SAS Leads Double-Decker Bus Training Exercise

Scottish Ambulance Service (SAS) clinicians joined colleagues from the Scottish Fire and Rescue Service (SFRS) and Lothian Buses on the 24^th of September for a multi-agency training exercise at Lothian's Longstone Depot in Edinburgh.

Developed by members of Edinburgh's Resuscitation Rapid Response Unit (3RU), the session used a double-decker bus to recreate the clinical and operational challenges of treating seriously unwell patients in a confined and difficult-to-access environment, including the extrication of patients from the upper deck while resuscitation continues.

Ambulance clinicians worked through a series of evolving scenarios across both decks, supported by first responders and volunteers. Scenarios included cardiac arrest, overdose and major trauma, as well as a cardiac arrest with an underlying cause that clinicians had to identify and treat.

Each scenario was designed to create competing priorities in a cramped space, testing how teams lead, communicate and manage resources, and how they keep treatment going while moving a patient.

Steve Reiffer, one of the Edinburgh paramedics who organised the session, said: "A double-decker bus presents some very obvious problems once you try to manage a cardiac arrest or seriously unwell patient in one for real. There is limited room to work, difficult access, equipment has to be moved through a confined space and ultimately the patient still has to get out.

"The aim was to put clinicians and our fire service colleagues into that environment and allow them to work through those problems together. The value is not in everyone performing a perfect scenario. It is in identifying the difficulties in training, understanding what each organisation can bring to the incident and taking that learning back into practice."

SFRS crews from Tollcross brought a specialist height appliance, allowing ambulance and fire personnel to work together on safely extricating critically unwell patients from the upper deck while resuscitation continued. The exercise also helped staff from each organisation better understand one another's capabilities before meeting the same challenges at a real incident.

Robin Jeffrey, Area Service Manager for SAS, said: "It is particularly positive to see frontline colleagues identifying learning opportunities and taking the initiative to develop practical CPD around the challenges they encounter operationally. Working alongside our colleagues from SFRS and Lothian Buses helps build relationships and understanding between services, so that when we meet at a real incident we are better prepared to work together effectively for our patients."

The exercise was made possible by Lothian Buses, which provided access to Longstone Depot and a vehicle, and SFRS, whose personnel and specialist equipment allowed technical rescue to be built into the scenarios. Thanks also go to the facilitators, volunteers and staff who took part.

The session forms part of locally organised continuing professional development (CPD) aimed at giving frontline clinicians the opportunity to practise uncommon but high-risk situations in realistic environments, and to strengthen joint working with partner agencies.