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The London Ambulance Service NHS Trust (LAS) is an NHS trust responsible for operating
ambulances An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
and answering and responding to urgent and
emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...
medical situations within the
London region London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a major s ...
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. It is one of the busiest
ambulance An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
services in the world, and the busiest in the United Kingdom, providing care to more than 8.6million 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 trust An ambulance services trust or ambulance trust is an organisation which provide ambulance services within the National Health Services of England and Wales. There are currently 11 ambulance services trusts in England and Wales. Ambulance services ...
s 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 2.1million 999 calls for assistance, and over 1.2million incidents in the year ended March 2020. Incidents rose by 20,000 in 2015/16, putting more pressure on the service. All
999 call 999 is an official emergency telephone number in a number of countries which allows the caller to contact emergency services for urgent assistance. Countries and territories using the number include Bahrain, Bangladesh, Botswana, Eswatini, Ghana ...
s 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 Computer-aided dispatch (CAD), also called computer-assisted dispatch, is a method of dispatching taxicabs, couriers, field service technicians, mass transit vehicles or emergency services assisted by computer. It can either be used to send messag ...
(CAD) log, to be viewed by the EOC, and the resources allocated to the job.


History

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 Deptford is an area on the south bank of the River Thames in southeast London, within the London Borough of Lewisham. It is named after a ford of the River Ravensbourne. From the mid 16th century to the late 19th it was home to Deptford D ...
, in October 1883. In all, six hospitals operated horse-drawn "land ambulances", putting almost the whole of London within 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 A paddle steamer is a steamship or steamboat powered by a steam engine that drives paddle wheels to propel the craft through the water. In antiquity, paddle wheelers followed the development of poles, oars and sails, where the first uses were ...
"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 The London Fire Brigade (LFB) is the fire and rescue service for London, the capital of the United Kingdom. It was formed by the Metropolitan Fire Brigade Act 1865, under the leadership of superintendent Eyre Massey Shaw. It has 5,992staff, i ...
.Ayers, Gwendoline M (1971
''England's First State Hospitals and the Metropolitan Asylums Board, 1867-1930''
Wellcome Trust Centre for the History of Medicine at UCL, (pp. 190-191)
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 County of London was a county of England from 1889 to 1965, corresponding to the area known today as Inner London. It was created as part of the general introduction of elected county government in England, by way of the Local Government ...
. The LCC also took control of the River Ambulance Service, but it was disbanded in 1932. 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 Portland Place is a street in the Marylebone district of central London. Named after the Third Duke of Portland, the unusually wide street is home to BBC Broadcasting House, the Chinese and Polish embassies, the Royal Institute of British Ar ...
, commemorates their wartime service. In 1948, the
National Health Service Act 1946 The National Health Service Act 1946c 81 came into effect on 5 July 1948 and created the National Health Service in England and Wales thus being the first implementation of the Beveridge model. Though the title 'National Health Service' implies a ...
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 Yorkshire Ambulance Service NHS Trust (YAS) is the NHS ambulance service covering most of Yorkshire in England. It is one of ten NHS Ambulance Trusts providing England with emergency medical services as part of the National Health Service it r ...
, West Midlands Ambulance Service and South Western Ambulance Service.


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 Central London is the innermost part of London, in England, spanning several boroughs. Over time, a number of definitions have been used to define the scope of Central London for statistics, urban planning and local government. Its character ...
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 The Cabinet Office Briefing Rooms (COBR) are meeting rooms in the Cabinet Office in London. These rooms are used for committees which co-ordinate the actions of government bodies in response to national or regional crises, or during overseas ev ...
) *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 The 7 July 2005 London bombings, often referred to as 7/7, were a series of four coordinated suicide attacks carried out by Islamic terrorists in London that targeted commuters travelling on the city's public transport system during the mo ...
.


