Guernsey’s approach to prehospital emergency care could provide valuable insights for healthcare systems around the world, particularly as more countries prepare for the challenges of ageing populations.
American emergency medicine student Kenzie Bay recently spent two weeks with St John Ambulance and Rescue Service in Guernsey and Alderney as part of an international research project examining how emergency medical services adapt to different communities, environments and levels of available resources.
The 23-year-old, who studied Health and Humanism at Whitman College, visited the islands during a fact-finding tour funded by the Watson Foundation. Her research has also taken her to Tanzania, India, Thailand, Nepal, Estonia, Norway, the UK and El Salvador, comparing advanced models of care with those operating in less well-resourced settings.
“I have designed my project to learn about the delivery of care across various modes of transportation and diverse geographies, and how communities build and adapt the emergency care system to fit the environmental context,” Kenzie said.
Reflecting on her time in Guernsey, she said the island’s ambulance service demonstrated how emergency medical systems are shaped by the communities they serve.
“The ambulance service in Guernsey is a testament to the idea that EMS is shaped by its community. It has been built and supported by its residents since the start and is specifically designed to support the Guernsey environment.
“The involvement of fire services, community first responders with AEDs, and the Flying Christine III are all components of extending the ambulance service’s reach and delivering care to small islands without the ease of access to a metropolitan EMS system.”
Kenzie also observed how the close-knit nature of the island benefits patient care.
“I observed how professional relationships and patient care are influenced by community size, as relationships and rapport were often already established between ambulance, hospital and firefighting staff, allowing for more efficient and greater continuity of care.
“Given the greater proportion of elderly patients in the population, exposure to this patient group was higher than I had previously experienced. I appreciated the opportunity to learn from skilled paramedics, EMTs and ECAs who have become highly knowledgeable at assessing and managing this specific patient population with multiple comorbidities, polypharmacy and complex social contexts.”
As part of her visit, Kenzie also spent time in Alderney, where the ambulance service is provided by Guernsey’s Ambulance and Rescue Service through a small, dedicated local team. It was the smallest healthcare system she visited during her international study.
“Alderney was a fascinating environment to learn from, as the EMS system has to plan around a higher level of uncertainty and preparedness while balancing the appropriate level of staffing and resources for the community’s size,” she said.
“The island occupies a difficult position in systems development as it is too large to rely primarily on a community first responder model like Sark or Herm, yet too small to warrant the level of services present in Guernsey.
“Determining the level of resources in Alderney is further complicated by the island’s need for external assistance in the event of high-acuity cases, along with the consideration that access to external resources may be delayed by weather or other operational constraints.
“While navigating this geographical tension is not necessarily unique, it is a good example of geography remaining a pivotal determinant of emergency care, requiring resiliency of resources to mitigate its impact and ensure equitable access to emergency care.”
She said the island also highlighted how clinical practice adapts to local circumstances.
“What also interested me about Alderney was that it illustrated how scope of practice is often determined by contextual evaluation, rather than being standardised. Compared with Guernsey, ambulance staff practise with greater autonomy and scope because the environment requires such flexibility in protocols.
“This is an excellent example within my project of how geographic challenges, delayed access to definitive care and limited local resources can necessitate broader decision-making responsibilities. Providers in Alderney must also balance clinical readiness and clinical exposure, and work to maintain proficiency in low-frequency, high-acuity events.”
During her stay, Kenzie joined ambulance crews for joint training exercises with Guernsey Fire and Rescue Service, including complex patient extrication and pit-stop CPR scenarios.
“From the standpoint of a high-income island environment, Guernsey is a great example of a proportionally designed system, with an approach heavily focused on scale, geography and community needs.
“The system in Guernsey is about building and maintaining a system that strikes the right balance: enough resources but not too many, enough scope and specialisation but not excessive, and not at the cost of generality.”
She believes Guernsey’s experience caring for an ageing population could prove increasingly valuable to ambulance services internationally.
“While many countries are preparing for and beginning to feel the effects of an ageing population, Guernsey is already experiencing this in its day-to-day operations. Ambulance staff have honed their assessment of frailty, polypharmacy and complex comorbidities.
“They are aware of the complexities and pitfalls of prehospital care and social services when managing a growing number of elderly patients. Therefore, providers in Guernsey may have useful insights into the challenges that many ambulance services will increasingly face over the coming decades.”
