St John Ambulance (England)

St John Ambulance
England and the Islands

File:StJohnAmbulanceLogo.png Logo of St John Ambulance England and the Islands
Formation	1877
Type	Charitable organisation Limited company
Headquarters	Registered Office: St John's Gate, Clerkenwell, London EC1M 4DA Headquarters: 27 St John's Lane, Clerkenwell, London EC1M 4BU
Location	England
Membership	Not reported since 2012
Chief Volunteer	Mr Mick Messenger
Key people	Sue Killen (CEO)
Affiliations	St John Ambulance Johanniter International
Revenue	£91.4m per annum
Staff	1682
Website	http://www.sja.org.uk

St John Ambulance is a volunteer-led, charitable non-governmental organisation dedicated to the teaching and practice of first aid in England. Along with St. Andrew's First Aid in Scotland and St John Ambulance in Wales, St John Ambulance is one of three affiliates of the international St. John Ambulance movement in the United Kingdom. The organisation is a subsidiary charity of the Priory of England and the Islands of the Venerable Order of St John which also oversees similar activities in Northern Ireland, the Isle of Man and the Channel Islands.

History

In the 1820s, the Knights of Malta living in France offered knighthoods to specific people supporting the Order of Malta in Great Britain, irrespective of their Christian denomination. Their approach was not part of the official policy of the Order of Malta but the English Knights devoted themselves to charitable activities, which were organised into what became known as Foundations. This British group carrying out very substantial charitable activities was recognised and incorporated in 1888 as the Grand Priory of the Order of the Hospital of Saint John of Jerusalem in England.

The St John Ambulance Association was set up in 1877 by the Venerable Order of Saint John to teach industrial workers first aid, so that they could provide on-the-spot treatment in emergencies. Workers rarely had ready access to a doctor in 19th century workplaces, and since accidents were frequent, death or disability from injuries were common. The St John Ambulance Association set up training sessions across the country, particularly in workplaces in areas of heavy industry, but also in villages, seaside towns and suburban areas.

In 1887, trained volunteers were organised into a uniformed Brigade to provide a first aid and ambulance service at public events. In many parts of England (and in parts of Scotland, until 1908), St John Ambulance was the first and only provider of an ambulance service right up to the middle of the 20th century, when the National Health Service was founded. When there were far fewer doctors and hospital beds than today, St John Ambulance nurses looked after the sick and injured in their own homes.

The St John Ambulance Brigade and St John Ambulance Association merged in 1968 to form St John Ambulance, a single organisation providing both training an first aid cover.

During 2013, St John Ambulance trained approximately 278,000 adults through its workplace and community first aid programmes, and directly trained 91,000 schoolchildren. St John Ambulance personnel attended 45,000 public events, treating approximately 102,000 individuals. It also distributed 100,000 free first aid guides nationwide and its free smartphone app was downloaded by 148,000 people.

Key dates within the history of St John Ambulance in England

• 1540: The original Order of St John, the Knights Hospitallers is disbanded in England by Henry VIII
• 1826: An idea to re-establish the Order within England is put forward by some remaining French Knights of the original worldwide Order
• 1841: The "St John's Day Declaration" is prepared to seek official recognition of the new Order by the original Order, now known as SMOM
• 10 July 1877: St John Ambulance Association forms to teach first-aid in large railway centres and mining districts
• June 1887: St John Ambulance Brigade is formed
• 14 May 1888: English Order of St John is granted royal charter by Queen Victoria
• 1908 By reciprocal agreement St John Ambulance Brigade ceases to operate in Scotland and St Andrew's Ambulance Association ceases to operate in England
• March 1922: Cadet units are started
• 1968: The Association and Brigade merge to form a unified St John Ambulance
• January 1987: Badger setts are introduced to celebrate 100 years since the formation of the Brigade
• 1999: The Priory of England and the Islands is formed
• 2012: St John Ambulance changes its county structure to a regionalised model across England.

First aid cover at events

St John Ambulance provides first aid cover at thousands of events every year. This service is provided free at the point of delivery, although a charge may be made to the event organiser for provision of the service at their event.

In addition to providing volunteer first aiders for events, where necessary St John Ambulance can provide paramedics, doctors, nurses and cycle responders, as well as mobile treatment centres, ambulances and other medical provision .

