NHS patients dying in back of ambulances stuck outside A&E, report says (2023)

People are dying in the back of ambulances and up to 160,000 more a year are coming to harm because they are stuck outside hospitals unable to be offloaded to A&E, a bombshell report has revealed.

Patients are also dying soon after finally getting admitted to hospital after spending long periods in the back of an ambulance, while others still in their own homes are not being saved because paramedics are trapped at A&E and unable to answer 999 calls, said the report by NHS ambulance service bosses in England.

In addition, about 12,000 of the 160,000 are suffering “severe harm” such as a permanent setback to their health. These include people with life-threatening health emergencies such as chest pains, sepsis, heart problems, epilepsy and Covid-19 because growing numbers of paramedics are having to wait increasingly long times to hand over a patient to A&E staff.

Ambulance logjams outside hospitals have become a major problem in the NHS in recent years as A&E staff have struggled to find beds for patients they have decided to admit because the hospital has run out of beds as a result of Covid-19, their inability to discharge patients who are medically fit to leave and the record demand for care.

That has left A&E personnel having to limit the number of patients who can be in their unit at one time, which leads to sometimes long queues of ambulances outside. The problem has become much more serious in recent months as all NHS services have seen unprecedented demand for care.

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Labour and the Liberal Democrats said the “staggering” extent of damage to patients’ health underlined the risks posed by the deepening crisis facing NHS ambulance services.

The report, seen by the Guardian, has been drawn up by the Association of Ambulance Chief Executives (AACE) and is based on official NHS figures, which until now were secret. AACE represents the chief executives of England’s 10 regional ambulance services, all of which have had to declare an alert in recent months after being faced with unprecedented demands for help.

It concludes that: “When very sick patients arrive at hospital and then have to wait an excessive time for handover to emergency department clinicians to receive assessment and definitive care, it is entirely predictable and almost inevitable that some level of harm will arise.

“This may take the form of a deteriorating medical or physical condition, or distress and anxiety, potentially affecting the outcome for patients and definitely creating a poor patient experience.”

It does not say how many patients a year die because so many ambulances are stuck at hospitals. But it adds: “We know that some patients have sadly died whilst waiting outside ED [emergency departments], or shortly after eventual admission to ED following a wait. Others have died while waiting for an ambulance response in the community.

“Regardless of whether a death may have been an inevitable outcome, this is not the level of care or experience we would wish for anyone in their last moments. Any form or level of harm is not acceptable.”

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AACE studied all handover delays lasting more than an hour that occurred across the 10 ambulance trusts on 4 January, and the harm resulting. It used the data to estimate how many patients a year suffer a deterioration in their health, or need much more invasive treatment such as surgery, as a direct result of waiting a long time to be treated by doctors and nurses.

It concluded that: “If these results from 4 January 2021, which was not an atypical day, are extrapolated across all handover delays that occur every day, the cases of potential harm could be as high as 160,000 patients affected a year.

“Of those, approximately 12,000 patients could potentially experience severe harm as a result of delayed handovers.”

Daisy Cooper, the Liberal Democrats’ health spokesperson, said: “These staggering figures will shock people to their core. These are absolutely devastating findings, which reveal that there is a huge toll of harm and severe harm, including tragically patient deaths, as a direct result of the colossal number of ambulance handover delays we’re now seeing.”

Ambulances are meant to hand patients over to A&E staff within 15 minutes, with none waiting more than half an hour. However, queues of as many as 15 ambulances at a time have been building up outside hospitals in recent years because hard-pressed staff have been too busy to accept them.

Last month the West Midlands ambulance service admitted publicly that handover delays were causing “catastrophic” harm to patients. Mark Docherty, its nursing director, said that despite its best efforts “we know patients are coming to harm” and that some patients “are dying before we get to them”.

(Video) Ambulances forced to queue outside A&E because it’s so busy

Pressure on its ambulances forced the service to raise the risk assessment of harm to patients from level 20 to level 25 – the highest ever. “The definition of 25 is that harm is almost certain – and it’s going to be catastrophic. I think we’re now at that place,” Docherty added.

