NSW Ambulance, previously the Ambulance Service of NSW, is an agency of NSW Health and the statutory provider of pre-hospital emergency care and ambulance services in the state of New South Wales, Australia.

Established pursuant to the and operating within the , the service provides clinical care and health related transport services to over 7.9 million people in New South Wales (NSW), across an area of .

NSW Ambulance employs more than 6,100 staff including 4,952 paramedics who operate over 1,600 response vehicles from 220 locations across the state. The service responds to around 1.1 million calls a year, with an average response time of 7.47 minutes to 1A emergencies (cardiac or respiratory arrests), against a target of 10 minutes.

In 2018, paramedicine became a regulated profession, legally protecting the title of paramedic and establishing mandatory professional standards for practitioners. and the Australian Health Practitioner Regulation Agency provide minimum requirements to ensure that paramedics in Australia are competent, qualified, and able to provide safe and effective care to the public. Other requirements include holding an accredited qualification, being fit to practice, and passing a criminal history check.

NSW Ambulance headquarters officially moved to Sydney Olympic Park in 2024, joining the NSW Police Force Recruitment Branch and NSW Rural Fire Service Headquarters. They had previously been located at Callan Park in Rozelle, NSW for almost 30 years (uncited). Some NSW Ambulance functions, such as Communications Education and Virtual Clinical Care Centre (VCCC), operate at the former Gladesville Hospital site.

History

The first recognised ambulance service in New South Wales, known as the Civil Ambulance and Transport Brigade, commenced operations on April 1, 1895. Their first ambulance station was a borrowed police station in Railway Square, Sydney, which was staffed by two permanent officers. At the time, patients were transported on hand-held stretchers and hand-litters. As demand grew, so did the service and they were soon transporting over 2,000 patients a year. In 1905, they were reorganised into the Ambulance Transport Corps. In 1910, they opened their first station on the west side of the city, occupying the former parcels office at Summer Hill Railway Station.

In 1912, the first motorised ambulance entered service with the Corps, followed by two ambulance trams in 1915. The service was then renamed the NSW Ambulance Transport Service Board in 1921, with further technological advances such as the installation of radios in ambulance vehicles by the mid-1930s. By 1937, the Central District ambulance fleet had grown to 15 vehicles, with many others operating in districts across the state.

In 1958, the first fibreglass-body ambulances entered service, marking a significant advancement in the design towards the modern ambulance. In 1962, Station Officer Jim Smith (a former rigger at the Port Kembla Steelworks) became the first rescue trained ambulance officer in NSW. He received training from the existing Police Rescue Squad, and subsequently commenced operations on the service's new 'Q' (Rescue) Van. In 1967, the Air Ambulance Service was established, operating a single Beechcraft Queen Air B80. Over the next ten years, this would grow to a fleet of five aircraft. In 1970, the service purchased 45 new Ford F100 ambulances, which would become the face of the fleet for many years to come. By the late 1970s and 1980s, Intensive Care Paramedics were introduced, allowing the service to bring unprecedented levels of pre-hospital care to patients. In 1985, the Air Ambulance fleet received further upgrades with four new King Air B200Cs.

As the importance of pre-hospital care skyrocketed in the service, the Special Casualty Access Team (SCAT) was formed in 1986. This team of elite paramedics brought intensive care to patients in the most extreme of situations, ranging from cliff falls to building collapses. SCAT Paramedics were trained in a range of skills including climbing, winching, breathing apparatus, CBRNE, caving, canyoning, USAR, bushcraft, four wheel driving and wilderness survival. A major step forward for the service came in 1991, when every ambulance in NSW was equipped with a defibrillator. In 2004, both immediate and long distance care were enhanced across NSW, with the purchase of new rapid response cars and new Air Ambulances (four King Air 200s). The late 2000s saw vast increases to the service's specialist capabilities, with the creation of the Medical Retrieval Unit, the Special Operations Team and the Extended Care Program, making the service one of the most advanced providers of pre-hospital care in the world.

Paramedics Paramedics form the backbone of NSW Ambulance through their dynamic application of skills and expanding role in the community. They provide the bulk of frontline healthcare, responding to all types of emergencies across the state. Paramedics are highly trained in a broad variety of medical skills to assess patients’ conditions, make quick decisions, and perform life-saving procedures, often in high-pressure environments. Paramedics must hold an accredited degree or be assessed to have equivalent qualifications alongside experience.

Intensive Care Paramedics (ICP) are highly skilled and experienced paramedics, who provide advanced intensive patient care. Their extensive experience and training allows them to conduct advanced medical procedures in the field and administer specialist drugs to seriously ill or injured patients.

Extended Care Paramedics (ECP) are specialist paramedics who take a ‘GP’ type approach to non emergency incidents. Their role is to ease the workload of emergency ambulance crews by dealing with non emergency incidents using specialist training and techniques. These include prescribing medication, changing catheters and resetting dislocations among many other skills.

