Trends in demand for emergency ambulance services in Wiltshire over nine years: observational study

Demand for emergency medical services in the United Kingdom is rising.1 Research into the type of patients transported by emergency ambulances and the severity of their illness has tended to focus on identifying people who use the service inappropriately rather than factors influencing demand, and our understanding of the increase in demand is poor. 2 3 In Wiltshire, a largely rural county in the south west of England, the number of emergency transports of patients increased from 11 268 in 1988 to 16 814 in 1996, a crude increase of 49%.4 This increase is often attributed to general practitioners redirecting patients with urgent problems to the ambulance service, particularly out of surgery hours. Over the same period, however, urgent transports booked by general practitioners rather than in response to a 999 call rose from 9982 to 13 951 (40%). We examined the reasons for this rise