St John Ambulance (England)

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 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
The St John Ambulance Association was set up in 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. When there were far fewer doctors and hospital beds than today, St John Ambulance nurses looked after the sick and injured in their own homes.

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 1998, members of a paedophile ring which 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.

A significant restructure in 2012 consolidated 43 counties into eight large regions; these regions were then further merged during 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.

Key dates

 * 1540: The original Order of St John, the Knights Hospitallers is disbanded in England by Henry VIII
 * 1826: An idea to re-establish the Order within England is put forward by some remaining French Knights of the original worldwide Order
 * 1841: The "St John's Day Declaration" is prepared to seek official recognition of the new Order by the original Order, now known as the Sovereign Military Order of Malta
 * 10 July 1877: St John Ambulance Association forms to teach first-aid in large railway centres and mining districts
 * June 1887: St John Ambulance Brigade is formed
 * 14 May 1888: English Order of St John is granted a royal charter by Queen Victoria
 * 1908: By reciprocal agreement, St John Ambulance Brigade ceases to operate in Scotland and St Andrew's Ambulance Association ceases to operate in England
 * March 1922: St John Ambulance Cadets is formed
 * 1968: The Association and Brigade merge to form a unified St John Ambulance
 * January 1987: Badger Setts are introduced to celebrate 100 years since the formation of the Brigade
 * 1999: The Priory of England and the Islands is formed
 * 2012: St John Ambulance changes its county structure to a regionalised model across England
 * 2017–2018: Celebration of the organisation's 140th anniversary
 * August 2022: Commissioned as NHS England's ambulance auxiliary

Training
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, including courses for schools staff and people working with children, and professional drivers.

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.

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. St John Ambulance has delivered over 1.2 million hours of employed and volunteer frontline 999 ambulance support to NHS ambulance trusts since early 2020, treating over 150,000 patients. A national network of ambulance hubs allows both volunteer and salaried Emergency Ambulance Crew and Healthcare Professionals to deploy in support of almost every NHS ambulance trust in England. In some regions, such as the Isle of Wight, St John Ambulance crews are critical for the business continuity of the NHS ambulance trust and make up an integral part of their ability to respond to emergencies.

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).

In August 2022, St John Ambulance began a four-year contract with NHS England to provide an auxiliary ambulance service but believes that this has been lost in 2024.

Some Ambulance Operations volunteers and employees deploy in emergency ambulances on behalf of NHS Ambulance Service trusts in England, responding to some categories of 999 calls (depending on the area and NHS pressure), as part of their commitment to the NHS as ambulance auxiliary. The majority of NHS ambulance services regard SJA volunteers as working in an assistant role and are therefore primarily used to support qualified clinicians or to transport patients who have already been assessed and managed. Volunteers who are not professionally trained are usually only expected to attend more serious patients if there is no other properly qualified resource available.

Events
St John Ambulance provides first aid cover at thousands of events every year, including major events such as the London Marathon and Hyde Park concerts, 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, to subsidise the charity's free cover of community and charity events, as well as the organisation's wider charitable output. Where necessary, St John Ambulance can also provide healthcare professionals, cycle responders, as well as mobile treatment centres, emergency ambulances and other medical provision, and support functions including command & control vehicles and incident catering units.

Night-time economy
St John Ambulance provides first aid in many towns and cities at night, particularly on weekends and public holidays. First aiders, backed by healthcare professionals (including registered doctors, nurses and paramedics) deliver first aid to members of the public in these areas at night and provide a safe environment to ensure safe and prompt treatment to those who require it. St John Ambulance often have ambulances crewed by their Emergency Ambulance Crews (EACs) who will convey patients to hospital if they cannot be safely treated and discharged from the static treatment centre, and respond to emergency calls within the city centre from the 999 system.

