• emergency care

We are all too well aware of the problems of waits in emergency health care. They are consistently the issues that the public and media comment about when asked about emergency medicine. Delays in the emergency care system are invariably attributable to a complex mixture of problems before, during, and after the hospital episode.¹ Measures of performance in emergency care have focused on a few specific areas, for example, ambulance response to arriving at an incident and waiting times in the emergency department.² The blame for poor performance has often been cast on the area where the indicator has been measured rather than at the root cause. This has also allowed other areas to shy away from their responsibilities. These are all symptoms of an emergency care system that is fragmented,³ with each component struggling to solve its own problems.

Some issues can be partially solved by one organisation working alone but this is rare.

An ambulance service could achieve an eight …