What is the role of the ambulance service at a safety advisory Group (SAG)
Someone asked me this week: “What is the role of the local ambulance service at a Safety Advisory Group?”
It sounds straightforward, but it’s an important question. The ambulance service is there as a statutory responder, that doesn’t mean they run your event medical cover. Their role is assurance, advice, and making sure plans won’t put unnecessary strain on the wider NHS.
And when you look at coroners’ reports and the Manchester Arena Inquiry, the answer becomes even more critical. Those reports showed how gaps in planning and medical oversight can become gaps in care on the day.
At the same time, scrutiny on event healthcare is rising, expectations around clinical governance, contracting, data, safeguarding and interoperability are all tightening. Which brings us to who does what at SAG.
What is a SAG?
A Safety Advisory Group (SAG) is a multi-agency forum convened by the local authority to quality-assure public event safety. They’re not a legal requirement, but for larger or higher-risk events they’re considered best practice.
In the room you’ll usually have: the organiser, the event’s medical provider, police, fire & rescue, local authority teams (licensing, H&S, emergency planning), NHS reps and the local ambulance service (as a Category 1 responder). The job is to stress-test the plan and close gaps before the public arrives. The local authority decides whether one is needed, often based on the size, risk, or unusual nature of an event.
The Ambulance Provider’s Role at SAG
The local NHS ambulance trust attends as a Category 1 responder. Their core job is emergency response across the patch, not running your on-site medical team.
At SAG they will:
Review and assess if the medical plan is adequate based on risk and capacity (size, profile, venue, weather, alcohol, egress times, remoteness).
Offer clinical and operational advice on triage, escalation, access/egress and how you’d dovetail with 999 in a major incident (JESIP aligned).
Protect NHS capacity by checking hospital pre-alert/notification routes and likely impact on ED/UTC/ambulance operations.
Assure comms/interoperability (how event control/medical talk to ambulance control; how a M/ETHANE message would be sent; who says what, when).
Act as the critical friend by asking the awkward “what if…?” questions and recording any advice/actions.
They do not sign off the clinical governance, supervise your staff, or “own” the medical model. Responsibility stays with the organiser and their contracted provider.
The Medical Provider’s role at SAG
This is the part that often gets blurred. The provider isn’t just there to “show up”; they carry the detail. In practice, they should come to SAG ready to evidence and defend a safe, deliverable medical plan.
Before SAG, the medical provider should submit a complete event medical plan. This would typically include:
A demand and capacity model (forecasting case load and acuity).
Details of skill mix and staffing levels.
Equipment and medicines available on site, with governance arrangements.
A clear command-and-control structure.
(Follow the Purple Guide and your local authority’s guidance for completeness.)
At the SAG meeting, the medical provider will then be expected to:
Walk through the proposed medical model.
Justify staffing and skill mix against predicted case mix.
Outline the size and layout of the medical tent, including equipment.
Detail plans for transfers off site.
State any additional support needed from the festival to ensure a major incident plan could be implemented.
Why Does This Matter? (Lessons from inquiries)
The consequences of poor medical planning are well documented.
Coroner’s report into a festival death:
· No clear responsibility for making a hospital pre-alert call.
· Event ambulance not equipped to NHS standards.
· Gaps in planning and communication which led to a preventable tragedy.
Manchester Arena Inquiry:
Delays in triage and treatment.
Confusion around command and control.
Lack of coordinated medical oversight.
Both highlight the same message: robust scrutiny of medical plans is essential. Ambulance providers at SAG are critical in this process, but their statutory remit has limits.
Do you also need an independent strategic health advisor?
Often, yes. Especially for large, complex or higher-risk events, and whenever the provider and the ambulance service are the same organisation (conflict of interest).
What an independent advisor adds:
Assurance for the organiser: oversight of risk assessments, contracts and KPIs; makes sure paper promises become on-site reality.
Clinical governance depth: review schedule of works, medicines governance, safeguarding, debrief and learning processes.
Interface management: joins up harm-reduction, stewarding, security and medical with clear boundaries and triggers.
Regulatory readiness: ensures plans, contracts and data capture will stand up to scrutiny as expectations tighten.
This isn’t duplication of the ambulance role; it’s filling the parts no one else is positioned to do.
Final Thought
So where does this leave us?
The medical provider brings the detail of the plan: staffing, skill mix, equipment, governance, and how care will actually be delivered on site.
The ambulance provider stress-tests that plan: are the assumptions sound, will it protect NHS services, are comms and escalation routes robust? Their role is to be the statutory responder and the “critical friend” at the table, not to run the medical cover, but to make sure it stands up when tested.
The strategic health advisor, where appointed, adds a different lens. They sit alongside the organiser, providing independent assurance that what’s written on paper is deliverable in practice. They can strengthen contracts, KPIs and risk assessments, align plans with the Event Healthcare Standard and upcoming CQC regulation changes, and make sure safeguarding, governance and data capture are in place.
Together, those roles create balance:
Medical provider = delivery
Ambulance provider = assurance
Strategic health advisor = oversight and independence
When things go wrong at events, they tend to go really wrong. That’s why this three-way balance matters. The medical provider delivers, the ambulance provider assures, and the strategic health advisor oversees. Together, they create plans that don’t just sit on paper but plans that keep everyone safe when it matters most.
If you’re planning an event and want independent oversight of your medical provision, contact me to find out more about how I support organiser.
🩺 Acronym Buster
JESIP – Joint Emergency Services Interoperability Principles
A framework that ensures the emergency services work together effectively during major incidents through shared communication, coordination, and situational awareness.
M/ETHANE – Major incident declaration format used by emergency responders
It stands for:
M – Major incident declared?
E – Exact location
T – Type of incident
H – Hazards present or suspected
A – Access routes
N – Number of casualties
E – Emergency services present and required