Make a wish now

Application form

Welcome to The Ambulance Wish Foundation UK. Please fill out the form below and describe your wish are clearly as possible, stating the address where you would like to be picked up from and the address/destination you would like to go too.

We will then look into the organisation of all aspects of you wish and will contact you as soon as possible. In order for us to do this please provide us with a telephone number we can reach you on between the hours of 0800-1800.

The Ambulance Wish Foundation UK fulfils all wishes for free, however if you could include a brief account of your wish and the reasons behind it we would like to share you story anonymously with our sponsors and to generate more donations for the foundation in order to help others fulfil their wishes too.

Criteria and Conditions of transport

Please read this section carefully prior to completing your application form. If you have any questions, please contact your care providers in the first instance. If not please contact us and we can advise you further.

Criteria for the provision of wishes

1.       The Ambulance Wish Foundation UK (AWF-UK) aim is to assist any terminally ill person within the United Kingdom who is approaching the end of life, and who would otherwise be unable to fulfil their final wishes due to logistical barriers.

2.       The AWF-UK, due to limited resources and other operational reasons, cannot guarantee the fulfilment of any journey, and reserve the right to cancel or postpone a journey at any time.

3.       Persons must have a terminal diagnosis and require the use of the AWF-UK ambulance as no alternative means is accessible to complete their journey.

4.       The AWF-UK aim is to provide a suitable vehicle, with appropriately trained crew to convey a client between two points, however the AWF-UK cannot fund any other activities undertaken.

Conditions of transport

1.       Persons must have the support of their lead clinician in undertaking the proposed journey. And this person must be named on the application and be contactable of required for the duration of the wish?

2.       Persons must have sufficient and appropriate medicines and medical devices for the proposed journey, and an escort authorised to administer medicines and maintain any devices required during the journey. We can secure these drugs securly for the duration of the wish and administer only if they have already been prescribed and can be given in a way that a volunteer is trained to do so (e.g. IM or SC)

3.       The Ambulance Wish Foundation UK (AWF-UK) can carry persons under non-emergency conditions to places of personal significance. Should a person’s condition deteriorate during transport then staff can provide basic care only including basic life support (BLS) in the event of a cardiac arrest).

4.       Due to the Deregulation Act 2015 we cannot provide emergency transport to hospital using blue lights and sirens. The policy of the charity will be to halt the transport in a safe place and dial 999 to request the attendance of an NHS emergency ambulance.

5.       Whilst awaiting the attendance of an emergency ambulance AWF-UK staff can only provide basic emergency care and BLS until an NHS ambulance can attend.

6.       Persons who do not wish to be resuscitated in the event of a cardiac arrest must carry with them a valid Do Not Resuscitate order (DNA-CPR).

7.       Person who do not wish to receive basic care in the event of their condition deteriorating must carry a valid Advanced Directive to Refuse Treatment (ADRT) or have a person travelling with them with a valid Power of Attorney – Health and Welfare (LPA-Health & Welfare).

By completing and returning this application form we assume that you accept the above conditions.

For further information on the terms used please discuss with your Palliative Care Providers or go the following sites:

  • ·         DNA-CPR

https://compassionindying.org.uk/making-decisions-and-planning-your-care/planning-ahead/dnar-forms/

 

  • ·         Advanced Directives to Refuse Treatment (ADRT)

https://www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment.aspx

  • ·         Lasting Power of Attorney:

https://www.gov.uk/power-of-attorney

Your wish

About the patient

Enter the address where the patient may be picked up, if different from below:

Type of housing for pick up address

About the person referring the patient

Additional information

Beveiligingsvraag

The Ambulance Wish Foundation UK on Facebook

Facebook Like Follow our stories on Facebook, to help as many people as possible we need your support!