An Interview with cycle responder Tim Chivers

It’s almost 20 years since the London Ambulance Service first tested the concept of having a bicycle-mounted paramedic in London’s […]

It’s almost 20 years since the London Ambulance Service first tested the concept of having a bicycle-mounted paramedic in London’s West End.

Yet now these life-savers in lycra (well, baggie shorts at least) are a common sight in the capital. Coffee Stop’s Matt Lamy spoke to paramedic Tim Chivers about his job as a member of the LAS’s Cycle Response Unit.

CS: How did you become a cycling paramedic?

TC: I started on the bikes about seven years ago, but before then I was what’s called an ‘ambulance technician’. The difference between a technician and a paramedic is that a technician isn’t state registered and there are some procedures they can’t do. For example, they can give drugs but not controlled drugs, and they can’t do invasive procedures. Then I did my paramedic training seven years ago, which involves training in operating theaters, maternity departments, Accident and Emergency, minor injury units and various other placements. So now I have that academic qualification and I am state registered.

I’ve cycled all my life but I wasn’t a cycling enthusiast as such — I didn’t have a lot of cycling gear or spend a lot of time on bikes. But the advert came up and I was eligible to be a cycling paramedic as I had a good level of fitness, I was competent to cycle in London traffic and I could work alone as a solo responder, so I applied. They weren’t looking for only really keen cyclists, which helps make the cycle team more accessible than perhaps other specialist teams in the London Ambulance Service. The nice thing is that, since starting this job, it has really brought on my interest in cycling. Now I go mountain biking and cycle on my days off, so the job has actually developed my interest and encouraged my cycling.

CS: Did you have to do any cycle training before taking on the role?

TC: Yes. I had an assessment first of all, which was basically to see if I was safe on London roads. I cycled round with an instructor, went round some cones, and I was given an interview and a fitness test. Then I was offered a secondment with the Cycle Response Unit for six months. I remember turning up and being given bags and bags of really nice London Ambulance Service-branded cycle clothing.

I absolutely loved the job and we covered a lot of events: the London Marathon, the Notting Hill Carnival, Changing of the Guard, Chinese New Year, Pride, all the sorts of things where there were lots of road closures but a community that still needed access to the Ambulance Service. Our biggest year was 2012 where we escorted the Olympic flame through London and we did the Royal Wedding and the Royal Jubilee as well. I think in July 2012 alone I worked 26 days straight. But I really loved it and when the secondment came to an end I extended it for about three years in total. Then a permanent position became available and I took that.

CS: How long has the Cycle Response Unit been around for?

TC: We actually ran a trial back in 1999, which was before I even joined the London Ambulance Service. The Cycle Response Unit was started by and is still managed by Tom Lynch, who was British and European BMX champion in the 1980s. Tom is the pioneer of all this. When I give community talks about what we do, sometimes there’s a 16 or 17-year-old BMX fan who knows of Tom because he’s a bit of a legend in the BMX world, he coaches kids, and he even has an MBE for his contribution to cycling. So Tom started the initial cycle-mounted paramedic trial in 1999.

It’s interesting because back then the bike that was used was really basic. There was no proper cycle helmet and there weren’t a load of panniers bags or kit on the bike. But Tom went off on his own in the Soho area and his angle was to treat people on scene, discharge them into the community and not convey them to hospital. That was a major change of thought because back then the Ambulance Service used to convey people to hospital as a matter of course. But by treating people and discharging them at the scene, Tom recognised it could save a lot of time, money and was better for the environment by not using motorised vehicles. And met a lot of patient needs with this alternative treatment to A&E.

CS: So how many cycle-mounted paramedics are there now?

TC: There’s about 100 paramedics now, although not all working at one time. In a single day there’s probably 25-30 in London, including a three-person team who operate at Heathrow and are funded by BA.

CS: What is a typical day for you like?

TC: I turn up at 7am for a 12-hour shift. I’ve got my own bicycle that is allocated only to me, so I check that over and make sure it’s good to ride I check my kit is all good for the day ahead. I book my drugs out of the safe — I have to collect morphine out of a safe in the morning and because that is a controlled drug, that has to be witnessed and signed for. Then we have a specific drug bag that has about 30 different drugs in it, and I have to book that out as well. That all goes on my bicycle.