The organisation covers many major events across England including the London Marathon, V Festival and Hyde Park concerts, as well as smaller and charitable events such as fetes and local fairs .

Training

St John Ambulance runs courses in first aid and health and safety for members of the public, training 254,000 people in 2013. Its First aid at work course is used by many companies to train designated individuals as first-aiders, as required by employment laws; specialist training is also available, including courses for schools staff and people working with children, and professional drivers .

Charitable Community first aid courses also offer people of all ages the chance to learn basic first aid skills at little or no charge. In 2013, 24,000 people attended these courses .

Work with young people

St John Ambulance teaches first aid to thousands of young people, through programmes including Badgers (for five to ten-year-olds), Cadets (10 to 17-year-olds - see St John Ambulance Cadets in the UK for more information), LINKS (based in colleges and universities)and RISE, a specialist project aimed at those not in education, employment or training.

In 2013, 91,000 schoolchildren were trained in first aid by St John Ambulance's schools team, while hundreds of thousands more had access to the organisation's training materials for schools, which are available to download for free from its Teach the difference website.

In 2014, the organisation also launched The Big First Aid Lesson, a free first aid lesson, which was streamed live into classrooms across England. 32,384 students took part in the inaugural event, and another is planned for June 2015.

Super Badger Award

St John badgers work towards the 'Super Badger Award'. This award consists of members completing 12 subjects, such as 'Creative', 'Global' and 'Wild' Badger. The award is split into 5 sections, where badgers advance through completing more subjects.

Grand Prior Award scheme

The Grand Prior Award is the primary award designed for cadets. The award is an essential part of cadet life, and was updated in 2004 after around 50 years of retaining the previous programme. The award consists of completion of 24 subject areas over the period of cadet membership, until the age of 21. There is no maximum time limit (other than age restrictions) upon completion of the award, however the award should not be completed in fewer than 3 years from the commencement date. The subject areas range from topics such as photography and clerical skills to childcare and crafts. The award is seen as the highest award a cadet can achieve, and is one of the only badges, as well as the Amalfi Award, 1000 hours service badge, National Competition Winner's badge and Sovereign's Award, which may be retained on the adult uniform.

Every year a reception is held at Buckingham Palace and is attended by HRH The Princess Royal to celebrate chosen individuals who have gained their Grand Prior Award.

Amalfi Challenge

The Amalfi Award was launched in recognition of the need for a programme after the Grand Prior Award. The Amalfi Challenge is open to all cadet and adult members aged 16 to 25. The structure of the award focuses on personal task set by the individual. These tasks are categorised into service, relationships, society and challenge. Each participant has to undertake 12 tasks and at completion of 4, 8 and 12 subjects a badge is awarded.

Cadet leadership

Cadets in St John Ambulance are encouraged to attend cadet leadership courses. These courses are progressive and intended to give cadets the skills to take a more active role within their unit. The courses teach skills which enable cadets to be promoted to NCOs within their units. They can then progress and attend further courses designed to improve said skills. Ideally all cadets promoted to the ranks of cadet corporal or cadet sergeant should have completed Cadet Leadership 1, and those promoted to leading cadet should have completed Cadet Leadership 2. Both cadet leadership courses also count as a subject towards the cadet's Grand Prior Award. Following the Cadet Leadership 2 course, Cadet Leadership 3 allows cadets to learn the skills required to take on an assistant youth leader role within their units, and includes the BTEC-accredited Essential Skills in Youth Work course.

LINKS units

St John Ambulance units dedicated to meeting the needs of student and university communities can be found at many institutes of higher education across England, Wales and Northern Ireland. These units, known as LINKS units, were originally established at universities to form a 'link' between cadet and adult membership, allowing members to carry on their membership and maintain their skills whilst in higher education. However, LINKS units have become integral parts of the student community and the majority of members are new to St John Ambulance at the point of joining, as students new to university look for societies to join.

LINKS units differ from most other sections in that they do not use a rank structure, instead having a democratically elected committee. This is due to the fact that, as well as being a unit within St John Ambulance, a LINKS unit typically exists as a society in the university's Students' union and, as such, must have a committee structure.

As well as providing first aid training to the student community and first aid cover at student events, LINKS members can be found frequenting other events attended by mainstream St John Ambulance units.

