All 999 calls from the public are answered at one of the two Emergency Operations Centres (EOC) in Waterloo or Newham who then dispatch and allocate the appropriate resources.

In 1818, a parliamentary select committee had recommended that provision be made for carrying infectious patients in London "which would prevent the use of coaches or sedan chairs" but nothing was done.

The first permanent ambulance service in London was established by the Metropolitan Asylums Board (MAB) in 1879, when a new Poor Law Act empowered them "to provide and maintain carriages suitable for the conveyance of persons suffering from any infectious disorder".

Each ambulance station included accommodation for a married superintendent and around 20 drivers, horse keepers and attendants, nurses, laundry staff and domestic cleaners.

[6] At Deptford, in order to transfer patients between the hospitals at Joyce Green and Long Reach near Gravesend, a horse-drawn ambulance tramway was constructed in 1897 and extended in 1904.

Although the MAB was legally supposed to be transporting only infectious patients, it increasingly also carried accident victims and emergency medical cases.

[7] Also in 1915, the MAB Ambulance Section were the first public body to employ women drivers, due to the number of men who had volunteered for military service.

Taken with the 21 ambulances already operated by the LCC, this provided a comprehensive service for all kinds of illness and accident, which was under the direction of the Medical Officer of Health for the County of London.

On 1 April 1996, the LAS left the control of the South West Thames Regional Health Authority and became an NHS trust.

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.

A Tactical Response Unit contains paramedics specially trained to respond to complex incidents, such as those involving firearms or acid attacks.

Helicopter emergency medical service (HEMS) paramedics working for London's Air Ambulance Charity also fall under this department.

That is to attend medical emergencies as quickly as possible to improve the patient's chance of survival, saving lives which may have been lost without the additional resources being available to the ambulance service.

LAS can also call upon auxiliary aid from external voluntary organisations such as St John Ambulance and the British Red Cross, as demonstrated in the 7 July 2005 London bombings.

Previously a centrally funded service, this element of the LAS is now subject to an open market and is required to tender for work from primary care trusts (PCTs) and other NHS bodies.

[23] Cycle responders, who operate in areas such as the City of London, the West End, Stratford, Kingston Town Centre as well as Heathrow Airport, use custom built Rockhopper mountain bikes manufactured by Specialized Bicycle Components.

Examples include: Due to an increase in demand, the LAS has used private ambulance companies, and some charities, to provide additional everyday operational cover.

[33] In November 2021 the trust announced that it would be directly employing the 500 staff in "make ready" teams who are responsible for cleaning and restocking ambulances before they are taken out.

[41] A fire in the basement of its Waterloo base in October 2010 caused the LAS to relocate the EOC to the back-up control room in east London due to an interruption to the building's power supply.

[46] The trust was placed into special measures following a report by the Care Quality Commission (CQC) in November 2015, which rated it "inadequate" overall and raised "significant concerns" about its performance.

The report noted that the trust needed to focus on ensuring safe staffing levels of the control room, diversity amongst staff and improvements in management of mental health.

[49] Concerns were raised in internal LAS documents over the performance of radios and communication equipment used in the emergency operations after the 7/7 attacks.

[50] Again, the sheer volume of emergency calls received made radio communications difficult and put pressure on staff in the ambulance control room.

[51][52][53] In 1974, the LAS commissioned a computer-aided despatch system that remained unused for 13 years because union members refused to operate it.

[54] Poorly designed and implemented, its introduction led to significant delays in the assigning of ambulances,[55] with anecdotal reports of 11-hour waits.

[clarification needed] The crash coincided with hundreds of control room exceptions messages related to alerts that crews responding to emergencies had not reported mobile, and the ambulance had not moved 50 metres (160 ft) within 3 minutes of despatch.

[59] On 8 June 2011, the LAS attempted to implement a new CAD system, called CommandPoint,[60] costing £18 million,[61] and built by Northrop Grumman, an American aerospace and defence technology company.

[67] In October 2019, the service adopted a platform called GoodSAM, which enables control room staff to connect to a callers' smartphone and assess seriously injured patients via a video link.