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London Ambulance Service

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London Ambulance Service logo
London Ambulance Service logo

The London Ambulance Service (LAS) is a National Health Service trust that is responsible for responding to medical emergencies in Greater London with its ambulances and other response vehicles,[1] and over 4,500 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, receiving direct government funding for its role. There is no charge to patients for use of the service, as 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.[2] 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 London's 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.[3]

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.[3]

During World War II, the London Auxiliary Ambulance Service was operated by over 10,000 auxiliaries, mainly women, from all walks of life. They ran services from 139 Auxiliary Stations across London. A plaque at one of the last to close, Station 39 in Weymouth Mews, near Portland Place, commemorates their wartime service. [4]

In 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[3] 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.[3]

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.[5]

The chief executive and Chief Ambulance Officer have responsibility for oversight of seven directorates:[citation needed]

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.[6] 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.[7]

  • Platinum control: government level command (COBR);[8]
  • 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.[9]

Staff roles

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

Operational roles in the LAS include:[10][verification needed]

Fleet

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

The LAS operates around 900 ambulances. In addition it can deploy around 100 rapid-response units in various cars, motorcycles,[23] or bicycles.[1] 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.

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.[24]

Notable incidents

The LAS plays a significant role whenever an incident causes mass caualties in London. Examples include:

Difficulties and criticisms

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 in the case of Kent v Griffiths. The chief executive at the time, Michael Honey, left his post after talks with other members of LAS management.[32]

In 2010 the service 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.[33]

A fire in the basement of its Waterloo base in October 2010 caused the LAS to relocate the EOC to the back-up control room in east London due to an interruption to 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.[6]

In 2013, the LAS was named by the Care Quality Commission as one of 26 healthcare providers in England failing to operate with sufficient staff.[34]

7/7 bombings

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 7/7 attacks.[35] 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. In July 2009 the new radio system recommended after the bombings was rolled out.

Despite the changes after 7/7, the LAS 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 panic buttons on their radios did not work properly.[36][37][38]

System failures

On 26 October 1992 the LAS started to use a new computer-assisted dispatch (CAD) system, known as LASCAD.[39] Poorly designed and implemented, its introduction led to significant delays in the assigning of ambulances,[40] 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.[41] This failure is often cited in case studies of poor engineering management.[42]

A software upgrade in July 2006 led to repeated system crashes during August.[43] As a result, dispatchers had to go back to old pen-and-paper methods.[44]

On 8 June 2011 the LAS attempted to implement a new CAD system, called CommandPoint,[45] costing £18 million[46] and built by Northrop Grumman, an American aerospace and defense technology company.

During its implementation it developed technical problems and was replaced by a pen-and-paper method[47] for several hours until a decision was taken to revert to the previous system, CTAK, in the early hours of 9 June.[48] It was later announced that a review of the difficulties experienced would be undertaken.[49]

A second attempt at implementing CommandPoint was due to take place on 28 March 2012. The trust was considering terminating its contract with Northrop Grumman if the re-attempt to go live with the new system failed.[50][needs update]

See also

Other London emergency services:

