Carbon Copy: Why electrifying ambulances means less can go wrong

Diesel-guzzling ambulances are one of the most visible examples of what the NHS must change to meet its climate commitments.

But electric alternatives have recently been in the firing line, with concerns over patient safety and costs receiving national media attention.

The Daily Telegraph reported earlier this year that paramedics feared patients will be forced to wait longer because of the hours lost recharging the vehicles, and particular concern about coverage of rural areas.

Whilst such concerns are not completely without merit, system leaders have told Carbon Copy they are confident that the new models set to be rolled out will not suffer from these kinds of issues.

However, making sure electric ambulances have enough juice in the tank for a shift, charging is quick and easy with infrastructure in place, and not prohibitively expensive will be key to their success.

And with a new target announced last year that all new ambulances purchased must be zero emission by 2030, a standard which the entire fleet must meet by 2040, the NHS faces a huge challenge to deliver this transformation programme.

Most trusts still do not have a single electronic emergency ambulance, meaning the programme will entail upgrading thousands of vehicles.

The first electric ambulances were trialled in West Midlands, back in 2020. The pilot hit some bumps in the road over its range and cost – and evidence from here underpinned recent concerns reported in the media – but senior figures argue the rollout has moved on since. 

And there is a lot of optimism now, as technology and manufacturers are fast developing in this sphere.

London is as an example of where progress is being made, with the capital’s ambulance service recently adding a second electric ambulance to its trial.

The vehicles being trialled by LAS are the first ambulances to be built electric, rather than converted from diesel, to be used in England. This is different from the retrofitted model trialled in the West Midlands.

‘There’s a lot less to go wrong’

LAS head of fleet Rob MacIntosh told Carbon Copy there had been no problems since the first electric double crewed ambulance hit the roads in Brixton, south London, on new year’s eve last year. 

The model is a smoother drive for patients, and the vehicle more reliable. “There’s only three moving parts on an electric vehicle. Diesel engines have got something like 300 moving parts. So, there’s a hell of a lot less to go wrong.”

So far, the first one at Brixton station is “very comfortably” doing a 12-hour shift, he added. The Ford vehicle has a 120-mile radius and charges in four hours.

Mr MacIntosh agreed the nature of London has made the rollout easier, compared to rural areas that will have different challenges with longer drives – but he is optimistic for the future as technology continues to develop.

He continued said: “It’s only going to get better. But there isn’t a city in the UK that couldn’t work with what is available now.”

Cost

The Telegraph reported the rollout to electric ambulances could cost half a billion pounds earlier this year.

This followed the logic that WMAS estimated it would cost £70m more to make their whole fleet of 480 emergency ambulances electric, which was double the price of diesel models.

But it is hard to rely on this figure, as the costly WMAS model was different from those being used, and developed, now. 

Carbon Copy understands national leaders are not too concerned about the cost, as ambulance trusts naturally start buying up electric models to replace outgoing fleet (ambulances tend to only last for five or so years).

Even though EV ambulances cost more upfront now, it is expected they will be equal from 2027. And they already cost less over their lifetime than diesel. 

Mr MacIntosh said it was the latter that mattered, and so the greater upfront cost was not considered a “big hit” financially.

The next steps

It will soon be the turn of other ambulance trusts to trial electric ambulances. Carbon Copy reported last year that 15 had been ordered, to be rolled out across London, the North West, East of England, South West and Yorkshire. 

I understand they are expected to be delivered this financial year, with London preparing for two more to come into service in early 2025. 

The national rollout is still considered at its early stages, and NHS leaders believe a gradual approach is worth it. This allows for learning to be taken into account from the pilots, and ease into what will be a fundamental shift in how emergency care is organised and delivered. 

This will also enable a focus on urban areas first where emergency vehicles tend to travel less mileage, and less likely to come into trouble over running out of charge during a shift.

More rural areas – where ambulances can travel in some instances up to 400 miles in a shift – are expected to come at the end of the rollout when technology is more developed and lots of learning has taken place. 

Heatwave

It has been an odd summer with the weather, with bursts of hot weather largely short lived – to the relief of many system leaders.

Extreme heat piles additional pressure on the NHS, with increased demand and ageing infrastructure put under strain.

Sources say it has tended to manage pretty well this year, including on the hottest day of the year this month, at 35C in Cambridge. This is because there has not been an extended period of extreme heat, nor temperatures to collapse infrastructure.

We may have got off lightly this year, but climate change is making extreme heatwaves – such as that experienced in 2022 - more likely.

Adrian Boyle from the Royal College of Emergency Medicine said: “I think we’ve managed to cope with the heat. where the bits we’ve had have actually been very short.”

But he said the worry is for when the next extreme heat event hits. “We are concerned our ability around a major incident response is compromised by our chronic crowding.”

Piece was amended on 29th August to clarify type of vehicle-  emergency electric ambulance - referred to that most ambulance trusts still do not have.