London Ambulance Service
Encyclopedia
Emergency service
Emergency services are organizations which ensure public safety and health by addressing different emergencies. Some agencies exist solely for addressing certain types of emergencies whilst others deal with ad hoc emergencies as part of their normal responsibilities...
in the world. It responds to medical emergencies
Medical emergency
A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
in Greater London
Greater London
Greater London is the top-level administrative division of England covering London. It was created in 1965 and spans the City of London, including Middle Temple and Inner Temple, and the 32 London boroughs. This territory is coterminate with the London Government Office Region and the London...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, with the ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
s and other response vehicles and over 5,000 staff at its disposal.
It is one of 12 Ambulance Trusts in England providing emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
, and is part of the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
(NHS), receiving direct government funding for its role. There is no charge to patients for use of the service, and under the Patient's Charter
Patient's Charter
The Patient's Charter is a United Kingdom government document, which sets out a number of rights for National Health Service patients. It was originally introduced in 1991, under the then Conservative government, and was revised in 1995 and 1997....
, every person in England has the right to the attendance of an ambulance in an emergency.
The LAS responds to over 1.5 million calls for assistance per year All requests from the public are answered at the Emergency Operations Centre (EOC) in Waterloo
Waterloo, London
Waterloo is a district of London, England, and part of the London Borough of Lambeth. It is situated east of Charing Cross. The area is part of a business improvement district known as Waterloo Quarter, which includes The Cut and the Old Vic and Young Vic theatres, including some sections in the...
, Lambeth
London Borough of Lambeth
The London Borough of Lambeth is a London borough in south London, England and forms part of Inner London. The local authority is Lambeth London Borough Council.-Origins:...
, which then dispatches the appropriate resources. To assist, the command and control system is linked electronically with the equivalent system for the Metropolitan Police Service
Metropolitan Police Service
The Metropolitan Police Service is the territorial police force responsible for Greater London, excluding the "square mile" of the City of London which is the responsibility of the City of London Police...
. This means that police updates regarding specific jobs will be updated directly on the computer-aided dispatch (CAD) log, to be viewed by the EOC and the resources allocated to the job.
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.In 1930 the work of the MAB was taken over by the London County Council
London County Council
London County Council was the principal local government body for the County of London, throughout its 1889–1965 existence, and the first London-wide general municipal authority to be directly elected. It covered the area today known as Inner London and was replaced by the Greater London Council...
, who also took charge of the fleet of 156 ambulances , although it was not until 1948 that 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 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
NHS Trust
A National Health Service trust provides services on behalf of the National Health Service in England and NHS Wales.The trusts are not trusts in the legal sense but are in effect public sector corporations. Each trust is headed by a board consisting of executive and non-executive directors, and is...
.
Structure
As an NHS trust, the LAS has a Trust Board consisting of a Chief Executive, a Chairman, five LAS executive directors and five external non-executive directors.The Chief Executive and Chief Ambulance Officer have responsibility for oversight of seven Directorates:
- Accident and EmergencyEmergency departmentAn emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
(A&E) - Communications
- Finance and business
- Human resourcesHuman resourcesHuman resources is a term used to describe the individuals who make up the workforce of an organization, although it is also applied in labor economics to, for example, business sectors or even whole nations...
- Medical
- Patient Transport Services (PTS)
- Technology
Operations are directed from service headquarters in Waterloo Road
Waterloo Road, London
Waterloo Road is a road straddling Lambeth and Southwark, London, England. It runs between Westminster Bridge Road close to St George's Circus at the south-east end and Waterloo Bridge across the River Thames towards London's West End district at the north-west end.At the northern end near the...
which houses the Emergency Operations Centre (EOC) for despatching emergency service vehicles and also coordinates major incident responses. or from a Back-up Control Room in East London should the main control room become compromised.
Special Events in London are co-ordinated from the Service's Event Control Room also located in East London or from the Metropolitan Police Control Room as appropriate.
