This study explores how ambulance pre-alert calls impact patient care in UK emergency departments (EDs). Through observations and interviews with ED staff, the research reveals that while pre-alerts require significant resources, they help staff prepare for incoming patients. However, delays and high demand can lead to excessive pre-alerts, risking fatigue. Variation in responses is influenced by available resources and unclear processes for managing pre-alert information. Recommendations include improving communication and offering alternative advice routes for ambulance clinicians.