Staff ranks and roles

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 2.08million 999 calls, 1.22million 111 calls, and attended 1.18million 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 * Emergency ambulance crew - are either 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 36.6% of the target patient group. * Falls: A paramedic with additional training and equipment paired with an assistant to appropriately assess elderly fallers in a timely manner, treat as required and be able to make additional referrals to ensure patients are supported at home. * Mental health: Ensuring that a suitable mental health clinician is available to patients 24/7 by having registered
mental health nurse A Mental Health Nurse (MHN) refers to a '' psychiatric nurse'' in the UK, who specialises in the care of patients with mental health issues. Background MHNs comprise approximately 12% of the total NHS Nursing workforce. In order to qualify as a ...
s (RMN) available in the clinical hub, as well as introducing vehicles with a RMN paired with a paramedic to provide appropriate assessment and treatment for people experiencing a mental health crisis. This includes transport to more appropriate facilities than an emergency department where possible. * Maternity: An ambulance rapid response vehicle with a registered midwife and paramedic with an increased ability to assess and treat on scene, as well as increased access to community services enabling mothers to stay at home where possible. * End of life: LAS will invest in knowledge and skills involving these patients, developing stronger links with hospices and review the pharmacology available to the crews to make this stage of life as comfortable and dignified as possible.


Volunteers

Volunteers make up a small but significant proportion of front line ambulance staff that respond to emergency calls in London. Voluntary responders vary in skill level, but their principal purpose remains the same. That is to attend medical emergencies as quickly as possible to improve the patient's chance of survival, saving lives which may have been lost without the additional resources being available to the ambulance service. Importantly, the deployment of any voluntary responder will not replace the automatic allocation of a regular front line ambulance. There are two principal roles for volunteers within the London Ambulance Service. These roles include: *Emergency responder - clinically trained volunteers who operate in marked response cars with blue lights and wear full service uniform, typically working double-crewed and doing shifts of up to ten hours day and night. These come from public-sector backgrounds, including policing. *Community responder - defibrillator trained St John Ambulance volunteers attending on call from their homes and responding to 999 calls in their own car without blue lights alongside ambulances. LAS volunteers are supported by London Ambulance Service Voluntary Responder Group, providing logistical and financial assistance to keep volunteers operational. LAS can also call upon auxiliary aid from external voluntary organisations such as St John Ambulance and the British Red Cross, as demonstrated in the 7 July 2005 London bombings. LAS also utilises the GoodSAM app to alert off duty trained medical persons to a nearby cardiac arrest and the location of nearby
automated external defibrillator An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them th ...
s.