Youth leaders

It is essential that as a large major youth organisation as well as a first aid organisation that its youth leaders are trained appropriately to be youth leaders within the organisation, Youth leaders teach first aid; the Grand Prior Award Subjects; organise weekly meetings; social activities and games. Youth leaders often attend the BTEC-accredited Essential Skills in Youth Work course which St John Ambulance offers to all its members for the role of a youth leader; support is offered by divisional officers and county staff officers to members in this role where it is required for them to perform to their full potential.

Campaigning and awareness-raising

St John Ambulance campaigns to raise awareness of the importance of first aid, and equip more people with life-saving skills. Its 2013 Save the boy campaign, which featured an interactive element, demonstrating how to put a casualty in the recovery position, reached 15 million people through television and online media.

In January 2015, it launched a new campaign, The Chokeables, designed to teach parents how to treat a choking infant. The animated film featured the voices of actors John Hurt, David Walliams, Johnny Vegas and David Mitchell.

During the annual Save a Life September campaign, St John Ambulance trainers hold free first aid demonstrations in public spaces around the country, handing out first aid guides to attendees. A free first aid app for smartphones is also available to download.

Ambulance services

(CATS 1) St John Ambulance

St John Ambulance is leading supplier of ambulance services in England, providing patient transport services to over 100,000 people year, and working in partnership with NHS trusts, private healthcare groups, local authorities and individuals.

Services offered include A&E support, patient transport, bariatric transfer, paediatric and neonatal services, high-dependency transfers, planned journeys, repatriations, community first response and emergency response and major incident support.

In 2010, St John Ambulance was awarded the Private Ambulance Service Team of the Year Award by the Ambulance Services Institute for the work it carried out with the CATS(Great Ormond Street) and the South Thames Retrieval Service (Eveline Children's Hospital)

First aid and medical equipment services

St John Ambulance Supplies (often abbreviated to SJS) is a trading sub-division of St John Ambulance providing first aid and Medical equipment and consumables, training equipment, publications, health and safety equipment and clothing. Where a markup is made, surplus from sales are diverted into supporting the charitable work of the Order of St John and the St John Ophthalmic Hospital in Jerusalem.

SJS opened its doors at St John’s Gate in Clerkenwell on 12 February 1879 and was originally known as The Stores Depot. It is now a major commercial operation supplying to the public, private and voluntary sector.

Vehicles

St John Ambulance Crusader ambulance in a London street.

As individual (local) Divisions of St John Ambulance have historically been responsible for providing their own vehicles, these have taken many and varied forms, beginning with horse-drawn ambulances. Even into the late twentieth century, with some centralisation of control and classification of vehicle types such as Motor Ambulance Units (the title arising historically as a distinction from horse-drawn units), First Aid Posts and Rapid Deployment Vehicles, there remained within the organisation an enormous range of deployed vehicles of different types and even assorted local vehicle liveries. Some ambulances were donated second-hand from industrial plants, some were purchased (from different suppliers) and some were local conversions of commercial vehicles. At the start of the twenty-first century, new legislation regarding emergency ambulances effectively rendered a significant proportion of the then current St John Ambulance fleet redundant. The solution was the development of a specialist St John Ambulance vehicle, which was designed jointly by the organisation and vehicle manufacturer Renault. The result was the Crusader 900 ambulance.

An early assessment suggested that 100 of the Crusader ambulances (costing, at that time, £40,000 each) would be required immediately, representing an investment of £4 million. In 2000, St John Ambulance committed itself to raising £2 million by public subscription, whilst English and Welsh Freemasons committed a further £2 million, supplying 50 Crusader ambulances which were handed over in local ceremonies across the country during 2000 and 2001. This very large donation allowed the rapid transformation of the national St John Ambulance fleet of front-line ambulances within a much shorter time-scale than could otherwise have been possible. Subsequently, many local Provinces of Freemasons have maintained relations with their local St John Ambulance County units and supported the running costs of these vehicles or even donated further (additional) Crusader ambulances.

