As always, the bean counter's approach. In my own (rural) setting, people tend to summon an ambulance only when one is really needed, so pretty well all of our patients go to hospital. Despite this, we are still made to crew a couple of RRUs - by management's admission, just as CatA Target Busters. Our dispatchers tend to ignore the RRUs; if a double-crewed ambulance is available (which it usually is, even if it's 15 miles away (rural setting)), it gets sent, and that's the job done. If a recent rant about CatA responses is fresh in the despatcher's mind, though, he/she may send an RRU to race the responding ambulance to the scene, thereby committing 3 people to a job that only needs 2. What concerns me about your description of the FRU's role in London is the fact that a large number of ambulances has been sacrificed to provide you with cars. I can understand the attraction of single-crewed assessment of patients to the bean-counting mind; however, I wear a green suit, and I know that I would still be sending everybody in. ("Crew and patient safety." The word "crew" comes first, and I take "safety" to include keeping my job.) So, I suspect, will the LAS staff - and now you have 100 fewer ambulances with which to do it. As you say, it could work, and I sincerely hope that it does. However, I think it more likely that it won't. You can't escape the fact that nobody ever was disciplined for taking a patient to hospital.