Intended for healthcare professionals


Covid-19: High prevalence and lack of hospital beds putting “intense pressure” on ambulances

BMJ 2022; 378 doi: (Published 15 July 2022) Cite this as: BMJ 2022;378:o1763
  1. Elisabeth Mahase
  1. The BMJ

All 11 ambulance services in England are working under extreme pressure because of rising rates of covid-19 and a lack of available hospital beds, and leaders are now asking the public to take extra precautions in the hot weather to avoid adding to the already overwhelming workload.

In a statement issued on 12 July, Martin Flaherty, managing director of the Association of Ambulance Chief Executives said that the NHS ambulance sector was “under intense pressure” and was now operating at the highest level of their local resource escalation action plans, which is normally reserved for “major incidents or short term periods of unusual demand.”

In their Resource Escalation Action Plan there are four levels used to describe the pressure that ambulance services are under, with level 1 being “steady state” and level 4 “extreme pressure.”1

Positive tests for SARS-CoV-2 rose 32% at the end of June, with an estimated 2.3 million people infected.2

Flaherty said, “Severe delays in ambulance crews being able to hand over their patients at many hospital emergency departments are having a very significant impact on the ambulance sector’s ability to respond to patients as quickly as we would like to, because our crews and vehicles are stuck outside those hospitals.” He added that staff absence caused by covid-19 and the “additional pressure caused by the current hot weather” were making the situation even tougher.

The latest data on ambulance services, published on 14 July, show that in June 2022 the mean average response time for the most urgent incidents (category C1) in England was just over nine minutes, far higher than the seven minute mean standard. For serious conditions such as a stroke or chest pain (C2) the mean response time was nearly 52 minutes, nearly three times the 18 minute target.3

Speaking in the House of Commons on 13 July, Maria Caulfield, the health minister responsible for ambulance services, acknowledged the “significant pressure” and attributed it to the high bed occupancy, high rates of covid admissions, delayed discharges, and a record number of calls to the ambulance service—100 000 more than in May last year.4

“I will be meeting all 11 ambulance trusts over the coming days to make sure that they have the capacity and the resilience they need not just to deal with the pressures now, including with the warm weather, but to prepare for the forthcoming winter pressures that we know are inevitable. This is an important issue that I take extremely seriously,” she said.


With the Met Office issuing an “amber extreme” heat warning,5 East Midlands Ambulance Service has asked the public to take precautions, including staying hydrated and checking on elderly or vulnerable neighbours.6

Its deputy director of operations, David Williams, said, “We need each and every person to take this heat warning seriously and to do everything they can to stay well to prevent additional pressure on the NHS. We continue to experience immense pressure on our ambulance service, and our staff are working phenomenally hard to the sickest and most severely injured patients.”

Meanwhile, Brian Jordan, director of 999 emergency operations centres for the London Ambulance Service, said, “High temperatures like these can have a significant impact on people’s health, and sadly we are expecting to see an increase in calls relating to difficulty in breathing, dizziness, and fainting, as well as more calls relating to chest pains and heart problems. People are also more likely to experience heat stroke during high temperatures. Our services are currently very busy, so we would urge everyone to take a little extra care during these soaring temperatures.”7

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