emergency care assistant emergency care assistant an emergency care assistant is a type of nhs emergency medical service worker in the united kingdom, often used to support paramedics in responding to emergency calls. this frontline staff role was introduced in 2006 as part of the modernisation of nhs emergency ambulances and also to lower costs. by 2011 there were 2000 people working as ecas in the united kingdom. the role has varied scope across the country, as it is defined by the local ambulance service policy, although the role primarily involves assisting ambulance clinicians. ecas are trained with emergency driving skills. they may carry out basic diagnostic procedures under the direct supervision of a paramedic. the college of paramedics does not expect ecas to be required to make complex clinical decisions. implementation each regional ambulance service determines its own criteria around what is needed to become an eca. they are amongst the lowest paid front line staff in the nhs, typically being paid at afc band 3 or 4. ambulance crew unions and a range of healthcare professionals have expressed reservations about having ambulance services employ a large number of ecas, both before and after the change. unions representing ambulance workers had fears that the workforce changes could lead to an increase in the risk to patients as well as adding to the workload of paramedics and had written to east midlands ambulance service to ask for the reintroduction of the technician role. another issue is the amount of driving an eca has to do during a 12-hour shift, as driving time regulations do not apply to emergency services. whilst either of the crew members may drive when responding to an emergency case, the paramedic is more likely to attend a patient during an emergency transport, meaning that the eca is likely to do more driving. in december 2014, after a steep rise in the number of paramedics on long term sick leave suffering stress, yorkshire ambulance service said they would be bringing back the technician role. career development there is a route for some ecas to progress to technician level. a training programme is run by the east of england ambulance nhs trust (eeast) which aims to help ecas progress to technician within 1 year of their basic training; by november 2015, most ecas working for the east of england ambulance service nhs trust (eeast) have made the transition from eca to technician on this programme. ecas who wish to progress to become a paramedic will need to complete a university degree, some employers do provide structured training to support this, with an expectation that it would take at least two and a half years for an eca to complete this on a part-time basis.