Jonathan Ashworth, the shadow health secretary, said: “This is a devastating report. The scale of harm and severe harm being done to patients is a scandal.

“Ministers should be ashamed that colossal numbers of patients – thanks to years of Tory NHS neglect – are languishing in ambulances waiting for vital life-saving care at risk of, and indeed suffering, serious harm, permanent disability or loss of life.”

Hospitals are under such pressure that about 190,000 handovers a month – around half the total – now take longer than they should, AACE’s report said. Paramedics have been warning that patients whose health has collapsed in their home or another setting have also been put at risk because being trapped outside A&Es means they are not available to respond quickly to 999 calls.

A series of recent incidents illustrate the crisis confronting ambulance services:

  • A patient died of a cardiac arrest in Worcestershire royal hospital in Worcester on 4 October after waiting five hours in an ambulance outside. Paramedics warned A&E staff the patient was having trouble breathing but the patient died despite being rushed into the resuscitation room.

  • A woman died in eastern England last month after waiting an hour for an ambulance crew to reach her on what should have been a seven-minute response. No crews were available in the 50 miles between Cromer and Waveney in Norfolk, so an ambulance from Ipswich in Suffolk had to answer the 999 call.

A Department of Health and Social Care spokesperson said: “We are committed to supporting ambulance crews who work tirelessly responding to emergencies every day. NHS England and Improvement has given ambulance trusts an extra £55m to boost staff numbers for winter, helping them to bolster capacity in control rooms and on the frontline.

“We are supporting the NHS to meet the unprecedented pressures it is facing, with record investment this year including an extra £5.4bn over the next six months to support its response to Covid-19 and £36bn for health and care over the next three years.”


How long does an ambulance take if not life threatening? ›

The national standard sets out that all ambulance trusts must respond to Category 1 calls in 7 minutes on average and respond to 90% of Category 1 calls in 15 minutes.

What is a Category 3 emergency? ›

Category 3. An urgent problem, such as an uncomplicated diabetic issue, which requires treatment and transport to an acute setting. 2 hours. Category 4. A non-urgent problem, such as stable clinical cases, which requires transportation to a hospital ward or clinic.

What does Category 4 mean in A&E? ›

Category four: less urgent calls such as diarrhoea and vomiting and back pain.

What are the 5 biggest current challenges facing the NHS ambulance services today? ›

  • Hospital Handovers.
  • Violence Prevention & Reduction (VPR) Work Without Fear.
  • Managing Ambulance Fatigue.
  • Exploring Disability Culture.
  • Women In Leadership.
  • The Mental Health Continuum.
  • Abuse of Position.
7 Jun 2016

What are 5 life threatening emergencies? ›

You need to go to an emergency room or call 911 when you have:
  • Chest pain.
  • Trouble breathing.
  • Severe bleeding or severe head injuries.
  • Loss of consciousness or “black-out”
  • Sudden loss of vision or blurred vision.
  • Fever of 100.4 (rectal reading) in an infant less than 3 months old (Source Mayo Clinic)

What are the signs of a life threatening emergency? ›

  • Bleeding that will not stop.
  • Breathing problems (difficulty breathing, shortness of breath)
  • Change in mental status (such as unusual behavior, confusion, difficulty arousing)
  • Chest pain.
  • Choking.
  • Coughing up or vomiting blood.
  • Fainting or loss of consciousness.
  • Feeling of committing suicide or murder.

What are 4 life threatening emergency situations? ›

Recognizing medical emergencies
  • Bleeding that will not stop.
  • Breathing problems (difficulty breathing, shortness of breath)
  • Change in mental status (such as unusual behavior, confusion, difficulty arousing)
  • Chest pain.
  • Choking.
  • Coughing up or vomiting blood.
  • Fainting or loss of consciousness.
12 Feb 2021

What does Code 5 mean in a hospital? ›

Rapid Response Team: Hospitals–only. patient with rapidly changing condition. Code Silver: Weapon/Hostage. Code 5: Shelter in Place.

