London Ambulance Service
The London Ambulance Service NHS Trust 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.
It is one of the busiest ambulance 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 Jason Killens and chair Andrew Trotter. 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 2.1million 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 calls from the public are answered at one of the two Emergency Operations Centres 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 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 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 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 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 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.
| Grade | Meaning | Type of call | Initial response target | Response details |
| Category 1 | Immediate life threat | Cardiac 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 2 | Emergency | Stroke patients, unconscious, chest pain, road traffic collisions, major burns, sepsis | 18 minutes | Response time measured with arrival of transporting vehicle |
| Category 3 | Urgent | Falls, isolated limb fractures, some minor traumas, less serious burns | 120 minutes | Response time measured with arrival of transporting vehicle |
| Category 4 | Less Urgent | Diarrhoea, 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 5 | Urgent response | GP urgent admissions to hospital and urgent inter-hospital transfers | 8 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, 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
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 levels: gold, silver and bronze.
- Platinum command: government level command
- Gold command: strategic command, located in a situation room close to the main Emergency Operations Centre 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.
Staff ranks and roles
| Staff role | Epaulette/slider colour |
| Advanced care clinician | Green |
| Qualified non-registrant clinician roles | Navy blue |
| Assistant, trainee or student clinician, emergency responders and non-emergency transfer service | Sky blue |
| Non-clinical | Black |
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.