Community first responders
St John Ambulance community first responders (CFRs) were trained volunteers who provided emergency treatment to people in their region and were dispatched by NHS ambulance control to medical emergency (999) calls, with the scheme operating as a community partnership between St John Ambulance and local ambulance service trusts. CFRs were dispatched to attend Category 1 "immediately life-threatening" calls such as cardiac arrest, diabetic emergency, unresponsive patient, breathing difficulties and seizures. As of 2024, St John Ambulance CFR Schemes have all been transferred to local NHS Ambulance trusts and the St John CFR role has been retired.

Internal volunteer training
Volunteers receive training according to the role they fulfil. Most volunteers choose to undertake a clinical role (e.g. First Aider, Advanced First Aider) however non-clinical roles are available, such as logistics team members who help to facilitate equipment movement and set up at large events.

First aid roles
Those volunteering to provide event first aid services begin by attending a four-day Operational First Aid (FA) course covering common injuries and illnesses, basic life support, administration of over-the-counter medication, major trauma and casualty care, 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, basic airway management, splints, 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.

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" and the proposed tabling of Martyn's Law. Transition of existing volunteers is currently underway and the first aid qualifcations of Operation First Aid and Advanced First Aider are planned to be withdrawn by the end of 2025, and two new roles are planned to be introduced: Community First Aider and Emergency Responder.

Community First Aider (CFA)
The Community First Aider role is intended for small, low risk, non-licensed events that require simple first aid provision (e.g. village fetes). The course has a total qualifcation time of 26 hours. CFAs attend a two day first aid course, consisting of lifesaving skills such as basic life support, defibrillation, management of choking and bleeding, and recognition of common medical conditions, alongside e-learning and home study. CFAs are intended to be equipped to provide basic first aid care in their communities and to provide first aid awareness to members of the public.

Emergency Responder (ER)
The Emergency Responder role is intended to become the new minimum standard for first aid provision at medium and large events. Emergency Responders are trained and equipped to provide care at licensed events, events with higher crowd density and higher associated risk (e.g. stadia, concerts). The qualification that underpins this role is the Level 3 Award for First Responders On Scene (Emergency Responder). St John Ambulance has based the scope of practice for this role on the Advanced First Aider competencies, including basic life support, with bag valve mask ventilation and basic airway adjuncts (e.g. orpharyngeal and Nasopharyngeal airways), use of oxygen and nitrous oxide, catastrophic bleed management, patient assessment skills, measuring physiological parameters (e.g. blood pressure, blood glucose, oxygen saturation), extrication using carry sheet and carry chair, along with additional skills and knowledge such as Ten Second Triage. Emergency responders are also intended to be able to administer over-the-counter medicines, such as paracetamol, and give Penthrox analgesia for trauma-associated pain. The pathway for new volunteers to train to Emergency Responder is ten days in the classroom.

Ambulance crew roles
First Aiders and Emergency Responders are neither trained nor permitted to crew ambulances, but they may apply to train for one of two ambulance crew qualifications: Ambulance Care Assistant and Emergency Ambulance Crew.

Ambulance Care Assistant (ACA)
Ambulance Care Assistants are able to crew ambulances in response to low acuity and non-emergency calls only. St John Ambulance retains a very small number of ACA volunteers and staff, primarily centred around a geographic need to fulfil urgent care and hospital discharge contracts. The scope of practice is roughly equivalent to that of an Emergency Care Assistant or Ambulance Support Worker, although ACAs are not deployed in an emergency setting. The role is not being actively recruited into.

Emergency Ambulance Crew (EAC)
Emergency Ambulance Crew (EAC) is the highest and most time-intensive clinical role available to volunteers in St John Ambulance and is the minimum qualification required to crew an emergency ambulance for the charity. Through its NHS Ambulance Auxiliary work, St John Ambulance hopes to establish EAC as a "professional volunteering" role similar to that of volunteer Special Constables, Retained Firefighters or RNLI crews. EACs are required to volunteer a minimum of 240 hours each year to ensure a baseline of clinical exposure and to help maintain current practice and competency.