What is a priority 4 patient? ›

Priority 4 (Blue) Those victims with critical and potentially fatal injuries or illness are coded priority 4 or "Blue" indicating no treatment or transportation.

What are the 5 levels of triage? ›

The triage categories used in both systems are: Red (immediate evaluation by physician), Orange (emergent, evaluation within 15 min), Yellow (potentially unstable, evaluation within 60 min), Green (non-urgent, re-evaluation every 180 min), and Blue (minor injuries or complaints, re-evaluation every 240 min).

What is a Type 3 A&E attendance? ›

It may be co-located with a major A&E or sited in the community. A defining characteristic of a service qualifying as a Type 3 department is that it treats at least minor injuries and illnesses (sprains for example) and can be routinely accessed without an appointment.

What are the stages of A&E? ›

There are 5 stages:
  • Arrive and book in. You will register at reception, and be asked some simple questions about why you have come to A&E. ...
  • Triage. ...
  • Assessment by an Emergency Practitioner. ...
  • Diagnosis (what is wrong with you), plan and treatment. ...
  • Admission or discharge.

What happens at the end of ambulance 2022? ›

Danny has grown suspicious of their bond, and he reaches a breaking point when he realizes that it was Cam who shot Will. Will knows that Danny is crazy enough to kill her, so he shoots Danny through the chest with a shotgun. The two lie together in the streets, sharing a moment of unspoken forgiveness as Danny dies.

What is the biggest burden on the NHS? ›

The latest Global Burden of Disease study shows that the top five causes of early death for the people of England are: heart disease and stroke, cancer, respiratory conditions, dementias, and self-harm [112].

What is a major incident in the NHS? ›

A major incident is any occurrence that presents serious threat to the health of the community or causes such numbers or types of casualties, as to require special arrangements to be implemented.

What are 3 life-threatening conditions you should check for immediately? ›

Chest pain or other symptoms of a heart attack, such as pain in the back or jaw, weakness, exhaustion, or shortness of breath. Symptoms of a stroke, such as difficulty speaking, weakness on one side of the body, or drooping facial features. Severe allergic reaction. Head injury or trauma.

What are the 3 most common causes of death in emergency situations? ›

The most frequent final diagnoses in the case group consisted of cardiopulmonary diseases (39.2%), severe traumas (18.5%), cerebrovascular accident (17.7%), sepsis (13.1 %), renal diseases (3.7%), pneumonia (3.1%), and cancer (2.3%) in descending order (Table 2).
Table 2.
Control22 (2.3)
P47 (2.4)
7 more columns

Which is worse crisis or emergency? ›

The dictionary definitions of these words are as follows: Emergency - a serious, unexpected, and often dangerous situation requiring immediate action. Disaster - a sudden accident or a natural catastrophe that causes great damage or loss of life. Crisis - a time of intense difficulty or danger.

What happens to your body during an emergency? ›

Other physical responses include: increased heart rate, pupils dilate, increased breathing rhythm, stomach clenches and sexual organs wake up. These physical responses ready the body for survival. The body becomes primed with increased strength, heightened awareness and quicker reaction time.

What are considered life threats in a medical call? ›

Identifying life threats

For each area of the body assessed, it is helpful to review them while addressing the different parts of the mnemonic "DCAP-BTLS." This stands for: Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, and Swelling.

What should you not do during medical emergency? ›

Do not move the injured person unless there is danger of further harm. Keep the injured person warm. Do not exceed your training or knowledge when attempting to render first aid.

What are the five things not to do during emergency? ›

Here are five of them.
  • 1) Panic. When things go wrong, you need to stay calm. ...
  • 2) Rush. You probably feel like you don't have much time to react, and you may not. ...
  • 3) Stop doing checklists. Checklists are there for a reason. ...
  • 4) Stop communicating. ...
  • 5) Stop flying the plane.