Then I book out a radio and I make my way to the area where I’ll be working in. For the last six months I’ve been working in the Victoria area, which I really like. I cycle up there, then when I’m in position in Victoria, I’ll let them know on the radio and I’ll just wait for the jobs to come down.

In a typical day I probably do six to eight calls. We’re not going job to job to job like the ambulances do. I work alone and some days I can go a whole shift without seeing another member of Ambulance Service staff. We have a high rate of discharging patients back into the community — across the bicycle team about 70% of our patients don’t go on to hospital. If I have a day like that, I might not see another paramedic or member of staff.

You’ve got to be used to working alone, making decisions on your own quickly, and we haven’t got huge amounts of gear, so you have to be confident about treating people with slightly less monitoring equipment. It’s a very independent job, so it’s not for the inexperienced. Funnily enough, I actually applied for the job after I’d been working for the London Ambulance Service for two years and I failed with my application. I was really disappointed at the time but with hindsight it was probably a good thing. I wouldn’t have had enough experience in two years to comfortably discharge people

CS: Do you work for a specific NHS trust?

TC: Yes, it’s the London Ambulance Service NHS Trust. It’s funny, every day I must get asked which hospital I work out of, but ambulances haven’t worked out of hospitals for more than 50 years. We are a separate trust with our own budget and our own properties — we’re not tied to any hospital at all.

CS: Lets talk about your kit and your bike — what is it?

TC: It’s a Cube Acid. We had Specialized Rockhoppers for the first 12 or 14 years, but then there was a spec change and we moved onto Cubes. They are stock bikes with just a few minor modifications. We found we were breaking spokes a lot because of the weight we carry, so the wheels we now use have extra-thick tandem spokes. The other thing is, we were snapping rear rack brackets, so now we mount the racks directly and we use bespoke titanium racks just to take the weight of all our kit. We also have an upgraded chain as we used to snap a lot of chains, again because of the weight.

On the bike we carry a defibrillator — the government standard is to get a defibrillator to certain patients in less than eight minutes. We carry oxygen in special small Kevlar bottles that are very light and a lot more compact than the ones we carry in an ambulance. We carry Entonox, a pain relieving gas, which is nitrous oxide and oxygen mixed together — we use that for all sorts of complaints. We carry advanced airway tubes that go down into people’s lungs so we can manage airways and breathing. We carry cannulation equipment for putting lines into people’s veins so we can give drugs intravenously. We carry an intraosseous gun, which is, if we can’t get a vein, we’ll drill straight into the bone and give drugs through the bone marrow.

Then there are obvious dressings for bleeding and for burns, maternity packs — I’ve delivered a baby on the platform at Green Park tube station before. Of course, in the current climate, I have triage packs and major incident plans. And on our bodies we wear a ballistic vest, mainly to protect against knife attacks although it will stop bullets up to a certain caliber as well. So all in all, it’s quite a lot of kit.

CS: How much do you enjoy your job?

TC: It is great fun and we’re very high profile. I’ve met other cycle paramedics from other parts of the country and a lot of them don’t do it permanently, they’ll interchange with a car. In other countries, such as Australia and France, the cycle paramedics will just do big events. As far as I know there aren’t many cycle paramedics who do it full time like us.

And we are having an important effect. We worked out in the first 10 years that we helped save 110 tonnes of carbon dioxide per year; we helped free up a 5,600 hours of ambulance availability, and we save the London Ambulance Service NHS Trust almost £1.5 million each year. We cost so little to operate compared to a motorised ambulance. An ambulance alone costs £260,000 to £270,000, but our bike and kit costs nothing like that — we’re looking at something more like £10,000. So it’s great to be doing a job that is enjoyable and which is obviously helping people on a day-to-day basis and in the long-term, too. It’s good for me, also — I’m 52 now and I’m as fit as a fiddle, and that’s all thanks to riding my bike 12 or more hours a day.