In 2020, St John Ambulance withdrew all of its legacy ambulance roles and training suites and undertook a period of retraining and assessment of existing ambulance volunteers. Senior charity leaders felt that the legacy roles were no longer competitive and had become less relevant to the ambulance sector since their development in the early-mid 2000s. The roles of Emergency Transport Attendant (ETA), Emergency Medical Technician (EMT) and Emergency Care Technician (ECT) were poorly differentiated from AFA, lacked contact time in the classroom and did not incorporate skills and competencies that would typically be expected of an ambulance clinician. These roles were all superseded with the new Emergency Ambulance Crew (EAC) role in 2020. Ambulance crews that wished to move to the new role were required to attend upskill training, complete classroom-based assessments and produce a written portfolio of evidence.

EAC training, open only to existing volunteers, takes the form of a part-time training program delivered over six months. A small number of paid staff are also trained to the same standard to provide an organisational personnel baseline to fulfil core NHS and specialist contracts. The Emergency Ambulance Crew training program encompasses a combination of classroom and distance learning alongside practical assessments, around sixty hours of "third crew" shifts (ambulance shifts undertaken alongside two qualified SJA EACs, intended to facilitate learning and development in a real ambulance setting), written exams and a portfolio. The course content is intended to equip EACs with the skills and knowledge to respond to 999 calls and medical emergencies at events. The course content includes in-depth patient assessment skills, intermediate life support for all age groups, medical gases administration (oxygen and nitrous oxide), airway management (including supraglottic devices and waveform capnography), trauma care, obstetrics, paediatrics, major incident response, life-saving medications administration (e.g. adrenaline, naloxone, salbutamol, glucagon, hydrocortisone, ipratropium), Penthrox analgesia, 12-lead ECG acquisition and recognition of gross abnormalities and arrythmias (including STEMI). Once qualified, EACs must spend a minimum of twelve months (six months for paid staff) as Newly Qualified Emergency Ambulance Crew (NQEAC) with restrictions on crewing combinations before being allowed to practice autonomously.

Unlike most organisations (and somewhat controversially in the ambulance sector), St John Ambulance has not yet adopted an industry-recognised, accredited qualification for its ambulance roles. The EAC course has been internally developed by St John Ambulance and is not listed on the Regulated Qualifications Framework (RQF). The course is loosely based upon Associate Ambulance Practitioner (AAP) and Emergency Medical Technician (EMT) competencies and skills, but doesn't use the same learning objectives, assessment criteria or total qualification time (TQT) as the Level 4 Diploma for Associate Ambulance Practitioners (L4DAAP), which is widely accepted as the standard qualification for non-registered ambulance clinicians.

The lack of a regulated qualification means that the transferability of the EAC qualification has proved challenging for the charity and there are differing views on which level the role should operate at. The Health Practice Associate Council (HPAC) (an independent, non-affiliated register for medical providers) places the qualification in the Emergency Care Assistant category. In contrast, the charity's own clinical governance documents and deployment policies state that they consider the role and scope of practice of EAC to be similar to that of an AAP/EMT.

When deployed by St John Ambulance at events, EAC crews are equipped and deployed in the same manner as an AAP/EMT. Lack of a directly transferable qualification also means that each NHS Ambulance Trust has had to reach its own conclusion on the equivalence and comparability of EAC to established NHS clinical grades. Some NHS Ambulance trusts choose to deploy EACs at the grade of Emergency Care Assistant (thereby restricting the call types they are dispatched to) while others deploy EACs in the same manner as AAPs/EMTs. This means that the utilisation of EACs as part of the ambulance auxiliary contract varies widely across England, but in both of these deployment settings the Care Quality Commission found that EACs provide safe and effective care in their communities.

