Emergency chiefs fear commissioners will balk at paying for an ambitious plan to allow specialist paramedics into the heart of major incidents including terrorist attacks.

Commissioners have questioned how running costs for Hazardous Area Response Teams (HART) will be funded, HSJ has learned.

The scheme will see specialist teams set up in each ambulance trust to provide medical treatment at the inner core of major incidents such as terrorist chemical attacks and collapsing buildings.

Sue Wheatley, head of emergency preparedness at West Midlands Ambulance Service and NHS West Midlands, said: ‘It is going to be a challenge to sell it to the commissioners on the basis that it is not a mainstream service.’

‘I don’t think commissioners see emergency preparedness as a priority. I think they see HART as something that belongs to the ambulance service, I don’t think they have made the connection that the ambulance service will be custodians of the service, which will respond on behalf of the NHS.’

HART was ‘not on commissioners’ radar’, she claimed.

The NHS Confederation’s PCT network and NHS Alliance were unable to comment when contacted by HSJ, as not enough was known about the project.

Peter Old, emergency planning advisor at Shropshire PCT, said the DoH had failed to involve commissioners sufficiently in discussions about the project

He told HSJ: 'I think PCTs will be supportive of the scheme, but there's an ever-reducing pot of money and they will need guidance about where priorities sit.'

Mr Old said the value of the project lay in the way it will provide paramedics with the equipment and skills to attend patients in settings in which they are currently untrained, such as in confined spaces and contaminated zones.

Access to emergency scenes will continue to be controlled by the police and fire services.

The teams will respond to incidents involving chemical, biological, radiological, nuclear or hazardous materials, collapsed structures, major road traffic incidents and incidents in confined spaces such as broken down underground trains.

The Department of Health will fund the capital costs of the scheme, with PCTs’ picking up the revenue bill.

HSJ understands that SHA commissioners have questioned how the service will be paid for by PCTs.

A senior regional ambulance manager said the issue was ‘extremely sensitive’ at the moment. They declined to comment so as not ‘inflame it any further’.

It is being piloted at London Ambulance Service and, along with the urban search and rescue programme, at Yorkshire Ambulance Service. TheLondonpilot uses five vehicles including two rapid response cars.

Ambulance trusts in theNorth WestandWest Midlandsare expected to get the teams next followed by a roll-out acrossEngland.

The Department of Health spokeswoman said: ‘We haven't been contacted by commissioners expressing concerns.

She confirmed there were no plansto develop a specific commissioning framework for HART, butsaid the DoHwould consider developingcommissioningguidance should NHS commissioners requestit.

‘Wehave drawn up a broader commissioning framework to support the NHS commission for resilience and emergency planningand this does include HART teams,’ she said.