London Ambulance Service

The London Ambulance Service NHS Trust (LAS) is the largest "free at the point of contact" emergency ambulance service in the world. It responds to medical emergencies in Greater London, England, with its ambulances 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, and is part of the National Health Service (NHS), receiving direct government funding for its role. There is no charge to patients for use of the service, 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 every year. All 999 calls from the public are answered at the Emergency Operations Centre (EOC) in Waterloo, which then dispatches the appropriate resources. To assist, the service's command and control system is linked electronically with the equivalent system for the Metropolitan 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, 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.

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:^{[citation needed]}

• Accident and emergency (A&E)
• Communications
• Finance and business
• Human resources
• Medical
• Patient transport services (PTS)
• Technology

Operations are directed from service headquarters in Waterloo Road which houses the Emergency Operations Centre (EOC) for despatching emergency service vehicles and also coordinates major incident responses^{[citation needed]} 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 triage for casualties.

This system was used effectively in response to the suicide bombings on 7 July 2005.

Operational staff

LAS vehicles on the scene of an emergency incident in central London.

Operational roles in the LAS include:

• Ambulance attendant (PTS)
• A&E support
• Emergency Medical Dispatcher (EMD1, EMD2, EMD3, Allocator)
• Call-Handling Supervisor (a source of reference for LAS call-handling procedure and acting as a link between the "999" area and different dispatch positions within EOC)
• Clinical support advisor (working as the Clinical Support Desk (CSD) in EOC)
• Clinical telephone advisor
• Emergency medical technician (EMT1, EMT2, EMT3, EMT4)
• Student paramedic levels 1, 2, 3, 4
• Paramedic
• Emergency Care Practitioner (ECP) No longer within the service.
• HEMS Paramedic
• London Air Ambulance 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

An LAS ambulance, with integrated roof lightbar and high-visibility reflective chevrons

An LAS rapid-response bicycle

The LAS operates around 900 ambulances each crewed by two staff - two paramedics, an EMT and a paramedic, two EMTs, or two A&E support staff. An ambulance can also be crewed by any EMT3 or above and a trainee, for example EMT3 plus a student paramedic level 2 (SP2), or an SP2 and SP3.^{[citation needed]}

In addition to the ambulances, the LAS can deploy around 100 rapid-response units in various cars, motorcycles, or bicycles.

Although not a part of the LAS, the London 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 helicopter or a rapid-response 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 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 attacks: Four bombings across London. Voluntary aid services needed to assist the LAS due to lack of vehicles.
• Paddington train crash: Two trains collided a short distance outside of Paddington station, killing 31 people
• Cannon Street rail crash: Two people were killed and over 500 injured
• Marchioness disaster: A pleasure boat, Marchioness, was in collision with a dredger; 51 people died
• Clapham Junction train crash: 35 people were killed and 69 seriously injured
• King's Cross fire: 31 people died in a major fire in the Underground station
• Moorgate tube crash: 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.

Service difficulties

1992 CAD failure

On 26 October 1992 the LAS started to use a new computer-assisted dispatch (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 calls, and it was criticised for poor performance in its response times. The service was sued for negligence (Kent v Griffiths). 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

Ambulances in attendance at Russell Square on 7 July 2005

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 attacks. 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 its Waterloo base in October 2010 caused the LAS to relocate the Emergency Operations Centre from Waterloo to the back-up 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-life-threatening injuries.

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 Grumman, 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.

CommandPoint implementation re-attempt

A second attempt at implementing CommandPoint will take place on 28 March 2012. The Trust may terminate its contract with American supplier Northrop Grumman if the re-attempt to go-live with the new dispatch system fails. One commentator has noted that a defective first responder system is a public health menace, and that 2012 is bad timing for software testing due to the upcoming Olympic Games in London.

See also

Other emergency medical services

• Emergency medical services in the United Kingdom
• London Air Ambulance
• Scottish Ambulance Service
• British Red Cross
• St. John Ambulance
• International SOS, provider of air ambulance evacuation and repatriation services

Other emergency services

• London Fire Brigade
• Metropolitan Police Service
• British Transport Police
• City of London Police
• Royal National Lifeboat Institution (RNLI)
• 999 (emergency telephone number)

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

Video clips

• London Ambulance Service NHS Trust YouTube channel