The London Ambulance Service NHS Trust (LAS) is the largest "free at the point of contact" ambulance service in the world. It responds to medical emergencies in Greater London, England with the 400 ambulances ^[1] at its disposal.

It is one of 12 Ambulance Trusts providing England with 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, and under the Patient's charter, every person in England has the right to the attendance of an ambulance in an emergency^{[citation needed]}.

The LAS employs over 4,000 staff^[1] and responds to over one million calls for assistance a year.^[1] All requests from the public are answered at the Emergency Operations Centre (EOC) in Waterloo, Lambeth, which then dispatches the appropriate resources. To assist, the command and control system is linked electronically with the equivalent system for the Metropolitan Police. These means police updates regarding specific jobs will be sent directly to the ambulance responding to this call^{[citation needed]}.

[edit] History

The first permanent ambulance service in London was established by the Metropolitan Asylums Board (MAB) in 1897, and was used to transport patients to its hospitals.^[2]

In 1930 the work of the MAB was taken over by the London County Council, who also took charge of the fleet of 156 ambulances ^[2], although it was not until 1948 that the National Health Service Act (1946) made it a requirement for ambulances to be available for callout to anyone who needed them.

The present-day London Ambulance Service was formed in 1965 by the amalgamation of nine existing services in London ^[2] and in 1974, after a reorganisation of the National Health Service 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 ^[2].

[edit] Structure

Rear view of Mercedes Sprinter ambulance, showing stretcher lift (on right), integrated roof lightbar and high-visibility reflective chevrons (September 2006)

As an NHS trust, The LAS has a Trust Board consisting of a Chief Executive, a Chairman, five London Ambulance Service executive directors and five external non-executive directors.^[3]

The Chief Executive and Chief Ambulance Officer has responsibility for oversight of seven Directorates^{[citation needed]}:

• Accident and Emergency (A&E)
• Communications
• Finance and Business
• Human Resources
• Medical
• Patient Transport Services
• Technology

LAS operations are directed from Ambulance Service Headquarters in Waterloo Road, London SE1, which houses the Emergency Operations Centre (EOC) for despatching emergency service vehicles and also coordinates major incident responses.^{[citation needed]}

During mass casualty incidents, the command structure works on three (or four) levels — Gold, Silver and Bronze.^[4]

• Platinum Control is government level (COBR)^[5]
• Gold Control is the strategic command located in a situation room close to the main Central Ambulance Control (CAC) and managing communications between crews
• Silver Control provides tactical command from a designated point in the vicinity of the incident(s)
• Bronze Control is the on-site operational level organising triage for casualties.

This system was used effectively in the aftermath of the 7 July 2005 London bombings ^[6].

[edit] Operational staff

An LDV London ambulance, the standard fleet during the 1990s and early 2000s, still being used as front-line vehicles.

There are many operational roles in the LAS ^{[7][verification needed]}:

• Ambulance Attendant (PTS)
• Emergency Care Assistant / A&E Support
• Emergency Medical Dispatcher (EMD1, EMD2, EMD3, EMD4)
• Clinical Support Advisor (Working as the CSD/Clinical Support Desk in EOC)
• Clinical Telephone Advisor (CTA)
• Emergency Medical Technician (EMT1, EMT2, EMT3, EMT4)
• Student Paramedic
• Paramedic
• Emergency Care Practitioner (ECP)
• HEMS Paramedic
• Hazardous Area Response Team Operative (HART)
• Tactical Support Officer (TSO)
• Team Leader
• Training Officer
• Duty Station Officer (DSO)
• Ambulance Operations Manager (AOM)

[edit] Fleet vehicles

A London ambulance, one of the fleet of Mercedes Sprinters, outside Chiswick Ambulance Station - August 2006

A London ambulance RRV, one of the fleet of Vauxhall Zafiras, outside St George's Hospital Emergency department - April 2008

The LAS operates 400 ambulances each crewed by two EMTs or an EMT and a Paramedic or two EMT1s or A&E Support workers.^{[citation needed]}

In addition to these ambulances, the LAS can deploy 100 rapid-response units in cars, 10 motorcycles and 14 cycle units ^[1].

Although not a part of the LAS, the Helicopter Emergency Medical Service (HEMS) - popularly known as the Air Ambulance - can also be deployed by, and for, the LAS from its base at the Royal London Hospital in Whitechapel. The normal operating crew of a HEMS helicopter or car includes one LAS Paramedic on secondment to the service as well as a Doctor of Specialist Training/SpR level or above.^{[citation needed]}

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 PCTs and other NHS bodies. As well as being contracted by a number of London hospitals and primary care trusts (PCTs) to take patients to and from their pre-arranged hospital or clinic appointments, the PTS responds to ad-hoc journey requests and provide specialist transfer facilities.^[8]

There have been some recent incidents where LAS ambulances have been emitting hazardous levels of Carbon Monoxide and now all LAS ambulances are monitored on a regular basis for Carbon Monoxide Levels.^{[citation needed]}

