Giving a clinically appropriate response

Giving a clinically appropriate response

Following the largest clinical ambulance trials in the world, NHS England is implementing new ambulance standards across the country.    

East Midlands Ambulance Service launched the new Ambulance Response Programme (ARP) on 19 July.

ARP is not about the fastest response, but the most appropriate clinical response for each patient. For example, for stroke patients this means instead of sending any vehicle to get to them within eight minutes, eg an ambulance car, we will send an ambulance to take them to hospital for the treatment they need.    

When announcing the new standards, NHS England included several supportive statements from leaders at the Stroke Association, British Heart Foundation, and Royal College of Emergency Medicine. Their quotes and others can be viewed via the NHS England web page.

Staff rota consultation

In order to deliver our service through ARP and for patients to benefit fully from it, we are currently consulting with our staff and Trade Unions on a proposed new operating model.   

Discussions with our staff during June have helped shape the content of the staff consultation document.

The staff consultation is not about reducing the overall number of staff available across our region. It is about:
  • increasing the number of ambulances available through the day and night across the East Midlands
  • increasing the number of ambulances we have to take patients to hospital, and reducing the number of ambulance cars whilst making sure they are focused on the patients they can really help (see example in third paragraph of this document)
  • utilising a wider range of ambulance shift lengths
  • increasing the number of Ambulance Intervention Teams to increase our capacity and capability to respond to terror attacks

Using the 999 ambulance service  

Patient safety and patient care is at the heart of this change, and the way that people access the 999 ambulance service will not be different.

People will still ring 999 and our Emergency Operations Centres will still ask the same questions that they do now to determine the best response for each patient. It is important to note that not all 999 calls received are for a life-threatening or serious illness or injury.

Where ambulances are based

East Midlands Ambulance Service is a mobile emergency healthcare provider and our staff travel in ambulance vehicles to where help is needed. We do not treat people in ambulance stations.

On average, we receive a new 999 call every 34 seconds, therefore when an ambulance crew has started their shift, it is very rare for them to return to their station until their meal break several hours later. Gone are the days where a crew would return to their base after each call.

The ambulance vehicle that you may see in your local town might well have started their shift from a base many miles away. For example:

  • Ambulance Crew A start their shift at a station based in Anytown.
  • Their first 999 call comes in for a patient also located in Anytown.
  • Ambulance Crew A respond and the patient needs taking to the nearest major trauma centre which is over 20 miles away based in Anycity.
  • Ambulance Crew A and the patient make the journey from Anytown to Anycity.
  • Whilst they are travelling our Emergency Operations Centre continue to receive new 999 calls.
  • One call is from a new patient also located in Anytown.
  • Ambulance Crew A are already on their way to the major trauma centre in Anycity but this doesn’t mean that we can’t respond to the new patient.
  • Our Emergency Operations Centre constantly monitor 999 calls coming in and track where all of our available ambulances are located. They identify Ambulance Crew B (who started their shift at a different location) as the most appropriate, nearest ambulance and send it to the new patient in Anytown.
  • Ambulance Crew B reach the new patient and provide treatment and care.
  • Meanwhile, Ambulance Crew A have safely delivered their patient to the major trauma centre, and they are ready to respond to a new call.
  • A call comes in from a new patient located in Anycity. Ambulance Crew A are the nearest available ambulance and so they are sent to the patient instead of being sent back to their station at Anytown.
  • Ambulance Crew A get to the patient in Anycity. They treat the patient on scene, and then get another new call for a patient located in a different area.
  • Ambulance Crew A do not return to their station base in Anytown until their meal break several hours later.


Using our resources wisely means making sure we respond to 999 calls not dependent on where the ambulance started its shift, but dependent on the clinical need of the patient, and that we send the most appropriate, nearest and available resource to respond.


 Additional information

  1. Please see NHS England’s website for more details about the national Ambulance Response Programme, including animations about each performance standard category
  2. A recent 10 part series on BBC One, ‘Ambulance’, has helped people understand how modern ambulance services respond to patients and how calls are prioritised depending on the clinical condition reported.