It’s 35 years since the first ambulance service staff took part in the ‘extended training’ pilot courses 


It is 35 years since the first ambulance service staff, who took part in the National Health Service Training Authority’s (NHSTA) ‘extended training’ pilot courses, qualified.  Here, we take a look at how the course came about and why it became the blueprint for paramedic training.  

On August 12, 1985, more than 20 ambulance aid instructors arrived at Surrey Ambulance Headquarters in Banstead to take part in the first of two NHSTA ‘extended training’ pilot courses.

The students had all passed the entry examination to the course earlier in the year but now, as they arrived at the headquarters in Banstead, there was an air of trepidation amongst the group as this was new territory for them and the NHSTA.

In many ways they were right to feel nervous. The course, which was divided into four stages consisting of theory and practical learning, was tough. So tough, in fact, that only around one-third of the original 24 students went on to immediately progress to the next stage and then towards graduation six months later.

Following graduation, the ‘extended training’ programme was made available to all UK ambulance services. Before this, any training offered to ambulance staff was carried out at the discretion of the individual ambulance service, with the various regional pilots often differing according to local medical opinion.

This new standardised package of training, which quickly became the accepted training for paramedics, gave all graduates the same skills and knowledge. It brought uniformity throughout the UK, even in those early years when paramedics were still thin on the ground.

During the early 1970s, there had been a lot of talk regarding the merits of ‘extended training’ for ambulance staff following the successful cardiac and emergency training programmes offered by Dr Douglas Chamberlain in Brighton, Dr Peter Baskett in Bristol, and others. Yet, it wasn’t enough to see ‘extended training’ rolled out on a national scale. Things were slowly moving in the right direction however, and in 1974, all ambulance services, including those with local ‘paramedic’ schemes were transferred from local authority control to the NHS. Then, five years later another huge step forward was made when Dr Bernard Lucas, from the Medical Commission on Accident Prevention argued that ‘as ambulance staff were frequently the first to arrive at an accident scene, it would be logical to train them in advanced resuscitation techniques’.

This realisation that patients could indeed benefit from treatment before reaching hospital ultimately played a crucial role in instigating the need for a nationally-recognised ‘extended training’ course. As a result, the Department of Health commissioned an analysis into the potential benefits of such training and when the results were published in 1984 they proved extremely positive, providing a compelling and economically-sound argument in favour of ‘extended training’ for ambulance staff. Despite some resistance, acceptance of the need for more highly-trained ambulance crews grew rapidly and led to the Department of Health establishing a UK-wide pilot scheme in 1985 under the national leadership of Roland Furber - who in 2003 became the first Chief Executive of the British Paramedic Association, now the College of Paramedics - at Banstead in Surrey, which was eventually adopted by all UK ambulance services.

Divided into four stages, the first stage of the course was learning all about anatomy and physiology and lasted one week. At the end of the week students had to pass an exam before proceeding to the next stage of the course.

The second stage, again held at Banstead, lasted three weeks and during this time students had to apply what they had learnt in the first week and put it into practice. There were lectures given by experts in the medical profession and practical skills in defibrillation, cardiac monitoring, intravenous infusion, canulation, and the administration of seven drugs including adrenalin, lignocaine, and atropine. Like stage one, there were practical and written examinations at the end of the three weeks.

The third stage of the course was a six-week placement in hospital which consisted of two weeks in theatre under the supervision of consultant anaesthetists, one week in accident and emergency, one week in the intensive therapy unit and two weeks in coronary care. To proceed to the final stage of the course, which was an interview in front of a panel, including course director, Roland Furber, the students had to have completed all the training modules necessary. For example, they had to have demonstrated at least 25 successful intubations, 25 canulations etc.

Ambulance aid instructors from all over the UK attended the two pilot courses held at Banstead in 1985 and 1986 and those who were successful went on to set up approved NHSTA ‘extended training’ in their respective regions over the next few years.  Within two years of the first pilot scheme being held the courses became formally recognised as ‘paramedic training.’  

Just like those ambulance staff in the local schemes in Brighton and elsewhere 15 years earlier, the graduates from Banstead carried a huge weight of responsibility in rolling out ‘extended training’ nationwide.  It was the next logical step for the ambulance service and within a few short years, the content of these courses had become the norm for all paramedic courses going forward and helped shape the profession we all know and value so highly today.  

Head of Education for the College of Paramedics, Professor Bob Fellows said: “This was a special moment for our profession’s development. It came 15 years after the pioneering past of 1971 Intubation and Infusion and 15 years before the birth of the College and the first pre-registration graduates from Hertfordshire in 2001. The national approach consolidated what had previously been sporadic and local into unified and cohesive. We mustn’t forget what these pathfinders achieved and we mustn’t forget how important it is to keep learning from our past, as it nearly always informs our future”.