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Summary

  1. Our correspondents join ambulance crews across the UK on 30 November 2016
  2. Services are experiencing unprecedented pressure, with only one trust meeting targets
  3. About 30,000 999 calls are made to ambulance control rooms every day
  4. Services have to prioritise the most critical cases to cope
  5. Ambulances are more stretched than ever as winter looms

Live Reporting

By Jennifer Scott, Marie Jackson and Bernadette McCague

All times stated are UK

Eight things we have learnt today

That's all from us for now. Before we go, here are eight things we've learnt from our ambulance services across the country: 

  • The number of 999 calls has trebled in the past decade – London recorded its highest number of calls in history in November
  • But the volume isn’t the only pressure facing ambulance services across the country
  • Calls from people who don’t need a paramedic are still common – calls today included needing a glass of water, a cold and a cat bite
  • There are not enough beds – Norfolk and Norwich University Hospitals NHS Foundation Trust went on "black alert" today as they needed another 70 beds to cope with patient numbers
  • Handover times need to be quicker – Betty Smith in Yorkshire said when she was taken to hospital there were 14 ambulances lined up ahead of her
  • However, people still have a lot of praise for paramedics who work hard to look after the patients – Emma Sealey called them "angels in green"
  • They face abuse - like John, who has had a knife pulled on him twice, but he still loves the job, saying "it’s about making a difference"
  • If you call 999, you will always be taken seriously and an ambulance will come in an emergency – but think whether you can use another service, 111, your GP, a walk-in centre or pharmacist, to relieve some of the pressure, or, even better, learn first aid

Thanks for joining us. Goodnight. 

A final word from Nick Triggle on our ambulance system

Nick Triggle

Health Correspondent

Today the BBC has attempted to shine a spotlight on the ambulance system. 

We’ve heard about the thousands of calls they deal with - some real emergencies and, sadly, some that simply are a waste of time. 

But our coverage has not just been about what is happening today. We’ve also been looking at what will be happening tomorrow. 

The system is changing. More patients are being treated at the scene. The numbers classed as life-threatening are also being redefined to help ensure those who most need a fast response get it.

How well these initiatives and others work will determine what sort of 999 service we have in the future.  

'Athens ambulances respond after 20 minutes at best - so consider yourselves lucky'

A selection of overseas reaction on Facebook

Tricia Braid tells us:

I appreciate the look into your emergency services. We share this difficulty in rural areas of the U.S., as our emergency first responders are typically volunteers.  

Trish Reibert comments:

I wonder if they run into the same problems our EMT/paramedics have spending precious time and resources running on calls for people looking for free rides to the doctors office and other non-emergency calls. It's a huge problem in the U.S.  

Anna Lymperatou posts:

In Athens, Greece the ambulances respond after 20-40 minutes at the very best and that's because there are so few of them. So consider yourselves lucky   

Carole Seney writes:

Ambulance Squads here in the US are mostly crewed by volunteers who have their EMT certificates. They raise funds by having fundraisers like dinners (local businesses donate the food needed).  

George Stillitano says:

Are the firemen or police officers trained as first responders in England? that's what we do in some places in Canada  

Map of Northern Ireland ambulance hot spots

Northern Ireland map
BBC
Red marks the spot - where Northern Ireland's ambulances are being sent. The photo shows a screen in the Northern Ireland control room.

Call to North East Ambulance Service over 'cat bite'

Ambulances are being diverted from hospitals in the North East to deal with reports of cat bites and a toenail falling off.

Our reporter Sharon Barbour reports from a local ambulance control centre. 

View more on facebook

'Paramedic stayed until the undertakers arrived a few hours later'

A selection of your posts on Facebook

Cassie Burford says:

Can't say I'm surprised what with all the cuts to services. Where I work we had to call an ambulance out and we were told it would be a bit of a wait as it was coming from Weston-Super-Mare which is just over an hour away  

Tony Earp tells us:

After spending time with these guys, it is clear reduced budgets are having an adverse impact as well as inappropriate calls. Until people start taking responsibility for their own health and stop rushing to A&E at the slightest sign of illness, or calling emergency services at a whim, this is notwithstanding other issues such as taking responsibility for their diet and alcohol intake, the NHS will collapse.

