instances the there is a critical time factor, which in turn makes speed an essential part of the transport of these items. BUT again I ask who has the responsibility to organise and co-ordinate this task. The answers seems to be that there is NO Legislation, so ANYONE is able to fulfil this role.

It is perfectly obvious that it should be the responsibility of an Emergency Service, again, it is obvious that the Fire Service would not be suitable or indeed willing to undertake the job. The Coastguard are out of the question, the Police are very reluctant to be involved which leaves ??? - Ambulance Services.!!!!!!!!.

Common sense you would assume, as it clearly medically related, often there is also movement of the recipient patient involved as well, or frequently the Medical team and equipment, who will be undertaking the surgical procedures. - - Common sense dictates - - - Medical--- Ambulance.

BUT does the organ transportation actually need an Ambulance ??. A smaller fast response vehicle is the obvious solution. So we are now getting to the area, of separate, and definitive roles, within the Ambulance Service. No longer simply the large, conventional Ambulance taking patients to and from Hospital, but a diversification to meet the conditions that have developed and are now accepted normal practices.

For the sake of trying to separate the two sections we now have shall we call the Organ Transport Vehicles, “Medical Cars”. Unfortunately, no government has seen fit to legislate on the use of these vehicles. However, one small step forward was made when someone in government realised there was a problem with the need for urgent Road transport of these Organs. The Motor Vehicle Lighting Regulations contain a list of vehicles permitted to fit and use a Blue Light, this list was extended to include vehicles used for the transportation of Human Tissue / Organs. Whoever it was that introduced that measure, must have though that, that was all that was needed, without any thought whatsoever about the Construction & Use Regulations, regarding the fitting and use of audible warning devices, Sirens, Two Tone horns etc, or indeed the Road Traffic Act in relation to exemptions from the Speed Limits in the appropriate circumstances.

The end result of that ‘slap happy’ legislation was that anyone may use a blue light on a vehicle being used for the transportation of the said items. By anyone, I do mean ANYONE, which includes totally untrained drivers, with no experience whatsoever of Blue Light Driving. No additional Driver Training of any sort. No specification whatsoever of the type or nature of the vehicle being used.

There is also the question here, of what purpose does the Blue Light serve, if none of the other exemptions afforded to Emergency vehicles apply.

Can you imagine the danger to ALL other Road users if motorists, seeing the Blue Light vehicle behind them, made efforts to allow the Blue Light vehicle to pass, and the driver was not allowed to increase his speed over that of the vehicles he is trying to pass. A totally nonsensical situation.

Having said that, we now come back to various sections of the Law, and ask how they are interpreted. If I start with the POLICE. All of the exemptions for Emergency vehicles obviously apply. The wording of most of the Acts state :- “Any vehicle being used for Police purposes”.

Do we have a legal conflict here. There is nowhere in Legislation that defines the transport of Human Tissue / Organs, as Police Purposes. Therefore are the Police liable for prosecution for using Police vehicles for this work. Remember the Legislation says any vehicle being used for POLICE purposes.

Moving on, if the Police are entitled to use their vehicles for none Police purposes, do the aforementioned exemptions still apply. I think many people saw the Television program, Police, Camera, Action, which devoted a whole episode to a Police Car delivering an Organ. Full use of Blue Lights, Sirens, travelling the wrong way down a dual carriageway, jumping Red Traffic Lights, seventy miles an hour in a thirty mile an hour speed limit. Do we have a situation here that says the Police are making up their own Laws to suit themselves?

Suddenly now, CERTAIN Police Forces have decided that the transportation of Tissue / Organs etc, is NOT urgent. Vehicles ( other than Police I suspect) are NOT allowed to exceed the speed limit.

You will note I put CERTAIN in capitals. This is to emphasise that this indeed is only CERTAIN Police Forces. Other Forces will assist all they can, even providing Police Escorts if requested, and give the drivers CAD numbers to show that the Police are aware of the vehicle and its journey.

This however has little effect if the vehicle concerned is travelling a distance which takes them into another Police Force area, which happens to be one of those CERTAIN Police Forces.

What a total nonsense situation we now have, Police bending over backwards to assist with an emergency life saving journey, only for that same vehicle on the same journey to be stopped by the Police in the next Police Force area.

I wonder why the second Police Force does not prosecute the First Police Force for “Aiding and Abetting”.
If the matter wasn’t so serious, it would make a good script for the “Keystone Cops”.

Next I would like to raise a serious point. If a Police Officer stops a vehicle being used for the emergency transport of a human organ, and the delay incurred results in the death of the intended recipient patient , could that Police Officer be charged with Manslaughter.

I don’t know the answer, but it would appear to me that the circumstances fit the criteria for a charge to be brought.

As I said earlier, the whole of the Legislation, is out of date, badly thought out, and open to interpretation.

Look again at the definition of an Ambulance. Silly little things, of no real importance, but how many motorists can look in their rear view mirror, or in fact follow a vehicle, and read the word AMBULANCE, if by Law that word is displayed only on the side of the vehicle. I agree with anyone reading this, a particularly unimportant matter, BUT surely goes to show the amount of thought, or lack of thought, that was put into the Law.

