What it takes to build a more resilient ambulance service

As ambulance services declare major incidents and receive record amounts of calls from the public as a result of the heatwave gripping the UK, it is timely to talk to those who spend their time thinking about how to make the service more resilient. I spoke to Stu Holliday ahead of his appearance at The Emergency Services Show to find out how North East Ambulance Service is facing up to theses challenges and adapting its operations.

Stu is Head of Emergency Preparedness, Resilience and Response (EPRR) at NEAS and has more than two decades of experience spanning frontline paramedic work, including being part of the Hazardous Area Response Team (HART), in clinical management, and in leadership roles in both ambulance and acute trusts. His breadth of experience underpins his view that resilience is no longer a specialist concern on the margins of operations; it has to be embedded in everything the service does.

Stu’s early work with HART, the specialist paramedics trained and equipped to work in hazardous environments, illustrates how the ambulance service has evolved to meet complex threats. These teams respond to chemical, biological, radiological and nuclear (CBRN) incidents, hazardous materials, incidents at height or in confined spaces, and rescues in and around water. They operate 365 days a year and are designed to reach casualties where traditional ambulance crews and equipment simply cannot go.

As Stu explains, the team exists because there was a recognition that traditional health services “could only progress so far into an incident because they didn’t have the training or the levels of protective equipment to be able to get closer to the casualties.” The solution was to develop paramedics who could safely work in hazardous environments and complex rescue scenarios, rather than relying solely on fire and rescue services to bring patients out.

That operational capability now sits within a much broader EPRR function. For NEAS, resilience encompasses not just major incidents but also business continuity, supply chain fragility, cyber risk and the cascading impacts of climate change. The service works closely with partners in Local Resilience Forums to map and plan for high‑risk sites and scenarios: major industrial plants, high‑footfall venues, coastal areas at risk from storm surge, floodplains, communities vulnerable to water shortages, and locations exposed to wildfires or power outages.

Stu notes that they are constantly working to understand where those risks sit and how they are changing. “We live in an increasingly complex world with increasingly complex threats,” he says, and that complexity is only deepening as health policy moves more complex care into the community. In a flood or heatwave, that fundamentally alters the risk profile and the expectations placed on ambulance services, with more highly complex patients now being supported at home.

Climate change is forcing NEAS to rethink its capabilities from the ground up. At a strategic level, Stu and his colleagues are asking whether their fleet is capable of operating in extremes of temperature so that the medications and clinical equipment can continue to be stored within their defined temperature ranges. As the fleet electrifies, NEAS also has to understand the power demands of onboard systems and how they affect vehicle performance and resilience as well.

Access is another concern. The service has already cycled through various models of four‑by‑four and all‑terrain capability, particularly for winter and rural locations. HART’s specialist vehicles and off‑road resources play a role here, but Stu is clear that resilience is not just about kit. Community first responders and local volunteers remain vital assets when storms, flooding or landslips cut off roads and make it impossible for traditional vehicles to get through.

Resilience planning is as much about people as assets, he insists, with NEAS paying close attention to how its staff work in extreme conditions, especially sustained periods of high heat.

That ranges from policies on rest breaks, hydration and self-care during heatwaves to reconsidering the uniforms staff are required to wear. “We’re looking to purchase natural fabrics as opposed to synthetic fabrics,” Stu explains, and to introduce more breathable options for those who need them, including specific uniforms for women going through menopause.

Traditionally, Stu says, much of the health sector’s public messaging and surge planning has focused on winter pressures. As the experience of summer this year is already showing, ambulance services like NEAS are increasingly rebalancing their attention, recognising the growing demand created by heatwaves and prolonged warm periods.

It is clear from talking to Stu that resilience is no longer a discrete niche in an ambulance service. For NEAS, it is becoming the organising principle behind how the service prepares, equips and supports its people and communities in the face of a rapidly changing climate and an increasingly complex risk landscape.

You can hear Stu speak at The Emergency Services Show on 16 September as he kicks off the agenda on the Protecting the Protectors stage, expanding on the topic of resilience. Register to attend here.