Effects of ambulance response times are being evaluated

Editor—In his editorial Evans called for a review of the effects of improving ambulance response times on the outcome of coronary emergencies outside hospital.¹ This research is already under way. Over a two year period, we are investigating, on behalf of the Department of Health, the effect that changes in response times are having in four ambulance service areas. These changes are occurring as the services seek to implement the new standard that 75% of calls involving chest pain or other potentially serious signs should be responded to within 8 minutes (not 90% of all calls, as reported by Evans). The research has been designed to detect the size of effect that Norris hypothesises could be achieved (that is, a 7-10% reduction in the number of fatalities).²

However, as Ruston et al have pointed out,³ a bigger effect could probably be achieved if patients sought medical help earlier in response to warning signs. Evans suggests this requires more public education. A better solution might be to give patients and witnesses instant access to simple, confidential, and appropriate information about what to do at the point of need. We hope that the telephone lines for immediate care and advice, known as NHS Direct, that are being piloted in three areas of the United Kingdom—which we are also evaluating for the Department of Health—will reduce the time to seek help and lead to earlier medical care and better outcomes.