Consider the definition in relation to a Major Incident. Two fairly recent examples, serious Train crashes.
Ambulances pick up Doctors, Nurse, and other trained staff to rush them to the site of the accident.

We know of one Police Force who interpret that as “ILLEGAL”, according to the definition.

I agree with them. BUT can you imagine what would happen if Police Officers from that Force prevented them from doing so. !!!.

Can you imagine the Crown Prosecution Service even considering pursing a Court case.

Let us look again at the transport of Human Organs. The definition of an Ambulance as above, clearly prohibits the use of Ambulances for that purpose, and I also have this confirmed in writing from the DVLA, and the DETR. Another total nonsense.

There is a clear and obvious need for the “urgent” transportation of some vital Organs. This in most instances is undertaken by Private Ambulance Services who have dedicated vehicles specifically to fulfil this role.

Having purchased the vehicles specifically for the task, the operator is already conforming with, albeit totally senseless Legislation, in order to try and conform to the Law by now using shall we say the ‘Medical Car’, which no longer have the protection of the exemptions etc, afforded to Ambulances under various sections of the Law. CERTAIN Police Forces are actually attempting to stop, or prosecute these operators.

The most disquieting thing about the Police actions, is that all over the Country we hear about CERTAIN Police Forces who interpret the Definition exactly as it is written.

Other Police Forces however recognise the nonsense of the current legislation. This puts drivers in the position of not having to obey a Law of the Land, but having to consider which Police area they are driving in, to determine whether they are going to be prosecuted or not.

I would also point out the Paramedic Motor Cycles, and Paramedic Fast Response Cars, which cannot meet the definition of an Ambulance in any degree whatsoever, are permitted to operate without any hindrance from the Police, or even the mention that they cannot possibly meet the very definition that CERTAIN Police Forces are quoting as the standard.

I find it totally unbelievable that the Police do not recognise the need for the urgency of transporting human Organs, and rather than engage in persecuting the people who undertake this work, they should be using the power of their Association to point out the anomaly to the government, with a view to Legislation being introduced.

At this time CERTAIN Police Forces are simply building up resentment and hostility, and will no doubt suffer untold scorn and humiliation if the general public are made aware of their actions in attempting to stop live saving Services from operating.

Don Williams. President. British Ambulance Association.
​

 

[219]

This just goes to show that the law , in many ways , is an Ass .

I remember some time ago , Jumbobeef , an Ambulance driver member of this forum ( sadly , no longer frequents here as he no longer runs a Merc ) posted an excellent thread on the law as it affects Ambulance and other Emergency response drivers .

The only legal way round this situation , as the law stands at present , is to have the organ transported by a Police Traffic car .

 

[renault12ts]

The irony would be if travelling at 112mph an accident occurred and life was lost. We must weigh up the need to save life versus the need to protect other life. Either travelling at 112mph is unsafe or it is not. It does not matter who the driver is. He knew he was not allowed to exceed the limit...he endangered other road users in pursuit of saving one life. If a member of my family had been killed by his actions I'm not sure I would understand his motivation.

 

[Dai rees]

The irony would be if travelling at 112mph an accident occurred and life was lost. It does not matter who the driver is. He knew he was not allowed to exceed the limit...he endangered other road users in pursuit of saving one life. If a member of my family had been killed by his actions I'm not sure I would understand his motivation.

But how would you feel IF because he obeyed All of the speed limits on the journey, he was late delivering the Organ and because of that the Organ was now no longer suitable, they do only have a very short life once removed from the donor, and that Organ was destined for a close relative of yours would you still feel the same??? Just playing Devils advocate you understand.

 

[grober]

I would be asking why they didn't use a helicopter?

 

[st13phil]

he endangered other road users in pursuit of saving one life.

Did he? Is that a fact of the case or an assumption?

 

[davidjpowell]

The irony would be if travelling at 112mph an accident occurred and life was lost. We must weigh up the need to save life versus the need to protect other life. Either travelling at 112mph is unsafe or it is not. It does not matter who the driver is. He knew he was not allowed to exceed the limit...he endangered other road users in pursuit of saving one life. If a member of my family had been killed by his actions I'm not sure I would understand his motivation.

Why is 112 mph unsafe? It is safe, dependant on the road conditions, the weather conditions, the training and the skill of the driver.

It annoys me to read that some people believe the drivel spouted out by organisations such as Brake.

Inappropriate speed kills. Speeding does not.

 

[davidjpowell]

I would be asking why they didn't use a helicopter?

Cost and availability I suspect is your answer...

 

[Colin_b]

The irony would be if travelling at 112mph an accident occurred and life was lost. We must weigh up the need to save life versus the need to protect other life. Either travelling at 112mph is unsafe or it is not. It does not matter who the driver is. He knew he was not allowed to exceed the limit...he endangered other road users in pursuit of saving one life. If a member of my family had been killed by his actions I'm not sure I would understand his motivation.

