london ambulance service london ambulance service the london ambulance service nhs trust (las) is an nhs trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the london region of england. the service responds to 999 phone calls across the region, and 111 phone calls from certain parts, providing triage and advice to enable an appropriate level of response. london ambulance service nhs trustthe area served by the london ambulance servicetypenhs trustestablished1965headquarterswaterloo, london, englandregion servedlondonarea size607 square miles (1,570 km2)population8.6 millionestablishments73 sites including 5 control roomsbudget£158 million (2017/18)chairandrew trotterchief executivedaniel elkelesstaff6,497 (2020/21)websitewww.londonambulance.nhs.uk it is one of the busiest ambulance services in the world, and the busiest in the united kingdom, providing care to more than 8.6 million people, who live and work in london. the service is currently under the leadership of chief executive daniel elkeles and chair andrew trotter obe qpm. the service employs around 5,300 staff. it is one of ten ambulance services trusts in england providing emergency medical services, and is part of the national health service, receiving direct government funding for its role. the las responded to over 2.1 million 999 calls for assistance, and over 1.2 million incidents in the year ended march 2020. incidents rose by 20,000 in 2015/16, putting more pressure on the service. all 999 calls from the public are answered at one of the two emergency operations centres (eoc) in waterloo or newham who then dispatch and allocate the appropriate resources. to assist, the service's command and control system is linked electronically with the equivalent system for london's metropolitan police. this means that police updates regarding specific jobs will be updated directly on the computer-aided dispatch (cad) log, to be viewed by the eoc, and the resources allocated to the job. history the female crew of a london county council ambulance return to their station during the first world war in 1818, a parliamentary select committee had recommended that provision be made for carrying infectious patients in london "which would prevent the use of coaches or sedan chairs" but nothing was done. in 1866, a hospital carriage fund provided six carriages to hospitals in the metropolitan area, for the use of patients with smallpox or other infectious diseases, provided that they pay for the hire of the horses. the first permanent ambulance service in london was established by the metropolitan asylums board (mab) in 1879, when a new poor law act empowered them "to provide and maintain carriages suitable for the conveyance of persons suffering from any infectious disorder". the first became operational at the south eastern fever hospital, deptford, in october 1883. in all, six hospitals operated horse-drawn "land ambulances", putting almost the whole of london within 3 miles (4.8 km) of one of them. each ambulance station included accommodation for a married superintendent and around 20 drivers, horse keepers and attendants, nurses, laundry staff and domestic cleaners. a fleet of four paddle steamer "river ambulances" transported smallpox patients along the river thames to deptford, where they could be quarantined on hospital ships, departing from three special wharves at rotherhithe, blackwall and fulham. at deptford, in order to transfer patients between the hospitals at joyce green and long reach near gravesend, a horse-drawn ambulance tramway was constructed in 1897 and extended in 1904. in 1902, the mab introduced a steam driven ambulance and in 1904, their first motor ambulance. the last horse-drawn ambulances were used on 14 september 1912. although the mab was legally supposed to be transporting only infectious patients, it increasingly also carried accident victims and emergency medical cases. the metropolitan ambulance act, 1909, empowered the london county council to establish an emergency ambulance service, but this was not established until february 1915 and was under the control of the chief of the london fire brigade. also in 1915, the mab ambulance section were the first public body to employ women drivers, due to the number of men who had volunteered for military service. by july 1916, the london county council ambulance corps was staffed entirely by women. by 1930, the mab was the largest user of civil ambulance services in the world, however the local government act 1929 meant that work of the mab was taken over by the london county council, which also took charge of the modern fleet of 107 mab motor ambulances, together with 46 ambulances which were run by local poor law unions. taken with the 21 ambulances already operated by the lcc, this provided a comprehensive service for all kinds of illness and accident, which was under the direction of the medical officer of health for the county of london. the lcc also took control of the river ambulance service, but it was disbanded in 1932. during a training exercise in fulham in 1942, ambulance crew and civil defence workers place a "casualty" into an ambulance. during world war ii, the london auxiliary ambulance service was operated by over 10,000 auxiliaries, mainly women, from all walks of life. they ran services from 139 auxiliary stations across london. a plaque at one of the last to close, station 39 in weymouth mews, near portland place, commemorates their wartime service. in 1948, the national health service act 1946 made it a requirement for ambulances to be available for anyone who needed them. the present-day london ambulance service was formed in 1965 by the amalgamation of nine existing services in the new county of greater london, and in 1974, after a reorganisation of the nhs, the las was transferred from the control of local government to the south west thames regional health authority. on 1 april 1996, the las left the control of the south west thames regional health authority and became an nhs trust. in late 2017, las adopted the ambulance response programme, which altered the targets for response times to 999 calls to reflect patient outcomes by removing hidden waiting times after a successful trial by the yorkshire ambulance service, west midlands ambulance service and south western ambulance service. grademeaningtype of callinitial response targetresponse details category 1immediate life threatcardiac arrests, choking, continuous seizure, allergic reaction with breathing problems, major trauma, and major incidents 7 minutes response time measured with arrival of first emergency responder will be attended by single responders and ambulance crews category 2emergencystroke patients, unconscious, chest pain, road traffic collisions, major burns, sepsis 18 minutes