Services The Ambulance Services directorate provides front-line crews formed of paramedics, emergency medical technicians and emergency ambulance crew, and non-emergency transport services. The department also provides incident response officers who are operational commanders, and provide 24/7 operational management. Clinical team managers also provide operational command resilience but primarily provide 24/7 clinical management and leadership. Ambulance operations employs a total of 4,957 staff. Medical Directorate The Medical Directorate provides advanced paramedic practitioners in critical care who are specially trained to deal with critically ill patients, and who can provide interventions outside the normal scope of practice of a paramedic like mechanical ventilation and sedation. Advanced paramedic practitioners in urgent care support the LAS aim to reduce conveyance rates by managing more patients in the home environment without the need for a hospital admission. 999 Operations The 999 Operations department provides the staff to work in the EOCs, such as call-takers and dispatchers. The department also contains the clinical hub which is staffed by clinical advisors undertaking hear and treat, and clinical team navigators providing clinical support to frontline crews, other EOC staff and maintain oversight of clinical safety at the operational level. Resilience and Special Operations The Resilience and Special Operations department employs paramedics in the Hazardous Area Response Team (HART), who are specially equipped to deal with casualties at height, in water, or urban search and rescue. There are two HART teams, one each covering the east and west of London. A Tactical Response Unit contains paramedics specially trained to work in the warm zone of active shooter incidents. Helicopter emergency medical service (HEMS) paramedics working for London's Air Ambulance Charity also fall under this department. Front-line roles Front-line roles in the trust include: Advanced paramedic practitioner - responding to the most critically ill patients. In 2018, the trust announced plans to recruit up to 60 more advanced paramedic practitioners, of which there were then only 15, with the intention to treat more lower acuity patients at the scene or join them up with community-led services. HEMS paramedic - aircrew paramedic responding with London's Air Ambulance Charity alongside a doctor Paramedic - typically hold a BSc in paramedic science, but may also have been trained 'in-house' to the Institute of Healthcare Development (IHCD) paramedic qualification. Emergency medical technician - trained to the (now discontinued) IHCD ambulance technician qualification Emergency ambulance crew - are either trained to the (now discontinued) IHCD