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Urgent and emergency care services in England

NHS ambulance services

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.

Ambulance services will often also use a range of other vehicles, such as cars and motorcycles, to respond to an emergency in the quickest possible time.

Patients will always be taken to hospital when there is a medical need for this. However, paramedics now carry out more diagnostic tests and do basic procedures at the scene. Many crews also refer patients to social care services, directly admit patients to specialist units and paramedics 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:

1. Immediately life threatening 

  • A. Red 1: 75% of Category A Red 1 calls (the most time critical, where patients are not breathing or do not have a pulse) to be responded to within 8 minutes
  • B. Red 2: 75% of Category A Red 2 calls (still serious, but less immediately time critical, like strokes or fits) to be responded to within 8 minutes. The clock starts ticking up to 60 seconds after the clock for Red 1.
  • C. A19: 95% of Category A calls to be responded to within 19 minutes.

2. All other calls – For conditions that are not life threatening, response targets are set locally.

Figures from the Health and Social Care Information Centre (HSCIC) show that in 2013/14 ambulance trusts dealt with an average of 16.1 emergency calls per minute. You can find the full report about ambulance services in England on HSCIC's website. Find your local ambulance trust

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:

How and when to dial 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 calling NHS 111 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 and are dispatched by NHS Ambulance Services where there is a need. All air ambulances operate as independent charities. However, the cost of some clinical staff on air ambulances has been met by the NHS. 

Non-emergency patient transport services (PTS)

Non-emergency patient transport services, known as Patient Transport Services (PTS), are typified by the non-urgent, planned, transport of patients with a medical need for transport to and from a premises providing NHS healthcare and between NHS healthcare providers. This can and should encompass a wide range of vehicle types and levels of care consistent with the patients’ medical needs.

PTS services are commissioned by Clinical Commissioning Groups (CCGs). A range of different providers may provide PTS – for example, the local NHS ambulance trust, independent sector providers, or a combination of providers.

Decisions about patient transport services are a local matter and it remains up to local CCGs to decide how these services are managed.

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 NHS England 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 within 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 faster 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.

Category A19: 19 minutes transportation standard
Patient outcomes can be improved by ensuring patients with immediately life-threatening conditions receive a response at the scene, which is able to transport the patient in a clinically safe manner, if they require such a response.



The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Krissy2000 said on 08 April 2015

I'm 6 months pregnant and on the way to a client meeting I found myself not being able to walk so crawled onto some steps and called 111. Considering I was not bleeding and not visibly losing my baby, I was not sent an emergency ambulance. The person on the phone told me they would send a non emergency ambulance but could not give me a time frame.

3 hours passed and I was still sitting in the cold waiting for this ambulance as I could not walk or get to warmth. Eventually a taxi driver carried me into his vehicle. I still haven't received a call to ask me where I am and if I'm okay, 5 hours on who knows if it's actually been dispatched?

It's a shame and very sad that the NHS do not believe a 6 month pregnant lady in need of medical care deserves any kind of priority. I still can't walk but chances are - my GP won't care and the last time I went to a&e a cleaner stole £70 from my handbag and the hospital didn't care at all. Good Luck to the nation!

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Brian Best said on 18 January 2015

I just wanted to say big thank you to the fanastic crew that came out to my asthmatic wife very early on a snowy saturday morning she woke breathless after using her inhalers she found she needed the nebuliser, this didnt work either, I dialed 999 and the operater was brilliant he stayed with me on the phone until the crew got there. The crew arrived and immediately took over They acted totally professional. When she arrived at the hospital she was treated by the staff there equally in a professional manner, quickly and in my opinion life saving. The doctor and t stafnrses were brillant. I work at the hospital, but never ever thought I would need them A BigThank you A/E You were great. Thank colleagues

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Dave_W_123 said on 18 November 2014

I struggle to understand what warrants a 999 call these days. My partner last night developed agonising pain in his abdomen and after this got worse I called 999. At this point no one including your no medical call centre staff know what the problem is all I know is that my partner is seriously unwell and needs medical help. To be told that screaming agony of unknown origin doesn't warrant an emergency ambulance beggers belief! Do you have to be in the verge of death and probably not going to make it before one is sent?
The situation with the whole NHS is in crises but I thought this one service I could reliy on if needed, clearly not and discusted that my partners fait lay in the hands if a non medical person with a check sheet! How awful and how many more people are in this situation everyday.
After an agonising journey to A & E, and don't even get me started on that experience, , having to crawl in on hands and knees, waiting 39 minutes for an essesment, another 45 to actually be give some pain partner is undergoing emergency operation to remove a ruptured appendix.Clearly needed an ambulance, clearly has been failed in his time of need.
I don't dispute that when the emergency services get it right then Heroes they are but this experience has frightened me to death that if you don't get it quite right with the answers you give on the 999 call you may well in some cases die and this is thevery real truth if the matter. Outraged!!

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Cfran said on 09 May 2014

I had my first experience of the ambulance service on Easter Sunday! I had been feeling unwell all day and at later in the evening began with strong chest pains. We called the ambulance and they arrived in around 10 minutes and checked everything. They were friendly, kind and polite- I was on the verge of a panic attack and they helped me calm down. The end result was to see an out of hours doctor who too was brilliant. On this occasion, I couldn't fault the NHS and am grateful for their help.

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Peterpan39 said on 25 April 2014

This morning (25/04/2014) I collapsed in a shop in the centre of Birmingham (Evans Cycles). I don't remember much; but the paramedics were there very quickly - in around 10 minutes. I was treated with the utmost respect, kindness and professionalism. When it was found that I was fine to go home after a thorough check the paramedics waited patiently with me until my parents came to pick me up. Thank you so much for your kindness patience and excellent service!

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Davenettl said on 26 December 2013

Shocking service. Try phoning on the number you've been given for a start

Try reading or having access to patients medical records services before you phone.

Try knowing what you're talking about before you call.

Try not to patronise people!

When you're asked if you know what a condition is please don't lie and say you do and know about it. We know you're lying and don't have a clue!

In all, a truly shocking service, that's meant to be world leading, as we've been accustomed to for many years now!

Disgusted really doesn't come close to it! Happens every time though!

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woojharry said on 13 December 2013

I phoned an ambulance for a colleague who had all the symptoms of a stroke. Symptoms subsided slightly over the next half hour....ambulance didn't arrive for over 90 minutes. I'm furious. We needed you and you didn't come.

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tawam said on 02 December 2013

Just called the ambulance today because my two year old bumped his forehead. He was bleeding very badly from a deep cut and seemed dizzy. Waited for the ambulance half an hour,they didn't come so rang them back. Another Half an hour later no Ambulance! Luckily my husband arrived home so he toke my son to the children's hospital instead of waiting. Shame the ambulance couldn't manage to came for over an hour...

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Page last reviewed: 10/02/2015

Next review due: 10/02/2017

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