What is a Category 5 emergency? ›

Triage category 5

People who need to have treatment within two hours are categorised as having a less urgent condition. People in this category have minor illnesses or symptoms that may have been present for more than a week, such as rashes or minor aches and pains.

What is the most serious code in hospital? ›

Code blue indicates a medical emergency such as cardiac or respiratory arrest. Code red indicates fire or smoke in the hospital. Code black typically means there is a bomb threat to the facility. Hospitals are the most common institutions that use color codes to designate emergencies.

What is code GREY in a hospital? ›

Code Gray. Code Gray indicates a combative or aggressive person, requiring security personnel. It is also typically accompanied by a description of the dangerous person(s) and their location.

What is code Brown in a hospital? ›

Code brown: chemical spill/hazardous material.

What is a black tag patient? ›

Black tags: Used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

What is a priority 3 for ambulance? ›

Priority 3 represents a Non-urgent call. (response time target is to attend to 90% of non-urgent calls within 60 minutes) ..

Which patient is the highest priority? ›

Patients with trauma, chest pain, respiratory distress and cardiac arrest would get the highest priority on the list. Patients with minor injuries, cold symptoms or sprains would fall next. 1 Was this helpful?

What is a Level 5 emergency evaluation? ›

Level 5 – An immediate, significant threat to life or physiologic functioning.

Which Colour of triage is given the highest priority? ›

RED: (Immediate) severe injuries but high potential for survival with treatment; taken to collection point first. YELLOW: (Delayed) serious injuries but not immediately life-threatening. GREEN: (Walking wounded) minor injuries.

What are the 3 categories of triage? ›

Triage categories
  • Immediate category. These casualties require immediate life-saving treatment.
  • Urgent category. These casualties require significant intervention as soon as possible.
  • Delayed category. These patients will require medical intervention, but not with any urgency.
  • Expectant category.

What is a Category 2 patient emergency? ›

Emergency (triage category 2) is for conditions that could be life threatening and require prompt attention such as chest pain or possible stroke. Patients in this category should be seen within 10 minutes of presenting to the emergency department.

How long should you wait in A and E? ›

A&E departments

Constitution that at least 95 per cent of patients attending A&E should be admitted to hospital, transferred to another provider, or discharged within four hours.

Why is there a 4 hour target in A&E? ›

The four-hour A&E waiting time target is a pledge set out in the Handbook to the NHS Constitution. The operational standard is that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours.

What are the five 5 usual common emergencies? ›

7 Most Common Medical Emergencies
  • Bleeding. Cuts and wounds cause bleeding, but severe injury can also cause internal bleeding that you can't see. ...
  • Breathing difficulties. ...
  • Someone collapses. ...
  • Fit and/or epileptic seizure. ...
  • Severe pain. ...
  • Heart attack. ...
  • A stroke.

What are the 5 phases of an ambulance call? ›

The six phases of an emergency call are preparation, dispatch, response to the scene, arrival at the scene, transferring care of the patient to other EMS personnel, and postrun activities.

What happens in Resus A&E? ›

The resuscitation area, commonly referred to as "Trauma" or "Resus", is a key area in most departments. The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries.

Does anyone survive in ambulance? ›

In the end, Will is seen to be recovering, although he is in police custody, while officer Zach admits that Will had saved his life. Cam wastes no more time and now finds out about the little girl she had earlier saved from the accident scene and goes and meets her in her hospital ward.

Who's the little girl at the end of ambulance? ›

Rosie Kidd: Little girl in Ambulance.

What is the life expectancy of an ambulance? ›

They are supposed to have a life expectancy of about five years because they are in use 24/7 365. Unfortunately because of very tight budgets the ambulances are often used for double that time. It is not uncommon for an ambulance to have 500k miles on the clock.

What illness does the NHS spend the most on? ›

The cost of prescribing medication to people with diabetes in general practice has risen and remains the largest area of spending, according to analysis by Cogora.

