Fumes from idling ambulances stuck outside A&Es endangering staff

An ambulance trust is having to protect its staff from the effects of fumes – including potential cancer risk – as they are spending so long in their vehicles outside hospitals.

South Western Ambulance Service Foundation Trust has carried out a risk assessment of the impact of diesel engine emissions after following concerns from staff, many of whom are spending hours waiting to handover on each shift. The region has faced the worst handover delays to emergency departments in recent years.

Ambulance engines normally have to be kept on while waiting, to keep essential equipment running, and sometimes for warmth. But with queues of a dozen or more ambulances at times, staff and patients can be exposed to substantial emissions for long periods.

Teams have become increasingly concerned, and HSJ has been told of an alleged incident where staff refused to stay in a vehicle until they were threatened with disciplinary action. SWASFT said it was not aware of any disciplinary action.

But the trust’s risk assessment – which has been seen by HSJ – warns exposure to diesel emissions is associated with eye and upper respiratory tract irritation, while prolonged exposure can lead to coughing, increased sputum production and breathlessness.

There is also “epidemiological evidence which indicates that sustained occupational exposure to diesel engine exhaust emissions may result in an increase in the risk of lung cancer”.

It gives a risk rating of 20 – one of the highest possible – which, under the trust’s policies, indicates “activities must not proceed” until mitigations are in place.

But in response, the trust is now rating different accident and emergency as red, amber or green, based on handover time, and based on this it is putting in place additional “controls”, though it is unclear how effective these will be.

A trust spokesman said it was “working with hospitals to assess the risk and take practical steps to reduce vehicle emission, including having traffic management plans, ensuring our clinicians are clear on which instances require the engine to run and developing plans for local air quality monitoring”.

A&Es are red-rated if they have more than 3,000 hours of delays a month, averaged over a year. In February, four sites saw ambulances waiting for more than 3,000 hours: Derriford Hospital in Plymouth, the Royal Cornwall Hospital in Truro, the Great Western Hospital in Swindon, and Torbay Hospital in Devon.

The SWASFT spokesperson added: “The safety and wellbeing of our people and patients is our top priority. When an ambulance is at an emergency department waiting to handover a patient, there are times when it is necessary for the engine to be running, to continue to power essential items to support patient care…

“We continue to work closely with our NHS partners to do everything we can to reduce handover delays. A reduction in hospital handover delays will reduce the time ambulances are stationary with the engine running”.

This week’s board papers say the trust is continuing to see nearly 8,000 hours a week of delays. Data for February showed average handover times of 3h 50m at Derriford Hospital and 2h 15m at the Royal Cornwall Hospital.