By 2004, the national St John Ambulance emergency vehicle fleet was in a standard corporate livery, with standard vehicle types:

Image showing the various vehicles St John Use (Left to Right: 2 Crusaders, a Challenger, a Companion Plus and 2 further Crusaders)

• Crusader - a front-line emergency ambulance, based on the Renault Master (or similar);
• 4x4 Ambulance - a 4-wheel drive emergency ambulance, based on the Nissan Patrol (or similar), but with additional headroom, for rural and off-road deployment;
• Support Vehicle - Either based on a Van, a Car or a 4x4 vehicle, Support Unit's can be used for a variety of purposes. For instance, a Support Car may be used to carry members to and from duties, in a logistical capacity, or even as a response vehicle on larger duties. Support Van's are normally used only for logistical purposes. Mini-buses are also available, and can be used for Logistics or Member Transport. Occasionally these are also used to transport low priority patients.

Specialist Vehicles

St John Ambulance also maintains specialist response options in particular locations, such as the Motorcycle Units, Cycle Response Units, as well as larger vehicles or trailers used as static First Aid posts.

Volunteers

The majority of St John Ambulance's volunteers deliver first aid at events and as Community First Responders or work with young people as youth leaders. Other specialist roles are available for healthcare professionals, volunteer managers and in safeguarding, human resources, quality and assurance and health and safety.

Training and skills

Volunteers receive training according to the role they fulfill. Those volunteering to provide Event First Aid services are offered a number of first aid qualifications, ranging from a basic emergency life support course and the further first aid modules, which deal with common injuries and ailments, through to Emergency Transport Attendant training which covers many of the competencies of the National Health Service Ambulance Technicians. The training for those delivering Youth Services comprises emergency life support training, coupled with training from the organisation's own youth leader training suite including Essential skills in youth work and Leadership skills in youth work, depending on the volunteer's role. In addition to medical training offered, members have the opportunity to carry out other operational roles. These include event planning, event management, radio communications/control, plus other support roles such as providing member refreshements at events etc.

Qualifications in First Aid and Allied Subjects

Qualification levels for first aid volunteers (in order that they have to be achieved):

• Trainee First Aider (TFA)
• First aider (FA)
• Advanced first aider (AFA)
• Patient transport attendant (PTA)
• Emergency transport attendant (ETA)

Volunteers start as Trainee First Aiders and then, after a period of supervised practice and passing assessments, become first aiders, then, usually after a probationary period of six months or more and provided they can demonstrate significant experience as a first aider, they can move on to become Advanced First Aiders; then, if suitable, patient transport attendants (PTA) and finally, emergency transport attendants (ETA).

Beyond the initial qualification of First Aider, volunteers can train in additional medical skills as they progress up the qualifications ladder. Where previously members were able to study some of these advanced skills (such as administration of the medical gases oxygen and Entonox) as optional 'bolt-on' modules once they had reacted the level of First Aider, the use of medical gases is now a core Advanced skill and can only be performed by an Advanced First Aider. Similarly the use of an automated external defibrillator (AED) was previously held as an advanced skill which could be studied as an optional bolt-on, but is now incorporated as a core skill for all First Aiders. For those wishing to go further still, the organisation runs two internal qualification courses known as Patient Transport Attendant and Emergency Transport Attendant (formerly Ambulance Aid level 1 and 2 respectively). These build upon the first aid skills with additional skills required for ambulance crewing. Those attaining the first level are allowed to crew St John vehicles and provide Patient Transport services (PTS). Those attaining the second level are additionally called upon to crew emergency ambulances as necessary. Training of the Ambulance courses (especially the second) are sometimes undertaken or supplemented by the NHS Ambulance Services.

The use of Cycle Response Units has been introduced by the organisation. The cycles used by St John Ambulance are custom designed and built for the task, with strengthened frames to take the extra weight of the large quantity of medical equipment they carry, including oxygen cylinders and AEDs. Members acting as Cycle Response Units are additionally trained with commercial cycling courses and must demonstrate a reasonable level of fitness. They wear a dedicated cycle uniform, replacing the conventional operational uniform.

Trainee First Aider

Designed to be an introduction to what St John Ambulance is about, the course replaces the old 'induction' and brings in a variety of key skills and concepts vital for any future operational first aider. The two day course covers:

• Communication & casualty care
• Incident management
• Primary Survey (casualty assessment)
• Unconscious casualty & recovery position
• Compression only resuscitation (Vinnie Jones style)
• Bleeding & bruising (minor)
• Burns & scalds
• Fainting
• Choking
• Bites & stings
• Shock (recognition & treatment)

IPC (Infection Prevention & Control)

• Introduction
• Personal hygiene
• Care of uniforms
• Effective hand hygiene
• Effective use of PPE

Moving & Handling Principles

• Relevant Health & safety information
• Spinal Anatomy, relevant structure & function
• Causes of back pain
• Risk assessment & planning
• Basic rules & positions

First Aider

Once members are familiar with basic first aid and life-saving skills, the First Aider course provides them with a very comprehensive look at a wide variety of first aid principles and skills. All further training builds on what is taught on this course. If members complete the course successfully, they are permitted to treat on duties as a First Aider. The course typically lasts two days and consists of practical and theoretical training and a final assessment of competence.