In order to remain operational, EACs must provide annual evidence of regular patient contact, mandatory training and advised to complete Continued Professional Development (CPD) in order to be deemed safe and competent. This is measured through maintenance of a portfolio of evidence, including reflective practice and appraisals, classroom-based assessment of Intermediate Life Support (ILS) competencies (adult, child and neonate) and scenario based assessments, completion of an observed "ride-out" with a team leader and completion of annual training packages. Each EAC (unless a registered Healthcare Professional or NHS Trust AAP) must also complete a minimum of 240 hours per year in their ambulance role.

Emergency response driver 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. The charity employs its own in-house DERADI-qualified trainers to deliver this, as well as operating a commercial training venture for NHS Ambulance Services and partner organisations. A small number of RoSPA/IAM response drivers are still operational with the charity, but work is ongoing to ensure organisation-wide compliance with the proposed amendments to Section 19 of the Road Safety Act 2006.

Other specialist roles
In addition to the clinical training offered, members have the opportunity to carry out other operational roles. These include event planning, event management, radio communications/control, plus other support roles.

Healthcare professionals
Qualified healthcare professionals may also volunteer with St John Ambulance, including nurses, paramedics, physiotherapists and doctors. Professionals can carry out any skill appropriate to their type and level of training and competence. HCPs are managed by specialists within their area and are supported with relevant CPD and annual professional appraisals. St John bases operational deployments of HCPs on the individuals' skills and expertise, and assigns professionals to a "pillar of practice" to define their scope of practice in the PHEM environment. These pillars are "Health Care", "Urgent Care", "Emergency Care" and "Critical Care"; this is viewed as a sliding scale, with the highest complexity and highest risk skills being restricted to the emergency care and critical care roles. By default, paramedics are placed in the emergency care pillar and only PHEM specialists (e.g. HEMS doctors and paramedics) may be placed in the critical care pillar. An individual's pillar of practice may change as their career and experience develops. The charity has also developed a suite of Patient Group Directives (PGDs) to enable administration of relevant medications by nurses and paramedics. Healthcare professionals wear coloured rank slides to distinguish them from internally trained first aiders and ambulance personnel.

Youth
St John Ambulance teaches first aid to thousands of young people, through programmes including Badgers (for seven- to ten-year-olds), Cadets (ten- to seventeen-year-olds), Student Volunteering Units (based in colleges and universities) and RISE, a specialist project aimed at those not in education, employment or training. Cadets volunteer alongside their adult counterparts on events.

In 2013, 91,000 schoolchildren were trained in first aid by St John Ambulance's schools team, and the organisation made training materials for schools available to download for free from its Teach the difference website.

In 2014, the organisation launched The Big First Aid Lesson, a free first aid lesson, which was streamed live into classrooms across England. 32,384 students took part in the inaugural event. Events took place the following three years. The Big First Aid Lesson was not held in 2018, to allow the team to focus on promoting first aid as part of the national curriculum.

Super Badger Award
St John Ambulance Badgers work towards the "Super Badger Award". This award consists of members completing 12 subjects, such as "Creative", "Global" and "Wild" Badger. The award is split into five sections, where Badgers advance through completing more subjects. Badgers who achieve their Super Badger receive a ceramic trophy of Bertie Badger, the Badger mascot, dressed in the original Badger uniform. The programme was reviewed and redesigned in 2016, and the new version launched in 2017, coinciding with the 30th anniversary of the formation of Badgers.

Grand Prior's Award scheme
The Grand Prior's Award is the primary award designed for Cadets. The award consists of the completion of 16 subjects throughout Cadet membership, until the age of 18. The programme started being reviewed and updated in early 2017 and was released in mid-2021.

Amalfi Challenge
The Amalfi Challenge was open to all Cadets and adult volunteers aged 16 to 25. The structure of the award involved goals set by the individual themselves, and undertaking tasks categorised into service, relationships, society and challenge, with the Amalfi Award being achieved by completing 12 such tasks. The Amalfi Challenge is discontinued in England.

