NHS ambulance services

There are currently 11 NHS ambulance trusts in England (separate management arrangements are in place for the Isle of Wight).

Ambulance services help many people with serious or life-threatening conditions. They also provide a range of other urgent and planned healthcare and transport services.

Ambulance crews can include a range medical staff, such as emergency care assistants and paramedics. Ambulance trusts should ensure that patients are given the appropriate level of care. For example, if someone needs a paramedic, one should be dispatched. Crews are highly trained in all aspects of emergency care, from trauma injuries to cardiac arrests. An ambulance is equipped with a variety of emergency care equipment, such as heart defibrillators, oxygen, intravenous drips, spinal and traction splints and a range of drugs.

Patients will always be taken to hospital when there is a medical need for this. However, ambulance staff now carry out more diagnostic tests and do basic procedures at the scene. Many crews also refer patients to social services, directly admit patients to specialist units and administer a wide range of drugs to deal with conditions such as diabetes, asthma, allergic reactions, overdoses and heart failure.

Emergency 999 calls

Emergency 999 calls to the ambulance service are prioritised into two categories to ensure life-threatening cases receive the quickest response:

Immediately life threatening – An emergency response will reach 75% of these calls within eight minutes. Where onward transport is required, 95% of life-threatening calls will receive an ambulance vehicle capable of transporting the patient safely within 19 minutes of the request for transport being made.
All other calls – For conditions that are not life threatening, response targets are set locally.

A 999 call should only be made in a genuine emergency. To ensure seriously ill and injured patients are treated as quickly as possible, people whose call is not serious should consider other healthcare options rather than calling 999. These could include:

self-care at home
talking to your local pharmacist
visiting or calling your GP
calling NHS Direct on 0845 4647
calling NHS 111 if you live in an area where the service is available
going to a local NHS walk-in centre
attending a minor injuries unit
making your own way to your local A&E department (arriving in an ambulance does not mean you will be seen any quicker)

Dialling 999

Always call 999 if someone is seriously ill or injured, and their life is at risk.

Is it a genuine emergency?
If so, call 999 and don’t panic. Always call 999 if someone is seriously ill or injured, and their life is at risk. Once you are connected to an ambulance 999 operator or call handler, they will ask you a series of questions to establish what is wrong. This will allow them to determine the most appropriate response as quickly as possible.

Do not hang up
Wait for a response from the ambulance control room as they might have further questions for you. The person who handles your call will let you know when they have all the information they need. You might also be instructed on how to give first aid until the ambulance arrives.

When it's not a life-threatening emergency
If the situation is not a life-threatening emergency and you or the person you are with do not need immediate medical attention, consider other options before you dial 999.

For more advice read the Responding to an emergency information.

Air ambulances

Air ambulances deliver emergency care, especially in rural areas and where road access is a problem. They can be an effective way of getting better and faster access to hospitals and are valuable in transferring patients between hospitals. However, while air ambulances have benefits in particular circumstances, they are very expensive to operate. Research has failed to show that they are strong candidates to be entirely funded by the NHS. Since April 1 2002, the cost of clinical staff on air ambulances has been met by the NHS.

Non-emergency patient transport services (PTS)

As well as dealing with emergency care, some NHS ambulance services provide non-emergency patient transport services (PTS). PTS is used for the non-urgent, planned transport of patients (who have a medical need for it) to, from or between NHS healthcare providers. A non-emergency patient is someone who needs treatment, which may or may not be specialist, and who does not require an immediate or urgent response.

Local primary care trusts (PCTs) currently commission ambulance services, however, from April 2013 this will be done by Clinical Commissioning Groups (CCGs). They decide who provides PTS for eligible patients in their area. This can and should include a wide range of vehicle types and levels of care that are appropriate to the medical needs of a patient. PTS can include the local ambulance service, private or voluntary sector providers, or a combination of these organisations.

You are eligible for PTS if:

You have a medical condition that requires the skills and support of PTS staff during the journey, or if travelling by other means would have a negative impact on your condition or recovery.
Your medical condition affects your mobility so that you can't access healthcare by yourself, or if travelling by other means would have a negative impact on your condition or recovery.
You are recognised as a parent or guardian of children who are being transported.

Eligibility for PTS should be determined by a healthcare professional or a non-clinically qualified member of staff who is clinically supervised or working within locally agreed guidelines, and employed by or working under contract for the NHS.

PTS could also be given to a patient’s escort or carer where their particular skills or support are needed. This could include someone accompanying a person with a physical or mental disability or a vulnerable adult, or a patient's translator. However, this would need to be agreed in advance when transport is booked.

Clinical quality indicators

Clinical quality indicators were introduced on April 1 2011. They aim to make it easier for patients and the public to see the quality of care provided by ambulance services. How well ambulance services perform against these guidelines will be made regularly available.

The indicators were developed by leading health professionals. They aim to improve the quality and safety of care for patients who benefit most from rapid assessment, treatment and, in some cases, transport.

The aim of the indicators is not just to provide information. They are also meant to encourage discussion and debate among ambulance staff, NHS managers, commissioners and the public about the quality of the care being provided and how it can be improved.

You can find regular updates about the Ambulance quality indicators on the Department of Health website.

What are the indicators?

