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Tipping the traditional EMS service model on its head with Welsh Ambulance Service

“Instead of responding to the majority of 999 calls we receive every day, we want to flip that so we only go to those patients who really, really need a double staffed paramedic emergency ambulance quickly.”

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It’s very clear that Ryan Reynolds and Rob McElhenney have raised the profile of the country of Wales with their “Welcome to Wrexham” football (soccer) team and series, but one Welsh organization – the Welsh Ambulance Service NHS trust – has a vision and world class level of service delivery that should receive equal attention. In this audio and video edition of the EMS One-Stop podcast, Host Rob Lawrence speaks with Professor Jason Killens, Chief Executive of the Welsh Ambulance Service.

As the 999 emergency system that serves over 3 million Welsh citizens emerges into a post-pandemic world, Jason describes service delivery, the training and education of its medics and the fact that it is a about to operate without a medical director – in itself a move that identifies that clinical and academic paramedicine has come of age. As Jason tells Rob, “We are transforming the way we deliver our service here in Wales, looking to tip the service model on its head essentially. Instead of responding to the majority of 999 calls we receive every day, we want to flip that so we only go to those patients who really, really need a double staffed paramedic emergency ambulance quickly … car crashes, broken legs, falls from height, cardiac arrest; and the rest we would service by the means of telephone or video advice, upstream with clinicians in our contact center or with advanced practice clinicians in the community.”


When a patient calls 999, “you could see a traditional road ambulance, but increasingly here in Wales and in other services across the UK, you could see a disposal which includes telephone or video triage and advice from our clinicians in our contact centers – they could be either nurses or paramedics … and we are closing now here in Wales about 15% of all of our emergency calls every day by way of telephone or video consultation without turning a wheel or sending an ambulance” — Jason Killens

“If we do respond to the scene, it could be a traditional ambulance or increasingly it could be what we call an advanced paramedic practitioner, so that is an experienced paramedic, who has a degree, who has gone on to masters/education – those advanced paramedic practitioners with a master’s degree, increasingly we are seeing a non-conveyance rate some 35-40% higher than a regular paramedic crew, so what that means is we are able to safely close episodes of care in the community and not respond with a double staffed ambulance/not convey the patient to the emergency department.” — Jason Killens

“Fire Brigades and Departments in the UK aren’t associated with medical response – It is the exception in the UK rather than the rule.” — Rob Lawrence

“We are not transport organizations anymore, we do transport, but increasingly, we are providers of great clinical care in our communities … but we are looking to stretch and grow so we provide better outcomes for all patients here in Wales, and only convey them to the emergency department when we really need to and we think the solution to that is advance practice in communities with our own people.” — Jason Killens

“We have just agreed with our board that when our medical director retires at the end of this year, we will not replace him. We will be the first ambulance service in the UK not to have a medical director on the governance board. Instead, here, we will have our senior clinician leadership provided by our executive director of paramedicine and we are the first ambulance service in the UK to have that role on the board. And we have taken that point of view simply because the paramedic profession has developed over the last two decades, to the point now where we believe we have sufficiently experienced senior clinicians in the paramedic workforce that are able to provide that senior level governance leadership, and direction for our clinical strategy. It is an important signal and message to our paramedic workforce that the glass ceiling is broken and paramedics to join us at 21/22 years old from university can absolutely see a pathway through to senior leadership, to a director on the board, and ultimately to jobs like mine as a paramedic if that’s what they aspire to.” — Jason Killens


1:10 – Introduction of Professor Jason Killens

3:30 – Recruiting Australian paramedics to work in London

4:30 – Explaining EMS organization and control in England, Scotland, Northern Ireland and Wales

8:30 – In the UK, healthcare is free at the point of delivery

11:30 – Geographical distribution of ambulance services in Wales

12:38 – The provision of helicopter emergency medical services (which are mostly charity based, relying on donations to operate)

14:30 – What happens when a citizen calls 999 – how call taking and response is organized

15:30 – Hear and treat and advanced paramedic practitioners

21:10 – The journey of continuous service improvement

23:00 – Paramedic degree and advanced degree education, and career pathways

27:49 – Co-responding agencies including police, fire, the military and citizen responders

29:59 – Future plans for the Welsh Ambulance Service

31:00 – Senior clinical leadership provided by paramedics and not a medical director

34:00 – Fantastic people doing fantastic stuff


Professor Jason Killens has spent his career working in Ambulance Services in the UK and Australia. He progressed through the ranks in London Ambulance Service from an EMT to executive director of operations. He was appointed as the chief executive of the South Australia Ambulance Service in 2015 before joining the Welsh Ambulance Service as chief executive in September, 2018.

He is an honorary professor at Swansea University’s College of Human and Health Sciences, and the chief executive lead for operations at the Association of Ambulance Chief Executives.

About Welsh Ambulance Services NHS Trust

Welsh Ambulance Services NHS Trust (WAST) provides healthcare services for people across Wales, delivering high quality and patient-led clinical care, wherever and whenever needed

Services include:

  • The blue light emergency ambulance services: including call taking, remote clinical consultation, see-and-treat, and, if necessary, conveyance to an appropriate hospital or alternative treating facility.
  • Non-emergency patient transport service: taking patients to and from hospital appointments, and transferring them between hospitals and treatment facilities.
  • The 111 service: a free-to-call service which incorporates the NHSDW service and the call taking and first stage clinical triage for the out-of-hours GP service. The number was live throughout 2021/22 and the full service was rolled out in Betsi Cadwaladr, Cardiff and Vale University Health Boards in 2021/22, making the complete service universally available across Wales.
  • WAST also supports community first responders, co-responders and uniformed responders to provide additional resources to respond to those most in need of help.
  • During the pandemic, WAST provided the mobile PCR testing service for the whole of Wales.


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This article was originally posted August 17, 2023. It has been updated.

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.