Critical Care Paramedics (CCP) are elite paramedics assigned to the Medical Retrieval Unit. As well as intensive care skills, they're trained in Special Operations, allowing them to work in hostile environments such as building collapses, floods, caves, cliffs and remote bushland. They also have the ability to perform complex medical procedures and administer highly specialist drugs in the field to patients, under the authorisation of a Critical Care Doctor.

Duty Operations Managers (DOM) are senior paramedic inspectors responsible for supervising clinical operations and managing crews on shift across each ambulance zone. They provide an experienced oversight at complex medical incidents, supporting paramedics with patient management and treatment. DOMs are qualified Paramedics with additional formal qualifications in management and leadership, with a strong background of medical experience and leadership.

Community First Responders (CFR) are part-time and volunteer members of other emergency services or community members trained in nationally accredited advanced medical skills, who respond to medical emergencies in conjunction with Paramedics in remote areas of the state. There are 33 CFR units in total; 11 Fire and Rescue NSW, 11 NSW State Emergency Service and 12 Rural Fire Service, with each unit generally carrying their complement of medical equipment on board existing response vehicles such as fire engines.

Incidents The New South Wales Government has admitted to failings regarding the death of David Iredale, a high school student who died of dehydration in the bush near Katoomba, New South Wales, in late 2006. Iredale called 000 several times for help before he died. The NSW Ambulance Service Triple Zero call centre was accused of inappropriately handling Iredale's calls; he was not given any medical advice, and operators were accused of being "preoccupied" with obtaining a street address to send help to, although Iredale was in the bush. An inquest set up to investigate failings in the 000 system as a result of his death identified serious issues in the practices used by 000 operators.

Response priorities NSW Ambulance prioritise cases into several priority levels based on the urgency of the case, which are categorised into:

Urgent – Lights and Sirens Response Category 1 (Highest Priority) – Patient not breathing / ineffective breathing Category 2 (Priority) – Urgent response required Non urgent - Response without Lights and Sirens Category 3 – Attend within 30 minutes Category 4 – Attend within 60 minutes Category 5 – Urgent Medical Transfer (Can be upgraded to Lights and Sirens depending on situation) The remainder of the priority levels are made up of various priority transfers.

As of early 2019, NSW Ambulance attended over two thirds of Priority 1 calls within 30 minutes.

Special Operations The Special Operations Team (SOT) are responsible for specialised ambulance operations across the state. Their role is to bring paramedic level care to patients in any kind of hostile environment including cliffs, canyons, caves, floods, bushfires, building collapses, confined spaces, hazardous materials incidents, active shooters and the remote Australian wilderness.

SOT operate on a day-to-day basis from rapid response vehicles spread across Sydney, Wollongong and the Central Coast, located at St Ives, Bankstown, Picton, Caringbah, Point Clare, Wollongong, Northmead, and Katoomba and Lithgow in the Blue Mountains. They additionally operate a number of specialist vehicles from their Special Operations Base at Sydney Olympic Park, including 4WD Ambulances and numerous specialist support vehicles.

In some rural areas of Regional NSW, SOT are trained and equipped as primary rescue units, allowing them to extricate patients in addition to their medical access role. They operate six Rescue Units, based at Wagga Wagga, Singleton, Tamworth, Bomaderry, Cowra and Rutherford, with two spare vehicles located in Sydney. These Rescue Units are equipped with a range of rescue tools including battery extrication equipment and rope rescue gear. In the winter months, the Alpine Operations Team is active, based at Perisher Valley, this specialised team of 20 paramedics provide patient access and care to the entire NSW Alpine region. The Alpine Operations Team utilises unconventional vehicles to access patients, from snowmobiles to over-snow ambulances and their paramedics are specifically trained in overnight camping, search and rescue and avalanche recovery.

SOT is also responsible for providing the Tactical Medical Operations capability for NSW Ambulance. SOT was the first full-time Tactical Paramedic Team in Australia working in conjunction with the NSW Police Force Tactical Operations Unit.

Medical Retrieval

The Medical Retrieval Unit (MRU) (through the Rapid Launch Trauma Centre) are responsible for the coordination and response of NSW Ambulance's Medical Retrieval Teams. Each Medical Team consists of a Doctor and a Critical Care Paramedic, who work together to bring the highest level of pre hospital clinical care to patients. Medical Teams can perform a number of complex medical procedures beyond the scope of Primary and Intensive Care Paramedics.

It operates from six bases across NSW, located at Bankstown, Albion Park, Orange, Belmont, Tamworth and Lismore, along with Hume in the Australia Capital Territory. Three further Helicopter bases are being planned in Port Macquarie, Moruya, and Wagga Wagga. https://www.ambulance.nsw.gov.au/news/news-items/improving-regional-emergency-coverage-with-new-helicopter-bases