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The acute work of the ambulance service is of two sorts. Emergencies result from 999 telephone calls usually made by members of the public. Urgent transfers follow a request by a general practitioner (GP) or other health care professional to take a patient to hospital. In recent years there has been a large increase in emergency calls to the ambulance service. This has not been associated with a reduction in severity of illness, as judged by patient disposal from the A&E department.1 We felt that some of the increasing emergency calls was caused by a reduction in urgent calls and tested this hypothesis by examining the workload of the Westcountry Ambulance Service …