London Ambulance Service
2954499
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2008-06-20T16:58:17Z
123FM
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[[Image:LASLogo.jpg|200px|right|LAS Logo]]
The '''London Ambulance Service NHS Trust (LAS)''' is the largest "free at the point of contact" [[emergency service|ambulance service]] in the world that does not directly charge its patients for its services. It responds to [[medical emergency|medical emergencies]] in [[Greater London]], [[United Kingdom|UK]] with the 400 [[ambulance]]s <ref name=LASFacts>[http://www.londonambulance.nhs.uk/aboutus/facts/facts.html London Ambulance Service: Facts & figures]</ref> at its disposal.
It is one of 12 [[Emergency medical services in the United Kingdom|Ambulance Trusts]] providing England with [[Emergency medical service]]s, 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 <ref name=LASFacts>[http://www.londonambulance.nhs.uk/aboutus/facts/facts.html London Ambulance Service: Facts & figures]</ref> and responds to over 1 million calls for assistance a year <ref name=LASFacts>[http://www.londonambulance.nhs.uk/aboutus/facts/facts.html London Ambulance Service: Facts & figures]</ref>. All requests from the public are answered at the Emergency Operations Centre (EOC) in [[Waterloo, London|Waterloo]], [[London Borough of Lambeth|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]]. These means police updates regarding specific jobs will be sent directly to the ambulance responding to this call.
==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.<ref name=LASHist>[http://www.londonambulance.nhs.uk/aboutus/history/history.html London Ambulance Service: History]</ref>
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 <ref name=LASHist>[http://www.londonambulance.nhs.uk/aboutus/history/history.html London Ambulance Service: History]</ref>, 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]] <ref name=LASHist>[http://www.londonambulance.nhs.uk/aboutus/history/history.html London Ambulance Service website: History]</ref> 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]] <ref name=LASHist>[http://www.londonambulance.nhs.uk/aboutus/history/history.html London Ambulance Service: History]</ref>.
==Structure==
[[Image:LASAmbulance2.jpg|thumb|right|250px|Rear view of Mercedes Sprinter ambulance, showing stretcher lift ''(on right)'', integrated roof [[lightbar]] and high-visibility reflective [[Chevron (insignia)|chevron]]s ''(September 2006)'']]
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.<ref>[http://www.londonambulance.nhs.uk/aboutus/trustboard/trust.html London Ambulance Service: Trust Board]</ref>
The Chief Executive and Chief Ambulance Officer has responsibility for oversight of seven Directorates:
*[[Emergency department|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|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 Bronze command structure|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]] <ref>[http://www.jems.com/terrorism-wmdresponse/articles/13171/ JEMS.com: The EMS response plan that worked]</ref>.
==Operational staff==
There are many operational roles in the LAS <ref>[http://www.londonambulance.nhs.uk/careers/recruitment/recruitment_main.html London Ambulance Service: Recruitment]</ref>:
*Ambulance Attendant (PTS)
*Emergency Care Assistant
*Emergency Medical Dispatcher (EMD)
*Clinical Support Advisor (Working as the CSD/Clinical Support Desk in EOC)
*Clinical Telephone Advisor (CTA)
*[[Emergency Medical Technician]] (EMT)
*[[Paramedic]]
*[[Emergency Care Practitioner]] (ECP)
*Hazardous Area Response Team Operative (HART)
*Tactical Support Officer
*Team Leader
*Duty Station Officer (DSO)
*Area Operations Manager (AOM)
==Fleet vehicles==
[[Image:LASAmbulance.jpg|thumb|250px|A London ambulance, one of the fleet of [[Mercedes Sprinter]]s, outside [[Chiswick]] Ambulance Station - ''August 2006'']]
[[Image:LaszafiraRRV.JPG|thumb|250px|A London ambulance RRV, one of the fleet of [[Opel Zafira|Vauxhall Zafira]]s, outside [[St George's Hospital]] [[Emergency department]] - ''April 2008'']]
Image:
<!-- [[Image:London Ambulance Service rapid-response units.jpg|thumb|250px|LJ56 YVP This Vauxhall Zafira diesel is used for rapid response duties by LAS. Notice how it also has an airside beacon above the light bar much like the LDV minibus above.]] -->
[[Image:London_Ambulance_on_Hamilton_Terrace_.jpg|thumb|250px|An [[LDV Limited|LDV]] London ambulance, the standard fleet during the 1990s and early 2000s, some of which are still in service in 2008.]]
The LAS operates 400 ambulances each crewed by two EMTs or an EMT and a Paramedic.
In addition to these ambulances, the LAS can deploy 100 rapid-response units in cars, 10 [[motorcycle]]s and 14 [[bicycle|cycle]] units <ref name=LASFacts>[http://www.londonambulance.nhs.uk/aboutus/facts/facts.html London Ambulance Service: Facts & figures]</ref>.
Although not a part of the LAS, the [[London Air Ambulance|Helicopter Emergency Medical Service]] (HEMS) - popularly known as the [[air ambulance|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 Specialist Training/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 2005 London bombings|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 Silver Bronze command structure|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 [[Cabinet Office Briefing Rooms|COBRA]].