Service experience
Most, if not all, ambulance trusts carry out patient satisfaction surveys. Ambulance services are now required to do more than simply report the results. They must show and publish how they got the results (including results of focus groups, interviews and patient forums, rather than just patient surveys) and how they plan to act on them to improve patient care.

Outcome from acute STEMI
STEMI stands for "ST segment elevation myocardial infarction". This is a type of heart attack, the test for which is called an electrocardiogram (ECG). Patients are more likely to recover, and to recover more quickly, from many conditions if they are treated early. Early access to reperfusion (where blocked arteries are opened to re-establish blood flow) and other assessments and types of care are associated with reduced deaths from and incidence of STEMI. Measuring the outcomes of patients with STEMI will stimulate discussion about how to improve services in this area.

Outcome from cardiac arrest: return of spontaneous circulation
This indicator will measure how many patients who are in cardiac arrest (no pulse and not breathing) have a pulse on arrival at hospital following resuscitation. Providing resuscitation as early as possible to people in cardiac arrest is likely to improve their chances of recovery. Clearly, the higher the survival rate, the better.

Outcome from cardiac arrest to discharge
Ambulance services play a vital role in saving patients' lives. However, it is important to understand how effective the whole system is in managing patients who are in cardiac arrest. This indicator should show how effective the ambulance service is in responding to and treating patients in cardiac arrest when arriving at the hospital. It measures the rate of patients who recover from cardiac arrest and are subsequently discharged from hospital.

Outcome following stroke for ambulance patients
The stroke ‘Act F.A.S.T’ campaign has been very successful in raising the public's awareness of the signs of strokes and TIAs (transient ischaemic attacks, or mini-strokes). It also highlighted the importance of quick emergency treatment to reduce the risk of death and disability.

F.A.S.T stands for:

Facial weakness – Can the person smile? Has their mouth or eye drooped?
Arm weakness – Can the person raise both arms?
Speech problems – Can the person speak clearly and understand what you say?
Time to call 999 for an ambulance if you spot any of these signs.

Ambulance services are required to measure the time it takes from receiving a 999 call to getting stroke patients to a specialist stroke centre. Patients should arrive at a specialist stroke centre as soon as possible to be rapidly assessed for thrombolysis, using a CT scan, in a short but safe time frame. This has been proven to reduce deaths and improve patient recovery.

Proportion of calls closed with telephone advice or managed without transport to A&E
Ambulance trusts are good at handling and responding to 999 calls. But calling 999 does not necessarily mean that a "blue light" emergency response is the best response. Alternative healthcare options to A&E may be more appropriate for the patient. Also, as ambulance staff become increasingly skilled in treating patients at the scene, they may be able to treat the patient there and then without needing to take them to an A&E department.

This indicator should reflect how the urgent care system operates as a whole, rather than looking at ambulance services and A&E in isolation. It should reflect the availability and provision of alternative urgent care destinations and treatment of patients in the home. This will help improve urgent and emergency care services so that they offer the right treatment to patients in the right place and at the right time.

Re-contact rate following discharge of care
If patients have to call 999 a second time, it is usually because they are anxious about getting an ambulance to come or have not got better as expected. Occasionally, it may be due to an unexpected or a new problem. To ensure that ambulance trusts provide safe and effective care the first time, this indicator will monitor how many patients call the ambulance service back with 24 hours of the first call being made.

Call abandonment rate
The vast majority of people who phone 999 do so because they need emergency healthcare. If people do not get to speak to the ambulance service quickly, they may hang up or try to get the care they need elsewhere, for example by going to A&E. This indicator will ensure that ambulance trusts can take 999 calls and that people don't abandon their 999 call before a control room operator has answered.

Time to answer calls
It is equally important that 999 calls are answered quickly. This indicator will measure how quickly all 999 calls are answered. The quicker ambulance services answer a call, the quicker they can establish what is wrong with the patient so that the best type of response can be given. Answering the call quickly also reassures often very anxious and scared callers.

Time until treatment by an ambulance-dispatched health professional
It is important that people wait for as short a time as possible from the 999 call to when an ambulance crew arrives. This is because urgent treatment may be needed.

Category A: eight minutes response time
In truly life-threatening situations, the speed of an ambulance arriving can make the difference between life and death. This indicator measures the speed of all ambulance responses to the scene of potentially life-threatening incidents. Importantly, it measures whether those patients who are most in need of an emergency ambulance get one quickly.

Comments

1 Comments about ‘NHS ambulance services ’

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Comments are personal views. Any information they give has not been checked and may not be accurate.

BrianC3 said on 17 July 2012

Last night I called the Nenedoc and a doctor said to call 999. Called 999, directed to NHSDirect who then contacted the Nendoc. I finally got a call fron a doctor.

What a waste of time and resources.

Last reviewed: 27/02/2013

Next review due: 07/02/2015

Stroke: Act F.A.S.T. (male)

This video shows how to spot the signs of stroke in men. Call 999 immediately if you think someone is having a stroke.

Carers emergency scheme

Gordon Conochie from the Princess Royal Trust for Carers and Crossroads Care explains the carers emergency scheme, which gives peace of mind to carers. David, who cares for his partner Martin, carries a carers emergency card. It identifies him as a carer, and who he cares for, in case of an emergency.

Emergency and urgent care services