Gill Munn writes:

An ambulance was called to my mom who had already passed away and there was nothing they could do for her but the fast response paramedic still stayed at the property until the undertakers arrived which was a few hours later. I feel that this was wrong as my mom had already gone and while he was at the house, he could of been on an emergency call to somebody who could be helped and their life saved. I'm sorry if people find my comment wrong but I don't think that helps in emergency situations where paramedics are tied up waiting when they could be helping not one, but several people.  

Erica Law comments:

My friend waited over 20 mins for a ambulance with a baby having an allergic reaction and at points was unconscious ... They really need to totally redesign the ambulance and have more of them on the streets  

'All part of a day's work' for paramedics

Catherine Smyth

BBC News Northern Ireland

Nine hours into a 12-hour shift in the NI Ambulance control room and staff are as busy as ever. 

Matters shift up a gear as news comes in that four ambulances and one rapid response vehicle are being sent to a rural and isolated part of the country to deal with a road traffic accident involving five patients. 

Since 7.30am the control room has dealt with 256 calls - 62 of which are the highest priority - category A.

Amidst all this, the staff stay calm as they talk people through moments of crisis  - things like dealing with a very overweight man who needs specialist help, people with breathing difficulties and people who've fallen.

Snatches of conversation tell their own stories:"Just make sure his head is tilted back, I know it is hard with a little one"

"Tell me when the crew is with you" 

"Keep your hand on her forehead and stay with me" 

It all seems difficult. And challenging. But the staff here are taking it as part of their day's work.

Northern Ireland control room
BBC

East Midlands takes 1,290 calls so far

Update just in from East Midlands Ambulance Service. They have now taken 1,290 calls from 999 today, and 183 GP urgent transfers.

Of the calls, 200 were dealt with over the phone and 45% were treated away from hospital. 

Here is a map of all the calls the service  received so far today. 

EMAS map
EMAS

'The problem is the public - they need educating'

You continue to send us your comments

Michael comments:

Isn’t it about time the nuisance calls were dealt with?  The calls diverted to the police and fine the idiots wasting time. I’ve just read about lost keys, needing taxis and lost bank cards. These fools should be shamed in the national and local press!

Sharon Harrison, Stockport tells us:

My husband had a brain haemorrhage on a Saturday night at 1am. There was a delay on the ambulance that night, I was told, when I called 999. The paramedic however arrived swiftly, but was limited in treatment he could offer. His quick thinking led to the ambulance being diverted. The ambulance arrived as quickly as resources would allow, but if my husband was having a cardiac arrest or a stroke, there would have been more serious consequences. The stretch on resources has made me fearful, to the point where, as a family, we will look at a family first aid course so that we could deliver CPR in an emergency and possibly look at purchasing a defibrillator.

Adam writes:

I have been on both sides of the fence: I have called an ambulance for a seriously ill patient and had to wait so long I've taken them to hospital myself. However, I previously worked frontline for the ambulance service for six years and this is entirely down to abuse of the 999 system. The problem is the public, they need educating.  

Mark Arnold, Hampshire comments:

My father who had cancer collapsed at home two weeks ago vomiting blood and was in great pain. Due to hold ups at the hospital with signing over patients we had to wait an hour for a paramedic to arrive and 1.5 hours for the ambulance to turn up. The ambulance station is about eight minutes up the road and the hospital about 10. If I could have I would have driven him myself but my father was too weak due to loss of blood and low blood pressure. He passed away in hospital two days later due to the same problems.

Northern Ireland Ambulance Service 'close to breaking point'

Northern Ireland control room
BBC

Our Northern Ireland health correspondent, Marie-Louise Connolly, said staff within the control room want something to be done because "the system is really close to breaking point".

There are plans to use people differently, such as district nurses and diabetes teams, to triage as much as they can over the phone, she says.

