Fewer 999 callers will be attended by an ambulance and go to A&E under plans announced by the government.
Ambulances will not be sent to all 999 calls
Instead people may be dealt with over the phone, or treated at home by a new breed of "super paramedics", trained to the same level as a senior nurse.
The recommendations were made by London Ambulance Service chief Peter Bradley in a report for the government.
He said the changes could mean around one million fewer people in England going to A&E.
Four million people are currently taken to hospital by ambulance after 999 calls each year, and the service in England costs around £1.2bn pounds to run.
The Department of Health said any money saved from the introduction of the five-year plan would be ploughed back into other parts of the NHS.
Recommendations in the report will also mean that all trusts 'start the clock' for calculating response times when the 999 call is received, ending discrepancies in assessing calls which saw up to 14 different start points in the 31 English ambulance trusts.
The most serious Category A calls should still be responded to within eight minutes, whether a traditional ambulance crew or a 'super-paramedic' attends, the report recommends.
The maximum response time for Category B calls, now 14 minutes in urban areas, and 19 elsewhere, will be 19 minutes for all trusts.
The new breed of paramedics - emergency care practitioners (ECPs) - will have greater powers to refer patients to GPs or social services, eradicating the need to go to A&E.
Patients, such as elderly people who have had a minor fall, will be treated at home.
Ambulance staff will also be trained to carry out checks such as blood tests in patients' homes.
There are currently 600 ECPs working in England, but the numbers are set to rise under the proposals.
In addition, more 999 callers will be dealt with over the phone.
Just over half of the 11m calls a year which ambulance trusts receive are already dealt with this way.
The service is not currently integrated with the NHS Direct helpline, but health minister Lord Warner said how patients accessed NHS care would be addressed in the public consultation process which was recently announced.
He added: "People, by and large, would prefer to avoid a hospital visit, most would prefer to receive treatment at home.
"We are spending around £1.2 billion a year on ambulance services, and this report makes it absolutely clear there is scope for efficiency savings to be made."
But he said: "This is not a reduction in services or a reduction in the quality of services. It's an improvement.
"We can save one million people a year from going to A&E."
And he said the introduction of people carriers, as well as motorbikes in some areas, to respond to calls would not mean there would be fewer traditional ambulances.
"There is no plan to reduce the number of fully equipped ambulances, let's be crystal clear."
Peter Bradley said: "There are a huge number of people who require help but don't need it within eight minutes."
Mike Summers, chairman of the Patients Association, agreed: "The elderly in particular don't want to go in an ambulance and wait in A&E for four hours."
But Mark Weatherhead, General Secretary of the Association of Ambulance Personnel, questioned what role the 'super-paramedics' would really perform.
He questioned whether the ECPs would simply be a "substitute rather than a supplement" to the existing service.
Shadow health secretary Andrew Lansley said the review was a "missed opportunity" for better integration of emergency services.
Steve Webb, Liberal Democrat health spokesman said the motive for changing services must be giving people better treatment, "not cost cutting".