Fleet

The LAS operates around 450 emergency ambulances. In addition it can deploy around 100 fast response units in various cars, motorcycles, or bicycles. Although not a part of the LAS, London's Air Ambulance Charity is deployed by the LAS from its base at the Royal London Hospital in Whitechapel using either its ground RRVs or its helicopter. As well as accidents and emergencies, the LAS operates a 195-vehicle patient transport service (PTS). Previously a centrally funded service, this element of the LAS is now subject to an open market and is required to tender for work from primary care trusts (PCTs) and other NHS bodies. As well as being contracted by a number of London hospitals and PCTs to take patients to and from their pre-arranged hospital or clinic appointments, the PTS responds to ad hoc journey requests and provides specialist transfer facilities. Mercedes-Benz Sprinters are used as frontline A&E ambulances, while
Volkswagen Tiguan The Volkswagen Tiguan () is a car produced by German manufacturer Volkswagen since 2007, sitting between the smaller T-Roc and the larger Touareg in the company's crossover SUV range. The first generation is based on the PQ46 platform, while ...
s and
Skoda Octavia Škoda means ''pity'' in the Czech and Slovak languages. It may also refer to: Czech brands and enterprises * Škoda Auto, automobile and previously bicycle manufacturer in Mladá Boleslav ** Škoda Motorsport, the division of Škoda Auto respon ...
s cars are all used as Fast Response Units (FRU). Motorcycle responders are equipped with the
BMW R1200RT The BMW R1200RT is a touring or sport touring motorcycle that was manufactured from 2005 to 2019 by BMW Motorrad to replace the R1150RT model. It features a flat-twin engine with a six-speed gearbox and shaft drive. History Previous RT models, 1 ...
. Cycle responders, who operate in areas such as the City of London, the West End, Stratford, Kingston Town Centre as well as Heathrow Airport, use custom built Rockhopper
mountain bike A mountain bike (MTB) or mountain bicycle is a bicycle designed for off-road cycling. Mountain bikes share some similarities with other bicycles, but incorporate features designed to enhance durability and performance in rough terrain, which m ...
s manufactured by Specialized Bicycle Components. LAS employs Fiat Ducatos for use in its non-emergency transport service. The Hazardous Area Response Team vehicles include 4x4 Mercedes-Benz Sprinters, VW Transporters, Volvo XC70s and Polaris All-Terrain Vehicle. Volunteer emergency responders use a mix of Volkswagen Tiguan and
Volvo V50 The Volvo V50 is the station wagon version of the Volvo S40 small family car first unveiled at the 2003 Bologna Motor Show, both assembled at Ghent, Belgium. Sharing the Ford C1 platform with the European Ford Focus and the Mazda 3, the V50 ...
. As a part of the Emergency Preparedness, Resilience and Response strategy LAS also has a number of medium and heavy major incident response vehicles such as command vehicles and equipment vehicles on standby at all times around London, based on Mercedes-Benz Sprinters and
IVECO IVECO, an acronym for Industrial Vehicles Corporation, is an Italian multinational transport vehicle manufacturing company. It designs and builds light, medium, and heavy commercial vehicles. The name IVECO first appeared in 1975 after a merger o ...
trucks. In 2017 140 new Mercedes Sprinter ambulances are to be introduced and 60 new
Volkswagen Tiguan The Volkswagen Tiguan () is a car produced by German manufacturer Volkswagen since 2007, sitting between the smaller T-Roc and the larger Touareg in the company's crossover SUV range. The first generation is based on the PQ46 platform, while ...
to be incorporated into the fast response unit fleet.


Notable incidents