"It doesn't mean they would get any additional staff, but they would decide who needs those paramedics and perhaps use GP services in the country more."

Live at 999 centre: Helping out neighbouring service

Emily Ford

BBC South

When incidents in the Dorset area take South Central resources away call operators work quickly to find solutions.

There is shouting across the control room while the officers work out which ambulances are available to send out to help the neighbouring South West service in Ringwood.

Officers remain calm while finding a solution and have sent the crew out to the incident within seconds. 

'Drunk neighbour calls out ambulances 16 times a day'

More of your comments

Debra says:

Why are the ambulance service not charging people who abuse the service? We have a drunk neighbour who calls out ambulances up to 16 times a day. When they get there he wants them to pick him up off the floor because he has rolled off the sofa. He is abusive towards them so the police come, more wasted resources. 

Martin tells us:

I had a motorbike accident in February 2016. Broken kneecap, lying in middle of freezing road, 1 hour and 50 minutes wait for ambulance. I asked/ begged the police to take me to hospital in their car. They said I had to wait for paramedics. Absolutely disgusted with the wait.

Simon, Kegworth,  near Derby says:

October 3rd 2016: On the advice of my GP who suspected I might be having a heart attack, I called 999. The ambulance arrived about 20 minutes later; I was attended to by two extremely good paramedics and taken to hospital. During the 20 or so minutes it took to get booked in, I remarked that the queue of paramedics and ambulances was a waste of scarce resources.

"That's nothing" replied one of the paramedics. "We're due a 45 minute break now which we'll take when we've booked you in. But, we're based at Mickleover so we have to drive there - which takes 40 minutes - and then have our break.  After that, our next call could be back here so - why can't we take our break here? It would save 40 minutes for us, the ambulance and the travel cost. Lunacy!"

A hospital pharmacist writes:

I keep wishing that you would follow a few of us in various hospitals to report what goes on, how underrepresented we are, how not respected by other professionals we are, and how much we influence patient care by preventing doctors and nurses mistakes.

We don't have time to publish in journals as much as we should, or do anything to improve our situation as we usually work constantly trying to stop the boat from sinking and trying to keep ourselves from sinking, too tired and overworked.

'All children should be taught basic first aid at school'

A selection of your texts

Mick writes:

All children should be taught CPR and basic first aid at school. Also, all expectant mothers and fathers should have CPR training for babies at anti-natal classes and the handover of patients at hospitals should be simplified so to release the crews as quickly as possible so they can responded to another emergency.

Anonymous texts:

I worked in control room environment for 20 years. So much pressure on resources but the amount of time spent handling hospital transfers hasn't been mentioned. Lots of hospitals closing specific depts, i.e. Paediatric, stroke unit, cardiology mean that lots of hours are spent moving patients around to more suitable beds, or maybe even to find them a bed cos none are available

Ed, Isle of Wight comments:

Many ambulance services have been contracted out to private companies. There must be a response time difference between them and NHS service. Interesting to see that difference.

BBC's Nikki finds the back of an ambulance can be a bumpy ride

Look East's Nikki Fox is out with an ambulance crew in Norfolk.

Look East Reporter Nikki Fox
BBC
BBC Look East Reporter Nikki Fox

Rush hour 'busiest time' for Wales service

As rush hour approaches, the control room in Wales is preparing for its busiest time...

View more on twitter

Ambulance allocator delivered 12 babies over phone

Daisy Patterson describes how she helps delivers babies over the phone

999 caller asks for glass of water

London Ambulance Service control centre
BBC

Our reporter Mark Ashdown is in the London Ambulance Service's control room and says it is a service "under extreme pressure".

"They would normally get around 5,000 calls through here and they have already had 2,500," he said. 

"The air ambulance has been up three times and there have been 10 cardiac arrests".

But the most shocking stories were those calling without a real need...

"We have had someone calling needing a glass of water," said our reporter. "Someone else called saying they had a cold and asking for a paramedic.

"The advice is to use the service wisely as, like everywhere across the country, it is under pressure."

