St John Ambulance is a charitable non-governmental organisation dedicated to the teaching and practice of first aid and the support of the national emergency response system in England. Along with St John Ambulance Cymru, St John Ambulance Northern Ireland, and St John Scotland, it is one of the four United Kingdom affiliates of the international St John Ambulance movement.

The St John Ambulance Association was founded in 1877 to provide first aid training. In 1887, the St John Ambulance Brigade was founded to provide uniformed medics at public events. In 1968, the two were merged into the present foundation. The organisation is a subsidiary of the England and the Islands priory (i.e. branch) of the Order of St John. Until 2012, it also managed St John Ambulance services in the Isle of Man and Channel Islands.

In 2022, St John Ambulance was commissioned by NHS England to provide England's ambulance auxiliary.

History

Background

After the original Order of St John, the Knights Hospitallers, was disbanded by Henry VIII in 1540, an idea to re-establish the Order within England was put forward, starting in 1826, by some remaining French Knights of the original worldwide Order. By 1841, the St John's Day Declaration was prepared to seek official recognition of the new Order by the original Order, now known as the Sovereign Military Order of Malta.

Foundation The St John Ambulance Association was set up on 10 July 1877 by the Venerable Order of Saint John to teach industrial workers first aid so that they could provide on-the-spot treatment in emergencies. Workers rarely had ready access to a doctor in 19th-century workplaces, and since accidents were frequent, death or disability from injuries was common. The organisation in Ipswich was founded in 1880.

In 1887, trained volunteers were organised into a uniformed Brigade to provide a first aid and ambulance service at public events. In many parts of England (and in parts of Scotland, until 1908), St John Ambulance was the first and only provider of an ambulance service right up to the middle of the 20th century, when the National Health Service was founded. The St John Ambulance Brigade and St John Ambulance Association merged in 1968 to form St John Ambulance, a single organisation providing both training and first aid cover.

In 1908, a reciprocal agreement led to the cessation of the St John Ambulance Brigade's operations in Scotland and St Andrew's Ambulance Association's operations in England. The organization later expanded by forming the St John Ambulance Cadets in March 1922. By 1968, the Association and Brigade merged into a unified entity known as St John Ambulance.

The organisation celebrated its 140th anniversary between 2017 and 2018. In August 2022, St John Ambulance was commissioned as NHS England's ambulance auxiliary.

A significant restructure in 2012 consolidated 43 counties into eight large regions; these regions were then further merged in 2016 into four regions. During 2013, St John Ambulance trained approximately 278,000 adults through its workplace and community first aid programmes, and directly trained 91,000 schoolchildren. St John Ambulance personnel attended 45,000 public events, treating approximately 102,000 individuals. It also distributed 100,000 free first aid guides nationwide and its free smartphone app was downloaded by 148,000 people.

St John Ambulance announced a major restructure in June 2024 following deficits of £16.6m across the organisation.

Historic child sex abuse scandal In 1998, members of a paedophile ring that operated from within the St John Ambulance Brigade for several decades were arrested by police. The ring was headed by Leslie Gaines, superintendent of the Farnborough Division of the Brigade in Hampshire.

Ambulance services

St John Ambulance supplies ambulance services in England, providing services to over 100,000 people a year and working in partnership with NHS trusts, private healthcare groups, local authorities and individuals. Ambulance Operations, the division of the organisation responsible for the provision of ambulances, provides a range of services including NHS front-line ambulance support (999 and 111 calls), specialist transfer services for paediatric and neonatal patients and specialist emergency response services for bariatric patients.

In 2010, St John Ambulance was awarded the Private Ambulance Service Team of the Year Award by the Ambulance Services Institute for the work it carried out with the CATS (Great Ormond Street) and the South Thames Retrieval Service (Evelina Children's Hospital).

The 'National Ambulance Auxiliary' In August 2022, St John Ambulance began a four-year contract with NHS England to provide an auxiliary ambulance service. Some Ambulance Operations volunteers and employees deployed in emergency ambulances on behalf of NHS Ambulance Service trusts in England, responding to all categories of 999 calls (depending on the area and NHS pressure).

In April 2025, St John Ambulance announced that NHS England would end the National Ambulance Auxiliary, bringing the contract to an end 12 months earlier than anticipated.

Medical supplies

St John Ambulance Supplies (often abbreviated to SJS) is a trading sub-division of St John Ambulance providing first aid and medical equipment and publications. Where a profit is made, surplus from sales are diverted into supporting the charitable work of the Order of St John and the St John Ophthalmic Hospital in Jerusalem. SJS opened its doors at St John's Gate in Clerkenwell on 12 February 1879, and was originally known as The Stores Depot.St John Ambulance also provides first aid cover in events such as the London Marathon, as well as smaller events such as fetes and local fairs. This service is provided free to patients at the point of delivery, although a charge is often made to the event organiser for provision of the service at their event. St John Ambulance can also provide cycle responders as well as mobile treatment centres and other medical provision.

