Ambulances in some parts of England and Wales will be sent out only to patients at immediate risk of dying when staff strike on Wednesday – although ministers are spending Tuesday trying to persuade them to respond to more calls.
Ambulance services in different areas are taking slightly different approaches to the 24-hour strike period, but there is a broad expectation that only the most urgent calls, known as category 1 emergencies, will be responded to.
The health secretary, Steve Barclay, is meeting representatives of the three unions involved in the strikes – Unison, Unite and the GMB – to urge them to extend coverage to include category 2 emergencies. On Tuesday morning, the health minister Will Quince said people experiencing chest pain should still call an ambulance, regardless of whether they think services will respond. He encouraged people to “avoid risky activities”.
The ambulance emergency categories were introduced in 2017 for use in triaging calls to make sure the most unwell people receive care quickest and to help set performance targets for services.
Category 1
These are injuries and illnesses that pose an immediate threat to life – in particular, cardiac arrests and serious allergic reactions – and which need immediate resuscitation and intervention to give the person the best chance of survival. They will usually be called in by someone supporting the patient. Call handlers ask three questions to establish how unwell the patient is: whether they are breathing, whether they are conscious, and what happened. Advice is provided to the person looking after the patient. UK-wide standards require ambulance services to respond to these calls within seven minutes.
Category 2
These are for serious conditions that do not pose an immediate risk to life, such as a heart attack or stroke, or for people suffering from sepsis or major burns. They require urgent assessment and rapid transportation, and should be responded to within 18 minutes. To establish whether it’s a stroke, call handlers will ask of patients: if they smile, is it equal on both sides of the mouth? Can they say “the early bird catches the worm”? Can they raise their hands above their head?
Category 3
This applies to urgent calls such as abdominal pains, the late stages of labour, non-severe burns and diabetes. Patients will sometimes be treated in their own home. The target for services is to respond at least nine out of 10 times within 120 minutes.
Category 4
These are non-urgent calls such as diarrhoea and vomiting, urine infections and back pain. Some of these patients will be given advice over the phone or referred to another service such as a GP or pharmacist. Sometimes they are asked to wait to receive further advice by phone from a nurse or paramedic, unless their condition deteriorates. These less urgent calls should be responded to at least nine out of 10 times within 180 minutes.
• This article was amended on 21 December 2022. Heart attacks are category 2, not category 1, as an earlier version said. However, cardiac arrests are category 1.
