It was a bright, clear day in late September and, on an isolated vantage point on Raddick Hill, the Tavistock Ramblers were packing away their picnic lunch. There were lovely views towards Cramber Tor and, away to the south, a little stream gurgled down the valley towards Burrator Reservoir in the heart of the Dartmoor National Park.

With an experienced and well-prepared leader in charge, the group had followed the old railway track from Princetown through the fascinating landscape high above the River Walkham, chatting easily and taking photographs as they went. But now, as they prepared for a pleasant afternoon trekking back over the moor, something was wrong. Mary Stevens, normally a calm and capable walker, was in so much pain that she couldn’t stand or walk any further. She felt faint and shaky, and became very pale.

“Mary’s husband and other members of the group helped me to make her comfortable with coats and emergency foil blankets,” recalls the walk leader, Roger Fowler. “She was fully conscious, with no chest pain or breathing problems, and she had a strong and steady pulse. But she obviously needed evacuating from the moor for a proper medical assessment, so I got on my mobile and called 999.”

Roger carefully described the casualty’s condition to ambulance control. He gave a precise National Grid reference and stressed that the group was in a remote location, over a mile from the nearest road at Norsworthy Bridge. But, says Roger: “The operator was obviously inexperienced and seemed unable to locate us, either with a grid reference or from my description of local landmarks. In addition, she didn’t seem to grasp that we were more than 350m/1,150ft up on open moorland that could only be reached with a 4×4 or an air ambulance.”

Eventually, after seeking help from her supervisor, the operator pinpointed the group’s position and an ambulance was dispatched. “She estimated that it would arrive in an hour, and was counting down the arrival time as we talked,” says Roger. “But she still didn’t seem to realise that the vehicle simply wouldn’t be able to reach us.”

Meanwhile, the leader had other things on his mind. The remainder of the group was getting cold and restless and, with an ambulance on its way, someone had to go back to the road to meet it.

Luckily, there were several other competent leaders among the group: two returned to the road to rendezvous with the ambulance, while another guided the less-experienced walkers safely back to Princetown. There was more luck down at Norsworthy Bridge. “The ambulance crew soon realised that they couldn’t get their vehicle any further,” says Roger, “but fortunately a kind and capable man with a well-equipped 4×4 stepped in to drive them up the rough track to meet us. He later evacuated Mary, together with her husband and the ambulance crew, about an hour and a half after the incident began.”

Grid reference frustration

The story has a happy ending as Mary’s condition wasn’t life-threatening and she made a full recovery. Sadly, though, it wasn’t an isolated case: the Ramblers has some 40 similar incidents on file, recording the frustrations and delays caused by ambulance control rooms unable to recognise grid references or the special nature of emergencies in remote locations. And it’s not just frustrating for the casualties and walk leaders involved.

The Bluebell Walkers, an independent club affiliated to the Ramblers, was involved in a similar incident on Hepburn Moor, near Alnwick in Northumberland. Their leader was surprised when the ambulance call handler told him that they did not use National Grid references, but after a 45-minute wait the ambulance finally arrived to deal with a member who’d broken their ankle. Later, the paramedics said that they preferred to use a grid reference wherever possible, and could have reached the casualty half an hour earlier if only the control room had passed that information on to them.

“Our walk leaders first began highlighting ambulance services that couldn’t locate National Grid references about two years ago,” says Karen Inkster, who spearheads the Ramblers’ ‘999: It’s an emergency!’ campaign. “We know of just one incident in Scotland and another in Wales, but the overwhelming majority of reported problems are in England.” Karen, who represents the Ramblers on the emergency services’ Search and Rescue Committee, is also in touch with the Long Distance Walkers Association, the British Caving Association and other organisations working to support the Ramblers’ campaign.

Karen admits that unpicking Britain’s complex network of emergency services – and knowing exactly who to contact in a crisis – isn’t always straightforward. “England is covered by 12 independently managed NHS Ambulance Trusts,” she says. “A further Trust serves the whole of Wales, while the Scottish Ambulance Service covers mainland Scotland and its offshore islands.”

Ambulance services work closely with national search and rescue organisations when responding to calls from incidents in remote or hazardous locations. The Maritime and Coastguard Agency provides 24-hour cover around the UK’s coasts and cliffs, while the police are responsible for inland search and rescue throughout Great Britain. In turn, they rely on more than 80 volunteer Mountain Rescue teams – each one an independent charity – for help in rugged upland areas. In a typical year, these teams attend more than 1,000 incidents involving over 1,300 walkers, while the coastguard responded to 13 walking-related fatal accidents in 2010.

“Walkers in distress can dial 999 and ask for any emergency service,” says Steve West, Director of the Association of Ambulance Chief Executives. “All of them can and should be able to coordinate an appropriate response.” But the Ramblers’ advice is to always ask for the police if you are well away from a road or in a remote area. A regular ambulance will find it difficult to get to you lost on the moors or stuck on a cliff path, but the police can coordinate a rescue operation.