Let's all work together to improve patient care

Readers react to earlier posts

Boris Porter says:

I fully agree with Steve (13.56 post). My wife is a paramedic in a relatively local ambulance trust and, even in the years she has been working there, the pressures have increased enormously. After a change in their schedules which was clearly designed by someone, or more probably a well-paid external consultancy, with absolutely no knowledge of how the service works, they finish late far more often than on time. The workload is increasing with a triumvirate of an increasing population, an ageing population, and a progressively unthinking and demanding population unwilling to take responsibility for themselves where possible. All for a basic salary of just over £20,000. They must really love their jobs!

Cara tells us:

I am currently a second year student paramedic, and I think I can speak for most of my fellow students when I say that we are growing impatient with attitudes from some (and by no means all) ambulance staff such as John. I fail to see how educating paramedics to a degree level is anything but beneficial to an ever growing profession. Resentment towards students only adds pressure to an already struggling service. Embrace us and help us to learn, so that we can all work together to improve patient care and outcomes. 

James, East Midlands, comments:

Student paramedics are doing a great job training to be the future of an under-staffed service. There is a huge shortage across the country due to increased workload and ‘older’ staff leaving in droves.  Student paramedics are trained at university often to a higher standard than their peers they start work alongside.  Having accumulated learning on the job for 1500 hours they hit the road running on qualification reminding me of the young heroes in the Battle of Britain.  Yes the service needs more organisational support, more realistic targets and more resources, but let’s not add cynicism and knock those who want to put their hearts and souls into this great job!

'I probably wouldn't be here without them'

EMAS ambulances
BBC

Ben Robertson, from Nottingham, has been following the coverage today.

He said it prompted his to call East Midlands Ambulance Service to "thank them for everything they have done for me in the last 3 years." 

He added: "I probably wouldn't be here without them."

Paramedics treat people at home when they can

This Dudley paramedic did a great job... 

View more on twitter

'Cut delays, increase the journeys'

Nick Triggle

Health Correspondent

The 500,000 hours lost queuing at hospitals by ambulances – identified by the BBC in its coverage today – sounds a lot. 

That’s because it is. 

If these delays were completely eradicated ambulance services would be able to increase the journeys they make by 10%, which could significantly improve their response times to emergency calls.

'Please don't use us as a mobile GP'

More of your tweets

@BBC_HaveYourSay Re comments regarding teaching of CPR and first aid in schools. Retired 5 years ago but CPR was taught in our school.

@BBC_HaveYourSay @BBCNews It is high time ambulances were redesigned so that they do NOT reflect every bump in the road! #bbcambulances

#bbcambulances a lot of what we go to are minor injuries/illnesses that could be managed by taking themselves to A+E/MIU or to their GP

@Scotambservice @Godden78 #bbcambulances paramedic resources should be saved for life-threatening calls - please don't use us as a mobile GP

Paramedic abused by man collapsed in toilets

Martin Barber

BBC News, in Norwich

You might remember Larry from this morning... he couldn't apologise enough for "bothering" the crew. It's not always as nice.

Yesterday, John the paramedic was called to a collapse in a cafe toilet by concerned staff who couldn't rouse a person behind the door.

John went to assist, but when he looked over the top of the toilet, he was hailed with abuse.

"I'm only sleeping. Why do you care when I'm coming out?"

He wanted somewhere warm to sleep, but of course that took John out of the system.

So while John was waiting to ensure the man could leave under his own steam, it meant he wasn't available to assist other patients - potentially in a life threatening situation.

John has been a paramedic for 24 years
BBC
John has been a paramedic for 24 years

East of England Ambulance Service smashes government target

The pressures aren't going away, but well done to the East of England team!

View more on twitter

'Pressure building' at East Midlands hospitals

As of 2pm, East Midlands Ambulance Service had received 1,088 calls through 999 and 134 requests from doctors to transfer patients.

The Clinical Assessment Team (CAT) has managed to deal with 195 calls over phone, providing advice and directing patients to the right place. 

And 46% of patients who have called for help today have been treated away from hospital.

