Wales introduces new ambulance category for stroke
A new “orange” ambulance category will be introduced in Wales this winter to improve emergency care for stroke patients currently grouped within broader amber calls.
Under the new system, specialist nurses and paramedics will screen 999 calls to identify patients with stroke or STEMI heart attacks—where blood flow to the heart is completely blocked—who need a faster response and specialist care before arriving at hospital.
The aim is to better direct time-critical cases to specialist pre-hospital treatment.
Stroke patients are currently within the amber category, which covers about 70 per cent of all 999 calls in Wales.
The new orange category will not have a specific response time target, but average and longest response times will be recorded, along with the type and quality of care provided before hospital arrival.
Health secretary Jeremy Miles said: “For people in stroke, every minute counts if lives are to be saved and disability reduced or prevented.
“Around two million brain cells are lost for each minute that passes. That’s why we’re introducing a new orange category into the system which will help our ambulance service identify time-sensitive complaints such as stroke quickly and get patients the right specialist treatment faster.”
Alongside orange, two additional categories will replace the current amber group: yellow, for cases requiring further clinical assessment to determine the best response, and green, for issues such as blocked catheters that may need community care or planned transport.
The changes follow updates earlier this month to how the most urgent 999 calls are categorised.
A purple category was introduced for patients in cardiac or respiratory arrest, and a red emergency category for cases such as major trauma. These categories carry a target average response time of six to eight minutes.
A “video triage” pilot scheme is also underway in five areas, allowing paramedics to consult hospital stroke specialists in real time before the patient arrives.
Andy Swinburn, executive director of paramedicine at the Welsh Ambulance Service, said: “The nature of how patients present to 999 has changed and it’s important to reflect this in the way we respond.
“First and foremost to increase ambulance availability for those who truly need it but also to ensure that patients who can be cared for closer to home get that opportunity.”
Dr Shakeel Ahmad, national clinical lead for stroke in Wales, said: “When a patient is having a stroke, urgent rapid treatment is critical as every second counts in order to restore blood flow to the brain.”
He said the orange category would help “prioritise stroke patients who require this urgent treatment.”
The changes are being made against a backdrop of worsening ambulance delays. In January 2020, average amber response times stood at about 35 minutes, rising to almost 150 minutes by January 2025.
Last month, outgoing ambulance service chief Jason Killens said hundreds of patients each month suffer avoidable harm due to ambulances waiting outside overcrowded emergency departments.
He said handover delays—which have quadrupled during his time in post—were “unsustainable and unacceptable.”