The Sovereign's Award
The Sovereign's Award is given to young St John Ambulance volunteers in recognition of outstanding work in the areas of personal development, benefit to St John, and benefit to their community. It is awarded to a maximum of ten people worldwide each year. The award is presented at the Young Achievers' Reception hosted by Anne, Princess Royal, Commandant-in-Chief for Youth. The event is also attended by the National Cadet of the Year for England and the Islands, National Cadet of the Year for Cymru Wales, Regional Cadets of the Year from England and the Islands, Deputy Cadet of the Year for Cymru Wales, District Cadets of the Year and nominated young people, aged 7–17.

Student volunteering units
St John Ambulance units dedicated to meeting the needs of student and university communities can be found at many institutes of higher education across England. These units, formerly known as LINKS units, were originally established at universities to form a "link" between Cadets and adult volunteering, allowing people to stay affiliated to the organisation and maintain their skills while in higher education. However, student volunteering units have become integral parts of the student community and the 90% of their members are new to St John Ambulance at the point of joining.

Youth leader training
The training for those delivering Youth Services comprises emergency life support training, coupled with training from the organisation's youth leader training suite including Essential skills in youth work and Leadership skills in youth work, depending on the volunteer's role.

Raising of awareness and campaigning
St John Ambulance campaigns to raise awareness of the importance of first aid, and equip more people with life-saving skills. Its 2013 Save the Boy campaign, demonstrating how to put a casualty in the recovery position, reached 15 million people through television and online media.

In January 2015, it launched a new campaign, The Chokeables, designed to teach parents how to treat a choking infant. The animated film featured the voices of actors John Hurt, David Walliams, Johnny Vegas and David Mitchell.

During the annual Save a Life September campaign, St John Ambulance trainers hold free first aid demonstrations in public spaces around the country, handing out first aid guides to attendees. A free first aid app for smartphones is also available to download.

Between 9–16 October 2018, St John Ambulance was involved in the promotion of Restart A Heart Day 2018, overseen by the Resuscitation Council UK, on behalf of the European Resuscitation Council and the International Liaison Committee on Resuscitation. St John Ambulance and partner organisations trained over 200,000 people in emergency resuscitation during the two weeks.

In 2022 St John Ambulance partnered up with BBC Radio Manchester following the inqury into the Manchester Arena bombing. St John volunteers provided free emergency first aid awareness to the public throughout Manchester, and between May and December over 16,000 members of the public were trained in a life saving skill.

First aid and medical equipment 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 consumables, training equipment, publications, health and safety equipment and clothing. 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. It is now a major commercial operation supplying to the public, private and voluntary sector. The store is now only available online.

Vehicles
Originally, individual divisions of St John Ambulance were responsible for providing their own vehicles. These have taken many and varied forms, beginning with horse-drawn ambulances. Even into the late twentieth century, with some centralisation of control and classification of vehicle types such as Motor Ambulance Units (the title arising historically as a distinction from horse-drawn units), First Aid Posts and Rapid Deployment Vehicles, there remained within the organisation an enormous range of deployed vehicles of different types and even assorted local vehicle liveries. Some ambulances were donated second-hand from industrial plants, some were purchased (from different suppliers) and some were local conversions of commercial vehicles. At the start of the twenty-first century, new legislation regarding emergency ambulances effectively rendered a significant proportion of the then-current St John Ambulance fleet redundant. The solution was the development of a specialist St John Ambulance vehicle, which was designed jointly by the organisation and vehicle manufacturer Renault. The result was the Crusader 900 ambulance.

An early assessment suggested that 100 of the Crusader ambulances (costing, at that time, £40,000 each) would be required immediately, representing an investment of £4million. In 2000, St John Ambulance committed itself to raising £2million by public subscription, whilst English and Welsh Freemasons committed a further £2million, supplying 50 Crusader ambulances which were handed over in local ceremonies across the country during 2000 and 2001. This very large donation allowed the rapid transformation of the national St John Ambulance fleet of front-line ambulances within a much shorter time-scale than could otherwise have been possible. Subsequently, many local Provinces of Freemasons have maintained relations with their local St John Ambulance County units and supported the running costs of these vehicles or even donated further (additional) Crusader ambulances.