References

  1. ^ a b London Ambulance Service: Facts & figures[dead link]
  2. ^ "London Ambulance Service - Providing an emergency response". Londonambulance.nhs.uk. 19 April 2011. Retrieved 19 July 2012.
  3. ^ a b c d London Ambulance Service: History Cite error: The named reference "LASHist" was defined multiple times with different content (see the help page).
  4. ^ City of Westminster green plaques http://www.westminster.gov.uk/services/leisureandculture/greenplaques/
  5. ^ London Ambulance Service: Trust Board[dead link]
  6. ^ a b "London Ambulance Service - Fire at headquarters building". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  7. ^ [1][dead link]
  8. ^ [2][dead link]
  9. ^ JEMS.com: The EMS response plan that worked[dead link]
  10. ^ London Ambulance Service: Recruitment[dead link]
  11. ^ http://www.londonambulance.nhs.uk/working_for_us/current_vacancies/ambulance_staff/patient_transport_service_driv.aspx
  12. ^ "London Ambulance Service - Ambulance support (A&E support)". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  13. ^ "London Ambulance Service - Dan Ahmed - A&E support". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  14. ^ "London Ambulance Service - Karen Upton - emergency medical dispatcher". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  15. ^ "London Ambulance Service - Samad Billoo - emergency medical dispatcher". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  16. ^ "London Ambulance Service - Adam Swift - emergency medical dispatcher". Londonambulance.nhs.uk. 10 December 2009. Retrieved 19 July 2012.
  17. ^ Erich, John (2009). "Demand & Control". EMS : Emergency Medical Services.
  18. ^ "London Ambulance Service - Student paramedics". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  19. ^ "London Ambulance Service - Joanne Wood - student paramedic". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  20. ^ http://www.londonambulance.nhs.uk/working_for_us/career_opportunities/ambulance_staff/emergency_care_practitioners.aspx
  21. ^ a b c d [3][dead link]
  22. ^ "London Ambulance Service - Lord West visits London Ambulance Service's hazardous area response team". Londonambulance.nhs.uk. Retrieved 19 July 2012.
  23. ^ "London ambulance service chooses honda's st1300 pan european". Honda UK. 23 March 2009. Retrieved 21 February 2010.
  24. ^ London Ambulance Service website
  25. ^ .BBC News website: on this day 7 July 2005
  26. ^ "on this day 5 October 1990". BBC News. 5 October 1999. Retrieved 11 June 2009.
  27. ^ "on this day 8 January 1991". BBC News. 8 January 1991. Retrieved 11 June 2009.
  28. ^ "on this day 20 August 1989". BBC News. 20 August 1989. Retrieved 11 June 2009.
  29. ^ "on this day 12 December 1988". BBC News. 12 December 1988. Retrieved 11 June 2009.
  30. ^ "on this day 18 November 1987". BBC News. 18 November 1987. Retrieved 11 June 2009.
  31. ^ "on this day 28 February 1975". BBC News. 28 February 1975. Retrieved 11 June 2009.
  32. ^ "BBC: Ambulance chief quits". BBC News. 10 February 2000. Retrieved 11 June 2009.
  33. ^ "London Ambulance Service decides they will no longer use Emergency Care Practitioners as part of their workforce". LysaWalder.com. 4 June 2010. Retrieved 19 July 2012.
  34. ^ http://www.bbc.co.uk/news/health-21002205
  35. ^ "BBC: 7 July ambulance 'radio failure'". BBC News. 15 March 2006. Retrieved 11 June 2009.
  36. ^ "Industry news-1-1". IOSH. 13 July 2010. Retrieved 19 July 2012.
  37. ^ http://www.theregister.co.uk/2010/07/13/ambulance_radio_/
  38. ^ "Ambulance radios 'fail in rain'". BBC News. 13 July 2010.
  39. ^ Nick Plant. "University of the West of England: ''LASCAD Case Study''". Cems.uwe.ac.uk. Retrieved 11 June 2009.
  40. ^ "Personal Computer World: Ambulances won't crash again". Pcw.co.uk. 12 June 1997. Retrieved 11 June 2009.
  41. ^ Department of the Official Report (Hansard), House of Commons, Westminster (28 October 1992). "House of Commons Hansard debates for 28th October 2002". Publications.parliament.uk. Retrieved 11 June 2009.{{cite web}}: CS1 maint: multiple names: authors list (link)
  42. ^ Mike Dahlin. "Coping with complexity - Jerome H. Saltzer (MIT)" (PDF). Advice to systems researchers. Department of Computer Science, University of Texas at Austin. Retrieved 2 December 2010.
  43. ^ "BBC: Computer problem hits 999 calls". BBC News. 23 August 2006. Retrieved 11 June 2009.
  44. ^ "London Ambulance computer crashes nine times". E-Health Insider. Retrieved 11 June 2009.
  45. ^ "CommandPoint™". Is.northropgrumman.com. Retrieved 19 July 2012.
  46. ^ (07:00-10:00) (8 July 2009). "Ambulances Delayed By 50 Minutes As New Computer Fails". LBC. Retrieved 19 July 2012. {{cite web}}: |author= has numeric name (help)
  47. ^ "London Ambulance Service - Statement about our new call-taking system". Lond-amb.nhs.uk. Retrieved 19 July 2012.
  48. ^ "London Ambulance Service - Statement about our new call-taking system". Lond-amb.nhs.uk. Retrieved 16 October 2012.
  49. ^ "London Ambulance Service - Statement about our new call-taking system". Lond-amb.nhs.uk. Retrieved 16 October 2012.
  50. ^ "E-Health Insider :: LAS plans for IT go-live and failure". Ehi.co.uk. Retrieved 16 October 2012.
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