Intended for healthcare professionals

Education And Debate

NHS emergency response to 999 calls: alternatives for cases that are neither life threatening nor serious

BMJ 2002; 325 doi: (Published 10 August 2002) Cite this as: BMJ 2002;325:330
  1. Helen Snooks, senior lecturer (,
  2. Susan Williams, research fellowb,
  3. Robert Crouch, consultant nurseb,
  4. Theresa Foster, research associatec,
  5. Chris Hartley-Sharpe, senior operations officerc,
  6. Jeremy Dale, directord
  1. aCentre for Postgraduate Studies, Swansea Clinical School, University of Wales, Swansea SA2 8PP
  2. bSchool of Nursing and Midwifery, University of Southampton, Southampton SO17 1BJ
  3. cLondon Ambulance Service NHS Trust, London SE1 8SD
  4. dCentre for Primary Health Care Studies, University of Warwick, Coventry CV4 7AL
  1. Correspondence to: H Snooks
  • Accepted 14 December 2001

Ambulance services and emergency departments are under increasing pressure as the number of emergency calls continues to rise—but in many cases, patients do not need immediate clinical care. Helen Snooks and colleagues consider the alternatives to the standard NHS response and review the current literature

The number of emergency (999) calls received by ambulance services in the United Kingdom has risen consistently over recent years. Ambulance services must respond to calls immediately by sending vehicles staffed by paramedics, with flashing lights and sirens. All patients have to be taken to an accident and emergency department. This response is not always appropriate, and it can resultin inefficient use of resources and unnecessary risks to the general public, patients, and paramedics.

The NHS Plan and the recent consultation document Reforming Emergency Care have emphasised the importance of trying new approaches to deliver appropriate care. 1 2 They highlight the need to consider new ways to integrate the ambulance response to 999 calls into the overall system that deals with emergencies.

Summary points

Demands on emergency services and inappropriate requests for emergency ambulances are increasing

Ambulance services must respond to calls immediately by sending vehicles with flashing lights and sirens, staffed by paramedics

Many ambulance services want to develop alternatives to the standard response to all 999 calls

Evidence about the safety and effectiveness of alternatives is weak and few rigorous trials have been reported

Studies show that alternative responses are needed but that the work involved in their development is complex

Evidence of the need to change

In England, demand through the 999 telephone system for services has risen by 40% since 1990.3 Problems of overcrowding and high attendance have also been noted in emergency departments and in primary care. Concerns have been expressed over the number of home visits requested at night and whether all such visits are …

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