Some notable major incidents where the LAS has played a significant role:
*'''[[July 7, 2005 bombing|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.<ref>.[http://news.bbc.co.uk/onthisday/hi/dates/stories/july/7/newsid_4942000/4942238.stm BBC News wesbsite: on this day 7 July 2005]</ref>
*'''[[Paddington train crash|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 <ref>[http://news.bbc.co.uk/onthisday/hi/dates/stories/october/5/newsid_2493000/2493593.stm BBC News website: on this day 5 October 1990]</ref>
*'''[[Cannon Street station rail crash|8 January 1991 - Cannon Street Train Crash]]''' Two people were killed and over 500 injured <ref>[http://news.bbc.co.uk/onthisday/hi/dates/stories/january/8/newsid_4091000/4091741.stm BBC News website: on this day 8 January 1991]</ref>
*'''[[Marchioness disaster|20 August 1989 - Sinking of the Marchioness]]''' Pleasure boat the Marchioness was struck by a dredger the Bowbelle killing 51 people. <ref>[http://news.bbc.co.uk/onthisday/hi/dates/stories/august/20/newsid_2500000/2500211.stm BBC news website on this day 20 August 1989]</ref>
*'''[[Clapham Junction rail crash|12 December 1988 - Clapham Train Crash]]'''<ref>[http://news.bbc.co.uk/onthisday/hi/dates/stories/december/12/newsid_2547000/2547561.stm BBC News website: on this day 12 December 1988]</ref> 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.
*'''[[King's Cross fire|18 November 1987 - King's Cross Fire]]'''<ref>[http://news.bbc.co.uk/onthisday/hi/dates/stories/november/18/newsid_2519000/2519675.stm BBC News website: on this day 18 November 1987]</ref> 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.
*'''[[Moorgate tube crash|28 February 1975 - Moorgate Tube Train Crash]]'''<ref>[http://news.bbc.co.uk/onthisday/hi/witness/february/28/newsid_4298000/4298307.stm BBC News website: on this day 28 February 1975]</ref> A [[London Underground]] train failed to stop and crashed into the [[Buffer stop|buffers]] at the end of a tunnel. The driver and 42 passengers were killed.
*'''[[Provisional IRA campaign 1969–1997|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 [[London bombings|here]].
==Service difficulties==
===1992 CAD system failure===
On [[26 October]] [[1992]] the LAS started to use a new [[Computer-assisted dispatch|Computer Aided Dispatch]] (CAD) system, known as LASCAD <ref>[http://www.cems.uwe.ac.uk/teaching/notes/UQI101S2/lascad.htm University of the West of England: ''LASCAD Case Study'']</ref>. Poorly designed and implemented, its introduction led to massive delays in the assigning of ambulances <ref>[http://www.pcw.co.uk/computing/analysis/2073427/emergency-room-london-ambulances-won-crash-again-expert Personal Computer World: Ambulances won't crash again]</ref>, 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.<ref>[http://www.publications.parliament.uk/pa/cm199293/cmhansrd/1992-10-28/Debate-1.html House of Commons Hansard debates for 28th October 2002]</ref>
===Poor ambulance response times===
In [[2000]], the LAS faced funding difficulties and an increase in the volume of [[999 (emergency telephone number)|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 <ref>[http://news.bbc.co.uk/1/hi/health/638067.stm BBC: Ambulance chief quits]</ref>.
===Reaction to events of 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 London bomb attacks of [[7 July 2005 London bombings|7 July 2005]] <ref>[http://news.bbc.co.uk/1/hi/england/london/4810368.stm BBC: 7 July ambulance 'radio failure']</ref>. 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 <ref>[http://news.bbc.co.uk/1/hi/england/london/5279706.stm BBC: Computer problem hits 999 calls]</ref>. As a result, dispatchers had to go back to old pen-and-paper methods <ref>[http://www.e-health-insider.com/news/item.cfm?ID=2091 E-Health Insider: London Ambulance computer crashes nine times]</ref>.
==Address==
: London Ambulance Service
: 220 [[Waterloo Road, London|Waterloo Road]]
: [[London SE1]] 8SD
: United Kingdom
==References==
<references/>
==See also==
===Other emergency medical services===
* [[Emergency medical services in the United Kingdom]]
* [[London Air Ambulance|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]]
* [[RNLI|Royal National Lifeboat Institution (RNLI)]]
==External links==
* [http://www.londonambulance.nhs.uk/ Official website]
* [http://www.nhs.uk/England/AuthoritiesTrusts/Ambulance/showTrust.aspx?id=RRU NHS information]
* [http://www.google.com/local?q=london+ambulance+service&near=Lambeth,+UK&latlng=51489025,-111267,18414403967270151593 Google Local information]
* [http://www.cs.ucl.ac.uk/staff/A.Finkelstein/las Academic site detailing the CAD failure]
{{UK ambulance service}}
[[Category:London organisations]]
[[Category:Health in London]]
[[Category:Buildings and structures in Lambeth]] <!---Headquarters building--->
[[Category:NHS ambulance services]]
[[fr:London Ambulance Service]]
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