This edition includes a new section on prehospital care. The journal Pre-hospital Immediate Care has now merged with EMJ, a change that reflects the need for closer working between prehospital care and inhospital emergency medicine.

The way in which the ambulance service operates can have a major impact on the workings of accident and emergency (A&E) departments. At present most UK ambulances services have a limited range of responses to a 999 call. Most such calls result in a paramedic ambulance response, which then only has three choices. The majority of cases are taken to A&E, some cases are referred to the general practitioner and some patients sign their own discharge. Not all 999 calls are for emergency problems. It has been shown to be safe to refer non-urgent calls to a nurse or paramedic working with decision support to carry out further interrogation and decide on what further care is …