What illness does the NHS spend most money on? ›

The most money spent on a medicine, overall, according to the most recent data, is on adalimumab, an arthritis drug.

How much do NHS nurses get paid? ›

How much does NHS - Nursing in England pay? The average NHS salary ranges from approximately £20,983 per year for Field Nurse to £60,976 per year for Senior Nurse Manager. Average NHS hourly pay ranges from approximately £8.00 per hour for Nurse Consultant to £32.79 per hour for Nurse Practitioner.

What is classed as a serious incident in hospital? ›

Serious Incidents in health care are adverse events, where the consequences to patients, families and carers, staff or organisations are so significant or the potential for learning is so great, that a heightened level of response is justified.

What are the 4 types of major incidents? ›

There are several types of major incidents. There are natural, hostile, health related, and technological.

What is the most common incident reported in hospitals? ›

Medication-related incidents are the most commonly reported incidents in healthcare.

How long is too long to wait for an ambulance? ›

Category 1: An immediate response to a life-threatening condition, such as cardiac or respiratory arrest. The average response time should be under 7 minutes and 90% of ambulances should arrive within 15 minutes.

How long should it take for ambulance to arrive? ›

Ambulance services are measured on the time it takes from receiving a 999 call to the vehicle arriving at the patient's location. It should take 8 minutes for the ambulance to arrive if the call is life threatening or an emergency. Ambulance services often send more than one vehicle to try to meet the 8 minute target.

Does an ambulance get you seen quicker? ›

Calling an ambulance does NOT get you seen faster in the emergency room. You will be triaged like other patients and seen in the order the emergency room can assist you based off the needs of other patients. FOR TRUE MEDICAL EMERGENCIES, please call 9-1-1.

Do you get seen quicker if you go to hospital by ambulance? ›

Arriving at hospital in an ambulance does not get you seen any quicker – that's the message from North West Ambulance Service crews who want people to think twice before calling 999 if they can get to hospital by other means.

Is it faster to drive to the hospital or call an ambulance? ›

Calling 911 Can Mean Quicker Care.

It's not first come, first served. People who come in an ambulance might be regarded as having a more severe condition and needing care sooner than someone who was healthy enough to arrive by car.

Can you sue for an ambulance taking too long? ›

If you received negligent medical care from a paramedic or your treatment was delayed as a result of an ambulance arriving late, you could be entitled to compensation.

What does CODE RED mean in an ambulance? ›

Code Red: Fire, smoke, or smell of smoke. Code Yellow: Hospital-only trauma.

What is the average wait time for an ambulance in the UK? ›

For urgent calls, referred to as category three, which includes the late stages of labour and non-severe burns, 90 per cent of calls should be responded to within 120 minutes.

Who to call if ambulance hasn't arrived? ›

NHS 111 can help when you need medical help or advice fast – but it's not an emergency. The 111 online service can also help if you're not sure what to do.

What to say to get seen faster in an emergency room? ›

As your friend did, you can always try to drop a big name, like say you're friends with the president of the hospital. In general, if they think you're a VIP (even if you're not), you'll definitely get seen more quickly. ...

Can you bring someone with you in an ambulance? ›

Bring a family member or friend

You cannot bring more than 1 person because of limited space. It is also to protect the privacy and comfort of all patients.

Is it better to call an ambulance or drive to the hospital UK? ›

All of this can happen while you are being taken to the hospital, which is why an ambulance is a better option than having someone drive you to hospital. Don't be surprised if the paramedic team drives past your nearest hospital and takes you to another.

Does an ambulance give you priority? ›

Urgent, life-threatening situations such as cardiac arrest and serious trauma are the highest priority for ambulance services. If the ambulance call taker assesses your situation as potentially life-threatening or urgent, they will get an ambulance to you as soon as possible.

Why does the emergency room make you wait so long? ›

Most emergencies happen after work hours, at night and on the weekends. When there aren't enough emergency staff present during these busy times, it leads to overcrowded waiting rooms and extreme delays.


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