“Mountain-rescue teams aren’t insured without a police log number,” explains Andy Simpson from Mountain Rescue England & Wales, “but our volunteers have good relations with the statutory emergency services, including the coastguard, and teams are generally on their way within 15 minutes.”

Rapid ‘twin-track’ response

What happens when you make that emergency call is fascinating. “It’s a twin-track process,” explains Steve, regarding the complexities of handling 6.5 million calls each year. “The call handler should answer the phone in about two seconds and, if you’re calling from a landline, the registered address will already be displayed on their screen. Calls from mobile phones will trigger an approximate location, but the degree of confidence does depend on the location of the surrounding phone masts.”

The call handler will ask a series of structured questions to confirm the location and assess the clinical need. Then, they’ll be able to offer advice in looking after the casualty until the ambulance arrives.

While all that’s going on, an ambulance dispatcher will be picking the details off a linked computer and getting a response on its way – typically within 30 to 40 seconds of the call coming in. “It’s a complex decision matching the asset to clinical need,” says Steve. “Our options range from a community first responder with first-aid and a defibrillator to an air ambulance.”

The ambulance service aims to help 75% of life-threatening emergencies within eight minutes. The fastest response might be a paramedic in a car or on a motorbike. But, if the casualty needs transport to hospital, an ambulance should reach 95% of cases within 19 minutes.

Nevertheless, at a meeting with the Ramblers’ Karen Inkster in September, Steve West admitted that – in a small minority of cases – things don’t always work quite so smoothly. “Between them, the various Ambulance Trusts use four different computer-aided dispatch systems,” he says. “They all feature advanced mapping systems, but they don’t currently accept National Grid references in an easily accessible way.”

Following the meeting, Steve has agreed to raise the issue nationally with the NHS Ambulance Director of Operations Group, and to liaise with the national software suppliers’ forum to ensure that all the different systems can use National Grid references. Call handlers will also receive additional training after the software is upgraded. “It’s a fantastic result,” says Karen, “and we expect to have a follow-up meeting in about a year’s time.”

Meanwhile, the Tavistock Ramblers were recently involved in a second incident, when one of the group dislocated her knee near the start of a walk. “This time, South Western Ambulance Service was superb,” says their chairman, Paul Brookes. “They arrived promptly and the paramedics called in the fire service to carry the casualty back to the road. Afterwards, I wrote to congratulate them.”

Some individuals’ names in this article have been changed to protect their identities. Illustrations by Nina Hunter @ Illustration Ltd.

What to do in a medical emergency

Stay calm…

Dial 999 on your mobile… and ask for an ambulance. But if you are well away from a road or in an inaccessible location, then always ask for the police, who will contact the nearest Mountain Rescue service or coastguard.

Tell the emergency services what’s wrong… answer their questions clearly.

Give an accurate location… including the National Grid reference and any prominent landmarks.

If you’re uncertain of your position… Mountain Rescue may ask you to send them a picture message of what you can see.

Be patient… as calls are prioritised and will be handled as quickly as possible.

If there’s no signal on your mobile… send two people for help, if possible. Alternatively, use six quick whistle blasts or torch flashes, repeated after a one-minute interval, to give the emergency distress signal.

If you are deaf, hard-of-hearing or speech-impaired, you can register your phone at www.emergencysms.org.uk. This will allow you to send an SMS text message to the UK 999 service, where it will be passed to the police, ambulance, fire rescue or coastguard.

Email the mayor with your support for the campaign at www.livingstreets.org.uk/take-action

“In Scotland, better regulation and control of Network Rail is needed,” says Helen Todd, Ramblers Scotland’s development officer. “It failed to cooperate in drawing up the Scottish Outdoor Access Code in 2005 and since then has been trying to close level crossings without public consultation and erecting false notices.”

• Tendring Ramblers (pictured above) walked a long lost footpath over a level crossing at Brakey Grove, Wrabness, Essex, in August after they successfully campaigned to have it cleared by the council and got new steps installed by National Rail.

A well-equipped child is a happier child when out on the trail. Minnie Burlton and Paul McCarty offer their tips for kids’ jackets…

• A storm flap is useful for helping prevent wind and water getting through the zip.
• Adjustable, rather than elasticated, cuffs allow a more precise fit.
• When the hood is up, check it moves with the child’s head and doesn’t restrict vision.
• Pockets for hands, gloves and other things are a good idea, and zips to keep contents secure.
• If drawcords appear at the hem or waist, make sure they can be tucked away so they don’t snag or whip in high winds.

Clothing for children up to 7 years of age or 134cm in height should not have drawcords in the head or neck areas under international standards. You can find out more information by downloading this PDF, which also highlights the rules for drawcords on clothing intended for older children.