The syllabus consists of:

• Role of the FA
• Governance & documentation
• PPE, Management of waste etc.
• Resuscitation - Basic life support (all ages)
• Resuscitation - Use of face shield / pocket mask
• Secondary survey
• Bleeding (severe)
• Allergic reaction
• Auto-injector
• Low blood sugar
• Bone, muscle & joint injuries
• Asthma
• Casualty management outdoors
• Childhood conditions
• Stroke
• Seizures
• Eye injuries
• Head injury
• Administration of medication
• Chest pains
• Mental Capacity Act (consent)
• Meningitis
• Abdominal pain
• Heat + cold extremes
• Poisons
• Spinal injuries
• Foreign objects (ear, nose, eye)
• AED (Automated Defibrilator)
• Incident management
• Research into CPR & defibrillation
• Basic anatomy and physiology of the heart
• Practical Introduction to AED and use of AED protocol

Advanced First Aider

Once members have gained significant experience on duty and are confident with their first aid skills, they can progress to be an Advanced First Aider. This builds on their qualification as a First Aider by going into more depth about the medical conditions that AFA's may come across and by giving them the use of more advanced treatment and observation equipment. This added knowledge and improved skillset provides the AFA with more confidence when treating casualties, helping them to provide a higher standard of medical care.

The Syllabus includes:

• Role of the AFA (inc. Governance & Documentation)
• Blood oxygen measurement
• Mental Capacity Act (consent)
• Spinal immobilisation using collars
• Fracture immobilisation using splints
• Removing a crash helmet
• Patient care positioning
• Use of equipment carried on MTU
• Body temperature measurement (tympanic / electronic)
• Blood pressure measurement
• Use of spinal boards

Medical gases are an advanced first aid skill and are extremely valuable in the right circumstances. Oxygen is used to treat critical conditions (such as cardiac arrests and asthma attacks) and Entonox is used in relief of severe pain (usually fractures). Members must have a good amount of experience before venturing into these skills; the Advanced First Aider must know when to use gases and what safety precautions must be taken.

• Medical gas cylinders (safety, storage & preparation)
• Oxygen - casualty assessment
• Oxygen therapy (inc. suction & oropharyngeal airways)
• Oxygen as an adjunct to resuscitation
• Entonox as an analgesic gas (pain relief)

Moving & Handling for Advanced First Aiders

• Use of carry chairs
• Use of carry sheets
• Use of folding (Furley) stretcher
• Use of wheelchairs
• Use of ambulance trolley beds

Patient Transport Attendant

This course is aimed at the scenario of transporting by ambulance a patient whose condition is stable (typically chronic) and not expected to deteriorate. For example, an inter-hospital transfer may fall into such a category. On its own, the qualification usually will not allow you to crew an ambulance on a duty and bears a strong resemblance to the Advanced First Aid qualification, although the skills gained can be useful on duty. There is a strong emphasis on good patient handling.

• PTA: Role & responsibility
• Infection prevention & control (clinical)
• Vehicle inspection & use
• Ambulance familiarisation
• Radio communication protocol
• Patients with chronic conditions
• Medical gases
• Mental health

Moving and handling of patients/casualties (6 hrs)

• Safe manual handling techniques
• Ambulance carry chair
• Pole and canvas stretchers
• Carry sheet
• Furley stretcher
• Orthopaedic scoop stretcher
• Ambulance trolleys (Pioneer and Falcon)
• Wheelchair

Emergency Transport Attendant

This covers the competencies needed to provide accident and emergency care inside and outside of an ambulance. It is a high level First Aid course with a rigorous examination at the end, and in addition to the time commitment for formal instruction, candidates should expect to put in extra practice time. Significant experience of hands-on First Aid is essential.

