You may have seen them: a flash of fluorescence, a glint of bright helmet, a blur of wheel spokes, the intent concentration as they speed past: the cycle paramedics scrambling to give life saving support – not on four wheels, but two.

Cycle responders, bike medics, bike ambulances, as they are variously called in different parts of the world, are fit, professional, medically trained personnel who share one thing in common: they respond to emergencies by cycling to them on bikes carrying essential equipment, providing life-saving medical aid in situations that more conventional emergency vehicles cannot reach.

In Britain, there is evidence that they are not only saving lives, but saving money. Figures from the London Ambulance Service, whose super-fit cycle paramedics respond to 999 calls in heavy traffic, show that the special cycle crews have saved £300,000 in fuel costs, or the equivalent of 20,000 ambulance journeys since 2000.

London’s Cycle Response Unit has treated 50,000 patients since they were set up 10 years ago, freeing up around 5,000 ambulance hours a year, about the same as two extra ambulance vehicles staffed with two paramedics.

“What started out as an idea to reach patients faster in central London traffic is now attending thousands of 999 emergency calls a year,” Unit manager Tom Lynch MBE told the London Evening Standard in September 2010, when London’s Cycle Response Unit celebrated its 10th birthday.

Lynch, scheme founder and former British BMX champion, said that more patients are receiving the emergency care they need more quickly because cycle responders can access areas of the capital that ambulances cannot reach, such as pedestrianized zones and shopping malls.

Each cycle responder has a specialized Rockhopper aluminium-framed mountain bike with puncture and bullet-proof tyres. They carry the same equipment as a regular four-wheel ambulance minus the stretcher.

The 100-member London Unit has teams based in various parts of the capital, including the City, Canary Wharf and Heathrow Airport. As well as serving the designated areas, the Unit supports major outdoor events.

In Norwich, the birthplace of the cycle responder idea in the UK and first piloted there by Iain Colquhoun in 2000, the East of England Cycle Response Unit attends more than 1,000 call a year in the city centre.

Unit leader Darren Rutterford, told the press in March 2011 that having the cycle responders is a bonus for the city because “most of the urban centres have a mall and those malls are very difficult to access for ambulances and for rapid response vehicles”.

He explained in an interview with Norwich Evening News 24 that their bike ambulances are reaching 97% of the government’s target of answering category A calls, life threatening calls like cardiac arrests, within 8 minutes.

A cycle responder’s bike is nowadays quite different to the ones used by the pilot teams ten years ago. The equipment is highly specialzed and more lightweight than those carried in regular ambulances. This includes a lightweight defibrillator (a machine that helps the heart regain its natural rhythm following a cardiac arrest), and a portable monitoring pack that contains an ECG machine to detect abnormal heart beat and diagnose chest pains.

One example of how a cycle responder carrying all this specially adapted equipment can save lives was shown recently when paramedic Ben Forde, a 33-year-old colleague of Lynch’s in the London unit, rode his bike into a West End theatre to treat a heart attack patient. He cycled straight into the lobby of the theatre, much to the astonishment of the people there.

To be a cycle responder you have to be fit and have a high level of stamina. Candidates for the London Cycle Response Unit have to undergo a battery of fitness tests, including a 1 km sprint to enable the Unit to achieve their very fast response time, which on an average is about five minutes, but on occasions can be as low as 60 seconds.

Since the first pilot projects in Norwich and London in 2000, similar cycle response units have spread to other UK cities including York, Manchester and Cardiff, both within the NHS ambulance services but also within the voluntary sector, such as the St John Ambulance, a charity that teaches people essential first aid.

St John Ambulance has a cycle response unit in London, which since it was set up in 2004, has supported over 300 events across the City. Their volunteers also have specially equipped mountain bikes that carry advanced first aid equipment including an automated external defibrillator or AED and medical gases.

In the United States, cycle responders are more often referred to as EMS (emergency medical service) bikers, and classed as part of emergency and patrol cycling services that also include police, search and rescue, and in some cases, fire.

They were most likely first deployed during special events as an alternative way to reach casualties to walking. They quickly proved to be faster and more effective at getting through crowds and traffic than conventional emergency response vehicles.

This was probably around the 1980s, and was followed by other examples, such as the Indianapolis Fire Department, whose members started using their own bikes, and eventually the department started purchasing official bikes and by 1989 had set up an official team of bike responders.

In the 1990s, official EMS cycling units began to emerge throughout the US, and also in Canada. While the predominant use appears still to be at large events, more and more permanent units are now deployed in a variety of locations, such as tourist areas, amusement parks, sport arenas, college campuses, airports, train stations and other transport centres.

In their Spring 2008 newsletter, the International Police Mountain Bike Association (IPMBA) refer to a 200 US city survey that appeared in a 2000 issue of Journal of Emergency Medical Services that reported more than 300 bike medic teams were operational across the US and 52% of EMS organizations in the country’s largest cities had established EMS bike units.

An often overlooked aspect of the bike medic unit is public relations, explains Robert Dunivin, an EMS cyclist instructor with the IPMBA. In a training article he wrote last year for EMS1, a California-based online resource site for EMS, he writes that even though the fire and EMS personnel are often more popular with the public than police officers, they are not necessarily as accessible, and for most people, they only come face to face with EMS teams during emergencies.

“Bike Medic teams being deployed to street fairs, festivals, and races are very well received by the public,” sayd Dunivin, “the teams are usually right in the mix of the event and are very approachable”.

People also enjoy the “green” aspect of the bike medic scheme, and have a sense that something is being done to protect the evironment and save fuel, he adds.

Bike ambulances are also saving lives in developing countries, where they can mostly be found with trailers attached, so they can transport patients to hospitals and clinics. Many such bike ambulance schemes have been set up as part of charity and aid initiatives.

A famous example is the bike ambulance scheme set up in rural sub-Saharan Africa by the Canadian charity Design For Development Society. The aim is to improve the transport time for emergency cases in communities where motorized transport is either unavailable or just inappropriate.

The scheme focuses on using local materials and trade skills to make bike ambulances and trailers that are affordable to the communities they serve. Patient comfort is provided with a suspended bed for a removable stretcher, the use of inner tube strapping to absorb shocks, and an adjustable backrest.

Another example is the bicycle ambulance project in Zambia, sponsored by Transaid in partnership with World Bicycle Relief and Disacare. Started in 2008, the project made and distributed bicycle ambulance trailers to 40 volunteer healthcare workers. The aim is to improve rural access in communities where the cost of running a 4 by 4 vehicle would be impossible with current resources.

In Malawi, where nearly half of all births happen without the help of a trained health specialist, and a staggering number of women die in childbirth, the use of a bicycle ambulance appears to have helped wipe out the problem in one particular village, Pitala, where the closest health facility is some 30km (18 miles) away. Although much of the problem is cultural, in that hospital delivery is not the norm, the fact the bicycle ambulance can now ferry patients to the hospital is a big help.

In Nepal, UK-headquarted charity Practical Action, was already working with villagers to build bicycles and trailers to help them transport goods to market. They then adapted the trailers to become ambulances. While the charity provided the expertise, the “hard work” was done by the villagers themselves.

Sources: Sophie Goodchild, “Bicycle paramedics save lives and a lot of money for NHS”, London Evening Standard, 16 Sep 2010; St John Ambulance; Maureen Becker, “A Brief History of EMS Cycling” IPMBA News, Spring 2008; Robert Dunivin, “How to start a Bike Medic Team”, ems1.com, Apr 2010; LEPRA Health in Action; Design For Development Society; transaid.org; “Maternal Mortality Across the World”, BBC News Oct 2009.

Written by: Catharine Paddock, PhD