11/07/2025
Following lengthy discussions at different committees of the College, a position statement regarding treating patients in the back of ambulances has now been agreed as follows:
The relationship between the people who work within Emergency Departments (EDs), and those who work within the Emergency Services, is strong. RCEM and our members will always seek to work constructively with our colleagues where we face joint challenges, in order to improve patient care. RCEM is aware that ambulances are often held outside EDs with delays experienced by patients who are still in them. These delayed hospital handovers are unacceptable
RCEM completely rejects the increasing normalisation of attempts to care for patients in ambulances whilst they are waiting to come into ED. It is clear that trying to deliver Emergency Medicine to patients in ambulances is neither safe nor effective, and results in a poor patient experience.
However, RCEM does not support unilateral adoption of rapid offload policies based on a fixed time limit for delayed hospital handovers, and recommends a more balanced approach involving risk sharing across the system. Rapid offload policies may increase the risk to patients by adding to overcrowding in departments which will already be full. It should not be necessary to view such policies as a tool to focus attention on exit block. If such policies are under consideration they should be agreed with Emergency Department teams and never imposed upon them. Our previously published options appraisal is available here.
Emergency Physicians, nursing staff, and other hospital-based healthcare professionals are not specifically trained to work in ambulances outside their departments. They should not be expected to do so.
RCEM is however aware that some Emergency Medicine services undertake clinical assessment of patients in ambulances, or are considering doing so. It is not possible to be prescriptive on this topic since our members are being placed in an unacceptable position. The decision about whether or not to undertake assessment and treatment of patients waiting in the back of ambulances lies with individual departments, based on local circumstances. Should this be undertaken, RCEM guidance is available here as part of our Guidelines for the Provision of Emergency Medicine Services (GPEMS).
The phenomenon of ambulances being unable to offload patients at Emergency Departments (ED) is an appalling indictment of the state of the health services in the UK. The reason patients are having to be held in the back of ambulances outside EDs is that EDs are crowded as a consequence of ‘Exit Block’. It is not within the gift of EDs to enact the system-wide solutions required to address the issues of ‘Exit block’. EDs should not be blamed, or have unreasonable expectations placed upon them, as a result of health policy failure. Responsibility for this situation lies with governments across the four nations of the UK, and with local system leaders.