During mass casualty incidents, the command structure works on three (or four) levels: gold, silver and bronze.
- Platinum control: government level command (COBR);
- Gold control: strategic command, located in a situation room close to the main Emergency Operations Centre (EOC) and managing communications between crews;
- Silver control: tactical command, from a designated point in the vicinity of the incident(s);
- Bronze control: on-site operational level organising triageTriageTriage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
for casualties.
This system was used effectively in response to the suicide bombings of 7 July 2005
7 July 2005 London bombings
The 7 July 2005 London bombings were a series of co-ordinated suicide attacks in the United Kingdom, targeting civilians using London's public transport system during the morning rush hour....
.
Operational staff
Operational roles in the LAS include:- Ambulance attendant (PTS)
- Emergency care assistantEmergency care assistantEmergency Care Assistants , are a new role in the frontline staff on NHS emergency ambulances within the United Kingdom, introduced as part of modernisation of the NHS ambulance services to cut costs...
/ A&E support / Driver for paramedic - Emergency Medical Dispatcher (EMD1, EMD2, EMD3, Allocator)
- Clinical support advisor (working as the Clinical Support Desk (CSD) in EOC)
- Clinical telephone advisor
- Emergency medical technicianEmergency medical technicianEmergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
(EMT1, EMT2, EMT3, EMT4) - Student paramedic levels 1, 2, 3, 4
- ParamedicParamedicA paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
- Paramedic practitioner
- Emergency Care PractitionerEmergency Care PractitionerAn Emergency Care Practitioner may come from either a paramedic, nursing or allied health professional background and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard...
(ECP) No longer within the service. - HEMS Paramedic
- London Air AmbulanceLondon Air AmbulanceLondon's Air Ambulance, also known as London HEMS , is an air ambulance service that responds to seriously ill or injured casualties in and around London, England....
and BASICS doctors work alongside the LAS but are not part of it - Hazardous Area Response Team (HART) operative
- Tactical support officer
- Team leader
- Training officer
- Area Controller
- Duty station officer (DSO)
- Ambulance Operations Manager (AOM)
- Operational Control Manager (OCM)
Fleet
In addition to the ambulances, the LAS can deploy 100 rapid-response units in various cars, ten Honda ST1300
Honda ST1300
The Honda ST1300, also known as the Pan-European, is a sport touring motorcycle manufactured by Honda and introduced to Europe in 2002. The following year, it was released in North America as the ST1300....
motorcycle
Motorcycle
A motorcycle is a single-track, two-wheeled motor vehicle. Motorcycles vary considerably depending on the task for which they are designed, such as long distance travel, navigating congested urban traffic, cruising, sport and racing, or off-road conditions.Motorcycles are one of the most...
s, or 14 bicycle
Bicycle
A bicycle, also known as a bike, pushbike or cycle, is a human-powered, pedal-driven, single-track vehicle, having two wheels attached to a frame, one behind the other. A person who rides a bicycle is called a cyclist, or bicyclist....
s.
Although not a part of the LAS, the London Air Ambulance
London Air Ambulance
London's Air Ambulance, also known as London HEMS , is an air ambulance service that responds to seriously ill or injured casualties in and around London, England....
can also be deployed by, and for, the LAS from its base at the Royal London Hospital
Royal London Hospital
The Royal London Hospital was founded in September 1740 and was originally named The London Infirmary. The name changed to The London Hospital in 1748 and then to The Royal London Hospital on its 250th anniversary in 1990. The first patients were treated at a house in Featherstone Street,...
, Whitechapel
Whitechapel
Whitechapel is a built-up inner city district in the London Borough of Tower Hamlets, London, England. It is located east of Charing Cross and roughly bounded by the Bishopsgate thoroughfare on the west, Fashion Street on the north, Brady Street and Cavell Street on the east and The Highway on the...