By 2004, the national St John Ambulance emergency vehicle fleet was in a standard corporate livery, with standard vehicle types:
 * Crusader – a front-line emergency ambulance, based on the Renault Master (or similar);
 * 4x4 ambulance – a four-wheel drive emergency ambulance, based on the Nissan Patrol (or similar), but with additional headroom, for rural and off-road deployment;
 * Support vehicle – either based on a van, car or a 4x4 vehicle, Support Units can be used for a variety of purposes. For instance, a Support Car may be used to carry members to and from duties, in a logistical capacity, or even as a response vehicle on larger duties. Support Vans are normally used only for logistical purposes. Mini-buses are also available and can be used for logistics or the transport of members.

Fleet refresh strategy
In 2020, St John undertook a review of its fleet capabilities and developed a fleet refresh strategy. Many older vehicles were retired from service with a gradual replacement with newer models based on the MAN TGE 3.5-tonne chassis. Box-body and AWD variants of the MAN ambulance were introduced in late 2020, in a new, green livery style. , the organisation has 250 vehicles in its fleet. By 2023, all "Crusader-era" vehicles had been retired from the fleet, to be replaced by MAN TGE builds.

Specialist vehicles
St John Ambulance also maintains specialist response options in particular locations, such as Cycle Response Units, control and command units, as well as larger vehicles or trailers used as static first aid posts.

Regional structure
In 2012, St John Ambulance was reorganised into a regional structure, to increase accountability and maximise charitable outputs. Previously the organisation had been divided into 42 semi-autonomous county organisations.

As part of the reorganisation, a more streamlined structure was introduced, with fewer layers of management between the front-line and the St John Ambulance board.

St John Ambulance regions
The four regions are:
 * East – East of England and East Midlands
 * London & South – London and the South East
 * North – North East, North West and Yorkshire and the Humber
 * West – West Midlands and South West

Each region is managed by a paid regional director and is responsible for the delivery of programmes developed and overseen by the national headquarters (NHQ). All regions are accountable to the Care Quality Commission (CQC) and are independently inspected by the CQC against 14 different outcomes, such as care and welfare of people who use the services, cleanliness and infection control and supporting workers.

During regionalisation in 2012, St John Ambulance in Guernsey, Jersey and the Isle of Man became separate from England.

District
Each region is divided into several districts. A district may contain one or more former counties from the previous structure and may only have part of a county in. Each district is managed by a district manager (volunteer), and area managers report to them. District managers are in overall charge of all activities in their district, assisted by the area managers. They have a support team of district specialists in place coordinating functions such as event cover and youth provision, but they have no line management responsibility and report to their respective regional departmental manager. Each district usually contains three to six areas.

Area
Districts are further divided into geographic areas, led by an area manager. Unit managers report to the area manager, and the area manager is in overall charge of the activities of the units in their area, within the boundaries of policies, etc., set by regional and national headquarters. They are assisted and advised by district specialists to provide the day-to-day functions of the organisation, such as training members and covering events. Each area usually contains 8–15 units.

Unit
A unit (formerly a division) is the smallest administrative division of St John Ambulance. Most volunteers are managed within a unit by another volunteer. An adult unit is led by a unit manager, who may have one or more assistant unit managers to assist them. The unit usually has a weekly meeting where members train, practice their skills, and occasionally have visits from guest speakers. Units plan and execute the cover of most of the events requested of the organisation, supported by their area and district managers, district specialists and regional events team. Units are where most people start their time in the organisation. There are two types of youth units: Badger Setts (for ages 7–10) and cadets (for ages 10–18). They are typically based on the same site as an adult unit and are supervised by adult volunteers.

