Changes to improve how ambulances respond to 999 emergency calls will help to save more lives and improve people’s outcomes.
A new purple category is being introduced for responses to life-or-death cardiac and respiratory arrests as part of the changes.
They are being made in response to a recommendation by the Senedd’s Health and Social Care Committee, which concluded the existing targets are no longer appropriate or fit for purpose. A subsequent review found there is no evidence the existing response model supports better outcomes.
The eight-minute ambulance response target was introduced in 1974 by the UK Department of Health and Social Security.
The Welsh Ambulance Service’s current performance guidance focuses on a broad category of red calls and measures success in terms of the time it takes an ambulance to respond to a 999 call – not on the person’s ultimate outcome.
If an ambulance arrives after eight minutes and the individual survives, this is regarded as a failure, but if the ambulance arrives within eight minutes and the person dies, this regarded as meeting the target.
The changes to the response targets will focus on outcomes, especially for people who are in immediately life-threatening situations. This is already an approach used successfully in Ireland, Scotland and Australia where survival rates and outcomes have improved as a result.
There will be two new response categories – a new purple category for cardiac and respiratory arrests and a red emergency category for major trauma and other incidents where a person is at significant risk of experiencing a cardiac or respiratory arrest if they do not receive a rapid response.
It is expected ambulances will respond to 999 calls in both categories in an average of six to eight minutes.
A cardiac arrest happens when the heart unexpectedly stops pumping blood around the body. A respiratory arrest is when a person has stopped breathing. If untreated this can quickly lead to a cardiac arrest.
The new approach aims to improve survival rates for cardiac arrests experienced outside of hospital in Wales, which currently stand at less than 5%.
For purple category calls, the primary measure will be the percentage of people to have a heartbeat restored after a period of cardiac arrest which is subsequently retained until arrival at hospital. The expectation will be that this will continuously increase over time.
It will also be recorded where timely action is shown to improve outcomes, such as the average time it takes for receipt of bystander CPR and defibrillation following an out-of-hospital cardiac arrest.
Health Secretary Jeremy Miles said: “We want to save more lives and improve the chances of people surviving cardiac arrests in Wales.
“The current system treats someone in cardiac arrest the same as someone with generalised breathing difficulties who can often be treated safely at home. These changes will ensure ambulance clinicians reach those with the greatest need first, while making sure everyone gets the right care based on their clinical needs.”
Jason Killens, Chief Executive of the Welsh Ambulance Services University NHS Trust, said: “We welcome today’s announcement that the way Welsh Government will measure ambulance service performance is changing.
“Since 1974, our ambulance service has been measured by the time it takes to reach emergency calls.
“The ambulance service of today provides much more sophisticated care, so shifting the focus to how many people survive a life-or-death emergency because of our interventions, rather than how many minutes it takes us to get there, is an important step to reflect that.
“In the meantime, we remain committed to improving patient outcomes, and specifically, improving cardiac arrest survival rates in Wales.
“To that end, we will work even closer and more collaboratively with Save a Life Cymru to improve awareness of early CPR and defibrillation, and do what we do best, which is save lives.”
The Welsh Ambulance Services NHS University Trust is making changes to its response model, including the addition of 26 new clinical navigators who will screen 999 calls to ensure they receive the fastest possible response so they can access the right care, in the right place, every time.
An action plan to improve national ambulance patient handover will also be introduced to increase ambulance availability.
The new system will be piloted for a year from July 2025 and, subject to a successful evaluation, will be put in place permanently from August 2026.
