The modern ambulance service developed as a result of the 1946 National Health Services Act when local authorities were required to provide ambulances 'where necessary'. Prior to 1946 the chance of being transferred to hospital in an ambulance depended upon where you lived; ambulances were mostly available in cites and large towns.

Initially ambulances were staffed by volunteers transporting the sick and injured to hospital for treatment. Professionals were gradually introduced and in 1964 the Millar report recommended that the ambulance service should provide treatment in addition to transporting patients.

Following Millar the ambulance service began to provide clinical care including life saving procedures such as haemorrhage control, neck and back injury care, cardiopulmonary resuscitation and fluid, drug and oxygen therapy.

The extended training required to meet the introduction of more clinical care led to the State Registration of Paramedics. Paramedics in the UK are autonomous practitioners who provide treatments and diagnostics without seeking authorisation from doctors.

As more clinical care was provided, guidelines were developed by individual ambulance services to support ambulance clinicians; however the development of regional guidelines led to a variation of care across the UK. In order improve the quality of clinical care by reducing variation, a set of nationally applicable clinical practice guidelines were produced in 2000. The guidelines, based on current best evidence, are published biennially; they are dynamic and shift to meet the challenges of the modern ambulance service. The production of clinical practice guidelines is now the responsibility of the Joint Royal Colleges Ambulance Liaison Committee. Click on lay summary and/or scientific summary for information about the guideline process.