Emergency medical care

When should I use 999?

999 is the free, 24 hour number to call for emergency help of any sort. When you get through to the operator they’ll ask if you need police, fire or ambulance services. Then, if you say ambulance, they’ll take details of why you need help.

The first questions are to prioritise just how urgent the problem is (a process called triaging). In particular you will be asked if you, or the person you are calling about, have breathing difficulties or chest pain as these may be life-threatening and need the fastest response.

Try to stay calm and remember to give as much information about your location as you can to help the ambulance crew find you. Calls are then divided into three categories, based on the seriousness of the condition, and the target response time:

• Category A: Immediately life threatening conditions, such as cardiac arrest, unconsciousness and breathing difficulties, for which an emergency response should reach 75 per cent of calls within eight minutes.
• Category B: Serious but not immediately life threatening conditions, such as traumatic injuries or fractures, where an ambulance should arrive within 19 minutes, 95 per cent of the time.
• Category C: Not serious or life-threatening conditions for which target response times are set locally. For these problems, the 999 system may not have been appropriate anyway. Arriving at Accident and Emergency (A&E) by ambulance doesn’t mean you'll be seen quicker than if you get yourself there.

Since April 2008, ambulance response times are measured from the moment the caller is connected rather than when the key information has been obtained, making the ambulance services respond, on average, 90 seconds faster than before, resulting in better clinical outcomes, such as for those suffering a cardiac arrest.

To help meet these new response times, for some calls the first responder will be a lone paramedic or emergency care practitioner in a car or on motorbike, rather than a double-crewed ambulance. These fast response vehicles can often arrive quicker than traditional ambulances, providing initial assessment and care until the ambulance arrives to take the patient to hospital.

What’s the NHS 111 system?

NHS 111 is a new, free from landlines or mobiles, 24 hour service being introduced around the country, to make it easier to access all local NHS healthcare services when you need urgent medical help, but it isn’t a 999 life-threatening emergency. It will gradually replace the current NHS Direct 0845 4657 number.

For example, you should use it if you think you may need to go to the emergency department or another NHS urgent care service, and you don’t think your problem can wait until you can get a GP appointment, or if you don't know who to call for medical help. The advisors will assess if your problem does need an ambulance after all, in which case they’ll organise one, then give you healthcare advice and direct you to the appropriate local service as quickly as possible. For example, this may be the:

• Out-of-hours GP service.
• Emergency dentist.
• Nurse-run walk-in centre community nurses.
• Late-opening chemist.

What training do ambulance crew have?

An emergency ambulance crew usually consists of an emergency care assistant and a paramedic. They’re highly trained in all aspects of emergency care, ranging from trauma injuries to cardiac arrests. The old scenario of ambulance crews simply retrieving the patient to hospital no longer applies. They now will carry out more diagnostic tests and undertake basic procedures at the scene, stabilising the patient for example by putting up fluid lines, intubating those with breathing difficulties and giving a range of emergency drugs at the scene and en route.

The crew also have special driving training to allow them to get you as fast and safely as possible to hospital.

What equipment and services are carried on an ambulance?

The first responder vehicles and all emergency ambulances are equipped with a range of emergency care equipment such as:

• Heart defibrillators.
• Oxygen.
• Intravenous drips.
• Spinal and traction splints.
• Burns treatments.
• Drugs used to deal with a variety of conditions such as asthma, allergies, diabetes, overdoses, pain and heart failure.

What can ambulance staff do for me during the journey?

Once stable, you will be taken to the nearest appropriate hospital, but during the journey one of the crew will be monitoring you, giving oxygen or medication where necessary, and if needed the driver will stop the ambulance for both the crew to administer further, stabilising care before continuing.

Where will you be taken in the ambulance?

Once the crew have assessed and stabilised them, the patient will always be taken to hospital if and when necessary. However, if emergency department care is not what the patient needs, the crews can also refer patients to social services or directly admit patients to specialist units.

Alternatively, after administering a wide range of drugs to deal with urgent conditions such as asthma and heart failure, which may prevent the need for the patient being admitted, they may then get the GP to come to further assess the patient at home.

Air ambulances

Helicopter air ambulances have a role in delivering emergency care in rural areas and where road access is a problem, giving faster access to hospital care. They are very expensive to operate and are only used in certain scenarios. They also don’t qualify for full NHS funding, although the clinical staff are all NHS employees.