Other types of units exist, such as student volunteering units within universities, cycle response units, other specialised units, and sometimes informal social groups, each with a distinctive command, management or leadership structure. Specialised units are sometimes "virtual units", meaning the unit doesn't regularly meet physically, but instead works over the internet.

Historically, there were ambulance divisions (for men), nursing divisions (for women), ambulance cadet divisions (for boys) and nursing cadet divisions (for girls). No single-sex divisions remain.

Ambulance operations
Whilst all employed and volunteers are assigned a hub, Emergency Ambulance Crew are also seconded to a "Virtual Ambulance Unit" structured around the regional NHS ambulance trust they deploy in support of. Virtual Ambulance Units (VAUs) are managed by a combination of local, district and regional Ambulance Leads who provide managerial advice and support specifically to Ambulance Operations staff due to the nature of the role. CPD, portfolio support and ambulance specific development is managed through the VAU whilst HR pertaining to the individual and event support is managed through the home unit.

Uniform and ranks
St John Ambulance first aid personnel wear a service delivery uniform consisting of a green shirt; black combat trousers; and either a green and black Parka Jacket, a reversible fleece, or green and black softshell jacket with appropriate black footwear. Epaulettes on the shirts vary in colour depending on the profession of the volunteer: Black for first aid personnel, green for registered paramedics, grey for registered nurses, and red for registered doctors. Healthcare professionals' (HCPs) epaulettes do not show specialism such as midwives. Student HCPs wear black epaulettes until they are qualified in their respective profession.

On the service delivery uniform, a role bar is worn to denote the wearer's role in that event. High-visibility two-tone yellow-and-green tabards (accepted to denote medical personnel) are only worn when the risk assessment of the event calls for it.

Badgers wear a branded black polo-shirt and a branded black jumper, where they can wear the badges they earn through the Super Badger programme.

Cadets wear the same uniform as their adult counterparts, though are permitted to wear a brassard on their left arm (during ceremonial processions only; not whilst performing clinical duties) where they are able to show their current/highest Grand Prior Award badge at the top-centre; up to three badges, including duty hours, Duke of Edinburgh Award, Sovereign's Award, national competitions winners badge, Amalfi Challenge (discontinued) or Diana Award (if won for services to St John Ambulance); and the Super Badger award (if achieved) at the bottom of the brassard.

A ceremonial uniform still exists for adult volunteers, consisting of a peaked cap, tailored jacket, white shirt, black trousers, black shoes and a clip-on tie. All rank insignia are worn on the outer layer of the jacket.

British Armed Forces
A section of St John Ambulance, St John Ambulance British Forces Overseas (SJABFO), has British units running where there are a large number of British servicemen and women with their families overseas. These are namely in Cyprus, with units in Germany beginning to close in preparation for the British withdrawal from Germany in 2019. The divisions are directly linked to the UK and national headquarters so that members can transfer to another unit or region/district/area as they would be able to do at home. Cyprus and Germany are a part of St John Ambulance as two districts, unattached to any region, within the organisational structure. The uniform reflects the current service delivery uniform in England.

Volunteers can receive training in the full range of St John Ambulance qualifications.

The overseas forces units (then "divisions") were founded in 1980. They remained very strong for several years, however, as the forces in Germany were reduced many divisions closed. Since the final withdrawal of forces in Germany is expected in the next few years, the role for St John Ambulance will end. However, the two units in Cyprus founded in 1991 will continue to provide a service to the community there.

As well as providing medical cover at events, St John Ambulance British Forces provide first-aid training for people of all ages.

St John Ambulance British Forces Overseas works closely with the German Ambulance Services, particularly the sister organisation, Die Johanniter, in providing first aid and ambulance cover German public events where many British or English Speakers are expected to attend. Members can occasionally be seen on their non-emergency and emergency vehicles responding to public calls. St John Ambulance can also be seen working with Malteser, the German Red Cross and local fire brigades which provide ambulance services. The German Emergency Services also assist St John Ambulance at British events on military areas where many German civilians are expected to attend. With the planned withdrawal of British forces from Germany in 2019, this partnership, in this aspect at least, will be discontinued.