response time measured with arrival of transporting vehicle category 3urgentfalls, isolated limb fractures, some minor traumas, less serious burns 120 minutes response time measured with arrival of transporting vehicle category 4less urgentdiarrhoea, vomiting, non-traumatic back pain, health care professional admission 120–240 minutes may be managed through "hear and treat" response time measured with arrival of transporting vehicle category 5urgent responsegp urgent admissions to hospital and urgent inter-hospital transfers8 hours or scheduled timeframe, decided by admitting hcp structure as an nhs trust, the las has a trust board consisting of 13 members. the board includes; a non-executive chairman, five of the service's executive directors (including the chief executive), and seven non-executive directors. the chief executive and chief ambulance officer have responsibility for oversight of seven directorates: accident and emergency operations information management and technology finance people and organisational development medical patient transport services (pts) operations are directed from two control rooms: one in central london and one in east london, both of which have the ability to take over control entirely if required. special events in london are co-ordinated from the service's event control room, also located in east london. during mass casualty incidents, the command structure works on three (or four) levels: gold, silver and bronze. platinum command: government level command (cobr) gold command: strategic command, located in a situation room close to the main emergency operations centre (eoc) and not only managing the incident, but also ensuring that normal service function continues with reduced resources. silver command: tactical command, from the control room managing the incident; bronze command: on-site operational commanders managing sectors within the incident. this system was used effectively in response to the 7 july 2005 london bombings. staff ranks and roles las vehicles on the scene of an emergency incident in central london overview of epaulette/slider colouring staff role epaulette/slider colour advanced care clinician (e.g advanced paramedic in critical care or critical care doctor red registered clinician (e.g advanced paramedic in urgent care or paramedic or midwife) green qualified clinician navy blue assistant, trainee or student clinician, emergency responders and non-emergency transfer service sky blue non-clinical black the las employs a number of operational staff in different departments call centres and control rooms in addition to the 999 emergency service, las operates 111 urgent care services covering north east and south east london. in the year to march 2020, the service answered and triaged 2.08 million 999 calls, 1.22 million 111 calls, and attended 1.18 million incidents. the 999 and 111 call centres and control rooms employ a total of 1,655 staff. ambulance services the ambulance services directorate provides front-line crews formed of paramedics, emergency medical technicians and emergency ambulance crew, and non-emergency transport services. the department also provides incident response officers who are operational commanders, and provide 24/7 operational management. clinical team managers also provide operational command resilience but primarily provide 24/7 clinical management and leadership. ambulance operations employs a total of 4,957 staff. medical directorate the medical directorate provides advanced paramedic practitioners in critical care who are specially trained to deal with critically ill patients, and who can provide interventions outside the normal scope of practice of a paramedic like mechanical ventilation and sedation. advanced paramedic practitioners in urgent care support the las aim to reduce conveyance rates by managing more patients in the home environment without the need for a hospital admission. 999 operations the 999 operations department provides the staff to work in the eocs, such as call-takers and dispatchers. the department also contains the clinical hub which is staffed by clinical advisors undertaking hear and treat, and clinical team navigators providing clinical support to frontline crews, other eoc staff and maintain oversight of clinical safety at the operational level. resilience and special operations the resilience and special operations department employs paramedics in the hazardous area response team (hart), who are specially equipped to deal with casualties at height, in water, or urban search and rescue. there are two hart teams, one each covering the east and west of london. a tactical response unit contains paramedics specially trained to work in the warm zone of active shooter incidents. helicopter emergency medical service (hems) paramedics working for london's air ambulance charity also fall under this department. front-line roles front-line roles in the trust include: advanced paramedic practitioner - responding to the most critically ill patients. in 2018, the trust announced plans to recruit up to 60 more advanced paramedic practitioners, of which there were then only 15, with the intention to treat more lower acuity patients at the scene or join them up with community-led services. hems paramedic - aircrew paramedic responding with london's air ambulance charity alongside a doctor paramedic - typically hold a bsc in paramedic science, but may also have been trained 'in-house' to the institute of healthcare development (ihcd) paramedic qualification. emergency medical technician - trained to the (now discontinued) ihcd ambulance technician qualification or futurequals level 4 diploma for associate ambulance practitioners. assistant ambulance practitioner - trained in ambulance emergency and urgent care support. non-emergency ambulance crew - work for the non-emergency transport service to providing a response to patients who are ill or injured but do not require the skills of a frontline clinician. london's air ambulance charity work alongside and is dispatched by las, who also provides paramedics to the charity, to work alongside doctors who are sourced from national and international hospitals. pioneer services las published its strategy for 2018/19 – 2022/23 in april 2018. it focused heavily on in introduction of what it describes as "pioneer services". these are services which are focused on delivering a more tailored treatment package to specific and significant groups of patients in the community including: urgent care: managing low acuity patients in the community with the use of advanced paramedic practitioners (urgent care). these paramedics will have additional training, testing, referral and prescribing capability, which in the trial in south london reduced conveyance from 63% to