Patient Assessment:

• Extended primary survey
• Taking of observations (blood pressure, oximetry, chest auscultation and palpation)
• Patient assessment scenarios
• Fracture management
• Use of ambulance trolleys
• Spinal immobilisation: cervical collars, rescue board, scoop, KED
• Head and chest trauma
• Trauma and medical scenarios
• Paediatrics
• Maternity
• Assisting the paramedic

Healthcare Professionals

Qualified healthcare professionals may also volunteer their time in St John Ambulance. These include:

• Nurses
• Paramedics
• Doctors
• Midwives
• Operating Department Practitioners

All healthcare professionals have their qualifications and professional status checked with the appropriate regulatory body before practicing in St John Ambulance. Professionals can carry out any skill appropriate to their type, level of training, competence and when relevant to the situation or patient. Healthcare professionals wear coloured rank slides to distinguish them from internally trained first aiders and ambulance personnel. With the exception of Paramedics/IHCD Ambulance Technicians, any HCP wishing to work on an ambulance though must become a PTA/ETA, but parts of the training may be omitted if the candidate can attain accreditation of prior learning. This is dependent on the HCP's professional training already undertaken. This is to ensure that the HCP is prepared for working in an ambulance/emergency environment (which they may never have done).

Structure

In 2012, St John Ambulance was reorganized into an eight-region structure, with the goal of increasing accountability and maximising charitable outputs.

As part of the reorganization, a more streamlined structure was introduced, with fewer layers of management between the front-line and the St John Ambulance Board.

St John Ambulance regions

• East Midlands - Derbyshire, Leicestershire & Rutland, Lincolnshire, Northamptonshire, Nottinghamshire.
• East of England - Bedfordshire, Cambridgeshire, Essex, Suffolk, Norfolk, Hertfordshire.
• London - London.
• North East - Durham, Humberside, Northumbria, North Yorkshire & Teesside, South & West Yorkshire.
• North West - Cheshire, Merseyside, Lancashire, Greater Manchester, Cumbria.
• South East - Buckinghamshire, Oxfordshire, Berkshire, Hampshire, Kent, Surrey, Sussex, Isle of Wight.
• South West - Avon, Cornwall, Devon, Dorset, Gloucestershire, Somerset, Wiltshire.
• West Midlands - Herefordshire, Shropshire, Staffordshire, Warwickshire, West Midlands, Worcestershire.

• Guernsey, Jersey and the Isle of Man became separate Commandries in 2012.

Each region is managed by a regional director, and is responsible for the delivery of programmes developed and overseen by National Headquarters. All eight regions are accountable to the Care Quality Commission and are independently inspected by the CQC against 14 different outcomes, such as care and welfare of people who use the services, cleanliness and infection control and supporting workers.

District

The region is divided into a number of districts, usually between three and five, depending on the number of units in the region. A district may contain one or more former "counties" from the previous structure. Each district is managed by a district manager, and area managers report to them. District managers are in overall charge of all activities in their district, assisted by the area managers. They have a support team of district specialists in place coordinating functions such as event cover and youth provision, but they have no line management responsibility and report to their respective regional departmental manager. Each district usually contains 3–6 areas.

Area

Districts are further divided into geographic areas, led by an area manager. Unit managers report to the area manager, and the area manager is in overall charge of the activities of the units in their area, within the boundaries of policies etc. set by Regional Headquarters (RHQ) and NHQ. They are assisted/advised by district specialists to provide the day-to-day functions of the organisation, such as member training and event cover. Each area contains about 8–15 units.

Unit

A unit (formerly a "division") is the smallest administrative division of St John Ambulance. Most volunteers are managed within a unit and by a unit manager. Units traditionally were ambulance divisions (for men), nursing divisions (for women) and ambulance cadet divisions and nursing cadet divisions for boys and girls respectively. In modern times, only a few single-sex divisions remain and most are either termed 'combined division' (men and women together) or 'quadrilateral division' (men and women, boys and girls under one command structure). Other types of local units exist, such as Badger Setts (for 5- to 10-year-olds) and specialised groups such as cycle response units, LINKS units within universities and sometimes informal social groups, each with a distinctive command, management or leadership structure. The unit manager may have one or more assistant unit managers to assist them. The unit usually has a weekly meeting where members train, practice their skills, and occasionally have visits from guest speakers. Youth units (badgers and cadets) follow the St John Ambulance youth programme. Units plan and execute the cover of most of the events requested of the organisation, supported by their area and district managers, district specialists and regional events team. Units are where most people start their time in the organisation.

