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Background UK ambulance services attempt resuscitation on over 30 000 patients annually, but also receive 999 calls where the call assessor determines verification of death is the appropriate care pathway. In a quality improvement project for the Quality End of Life Care for All (QELCA) programme, we reviewed those cases where death is recognised during the 999 call.Methods We reported all cases with Pathways codes Dx020, Dx116 and Dx91 (expected and unexpected deaths), where death was recognised during the 999 call, from 1st February 2024 to 31st January 2025 for a single English NHS Ambulance Trust. We then performed retrospective case review on a 10% sample of patients attended by emergency ambulance, to understand whether the patients were recognised as being at their end of life before the 999 call, and whether other services had been contacted.Results 811 patients over the 12-month period received Hear and Treat care and were referred to primary care services for verification of death without an emergency ambulance being dispatched. These patients had a median age of 78 (range 20-103).919 patients received See and Treat care, having an emergency ambulance dispatched to verify death already recognised in the 999 call. They had a median age of 76 (range 13-104), a median response time of 14 minutes (90th centile: 146 minutes), and median scene time of 105 minutes (90th centile: 166 minutes). 145 patients had more than 1 resource attend. Of 92 sampled See and Treat callers, 20 (22%) were known to be end of life, and 2 (2%) were known to have called another service before 999.Conclusion 999 calls for verification of death are resource-intensive and may incur long delays for bereaved families. There is opportunity to optimise the verification process for both expected and unexpected deaths in the community.