But our correspondents in the region are reporting a rise in demand over the last few hours.

Pressure is beginning to build at several hospitals across the area and EMAS has sent a Hospital Ambulance Liaison Officer (HALO) to Kettering General to help coordinate handovers so they happen as quickly as possible.

Map of calls EMAS has responded to today
EMAS
All the calls EMAS has responded to so far today

Redefining 'life-threatening' in Wales

In October 2015 Wales introduced a new system to respond to emergency calls. It resulted in fewer 999 calls being categorised as life-threatening.

Wales graphs
BBC

Four cardiac arrests before lunch in Scotland

Over 100 calls dealt with over the phone in South West

Paramedic: A lot of calls could be handled without an ambulance

Full time paramedic James says a lot of calls he  sent on could be dealt with in other ways...

View more on twitter
View more on twitter

'One call every 15 seconds'

Services trial longer calls to get best first response

Nick Triggle

Health Correspondent

At the moment, about a quarter of crews dispatched to life-threatening emergencies are called back before they reach the scene after it emerges the call is not so critical. 

To help, some services have started giving call centres longer to assess calls to make sure they get the right response first time. 

The system is still being evaluated but initial findings are promising, ambulance bosses say.

'Quieter than expected' in Wales

Our Wales reporter, Teleri Glyn Jones, says it is quieter than expected in the country, but calls are still coming through to the control centre. 

So far today there have been 579 calls, relating to 459 incidents. 

Of those incidents, 6.75% have been categorised as red - the most urgent with an imminent threat to life.

And available to head to the scene are 105 ambulances and 33 rapid response vehicles.

Paramedic
Thinkstock

Over 700 critically ill patients in London

The capital is feeling the pressure today with the number of critical calls. 

View more on twitter

Never a slow day on the job

It is the job of ambulance crews to get to their patient as fast as they can. 

Here is what it feels like to be in the driving seat.

View more on twitter

How does the Welsh ambulance service work?

An animated guide to the ambulance service in Wales and the issues it faces.
Wales is the only UK nation to see an improvement in the time it takes ambulances to reach the most critical 999 calls, new BBC research has found.
The health secretary said it showed a "better service with a better outcome for patients".
It follows radical changes last year in the way 999 calls are prioritised.
But like other areas of the UK, Welsh ambulance crews are facing worsening delays in handing over patients when they get to hospital.
Here is an animated guide to the ambulance service in Wales and the issues it faces.
Video by Gwyndaf Hughes

'Call operator told me: We are extremely busy and do not have enough ambulances'

Another selection of your emails

Steve writes:

My partner is just about to leave the ambulance service after 10 years and I can’t say I’m sorry. She is consistently being put upon with ridiculous shift work and not finishing on time and added to this she has been abused both mentally and physically and to see her continually coming home in that state was the final straw for me. Her wages are appalling for what she has to contend with and it’s not a career I want her to pursue anymore. The whole NHS is at breaking point and those in Whitehall need to understand this without sending out figures for the amount of investment they have put in since the last government.

Andrew Alford, Portsmouth

Called 999 last night. Paramedic arrived in under a minute as he was in the area. Wife was struggling to breathe and pregnant. Ambulance arrived in five minutes. I would say that was outstanding.

Sarah

My father-in-law waited seven hours for an ambulance, having fallen and broken his hip.  - he was assisted by neighbours into wheelchair and was in pain and therefore unable to be moved again. The initial call was made at 3pm and the ambulance arrived at 9.30pm - he was assessed as a non-emergency initially but later upgraded to 'lights and sirens'.  However it still took another 3 hours after the upgrade. He is 82 years old and suffers from Parkinson's disease and dementia. The call operator told me 'we are extremely busy and do not have enough ambulances' before terminating the conversation to take other calls. Whilst I understand there there are life threatening priorities I think the call operator has said it all - there are simply not enough ambulances.

St John Ambulance: Learning first aid can save lives

3/3 We should all take responsibility to learn first aid as this can be the difference between a life lost and a life saved' #BBCambulances