Table 1.

Recommended thresholds for pre-alert.

	AACE/JRCALC	AS1	AS2	AS3	AS4	AS5	AS6	AS7	AS8	AS9
Matched with RCEM/AACE guidelines	–	3/23	4/23	6/23	10/23	7/23	19/23	10/23	10/23	4/23
RR	–			RR < 10 or > 30 for adults	Abnormal breathing rate, or irregular breathing pattern (e.g. Cheyne-Stokes breathing)	RR < 10 or > 29 (for adults)	RR ≤ 8 or ≥ 25	RR ≤ 8 or ≥ 25		NEWS > 7
Chest pains	ST elevation MI complete heart block or broad complex tachycardia with adverse features (shock, syncope, heart failure, myocardial ischaemia)		Current cardiac chest pain, with abnormal ECG (e.g. heart block, BBB)	STEMI, or cardiac chest pain where cardiac cause is suspected	STEMI, or patients with signs of cardiogenic shock	STEMI, or circulatory compromise	STEMI, or incomplete heart block	STEMI	ST elevation indicative of an MI for early thrombolysis, or haemodynamically unstable with signs and symptoms of shock
GCS	Unconscious with a GCS motor score of less than 4		Reduced ACVPU	GCS < 8	P/U on ACVPU scale, or injured with GCS motor score < 4	GCS < 14	Unconscious with GCS motor score < 4		Trauma patients with GCS < 9 or fall of > 2 since patient contact Medical patients – unconscious
Stroke	FAST-positive stroke within timeframe for thrombolysis	Use BE-FAST standardised framework	Any new limb weakness, speech impairment, sudden change in behaviour, FAST positive	New stroke with symptom onset of no more than 4 hours	Acute stroke (FAST-positive) being transported directly to a HASU Clinical suspicion of intracranial bleed (e.g. sub-arachnoid haemorrhage)	FAST-positive stroke	FAST-positive and within time frame for thrombolysis	FAST-positive

There was no specific pre-alert guidance available for four ambulance services and one ambulance service had no conditions consistent with RCEM/AACE guidance, so these have been omitted from this table.

AACE: Association of Ambulance Chief Executives; ACVPU: alert, confusion, voice, pain, unresponsive; BBB: blood–brain barrier; BE-FAST: balance, eyes, face, arms, speech, time; ECG: electrocardiogram; FAST: face, arms, speech, time; GCS: Glasgow Coma Scale; HASU: hyper-acute stroke unit; JRCALC: Joint Royal Colleges Ambulance Liaison Committee; MI: myocardial infarction; NEWS: National Early Warning Score; RCEM: Royal College of Emergency Medicine; RR: respiratory rate; STEMI: ST segment elevation myocardial infarction.