The LAS plays a significant role whenever an incident causes mass casualties in London. Examples include: * Provisional IRA bombing campaign: 1969–1997, a list of these and other bombings in London to which the LAS responded can be found
here Here is an adverb that means "in, on, or at this place". It may also refer to: Software * Here Technologies, a mapping company * Here WeGo (formerly Here Maps), a mobile app and map website by Here Television * Here TV (formerly "here!"), a ...
. *
Moorgate tube crash The Moorgate tube crash occurred on 28 February 1975 at 8:46 am on the London Underground's Northern City Line; 43 people died and 74 were injured after a train failed to stop at the line's southern terminus, Moorgate station, and crashe ...
: 28 February 1975, the train driver and 42 passengers were killed * King's Cross fire: 18 November 1987, 31 people died in a major fire in the Underground station * Clapham Junction train crash: 12 December 1988 35 people were killed and 69 seriously injured *
Marchioness disaster The ''Marchioness'' disaster was a collision between two vessels on the River Thames in London in the early hours of 20 August 1989, which resulted in the deaths of 51 people. The pleasure steamer ''Marchioness'' sank after being hit twice by ...
: 20 August 1989, A pleasure boat, ''Marchioness'', was in collision with a dredger; 51 people died * Cannon Street rail crash: 8 January 1991, Two people were killed and over 500 injured *
Southall rail crash The Southall rail crash occurred on 19 September 1997, on the Great Western Main Line at Southall, West London. An InterCity 125 high speed passenger train (HST) failed to slow down in response to warning signals and collided with a freight trai ...
: 19 September 1997, an InterCity 125 collided with a freight train on the
Great Western Main Line The Great Western Main Line (GWML) is a main line railway in England that runs westwards from London Paddington to . It connects to other main lines such as those from Reading to Penzance and Swindon to Swansea. Opened in 1841, it was the o ...
resulting in 7 deaths and 139 injured persons. * Paddington train crash: 5 October 1999, Two trains collided a short distance outside of Paddington station, resulting in the deaths of 31 and 523 persons injured * 7 July 2005 suicide attacks: Four simultaneous suicide bombings across London resulting in 56 deaths (including 4 assailants) and at least 700 persons injured. Voluntary aid services needed to assist the LAS due to scale of the attacks. *
2012 Summer Olympics The 2012 Summer Olympics (officially the Games of the XXX Olympiad and also known as London 2012) was an international multi-sport event held from 27 July to 12 August 2012 in London, England, United Kingdom. The first event, the ...
* Croydon tram derailment: 9 November 2016, a tram derailed in south London resulting in 7 deaths and 62 persons injured * Westminster attack: 22 March 2017, A vehicular ramming and knife attack resulting in 6 deaths (including the assailant) and 49 persons injured * London Bridge Attack: 3 June 2017, A vehicular ramming and knife attack resulting in 11 deaths (including 3 assailants) and 48 persons injured * Grenfell Tower fire: 14 June 2017 in
Kensington Kensington is a district in the Royal Borough of Kensington and Chelsea in the West of Central London. The district's commercial heart is Kensington High Street, running on an east–west axis. The north-east is taken up by Kensington Garden ...
, causing 72 deaths and over 70 injuries. *
Parsons Green bombing On 15 September 2017, at around 08:20 BST (07:20 UTC), an explosion occurred on a District line train at Parsons Green Underground station, in London, England. Thirty people were treated in hospital or an urgent care centre, mostly for burn ...
: 15 September 2017, A non-fatal bombing of a London Underground train resulting in 30 injured persons.


