London Ambulance Service



The London Ambulance Service NHS Trust (LAS) is the largest ambulance service in the world that does not directly charge its patients for its services. It responds to medical emergencies in London, UK with the 400 ambulances at its disposal.

It is one of 13 Ambulance Trusts providing England with Emergency medical services, and is part of the National Health Service, receiving direct government funding for its role. There is no charge to patients for use of the service, and under the Patient's charter, every person in the United Kingdom has the right to the attendance of an ambulance in an emergency.

The LAS employs over 4,000 staff and responds to over 1 million calls for assistance a year. All requests from the public are answered at the Emergency Operations Centre (EOC) in Waterloo, Lambeth, which then dispatches the appropriate resources. To assist, the command and control system is linked electronically with the equivalent system for the Metropolitan Police.

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 callout to 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 National Health Service the LAS was transferred from the control of local government to the South West Thames Regional Health Authority.

On 1st 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 London Ambulance Service executive directors and five external non-executive directors.

The Chief Executive and Chief Ambulance Officer has responsibility for oversight of seven Directorates:
 * Accident and Emergency (A&E)
 * Communications
 * Finance and Business
 * Human Resources
 * Medical
 * Patient Transport Services
 * Technology

LAS operations are directed from Ambulance Service Headquarters in Waterloo Road, London SE1, which houses the Emergency Operations Centre (EOC) for despatching emergency service vehicles and also coordinates major incident responses.

During mass casualty incidents, the command structure works on three levels — Gold, Silver and Bronze.
 * Gold Control is the strategic command located in a situation room close to the main Central Ambulance Control (CAC) and managing communications between crews
 * Silver Control provides tactical command from a designated point in the vicinity of the incident(s)
 * Bronze Control is the on-site operational level organising triage for casualties.

This system was used effectively in the aftermath of the July 7 2005 London bombings.

Operational staff
There are many operational roles in the LAS :


 * Ambulance Person
 * Emergency Medical Dispatcher
 * Emergency Medical Technician (EMT)
 * Paramedic
 * Emergency Care Practitioner
 * Team Leader
 * Duty Station Officer

Fleet vehicles


The LAS operates 400 ambulances each with a crew of two, usually an EMT and a paramedic.

In addition to these ambulances, the LAS can deploy 100 rapid-response units in cars, 10 motorcycles and 14 cycle units.

Although not a part of the LAS, the Helicopter Emergency Medical Service (HEMS) - popularly known as the 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 HEMS helicopter or car includes one LAS Paramedic on secondment to the service as well as a Doctor of SPR level or above.

As well as accidents and emergencies, the LAS provide 195 vehicles in a Patient Transport Service which takes non-emergency patients to and from hospital as required.

Notable incidents
The geographical area covered by the London Amublance Service along with the major transport infrastructure; and the political, business and administrative bases typical of a capital city has seen the LAS involved in several major incidents. A major incident requires the implementation of an inter-agency response to a pre-determined contingency plan.

Any of the emergency services can initiate Major Incident Procedure, this can be initiated by any employee in uniform. In legislative terms, in the UK the most senior fire officer is in charge of any incident involving fire, any other is the responsibility of the police, however as in the case of the 7 July bombings multiple major incidents were declared, with the LAS declaring one for the Tavistock Square bus bomb (which detonated close to the headquarters of the British Medical Association).

When a major incident is declared the services along with civilian agencies use a structural system known as gold command that allows them to follow a set procedure for incident management. In summary, gold command relates to strategic control of an incident, silver command tactical and bronze operational. The term gold command can also relate to an emergency service building, mobile control unit or other base that becomes the focal point (often remotely) for the incident's management. At the scene of an incident a Joint Emergency Services Control Centre JESCC is established where Silver officers from various services can co-ordinate their efforts.

Additionally, a major incident can lead to the government instigation its coordination facility known as COBRA.

Some notable major incidents where the LAS has played a significant role:


 * 7 July 2005 - London Bombings Multiple major incidents across London in which the LAS played a key role in triage and patient recovery and assessment.
 * 5 October 1999 - Paddington Train Crash Often referred to as Ladbroke Grove Crash due to it occurring on the stretch of line in that area, two trains collided a short distance outside of Paddington Station, killing 31 people
 * 8 January 1991 - Cannon Street Train Crash Two people were killed and over 500 injured
 * 20 August 1989 - Sinking of the Marchioness Pleasure boat the Marchioness was struck by a dredger the Bowbelle killing 51 people.
 * 12 December 1988 - Clapham Train Crash A packed commuter train passed a defective signal and ran into the back of a second train, derailing it into the path of a third coming the other way. The crash killed 35 people and seriously injured 69 others.
 * 18 November 1987 - King's Cross Fire Fire broke out under a wooden escalator leading from one of the underground station platforms to the surface. The blaze and resulting smoke claimed 31 lives, including that of a senior firefighter.
 * 28 February 1975 - Moorgate Tube Train Crash A London Underground train failed to stop and crashed into the buffers at the end of a tunnel. The driver and 42 passengers were killed.
 * 1970s-1990s - IRA bombing campaign Throughout the last quarter of the 20th century, several major bombings were carried out in London by the Provisional IRA. A list of these and other bombings in London to which the LAS responded can be found here.

1992 CAD system failure
On 26 October 1992 the LAS started to use a new Computer Aided Dispatch (CAD) system, known as LASCAD. Poorly designed and implemented, its introduction led to massive 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 LAS Chief Executive, John Wilby, resigned shortly afterwards.

Poor ambulance response times
In 2000, the LAS faced funding difficulties and an increase in the volume of 999 calls, and was criticised for poor performance in its response times which were reported to have endangered lives. The LAS Chief Executive at the time, Michael Honey, left his post after talks with other members of LAS management.

Reaction to events of July 7th, 2005
Concerns were raised in internal LAS documents over the performance of radios and communication equipment used in the emergency operations after the London bomb attacks of July 7th, 2005. 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 because the mobile phone networks were temporarily brought down during the day.

2006 computer system crashes
A software upgrade in July 2006 led to repeated system crashes during August. As a result, despatchers had to go back to old pen-and-paper methods.

Address

 * London Ambulance Service
 * 220 Waterloo Road
 * London SE1 8SD
 * United Kingdom

Other emergency medical services

 * Emergency medical services in the United Kingdom
 * London Air Ambulance (HEMS)
 * British Red Cross
 * St. John Ambulance
 * International SOS, Provider of air ambulance evacuation & repatriation services

Other emergency services

 * London Fire Brigade
 * Metropolitan Police Service
 * Royal National Lifeboat Institution (RNLI)