London Ambulance Service

London Ambulance Service
TypeNHS trust
Established1965
Headquarters220 Waterloo Road
London
SE1 8SD[1]
Region servedLondon
Area size607 square miles (1,570 km2)
Population8.6 million
Establishments70 sites including 2 control rooms
Budget£158 million (2017/18)
ChairHeather Lawrence
Chief executiveGarrett Emmerson
Staff5,493 (2019)[2]
Websitewww.londonambulance.nhs.uk Edit this at Wikidata

The London Ambulance Service 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 and 111 phone calls, providing triage and advice to enable an appropriate level of response.

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 Garrett Emmerson. The service employs around 5,300 staff.

It is one of 10 ambulance trusts in England providing emergency medical services, and is part of the National Health Service, receiving direct government funding for its role. There is no charge to patients for use of the service, as every person in the UK has the right to the attendance of an ambulance in an emergency.

The LAS responded to over 1.8 million calls for assistance, and over 1 million incidents in 2015/16.[3] 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 Bow 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 suffering from 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 three miles (five kilometres) 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.[4] 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.[5] 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.[4]

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.[6] 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.[7]

By 1930, the MAB was the largest user of civil ambulance services in the world,[4] 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.[6]

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.[8]

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,[9] 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.[9]

In late 2017 LAS adopted the Ambulance Response Program which altered the targets for response times 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.[10]

Grade Meaning Type of call Initial response target Response details
Category 1 Immediate Life Threat Cardiac arrests, Choking, Unconscious, Continuous seizure, Not alert after a fall, Trauma, Allergic reaction with breathing problems, Shootings and Major Incidents 7 min Response time measured with arrival of first emergency responder

Will be attended by single responders and ambulance crews

Category 2 Emergency Stroke patients, Fainting – not alert, Chest pain, Road Traffic Collisions, Major burns, Sepsis 20 min Response time measured with arrival of transporting vehicle
Category 3 Urgent Falls, Fainting – now alert, Diabetic problems, Isolated limb fractures, Abdominal pain 60 min Response time measured with arrival of transporting vehicle
Category 4 Less Urgent Diarrhoea, Vomiting, Non-traumatic back pain, Health Care Professional admission 120-240 min Maybe managed through hear and treat

Response time measured with arrival of transporting vehicle

Category 5 Urgent response GP urgent admissions to hospital. Urgent interhospital transfers 8 hours or scheduled timeframe, decided by admitting HCP