. The normal operating crew of a helicopter or car includes one LAS paramedic on secondment to the service as well as a doctor of specialist training/SpR level or above.
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.
Notable incidents
The LAS plays a significant role whenever an incident causes mass caualties in London. Examples include:- 7 July 2005 suicide attacks7 July 2005 London bombingsThe 7 July 2005 London bombings were a series of co-ordinated suicide attacks in the United Kingdom, targeting civilians using London's public transport system during the morning rush hour....
: Four bombings across London. Voluntary aid services needed to assist the LAS due to lack of vehicles. - Paddington train crashLadbroke Grove rail crashThe Ladbroke Grove Rail Crash was a rail accident which occurred on 5 October 1999 at Ladbroke Grove, London, England. Thirty-one people were killed and more than 520 injured...
: Two trains collided a short distance outside of Paddington station, killing 31 people - Cannon Street rail crashCannon Street station rail crashThe Cannon Street station rail crash was an accident on the British railway system which occurred on 8 January 1991 at Cannon Street station. The accident killed two people and injured 524 others...
: Two people were killed and over 500 injured - Marchioness disasterMarchioness disasterThe Marchioness disaster occurred on the River Thames in London in the early hours of 20 August 1989. The pleasure boat Marchioness sank after being run down by the dredger Bowbelle, near Cannon Street Railway Bridge. There were 131 people on the Marchioness. Some were members of the crew, some...
: A pleasure boat, Marchioness, was in collision with a dredger; 51 people died - Clapham Junction train crashClapham Junction rail crashThe Clapham Junction rail crash was a serious railway accident involving two collisions between three commuter trains at 08:10 on the morning of Monday, 12 December 1988....
: 35 people were killed and 69 seriously injured - King's Cross fireKing's Cross fireThe King's Cross St. Pancras tube station fire was a fatal fire on the London Underground. It broke out at approximately 19:30 on 18 November 1987, and killed 31 people....
: 31 people died in a major fire in the Underground station - Moorgate tube crashMoorgate tube crashThe Moorgate tube crash was a railway disaster on the London Underground, which occurred on 28 February 1975 at 08.46 am.A southbound train on the Northern Line crashed into the tunnel end beyond the platform at Moorgate station...
: the train driver and 42 passengers were killed - Provisional IRA bombing campaign: a list of these and other bombings in London to which the LAS responded can be found here.
1992 CAD failure
On 26 October 1992 the LAS started to use a new computer-assisted dispatchComputer-assisted dispatch
Computer-assisted dispatch, also called Computer Aided Dispatch , is a method of dispatching taxicabs, couriers, field service technicians, or emergency services assisted by computer. It can either be used to send messages to the dispatchee via a mobile data terminal and/or used to store and...
(CAD) system, known as LASCAD. Poorly designed and implemented, its introduction led to significant delays in the assigning of ambulances, 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-chief executive, John Wilby, resigned shortly afterwards.
The Report of the Inquiry into the LASCAD failure can be viewed here
This failure is often cited in case studies of poor engineering management.
Ambulance response times
In 2000, the LAS faced funding difficulties and an increase in the volume of 999 calls999 (emergency telephone number)
999 is an official emergency telephone number in a number of countries which allows the caller to contact emergency services for urgent assistance....
, and it was criticised for poor performance in its response times. The service was sued for negligence (Kent v Griffiths
Kent v Griffiths
Kent v Griffiths [2000] 2 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 chief executive at the time, Michael Honey, left his post after talks with other members of LAS management.
Reaction to events of 7 July 2005
7 July 2005 London bombings
The 7 July 2005 London bombings were a series of co-ordinated suicide attacks in the United Kingdom, targeting civilians using London's public transport system during the morning rush hour....
. 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. As of July 2009 the new radio system recommended after the bombings is in the initial stages of being rolled out service wide.
