The London Ambulance Service and West Midland Ambulance Service have been trialling a new approach to handling Category 2, medical emergency 999 calls.

Posted: 22nd February 2023

The 4 categories:
Currently when you call 999 for a medical emergency, you are triaged into 4 categories. These 4 categories reflect how urgently you need to be treated.

Category 1
patients are those with an immediate threat to life. They are patients experiencing conditions such as a cardiac arrest or serious allergic (anaphylactic reaction). The ambulance control handler will be asking questions such as – are they conscious? Are they breathing? And what happened?

Category 2
patients are those experiencing life threatening medical emergencies – such as a stroke, heart attack, severe burns, sepsis or seizures and many others.

New plans for category 2 patients
NHS England are now going to treat a specific group of patients differently. 40% of patients assessed as category 2, have a condition that may be better treated elsewhere. These patients will now receive a call back from a doctor or nurse who will talk with them to better assess their needs and advise on first aid and immediate treatment. When appropriate, those patients will be referred to other services.

Category 3
patients are considered as requiring urgent treatment. They may have conditions such as: abdominal pains, late labour, non-severe burns, or someone who is having a diabetic emergency.

Category 4
patients are considered non-urgent and could probably make their own way to A&E or be better treated in an urgent treatment centre or even by their GP or pharmacist.

Ambulance response times
Ambulance Trusts across the country remain under intense pressure and continue to miss existing targets for answering 999 calls on time.

Figures published earlier this month showed ambulances had improved their response times, with the average response time in January for ambulances dealing with the most urgent, category 1 incidents, such as cardiac arrest, being eight minutes and 30 seconds, an improvement from 10 minutes and 57 seconds in December.

The target standard response time for these incidents is just seven minutes.

Meanwhile, it took an average of 32 minutes and six seconds in January to respond to serious category 2 emergency calls such as heart attacks, strokes and sepsis, down sharply from one hour, 32 minutes and 54 seconds in December. However, the response time is still well above the target of 18 minutes.

How the new plan will work
Under this new plan, there will be more clinicians in ambulance control rooms.

Officials say they have identified a group of patients who will always require an immediate ambulance response – such as those experiencing strokes and heart attacks under category 2.

However, around 40% of people in category 2 could receive a call back which will result in them either keeping their place in the queue for an ambulance, being reprioritised, or directed to alternative services such as their GP or an urgent treatment centre.

This group of people may include those with burns, or other medical emergencies where the severity of the condition can vary. Therefore, it is helpful to speak to a clinician and discuss things in more detail.

Results from the pilot studies
According to the pilot studies, no patient safety concerns have been raised so far and this system freed up more resources. Consequently, ambulances were able to get to more serious cases quicker. Nearly half the calls that received a call back resulted in the patient being given advice or referred to a different service.

Sir Julian Hartley, chief executive at NHS Providers, said: “This is a welcome step to safely respond to pressure on ambulance services and hospitals.

“The focus is on ensuring patients’ needs are met in the right place – whether that’s a hospital or a community setting – and that more urgent category 2 calls, such as for a suspected stroke or heart attack, are responded to as quickly as possible.

“However, reducing demand at the front door isn’t enough to ensure sustained improvement.

“Pressures in the ambulance service are linked to pressures across the whole system.

“We need to focus on reducing high bed occupancy, increasing bed capacity, and reducing delayed discharges through increased investment in social care and community services, too.

“Major workforce shortages also need to be addressed to ensure measures like this can be put in place. We eagerly await the Government’s long-term, fully funded workforce plan.”

Response from NHS England
Professor Julian Redhead, NHS England national clinical director for urgent and emergency care, said: “This new system will allow a conversation between a nurse and paramedic or a doctor and the patient – and between them, they’ll be able to decide whether an ambulance is the best response or whether no ambulance is required, and they’re better cared for in a different environment.

“It’s really important that people know it doesn’t mean anyone loses their place in the queue (while they are assessed).

“What it does is provide more individualised care for a patient but also allows us to free up the resource for our most vulnerable patients, patients who will have had strokes and heart attacks.”

NHS England ambulance services are proposing to move to the new system in the next couple of weeks and will keep it under review during its initial months.


NHS England » Ambulance response times improve in face of ongoing winter pressures

NHS England » Ambulance Response Programme

New Ambulance Standards (Easy Read) – attached.


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