Uniform and ranks

Main article: St John Ambulance Ranks and Insignia

Uniform

St John Ambulance first aid personnel wear a service delivery uniform consisting of a green shirt, black combat trousers, either a green and black Parka Jacket or a reversible fleece and appropriate black footwear. A ceremonial uniform still exists, consisting of a peaked cap, tailored jacket, white shirt, black trousers, black shoes and clip-on tie. All rank insignia are worn on the outer layer of the jacket; on the service delivery uniform, a role badge is worn to denote the wearer's first-aid qualification. High-visibility two-tone yellow-and-green tabards (accepted to denote medical personnel) are only worn when the risk assessment of the event calls for it.

St John Ambulance in the British Armed forces

St John Ambulance now has British divisions running where there are a large amount of British servicemen and women with their families overseas. These are namely in Germany and Cyprus. The divisions are directly linked to the UK and national headquarters so that members can transfer to another division or county as they would be able to do at home. The overseas divisions are classed as one whole extra county for the UK in the St John Ambulance structure. The shoulder flash on the uniform states "St John Ambulance Germany" as it would say, for example, "St John Ambulance London District" which shows that they are directly linked to the UK. St John Ambulance British Forces Overseas is run by a volunteer paramedic with links to the military.

Members are able to be trained in a the full range of St John Ambulance qualifications. The majority of the volunteers hold positions as First Aiders or Advanced First Aiders; however, recently some members have been trained up to Patient Transport Attendant (PTA) or Emergency Transport Attendant (ETA) qualifications.

The overseas forces divisions were originally founded in 1980. They remained very strong for several years, however, as the forces in Germany were reduced many divisions closed. Over the past few years, St John Ambulance is again making a strong return to British Forces Germany and in the past year a series of divisions were re-opened across Germany.

In the past they had a number of ambulances available for public use; but these were decommissioned and an ambulance from the UK borrowed for use in Germany. A car was also donated by a local dealership for use of the training services or transport of volunteers. Fund-raising for new ambulances was started.

St John Ambulance British Forces does not just provide medical cover for events, but just as in the UK they provide commercial first-aid training, quite often run in co-ordination with Military Education Centres. There is a strong team of first-aid trainers across Germany who can teach the range of civilian first aid courses include the HSE-approved First Aid at Work. They are the sole supplier of these courses to soldiers and civilians in the British Forces.

St John Ambulance British Forces Overseas works closely with the German Ambulance Services, particularly the sister organisation "Die Johanniter" in providing first aid and ambulance cover German public events where many British or English Speakers are expected to attend. Members can occasionally be seen on their non-emergency and emergency vehicles responding to public calls. St John Ambulance can also be seen working with "Malteser", the German Red Cross and local fire brigades which provide ambulance services. The German Emergency Services also assist St John Ambulance at British events on military areas where many German civilians are expected to attend.

Relations with the Order of St John and other organisations

Although the Order of St John is largely seen as a Christian organisation for historical reasons, St John Ambulance does not restrict membership to nor promote any particular religion or denomination. Technically, it falls under the sovereignty of The Queen, and thus is linked to the Church of England; however, this relationship is more tradition than authority, and adult members are not required to pledge allegiance to or support either the monarchy or the Christian faith. Cadet members do still make a pledge upon joining to the monarch and "God"; however, this is again largely seen as tradition and there is no pledge to the Church of England.

St John Ambulance personnel serve alongside the British Red Cross, whose members also undergo advanced training in first aid and event cover. Both organisations work support the statutory services in times of civil emergency or crisis.

St John Ambulance, St. Andrew's First Aid in Scotland and the British Red Cross co-author and authorize the official First Aid Manual, the de facto UK guide for emergency first aid.

See also

• St. John Ambulance
• St John Ambulance Ranks and Insignia
• St. John Ambulance Brigade of Ireland
• Venerable Order of St. John
• Service Medal of the Order of St John
• Insignia of the Venerable Order of St John

External links

• St John Ambulance - The Priory of England and the Islands
• Caring on the Home Front A website dedicated to the memories of St John Ambulance and British Red Cross volunteers during World War II.
• "St John England, registered charity no. 1077265". Charity Commission for England and Wales.