Ambulance services were developed to respond to traumatic injury from motor vehicle accidents and life saving cardiac resuscitation, and 999 (or 911) is the main resource for many patients for acute, chronic and often primary care. Although EMS does respond to such calls, these are a very small part of the services that they provide to patients. Informally, field staff complain about the misuse of the system, through lack of education in the part of the patients. This poster summarizes on-going research with ambulance crew staff or EMTs in Spartanburg NC, Bellingham WA, and Richmond VA in the USA, and Edinburgh, Scotland. When this project began, the researcher was exploring the work culture and workflow of emergency medical responders in the U.S and U.K. After completing research at four of five planned sites, it became evident that areas for innovation in pre-hospital care were not only related to workflow issues, but to the entire healthcare infrastructure.