Contracting services

Due to an increase in demand, the LAS has used private ambulance companies, and some charities, to provide additional everyday operational cover. This is largely to ensure set response targets are met and so that the level of resources available to the service stays at a safe level. The future of private ambulances within the LAS is unclear. In March 2014, operational difficulties were reported at Hillingdon Hospital because the private ambulances did not appear on the A&E hospital alert system. , LAS contracts out to two private company, EMFS Group and Polaris Medical who both provide Bariatric services as well as a small number of ambulances. LAS also deploys St John Ambulance mutual aid crews to a limited range of low acuity calls. In November 2021 the trust announced that it would be directly employing the 500 staff in "make ready" teams who are responsible for cleaning and restocking ambulances before they are taken out. They have been employed by
Mitie Mitie Group PLC (pronounced "mighty") is a British strategic outsourcing and energy services company. It provides infrastructure consultancy, facilities management, property management, energy and healthcare services. It has a head office at The ...
for some years.


CQC performance rating

In its last inspection of the service in September 2019, the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. It ...
(CQC) gave the following ratings on a scale of outstanding (the service is performing exceptionally well), good (the service is performing well and meeting our expectations), requires improvement (the service isn't performing as well as it should) and inadequate (the service is performing badly):


Difficulties and criticisms

In 2000, the LAS faced funding difficulties and an increase in the volume of 999 calls, and it was criticised for poor performance in its response times. The service was sued for negligence in the case of
Kent v Griffiths ''Kent v Griffiths'' 0002 All ER 474 is an English tort law case from the Court of Appeal concerning negligence, particularly the duty of care owed by the emergency services; particularly the ambulance service. The emergency services do not gener ...
. The chief executive at the time, Michael Honey, left his post after talks with other members of LAS management. In 2010, the service lost its funding for the emergency care practitioner (ECP) role and existing ECPs were told they must change to a different role within the service, or leave. A fire in the basement of its Waterloo base in October 2010 caused the LAS to relocate the EOC to the back-up control room in east London due to an interruption to the building's power supply. The service took the step of urging the public to find other means of transport to hospital for anyone with non-life-threatening injuries. In 2013, the LAS was named by the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. It ...
as one of 26 healthcare providers in England failing to operate with sufficient staff. In September 2014, the trust announced that it would reduce the number of category C calls (the least serious) which receive an ambulance response by 15%. These calls will be triaged by a call handler and either referred to
NHS 111 111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health ...
or given telephone advice by a paramedic. In 2014 only 64% of category A patients were reached within eight minutes and it is hoped that by this measure there will be an improved response to the most urgent calls. It has also implemented a system of "intelligent conveyancing" where ambulances avoiding hospitals that are known to be under pressure. This has reduced the average waiting time for handover from ambulance to hospital staff by 180seconds, though the average journey time has increased by 27seconds. In December 2014, it asked other ambulance services for help after its busiest ever week with 11,008 call outs for the most seriously ill and injured. Demand is up 15% on the same time last year. Help has only been requested previously in respect of events like the Olympics or the 2005 bombings. The service has more than 400 vacancies and has had problems recruiting people. It is failing to reach its response targets. In 2014/15, the trust recruited 175 paramedics from Australia. The trust was placed into
special measures Special measures is a status applied by regulators of public services in Britain to providers who fall short of acceptable standards. In education (England and Wales) Ofsted, the schools inspection agency for England and some British Overseas Te ...
following a report by the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. It ...
(CQC) in November 2015, which rated it "inadequate" overall and raised "significant concerns" about its performance. 54 inspectors visited 16 ambulance stations and emergency operation centres in June. Criticisms focussed on: *a "culture of harassment and bullying" and a perception that "discrimination" was not dealt with. Verbal and physical abuse, ostracisation, sexual harassment, misuse of power and cyber-bullying had been featured in an earlier independent report *long working hours, with high levels of stress and fatigue reported by a large number of "demoralised" frontline staff *response times which had deteriorated since March 2014 with a consistent failure to meet the national benchmark of 75% of patients with life-threatening conditions receiving treatment within eight minutes *many frontline vacancies, and insufficient appropriately trained paramedics to ensure patients were consistently safe and received good care *lack of necessary equipment *insufficient understanding of the challenges staff experienced by senior managers and board members *insufficient supervision for newly qualified paramedics from senior colleagues *failure to review major incident procedures, which are supposed to be reviewed annually, or to ensure all staff were aware of them On 23 May 2018, LAS was taken out of special measures by the CQC, being rated good overall and outstanding in patient care. The report noted that the trust needed to focus on ensuring safe staffing levels of the control room, diversity amongst staff and improvements in management of mental health.


7/7 bombings

Concerns were raised in internal LAS documents over the performance of radios and communication equipment used in the emergency operations after the 7/7 attacks. Again, the sheer volume of emergency calls received made radio communications difficult and put pressure on staff in the ambulance control room. Staff were also hampered in their use of mobile phones as the mobile phone networks were temporarily brought down during the day. In July 2009, the new radio system recommended after the bombings was rolled out. Despite the changes after 7/7, the LAS was criticised in 2010 for failures to provide fully working radios to its frontline staff. Health and safety inspections found that some radios failed during heavy rain and staff sometimes had to do without. Crews also raised concerns that the panic buttons on their radios did not work properly.


