Vision for the Role of AHPs in Ambulance Service-Led Urgent and Emergency Care
The recent AACE strategic commissioning paper took me by surprise. Having spent much of my career trying to reduce pressure on the ambulance service (see my earlier reflections), I wasn’t expecting to see a proposal for the ambulance service to lead the urgent and emergency care (UEC) pathway.
At first, it felt counterintuitive. But the more I reflected, the more it began to make sense. In a crisis, people need a simple, trusted way to get help. That’s why 999 has endured as the default option—and why 111, despite its benefits, hasn’t fully shifted behaviours.
So if 999 is where people turn, why not build the system around that reality?
Why Ambulance Services Make Sense as System Leaders
Ambulance services have long demonstrated integration at times of crisis—direct lines with police and fire, shared control rooms, and joint responses to major incidents. Increasingly, paramedics are working with occupational therapists, mental health practitioners, and others in paired or blended roles.
This is about more than blue lights. It’s about layers of expertise:
First, rapid triage to identify and prioritise serious illness or injury.
Then, timely assessment by the right professional with the right skills.
Finally, clear pathways into ongoing management and prevention.
The ambulance service is uniquely positioned to orchestrate this sequence. But if we only draw on the medical model, we risk narrowing our vision.
The Medical Model—Strengths and Limits
The medical model is invaluable for:
Rapid diagnosis and stabilisation of life-threatening conditions.
Managing pharmacological interventions.
Standardising approaches to acute illness.
But it has limitations:
Not all urgent presentations are medical—some are functional, social, or psychological in nature.
Over-medicalisation risks missing person-centred and preventative solutions.
Relying solely on prescribing can create bottlenecks when many needs could be met differently.
That’s where Allied Health Professionals (AHPs) come in.
The Value of AHPs in Urgent, Emergency and Crisis Care
AHPs offer unique expertise that complements the medical model:
Occupational Therapists and Physiotherapists can lead holistic assessments, ensuring function, environment, and recovery are prioritised.
Radiographers, Operating Department Practitioners, and Paramedics already play critical roles in advanced clinical practice.
Speech and Language Therapists, Dietitians, Podiatrists, Orthoptists, Prosthetists/Orthotists, and the Creative Arts Therapies can each contribute specialist knowledge in acute, complex, or preventative scenarios.
It’s unrealistic for ambulance services to directly employ every AHP. But with integrated access to these professions, patients can receive timely and appropriate input—reducing delays, preventing deterioration, and strengthening secondary prevention.
Enhanced and Advanced Practice—Clarifying the Opportunity
Here lies the opportunity. Many AHPs want to contribute at a higher level in urgent and emergency care, but the pathways are confusing. Advanced practice roles often follow a medical model, while enhanced practice is inconsistently understood or applied.
I believe we need both:
Advanced practice for those leading first assessment, capable of ruling out serious illness and providing complex management.
Enhanced practice for continuing the assessment, managing non-critical presentations, and ensuring ongoing care is person-centred and preventative.
This dual approach balances safety, efficiency, and patient experience. It also offers a structured vision for AHP development, rather than leaving progress to chance or local need.
Looking Ahead—System-Wide Planning
At present, access to education, apprenticeships, and roles in enhanced and advanced practice feels like a lottery. If ambulance services are to lead urgent and emergency care, we need strategic workforce planning that:
Maps demand against capability.
Designs roles around system need, not gaps in cover.
Integrates knowledge and skills across professions.
Anchors all development in prevention and community-based care.
This would not only strengthen ambulance-led coordination but also embed AHPs as essential partners in shaping a safer, more sustainable urgent and emergency care system.
Final Thought
This strategy isn’t about shifting more pressure onto ambulance services—it’s about harnessing what already works, simplifying access for patients, and building layers of expertise into every response.
If we get this right, ambulance services can lead with confidence, AHPs can contribute with clarity, and together we can design a system that’s safer, more efficient, and more person-centred.
👉 Curious about how this could be applied in your service or system? I’d be happy to explore—book a free 20-minute discovery call here.