[edit] Significant incidents

The LAS plays a significant role whenever an incident causes mass caualties in London. Such incidents include:

• 7 July 2005 London Bombings Multiple terrorist attacks across London.^[9]
• 5 October 1999 - Paddington Train Crash Two trains collided a short distance outside of Paddington Station, killing 31 people ^[10]
• 8 January 1991 - Cannon Street Train Crash Two people were killed and over 500 injured ^[11]
• 20 August 1989 - Sinking of the Marchioness Pleasure boat the Marchioness was in collision with a dredger: 51 people died. ^[12]
• 12 December 1988 - Clapham Train Crash^[13] 35 people were killed and 69 seriously injured.
• 18 November 1987 - King's Cross Fire^[14] 31 people died.
• 28 February 1975 - Moorgate Tube Train Crash^[15] The driver and 42 passengers were killed.
• 1970s-1990s - IRA bombing campaign A list of these and other bombings in London to which the LAS responded can be found here.

[edit] Service difficulties

[edit] 1992 CAD system failure

On 26 October 1992 the LAS started to use a new Computer Aided Dispatch (CAD) system, known as LASCAD ^[16]. Poorly designed and implemented, its introduction led to massive delays in the assigning of ambulances ^[17], with anecdotal reports of 11 hour waits. Media reports at the time claimed that up to 30 people may have died as a result of the chaos. The then LAS Chief Executive, John Wilby, resigned shortly afterwards.^[18]

[edit] Poor ambulance response times

In 2000, the LAS faced funding difficulties and an increase in the volume of 999 calls, and was criticised for poor performance in its response times which were reported to have endangered lives, resulting in the service being sued for negligence (Kent v Griffiths). The LAS Chief Executive at the time, Michael Honey, left his post after talks with other members of LAS management ^[19].

[edit] Reaction to events of 7 July 2005

Ambulances in attendance at Russell Square, during the 7 July 2005 London bombings

Concerns were raised in internal LAS documents over the performance of radios and communication equipment used in the emergency operations after the 7 July 2005 London bombings ^[20]. 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 because the mobile phone networks were temporarily brought down during the day. As of July 2009 the new radio system recommended after the 7/7 bombings is in the initial stages of being rolled out service wide.

[edit] 2006 computer system crashes

A software upgrade in July 2006 led to repeated system crashes during August ^[21]. As a result, dispatchers had to go back to old pen-and-paper methods ^[22]. This resulted in delayed ambulance activations, and thus delays in reaching patients.

[edit] December 2008 - February 2009

The workload has continued to increase for the LAS over December 2008 and the London Ambulance Service Chief Executive Peter Bradley stated that ambulance services were 'struggling to cope'^[23]. Paramedics have been publicly voicing their concerns stating that they '...are short-staffed and there are not enough of [them] to deal with the call rate."^[24]. In February 2009 the LAS was so overstretched due to winter pressures that they limited their responses to only 'life-threatening calls' which meant refusing many people ambulances^[25]. During this time the LAS described the service as being in a CRITICAL or SEVERE PRESSURE state of operations, and it remained at this level for a number of weeks^[26].

The LAS has also continued its recruitment for Student Paramedics. This has allowed more vehicles to be crewed but in some respects it creates a double standard of practitioner with university-educated Paramedics holding a FdSc or BSc (Hons) Degree in Paramedic Science or higher degrees, and the necessary A-Levels to gain a place on the course, and the Student Paramedics (Trained by the LAS) needing minimal qualifications, if any.^{[neutrality disputed][27]}. The Student Paramedics start working on frontline ambulances after 16 weeks basic training and a 8 week supervisory period, followed by various further examinations over a 2 year vocational period and finally a further 24 week final classroom / hospital based period where after passing final exams they then become qualified state registered Paramedics.; in comparison the university-educated Paramedics receive regular supervised placements in various clinical settings and are employed either full-time for one year during the course or throughout their course, working a part-time rota to allow time to study^{[28][29][30][neutrality disputed]}.

[edit] Summer 2009

During the heatwave in the summer of 2009, there was an increase in demand for ambulances due to the hot weather, and the LAS took the step of urging members of the public to take taxis or ask relatives to take them to hospital rather than phone for an ambulance.^[31][32] A lack of resources meant that the LAS found it difficult to meet an increased demand for ambulances during the period.

[edit] See also

[edit] Other emergency medical services

• Emergency medical services in the United Kingdom
• London Air Ambulance (HEMS)
• Scottish Ambulance Service
• British Red Cross
• St. John Ambulance
• International SOS, Provider of air ambulance evacuation & repatriation services

[edit] Other emergency services

• London Fire Brigade
• Metropolitan Police Service
• British Transport Police
• Royal National Lifeboat Institution (RNLI)

[edit] References

[edit] External links

• Official website
• NHS information
• NHS Trust - Local London Ambulance Station Site List
• Google Local information
• Academic site detailing the CAD failure

[edit] Video clips

• London Ambulance Service NHS Trust YouTube channel

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