Here in Buxton, derbyshire, we don't have an A&E dept at all. Nearest is Stepping Hill or Chesterfield. When my daughter had a severe asthma attack (I'm not one to panic as I am ex military medic and can handle most emergency situations - but this one had me almsot frantic trying to get her to breathe), ambulance came and paramedics said "Don't piss baout with NHS Direct - next time this happens call us straight away. I like to think that the ambulance service do know when it is being tried on and when it isn't and can determine whether a patient should be seen straight away on admission to A&E, or can just wait their turn.