What Really Happens Inside an Ambulance

What Really Happens Inside an Ambulance: A First Aider’s Guide

Understanding the stages of pre-hospital care used by the East of England Ambulance Service (EEAST), which covers Suffolk and Essex, can give you a clearer picture of what your actions lead into.

This guide breaks down the typical stages of ambulance care so you know exactly what to expect once the professionals take over.

The Importance of a Good Handover

In the Suffolk and Essex area, ambulance crews follow nationally recognised handover structures such as ATMIST or SBAR. A clear, concise handover helps the paramedics immediately understand the situation.

A strong handover includes:

  • Age of the casualty
  • Time of the incident
  • Mechanism of injury / medical issue
  • Injuries or illness findings
  • Signs and observations (breathing, consciousness, bleeding, etc.)
  • Treatment you have provided

This information directly influences the crew’s priorities and the speed at which they act.

Step 1: Rapid Primary Survey

Once the casualty is on board the ambulance, the crew will carry out a Primary Survey, following the national ABCDE approach:

  • Airway: Ensuring it is open and protected
  • Breathing: Assessing rate, quality, and oxygen needs
  • Circulation: Checking pulse, skin colour, bleeding, and signs of shock
  • Disability: Assessing consciousness using AVPU or GCS
  • Exposure: Looking for hidden injuries while keeping the casualty warm and dignified

Paramedics in Suffolk and Essex follow these same NHS England clinical guidelines, ensuring consistency across the region.

Step 2: Monitoring and Observations

Next, the casualty will be connected to essential monitoring equipment. On an EEAST ambulance, this usually includes:

  • ECG leads to monitor heart rhythm
  • Non-invasive blood pressure cuff
  • Pulse oximeter for oxygen saturation
  • Blood glucose testing where relevant
  • Temperature reading

These observations give the crew a clearer clinical picture and help identify any time-critical issues early.

Step 3: Immediate Treatment and Management

Treatment depends on the casualty’s condition but may include:

  • Oxygen therapy when clinically indicated (EEAST follows JRCALC guidelines)
  • Pain relief, such as Entonox (gas and air), IV analgesics, or oral medications
  • Bleeding control, including dressings or trauma bandages
  • Splinting fractures using vacuum splints or traction splints
  • IV access or fluids if shock is a concern
  • Condition-specific medication, such as for asthma, allergic reactions, cardiac events, or seizures

Your initial first aid — especially airway management, CPR, bleeding control, and reassurance — sets a strong foundation for these next steps.

Step 4: Secondary Assessment

Once stabilised, the crew will carry out a more detailed, structured assessment. This may include:

  • SAMPLE history (Symptoms, Allergies, Medications, Past history, Last food/fluids, Events leading up)
  • Full-body inspection for trauma
  • Neurological assessments
  • Listening to breathing with a stethoscope
  • Checking for medical alert bracelets or devices

In Suffolk and Essex, these assessments help determine whether the casualty needs the local A&E or a specialist centre, such as:

  • Broomfield Hospital (Major Trauma Centre – Essex)
  • Ipswich Hospital A&E
  • Colchester Hospital A&E
  • James Paget Hospital (for some East Suffolk areas)

Step 5: Transport and Ongoing Care

During transport, the casualty is continually monitored. The paramedic or EMT will:

  • Reassess vital signs
  • Adjust treatment as needed
  • Continue to manage pain, oxygen, and reassurance
  • Keep the receiving hospital informed with an early alert

Ambulances in the Suffolk/Essex area are equipped to manage most emergencies en-route, ensuring the casualty arrives in the best possible condition.

Step 6: Handover at Hospital

On arrival, the crew will give the hospital a professional, structured handover — again using ATMIST or SBAR. This includes:

  • What happened
  • What injuries or symptoms were found
  • What treatments have been given
  • How the casualty has responded
  • Any ongoing concerns

Your early actions as a first aider form part of this clinical timeline, giving hospital staff essential context.

Why First Aiders Are Essential

Good first aid can:

  • Stabilise a casualty before professional help arrives
  • Slow deterioration
  • Improve outcomes dramatically
  • Provide vital information for paramedics
  • Reduce the severity of injuries

Your first few minutes of action often shape the entire emergency pathway.

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