2006 computer system crash
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. This resulted in delayed ambulance activations, and thus delays in reaching patients.2009 heatwave
During the heatwave in the summer of 2009, there was an increase in demand for ambulances 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. A lack of resources meant that the LAS found it difficult to meet an increased demand for ambulances during the period.Loss of ECP funding
In 2010 the service trust 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.Frontline radios
The service 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 emergency assistance panic buttons on their radios did not work and left the crews vulnerable and unsupported.2010 Headquarters Fire
A fire in the basement of Ambulance Headquarters, Waterloo in October 2010 caused the LAS to relocate the Emergency Operations Centre from Waterloo to the Backup Control Room in East London after the fire caused an interruption of the building's power supply. The Service took the step of urging the public to find other means of transport to hospital for anyone suffering non-lifethreatening emergencies.2011 CAD failure
On 8 June 2011 the London Ambulance Service tried to implement a new CAD System, CommandPoint. Costing £18,000,000 and built by Northrop GrummanNorthrop Grumman
Northrop Grumman Corporation is an American global aerospace and defense technology company formed by the 1994 purchase of Grumman by Northrop. The company was the fourth-largest defense contractor in the world as of 2010, and the largest builder of naval vessels. Northrop Grumman employs over...
, an American aerospace and defense technology company.
During CommandPoint's 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 old CAD System, CTAK, in the early hours of 9 June 2011. It was later announced that a review of the difficulties experienced would be undertaken.
Severe delays of up to 50 minutes had been reported.
Other emergency medical services
- Emergency medical services in the United Kingdom
- London Air AmbulanceLondon Air AmbulanceLondon's Air Ambulance, also known as London HEMS , is an air ambulance service that responds to seriously ill or injured casualties in and around London, England....
- Scottish Ambulance ServiceScottish Ambulance ServiceThe Scottish Ambulance Service is part of NHS Scotland, and serves all of Scotland. It is a Special Health Board funded directly by the Scottish Government Health Department....
- British Red CrossBritish Red CrossThe British Red Cross Society is the United Kingdom branch of the worldwide impartial humanitarian organisation the International Red Cross and Red Crescent Movement. The society was formed in 1870, and is a registered charity with over 31,000 volunteers and 2,600 staff. At the heart of their work...
- St. John AmbulanceSt. John AmbulanceSt John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John...
- International SOSInternational SOSInternational SOS provides integrated medical, clinical, and security services to organisations with international operations. Services include planning and preventative programs, in-country expertise, and emergency response. It has 9,000 employees, led by 1,100 full-time physicians and 200...
, provider of air ambulance evacuation and repatriation services
Other emergency services
- London Fire BrigadeLondon Fire BrigadeThe London Fire Brigade is the statutory fire and rescue service for London.Founded in 1865, it is the largest of the fire services in the United Kingdom and the fourth-largest in the world with nearly 7,000 staff, including 5,800 operational firefighters based in 112 fire...
- Metropolitan Police ServiceMetropolitan Police ServiceThe Metropolitan Police Service is the territorial police force responsible for Greater London, excluding the "square mile" of the City of London which is the responsibility of the City of London Police...
- British Transport PoliceBritish Transport PoliceThe British Transport Police is a special police force that polices those railways and light-rail systems in Great Britain for which it has entered into an agreement to provide such services...
- City of London PoliceCity of London PoliceThe City of London Police is the territorial police force responsible for law enforcement within the City of London, England, including the Middle and Inner Temple. The service responsible for law enforcement within the rest of Greater London is the Metropolitan Police Service, a separate...
- Royal National Lifeboat Institution (RNLI)
- 999 (emergency telephone number)999 (emergency telephone number)999 is an official emergency telephone number in a number of countries which allows the caller to contact emergency services for urgent assistance....
External links
- Official website
- NHS information
- NHS Trust - Local London Ambulance Station Site List
- Google Local information
- Academic site detailing the CAD failure
- CommandPoint (2011 CAD system) - Northrop Grumman