I'd be rather miffed if a member of my family died as it took slightly too long to get the organ there due to rigid application of ill though out laws.

I rather fear you are in the 'speed kills' camp. I prefer 'inappropriate speed kills'.

 

[MOCAŠ]

I'd be rather miffed if a member of my family died as it took slightly too long to get the organ there due to rigid application of ill though out laws.

I rather fear you are in the 'speed kills' camp. I prefer 'inappropriate speed kills'.

Even inappropriate speed won't necessarily kill anyone or even cause an accident, although it will usually increase the risk substantially.

This is undoubtedly an emotive topic, and it goes without saying that anyone would want to ensure that someone awaiting the delivery of a life-saving organ was given the best possible chance of receiving it on time. But equally, the driver in question is by his own admission highly trained and experienced, so would have known that he was not allowed to break the speed limit on this run. In law, his one clear advantage was the use of blue lights to alert other road users to his presence.

Yes, he has a duty of care to the patient awaiting the organ, but as renault12ts has said, he also has a duty of care to his fellow road users. If his speed had been a contributory factor in an accident, that could also have prevented the organ from being delivered on time or at all.

As things stand, it seems any private medical organisation is able to buy a van, attach some blue lights and write 'Ambulance' on it. That in itself does not confer any special privileges on the driver of the vehicle, nor does it render the vehicle itself any more capable of coping with high-speed runs than the next van on the road.

Was it even appropriate to use this type of vehicle for such a long, high-speed journey? I think davidjpowell is correct in citing cost and availability as reasons why an air transfer was not arranged (perhaps poor flying conditions were also a factor), but a high-performance car, with high performance brakes and other safety systems, would surely have been more suitable than what was actually used over this kind of distance.

Perhaps what is needed is a specific clause covering the time-critical transfer of organs and other tissue when this has to be done by road. The vehicles that need to be used for this are clearly not ambulances as they carry neither patients nor trained medical personnel - they are emergency response cars. The law should recognise this as a separate category, require that the vehicle is of a suitable specification and afford their drivers the same exemptions as a police driver would have in an emergency, provided they have been trained to the same standard. The 2006 Act comes close to achieving this, but is being held back by the fact that other conflicting legislation remains in effect.

 

[renault12ts]

If he had crashed, causing death, where would the law stand? Emotive subject...yes. It is typical that only one side is seen. 112mph may not be dangerous on an empty motorway, but with any other traffic present the level of danger increases because other traffic does not expect such high approach speeds.

I'm sure you all recall this piece from the 80s. In this case a liver is transported very quickly. But look at the level of other support needed and the weariness of the driver at the end. Can anyone say the ambulance driver (Bex) involved was A, as competent or B, had the same level of support? And if the police driver needed this support why did Bex not?

YouTube - Metropolitan Police Escort -The Liver Run 1of3

A little over the limit I could accept, but not that far over.

IMO.

 

[Hi-Ho Silver]

He didn't crash, nobody was injured and nothing happened! Get over it! All the 'what if's' in the World don't protect against accidents. I've seen people drive into other people's cars at 10mph!! I hope you take my point.

To precis the above:

Inappropriate speed kills. Driving does not.

 

[renault12ts]

I seem to have upset you. Apologies. Now...get over it.

 

[flango]

Ambulance drivers including RRV drivers do not have the same level of training as Class 1 police officers. If the organ is time critical then it is delivered by traffic officers or helicopter. If not then by the ambulance service same applies to delivery of rare blood types.

This was a private company who did not have the authority to drive on blue lights with a driver not trained to drive at the speeds encountered. He was misguided in the fact an organ going from Adenbrookes to the North East was not an easy task by road and this company was not capable of delivering it safely. It should have gone by traffic car or helicopter.

If I were the judge I would be going after his company not the individual but he was responsible for his actions so should face the consequences and should not have accepted the task in the first pace

 

[renault12ts]

Thanks for that...I feel vindicated.

 

[davidjpowell]

This person seems to do a lot of these...

YouTube - sherlock4095's Channel

 

[Tyler Durden]

Ambulance drivers including RRV drivers do not have the same level of training as Class 1 police officers. If the organ is time critical then it is delivered by traffic officers or helicopter. If not then by the ambulance service same applies to delivery of rare blood types.

This was a private company who did not have the authority to drive on blue lights with a driver not trained to drive at the speeds encountered. He was misguided in the fact an organ going from Adenbrookes to the North East was not an easy task by road and this company was not capable of delivering it safely. It should have gone by traffic car or helicopter.

If I were the judge I would be going after his company not the individual but he was responsible for his actions so should face the consequences and should not have accepted the task in the first pace

Absolutely spot on.

 

[johngates100]

Important thing is to know the fault of the person who is actually guilty otherwise it will be unfair to do something against any body.Emergency drivers are bound to drive vehicle speedly and if something happen because of speed then they should not be punished.