Emergency care assistant

Emergency care assistants (ECAs) work with paramedics as part of emergency ambulance crews attending 999 calls. 

Working life

An emergency care assistant responds to emergency calls alongside a paramedic, helping them to provide patients with potentially life-saving care and, where needed, getting patients to hospital. They attend every kind of accident and emergency, sometimes covering considerable distances, using expert emergency driving skills to get to the scene with the greatest speed possible. 


Under the direct supervision of the paramedic, you'll carry out essential emergency care, such as:

  • controlling severe bleeding
  • treating wounds and fractures
  • looking after patients with possible spinal injuries 

You will use a defibrillator to resuscitate patients with heart failure and will be trained to give a range of different drugs. 

ECAs have to respond to any emergency situation. Many emergencies are likely to be distressing and involve people who are badly hurt and severely traumatised. For example:

  • road accidents with victims who have multiple severe injuries
  • someone who has had a heart attack in a busy shopping centre
  • an elderly person who has fallen down the stairs
  • a case of domestic violence
  • a very sick baby being moved to a specialist centre

ECAs take relevant information from carers or others at the scene who may be highly distressed or aggressive. 

As well as driving emergency vehicles, ECAs check their vehicle at the start of and during each shift, to make sure they are clean, have fuel and are stocked with the right supplies. Other duties include completing paperwork and using communication equipment (radios and telephones) to speak to colleagues.

As well as working with paramedics, ECAs work with other members of the ambulance service, such as control room staff. They also work with doctors and with staff from the other emergency services, including the fire and rescue service and police.

You'll usually work standard hours of 37.5 per week, these are on a shift pattern. Shifts cover 24 hours a day, 7 days a week throughout the year. So an ECA’s work pattern includes evenings, nights, early starts, weekends and bank holidays. ECAs need to be prepared to work outdoors in all conditions, where necessary.

How much will I earn? 

Most ECA jobs will usually be at band 3 or 4 of NHS Agenda for Change. You’ll also have access to our generous pension scheme and health service discounts, as well as 27 days of annual leave plus bank holidays

Entry requirements

There are no set entry requirements to become an ECA. Most employers expect good standards of literacy and numeracy. Some may ask for qualifications such as GCSEs, NVQs or equivalent. Employers may ask for relevant work experience. For example, working with elderly or disabled people, either in paid employment or voluntary work. First aid work would also be useful, such as volunteering with St John Ambulance or the British Red Cross.

To drive an ambulance, you'll need a full, manual driving licence. If you passed your test after 1996, you may need an extra driving qualification for larger vehicles and carrying passengers.  Ambulance service trusts use vehicles of different sizes, so check carefully which classifications you need on your licence.

Must have skills 

You'll need to be:

  • able to understand a situation quickly
  • calm in stressful situations
  • confident and reassuring
  • resilient in dealing with other people’s strong emotions
  • able to follow procedures
  • able to work alone or in a team
  • prepared to go into unknown or unpredictable situations
  • good communication skills
  • excellent driving skills
  • organisational skills
  • to be able to use equipment and machinery 

Training and development

All ambulance service trusts offer initial training for new ECAs, usually around six to nine weeks. This covers:

  • moving and handling techniques
  • emergency first aid
  • basic patient skills
  • safe driving techniques

Training includes practical assessments and written exams. Once you have passed these tests, you are allocated to an ambulance station. You work under the guidance of a trained supervisor before working unsupervised.  

Where can the role take you

You could progress to become a team leader or supervisor. You would be in charge of a team of ECAs, responsible for allocating work and drawing up shift rotas.

You could apply to train as a paramedic. You would have to pass entrance exams and meet other requirements before being accepted onto a paramedic course.

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