It’s , and the pressures on emergency medical services continue to mount. In Wales, a radical shift is underway, moving away from automatic ambulance dispatch for many 999 calls towards remote assessment and a tiered response system. This change, implemented from , aims to alleviate the strain on ambulance crews and improve patient outcomes by directing resources to those with the most critical needs.
The Welsh Ambulance Services University NHS Trust (WAST) is now prioritizing responses to life-threatening emergencies – cardiac arrest and situations where a patient’s breathing or heart are at immediate risk – which account for approximately 15% of 999 calls. For the remaining calls, patients are initially assessed remotely, often by a nurse or paramedic, with alternative care pathways explored before dispatching an ambulance. This includes utilizing advanced paramedic practitioners (APPs) who can provide in-person care and prescribe medications, and leveraging community welfare responders – volunteers who assist with initial assessments and support.
The impetus for this change stems from a growing crisis in ambulance response times. Since the pandemic, WAST has consistently failed to meet its target of arriving at 65% of life-threatening emergencies within eight minutes. In , crews reached less than half of the most urgent “red” calls within the target timeframe, while “amber” calls faced an average wait of 1 hour and 33 minutes – a significant increase from 11 minutes a decade prior. A major contributor to these delays is the prolonged time ambulance crews spend waiting to transfer patients to busy emergency departments, with an average of 23,550 working hours lost per month between and due to hospital handover delays. In Swansea, ambulances waited an average of three hours for each A&E handover in .
The shift towards remote assessment is supported by technology such as video consultations and monitoring apps, enabling clinicians to track patient health data in real-time. A platform powered by Luscii’s digital platform allows WAST clinicians to remotely monitor vital signs and symptoms, facilitating earlier interventions. Trials are underway to utilize drones to deliver life-saving defibrillators to remote locations, potentially improving survival rates for cardiac arrest victims, which are currently just 5% outside of a hospital setting in Wales.
This approach represents a significant departure from the model in England, which has focused on increasing the number of ambulances. However, WAST believes that optimizing resource allocation and providing appropriate care in the right setting is crucial. The trust has also overhauled its systems to flag cases such as strokes and heart attacks as more urgent, moving them into a higher priority category.
The new system isn’t without its challenges. Concerns remain about the potential for delayed care if remote assessments are inaccurate or if patients are not appropriately triaged. The coroner for South Wales Central issued a warning in , expressing concern over the continued delays and a lack of discernible improvement despite previous warnings. However, early data suggests positive trends, with ambulances reaching the most serious emergencies in an average of 7.05 minutes and 8.27 minutes in – an improvement from 10.12 minutes the previous year.
A key component of the new strategy is the expansion of the community welfare responder program. These volunteers, trained in basic first aid, provide on-scene assessments and support, freeing up ambulance crews for more critical cases. The program currently involves 280 volunteers, with another 130 in training. WAST assumes legal responsibility for volunteer actions, providing them with insurance coverage.
Alongside the volunteer program, WAST is also leveraging the expertise of nurses and paramedics through remote consultations. Clinicians can assess patients over the phone or via video link, providing guidance and potentially avoiding unnecessary ambulance dispatches. The Consultant Connect service, utilized by WAST paramedics, has facilitated approximately 57,000 consultations in the past two years, preventing an estimated 62,000 patient trips to the emergency department.
Looking ahead, WAST plans to integrate artificial intelligence (AI) into the 999 call handling process, potentially identifying critical cases based on speech patterns or keywords. The trust is also exploring the use of technology to perform hospital-grade tests and scans in ambulances, and is adding satellite antennae to 12 ambulances to improve connectivity in rural areas. Trials are also underway to explore the use of drones for patient transport, although regulatory hurdles currently prevent beyond-line-of-sight drone operations.
The Welsh Ambulance Service’s transformation reflects a broader effort to address the challenges facing emergency medical care. By embracing technology, empowering community responders, and prioritizing remote assessment, WAST aims to deliver more efficient and effective care to the people of Wales. The shift in focus, from simply responding to emergencies to proactively managing patient needs, represents a significant step towards a more sustainable and patient-centered healthcare system.