Night-time economy

St John Ambulance provides first aid in many towns at night, particularly on weekends and public holidays. First aiders deliver first aid to members of the public. St John Ambulance often have ambulances crewed by their Emergency Ambulance Crews (EACs) who can respond to emergency calls within the city centre from the 999 system.

Workplace and commercial training

Training courses St John Ambulance runs courses in first aid and health and safety for members of the public, training 254,000 people in 2013. Its First aid at work course is used by many companies to train designated individuals as first aiders, as required by employment laws; specialist training is also available. Charitable community first aid courses also offer people of all ages the chance to learn basic first aid skills at little or no charge. In 2013, 24,000 people attended these courses.

Volunteer clinical training Those volunteering to provide event first aid services begin as first aiders, by attending a four-day Operational First Aid (FA) course covering common injuries and illnesses, over-the-counter medication administration, in addition to organisation-specific elements such as safe discharge and patient report forms. Further progression is to the Advanced First Aider (AFA) course, a four-day course covering medical gases administration, taking vital signs and manual handling with equipment. Advanced First Aider is the standard required for entry to the Cycle Response Unit, Medical Response Team (a specialist resource for working in dense crowds) and to be considered for selection for Ambulance Training.

First aid roles In early 2024, St John Ambulance announced a change to its internal first aid training for volunteers, primarily driven by changes to the "Purple Guide", the assumed outcome of Martyn's Law and the perceived future regulation of event first aid. Transition of existing volunteers is currently underway and the first aid qualifications of Operational First Aid and Advanced First Aider are planned to be withdrawn by the end of 2025, two new roles have been introduced in their place: Community First Aider and Emergency Responder.

Community first aider

This basic first aid role is intended to equip volunteers with the skills to attend very small, low risk, non-licensed events that require simple first aid provision (e.g. village fetes). The CFA role is primarily intended for those that wish to attend fundraising, community engagement and PR events. The course has a total qualification time of 26 hours and is level B on the PHEM framework, meaning CFAs are unable to attend licensed events unless working under direct supervision as part of a wider team.

Emergency responder The role will become the new minimum standard for first aid provision at licensed events. The qualification that underpins this role is the Level 3 Award in Immediate Response Emergency Care (IREC3). St John Ambulance has based the scope of practice for this role on the Advanced First Aider competencies, including:

Basic life support (BLS), with bag valve mask ventilation Catastrophic bleed management, along with additional skills such as Ten Second Triage. Patient assessment skills (inc. blood pressure, blood glucose, temperature & pulse oximetry) Fracture management & immobilisation Assisting with extrication of the injured Administration of Oxygen, Entonox, Penthrox and GSL medications

Emergency Ambulance Crew (EAC) Emergency Ambulance Crew (EAC) is the minimum qualification required to crew an emergency ambulance for the charity and currently the highest clinical role available to non-registrants. EAC training, open only to existing volunteers, takes the form of a 30-day training program delivered in a blended modular format over six months. Once qualified, EACs must spend a minimum of twelve months as Newly Qualified Emergency Ambulance Crew (NQEAC) with restrictions on crewing combinations before being allowed to practice autonomously. EACs are required to volunteer a minimum of 240 hours each year to demonstrate ongoing clinical exposure.

EAC is intended to be a clinical role similar to that of a Technician or AAP, with EACs working both on events and providing NHS 999 support on an ad-hoc basis. When deployed by St John Ambulance at events, EAC crews are equipped and deployed in the same manner as an AAP/EMT, including the same medications formulary and scope of practice.

Clinical competencies include:

Comprehensive patient assessment skills, including patient monitoring and 12-lead ECG acquisition & recognition of gross abnormalities (inc. STEMI) Immediate Life Support (ILS) skills, including supraglottic airway devices and capnography Administration of 'life-saving', analgesic and GSL medications (Penthrox, Oxygen, Entonox, Salbutamol, Adrenaline 1:1000, Glucagon, Hydrocortisone, Naloxone, Ipratropium Bromide, GTN, Ibuprofen, Paracetamol, Aspirin, Loratidine, Glucose) Assessment and management of Medical, Surgical, Traumatic and Obstetric emergency presentations Catastrophic haemorrhage control (inc. Pelvic splinting, chest seals, haemostatic dressings, gauze & tourniquets) Fracture management inc. Splinting & Traction devices Manual handling, inc. extrication devices, immobilisation aids & Mangar Elk lifting devices. Appropriate disposition of patients, including discharge rights from events, referral to alternative care, routine and emergency transport to NHS receiving centres, inc. bypass to pPCI Major Incident readiness: Ten Second Triage & MITT Assisting other clinicians: IV fluid assist, Cannulation assist

In addition to clinical training, the Level 3 Certificate in Emergency Response Ambulance Driving (CERAD) blue light driving course is available to fully qualified EACs. This may either be delivered as a modulated weekend course or as a four-week full time course.