DONT expect an ambulance if you dont need an emergency trip to hospital. That is the message of planned changes to the East of England Ambulance Service due to be discussed at a meeting of the trust board in Hertfordshire this morning (Wednesday). The service will still aim to get to urgent red calls within eight minutes, but there are proposals to beef up the triage element of the 999 service to avoid sending blue-light ambulances out unnecessarily. The plan is to reduce the number of ambulances, increasing instead the number of much less expensive cars that can be sent out for treatment of casualties where they are, often at home. As well as reducing the burden on the ambulance service, the move could also take pressure off hospital accident and emergency departments that are often abused by patients who are victims of neither. The ambulance services integrated service model aims to re-position the patient as central within professionally-led health and social care commissioning. It means the service will provide the most appropriate clinical response for the patient which could be a telephone call from a clinician so that people who really need blue-light ambulances get them more quickly. The aim is that patients should receive the right care at the right time and the right place. Currently, the service takes about 70 per cent of patients it attends to treatment centres because of the inadequate availability of triage assessment among staff answering the phones. Better triage assessment by qualified people at that stage would reduce unnecessary attendance, the service believes. Changes to ambulance response targets mean more people dialling 999 could get a call back from a clinician rather than a visit by paramedics. As part of this new way of working, the ambulance service is looking at reducing its intensive care ambulance fleet size from 276 to 138 vehicles and increasing its response car fleet from 145 to 232 vehicles. It could also increase its intermediate tier vehicles from 21 to 105. If approved, the changes could see half of the intensive care ambulances withdrawn towards the end of 2012. From April 1, the East of England Ambulance Service no longer had to meet a 95 per cent target of sending an ambulance to serious, but not immediately life-threatening cases within 19 minutes. The Governments decision to scrap the target means that people ringing 999 could receive a call back from a clinician to assess the seriousness of the case further in some of these calls. Emergency 999 calls to the ambulance service are prioritised into categories to ensure life-threatening cases receive the quickest response. They used to be called categories A, B and C calls, but they are now being called red and green calls. The 75 per cent target to respond to red calls immediately life-threatening within eight minutes remains. The service has now identified four less severe green call categories below this, which would be dealt with in different ways, including getting a call back from the clinical support desk, which is manned by staff with clinical knowledge who are able to ask more detailed questions than normal call handlers. One option they will have is to refer callers to more appropriate NHS services, such as a walk-in centre, pharmacy or a GP. Patients could also receive a visit from a response car, to enable a paramedic to carry out further assessment of the severity of the case or treat a patient at home.