Innovation

In 1974, the LAS commissioned a computer-aided despatch system that remained unused for 13years because union members refused to operate it. A replacement system failed acceptance tests in 1990 and a further replacement system was designed and ordered. On 26 October 1992, the LAS started to use the new
computer-assisted dispatch Computer-aided dispatch (CAD), also called computer-assisted dispatch, is a method of dispatching taxicabs, couriers, field service technicians, mass transit vehicles or emergency services assisted by computer. It can either be used to send messag ...
(CAD) system, known as
LASCAD On 26 October 1992 the London Ambulance Service started to use a new computer-assisted dispatch (CAD) system, known as LASCAD. Poorly designed and implemented, its introduction led to significant delays in the assigning of ambulances, with anecdo ...
. Poorly designed and implemented, its introduction led to significant delays in the assigning of ambulances, with anecdotal reports of 11-hour waits. A subsequent enquiry found no evidence to support union claims that up to 30 people may have died as a result of the crash. The crash coincided with hundreds of control room exceptions messages related to alerts that crews responding to emergencies had not reported mobile, and the ambulance had not moved within 3minutes of despatch. The then-chief executive, John Wilby, resigned shortly afterwards. This failure is often cited in case studies of poor engineering management. A software upgrade in July 2006 led to repeated system crashes during August. As a result, dispatchers had to go back to old pen-and-paper methods. On 8 June 2011, the LAS attempted to implement a new CAD system, called CommandPoint, costing £18million, and built by Northrop Grumman, an American aerospace and defence technology company. During its implementation it developed technical problems and was replaced by a pen-and-paper method for several hours, until a decision was taken to revert to the previous system, CTAK, in the early hours of 9 June. It was later announced that a review of the difficulties experienced would be undertaken. A second attempt at implementing CommandPoint took place on 28 March 2012. The trust was considering terminating its contract with Northrop Grumman if the re-attempt to go live with the new system failed. Despite a drop in response times to "Category A" (life-threatening) emergency calls in the period immediately after implementation, which coincided with above average demand, the LAS stated that "The new system is now familiar to all control room staff and demand has returned to more or less predicted levels, with a corresponding increase in performance". On the morning of 1 January 2017, one of the busiest nights of the year due to new year celebrations, a system failure impacted the system for several hours. Between 00:30 and 05:15 control room staff had to fall back on pen and paper methods. Response times were further impacted by the concurrent failure of the web based tracking system and of automated satellite navigation systems for ambulance crews. This required location details to be passed by radio and then manually entered into satellite navigation systems in vehicles. The ambulance service stated that an investigation would be launched to establish the reasons for the system failure. In October 2019, the service adopted a platform called GoodSAM, which enables control room staff to connect to a callers' smartphone and assess seriously injured patients via a video link. They can locate a caller and check a patient's pulse from the scene. Using the service in the first month staff decided not to use an air ambulance in 38 of the 67 cases where it was used. It plans to expand the use of the technology across 999 and 111 calls.


Finance

In April 2015, the trust asked its commissioners for £27M extra funding to help it recruit more staff and buy new vehicles.


Popular culture

London Ambulance Service has appeared in multiple documentary series including: * ''Men in the Ambulance'' - 1974 * ''Bloomsbury 3'' - 1986 * ''Red Base One Four'' - Channel 4 - 1996 * ''Condition Critical'' Channel 5 - 2000 * '' 999: What's Your Emergency?'' Channel 4 Series 2 - 2013 * ''An Hour To Save Your Life'' BBC Series 1-3 2014-2016 * ''
Ambulance An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
'' BBC series 1 (2016) and series 6 (2020)


See also

* Emergency medical services in the United Kingdom *
British Red Cross The British Red Cross Society is the United Kingdom body of the worldwide neutral and impartial humanitarian network the International Red Cross and Red Crescent Movement. The society was formed in 1870, and is a registered charity with more ...
Other London emergency services: *
London Fire Brigade The London Fire Brigade (LFB) is the fire and rescue service for London, the capital of the United Kingdom. It was formed by the Metropolitan Fire Brigade Act 1865, under the leadership of superintendent Eyre Massey Shaw. It has 5,992staff, i ...
*
British Transport Police , nativename = , abbreviation = BTP , patch = , patchcaption = , logo = British Transport Police Logo.svg , logocaption = Logo of the British Transport Police , badge = , badgecaption = , f ...
*
City of London Police The City of London Police is the territorial police force responsible for law enforcement within the City of London, including the Middle and Inner Temples. The force responsible for law enforcement within the remainder of the London region, ...
* Metropolitan Police *
Royal National Lifeboat Institution The Royal National Lifeboat Institution (RNLI) is the largest charity that saves lives at sea around the coasts of the United Kingdom, the Republic of Ireland, the Channel Islands, and the Isle of Man, as well as on some inland waterways. It i ...


References


External links

*
Inspection reports
from the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. It ...
{{Authority control Medical and health organisations based in London Health in London Buildings and structures in the London Borough of Lambeth NHS ambulance services trusts Organisations based in the London Borough of Lambeth Organizations established in 1965 Ambulance services in England