Relations with the Order of St John and other organisations
Although the Order of St John is largely seen as a Christian organisation for historical reasons, St John Ambulance does not restrict membership to, or promote, any particular religion or denomination. Technically, it falls under the sovereignty of the King, and thus is linked to the Church of England; however, this relationship is more tradition than authority, and adult members are not required to pledge allegiance to or support either the monarchy or the Christian faith. Historically, Cadet members pledged to join to the monarch and God, though this is no longer a requirement.

St John Ambulance personnel serve alongside the British Red Cross, whose members also undergo advanced training in first aid and event cover. However, the British Red Cross no longer has an event first-aid (EFA) department due to lack of profit and funding. (The Red Cross EFA department officially closed in March 2020. ) Both organisations' work supports the statutory services in times of civil emergency or crisis. In peacetime, St John Ambulance is senior to the Red Cross. However, in wartime, the Red Cross would become senior due to an agreement with the International Red Cross and Red Crescent Movement.

St John Ambulance, St. Andrew's First Aid of Scotland and the British Red Cross co-author and authorise the official First Aid Manual, the de facto UK guide for emergency first aid.

Response to the COVID-19 pandemic
During the COVID-19 pandemic in England, St John Ambulance equipped their personnel with protective equipment to prevent the spread.

In March 2020, the charity had around 8,500 volunteers available to support alongside the NHS in hospitals. This was trialed the same month, which saw volunteers in NHS hospitals across England including the NHS Nightingale Hospital London.

St John Ambulance announced in January 2021 that their staff would be volunteering to help in the national vaccination program for the Oxford-AstraZeneca vaccine, alongside NHS staff. Training centres were established across the country to train a targeted 30,000 vaccination volunteers. These volunteers would be made up of pre-existing volunteers and newly recruited people, and would be trained to one of the three operational roles.

30,000 vaccination volunteers were recruited and trained between November 2020 and March 2021. Vaccination volunteers were assigned a Vaccination Volunteering Lead (VVL) who served as the volunteer's line manager. The majority of VVLs were volunteers themselves, and were recruited from pre-existing volunteers within the organisation.

The programme was hit by a number of technical problems throughout its operation including using the rostering system GRS, which hadn't been used by the charity before. This ultimately led to many delays to volunteers being able to deploy to vaccination centres, and many didn't continue with the programme after completing their training.

In December 2021, the organisation put out a press release with the aim of encouraging people who had been trained as a vaccination volunteer to return to the organisation, as there had been a significant number of volunteers who had been trained but never completed a shift.

Between July and September 2022, St John Ambulance sought an additional 5,000 Vaccination Volunteers to support the programme. Morale was low amongst the volunteers, who had already been recruited, due to lack of engagement and St John Ambulance volunteers not being utilised in parts of the country.

Due to the decrease in public events throughout 2020, when Event Operations began to restart in 2021, the charity provided additional training for vaccination volunteers to be able to support Event Operations as First Aiders. Following successes at the Great North Run 2021 and Brighton Marathon 2021, the programme was rolled out more extensively, primarily in London, and was informally called the SJA Reserves Programme. Although it never left the pilot phase, the programme trained a significant number of vaccination volunteers to be able to support some of the charity's largest Event Operations including the London Marathon, the Platinum Jubilee of Queen Elizabeth II, and the funeral of Elizabeth II.

By July 2021, volunteers had volunteered over 1 million hours towards the COVID-19 response programme since the beginning of the pandemic, including work in hospitals, responding to NHS 999 ambulance calls and on the vaccination programme. The organisation's involvement with the vaccination programmes ended on 31 March 2023, having delivered 1.7 million hours to the overall Covid response.