diff --git a/resources/views/care/partials/queue-board-card.blade.php b/resources/views/care/partials/queue-board-card.blade.php
index 0cfe04a..614c27b 100644
--- a/resources/views/care/partials/queue-board-card.blade.php
+++ b/resources/views/care/partials/queue-board-card.blade.php
@@ -6,6 +6,9 @@
 
   Open (view workspace / form) is available whenever a destination URL exists —
   not gated by canConsult. Start / Call again remain consult-manage only.
+
+  Layout: stacked — badges on top, patient info in the middle, actions in a
+  footer row — so narrow board columns never squeeze text under buttons.
 --}}
 @php
     $stage = $stage ?? 'waiting';
@@ -13,6 +16,10 @@
     $isCalled = in_array($ticketStatus, ['called', 'serving'], true);
     $openUrl = isset($openInCareUrl) ? $openInCareUrl($appointment) : null;
     $canConsult = $canConsult ?? false;
+
+    $canRecall = ! empty($queueIntegration['enabled']) && $appointment->queue_ticket_uuid && $isCalled && $canConsult;
+    $showStart = $canConsult && ($stage === 'waiting' || $stage === 'called');
+    $hasActions = $openUrl || $canRecall || $showStart;
 @endphp
 <article
     @if ($openUrl)
@@ -23,15 +30,15 @@
         onkeydown="if ((event.key === 'Enter' || event.key === ' ') && ! event.target.closest('a, button, form, input, select, textarea, label')) { event.preventDefault(); window.location.href = this.dataset.href }"
     @endif
     @class([
-        'group relative flex gap-3 rounded-xl border px-3 py-3 transition',
+        'group relative flex flex-col rounded-xl border transition',
         'cursor-pointer hover:shadow-sm' => (bool) $openUrl,
         'border-indigo-200 bg-indigo-50/70 ring-1 ring-indigo-100' => $stage === 'called' || ($stage === 'waiting' && $isCalled),
         'border-emerald-200 bg-emerald-50/60' => $stage === 'in_care',
-        'border-slate-100 bg-slate-50/80' => $stage === 'waiting' && ! $isCalled,
-        'border-slate-100 bg-white opacity-90' => $stage === 'done',
+        'border-slate-200 bg-white' => $stage === 'waiting' && ! $isCalled,
+        'border-slate-100 bg-white opacity-80' => $stage === 'done',
     ])
 >
-    <div class="min-w-0 flex-1 space-y-1.5">
+    <div class="min-w-0 space-y-2 px-3 pt-3 {{ $hasActions ? 'pb-2.5' : 'pb-3' }}">
         @if (! empty($queueIntegration['enabled']) && $appointment->queue_ticket_number)
             @include('care.partials.queue-ticket', [
                 'ticketNumber' => $appointment->queue_ticket_number,
@@ -39,12 +46,12 @@
                 'destination' => $appointment->queue_destination,
                 'staffDisplayName' => $appointment->queue_staff_display_name,
                 'showAssignment' => $stage !== 'in_care' && $stage !== 'done',
-                'prominent' => true,
+                'prominent' => false,
             ])
         @elseif (! empty($queueIntegration['enabled']) && ($appointment->queue_routing_status ?? '') === 'unresolved')
             <span class="inline-flex rounded-md bg-amber-100 px-2 py-0.5 text-[10px] font-semibold uppercase tracking-wide text-amber-800">Unassigned</span>
         @elseif ($appointment->queue_position)
-            <span class="inline-flex h-8 min-w-[2rem] items-center justify-center rounded-lg bg-slate-200/80 px-2 font-mono text-sm font-bold text-slate-700">{{ $appointment->queue_position }}</span>
+            <span class="inline-flex h-6 min-w-[1.75rem] items-center justify-center rounded-md bg-slate-100 px-1.5 font-mono text-xs font-bold text-slate-600">{{ $appointment->queue_position }}</span>
         @endif
 
         <div class="min-w-0">
@@ -65,45 +72,35 @@
         </div>
     </div>
 
-    <div class="relative z-10 flex shrink-0 flex-col items-end justify-center gap-1.5" @click.stop>
-        @if ($stage === 'waiting' || $stage === 'called')
-            @if (! empty($queueIntegration['enabled']) && $appointment->queue_ticket_uuid && $isCalled && $canConsult)
+    @if ($hasActions)
+        <div class="relative z-10 flex items-center justify-end gap-1.5 border-t border-slate-900/5 px-3 py-2" @click.stop>
+            @if ($canRecall)
                 <form method="POST" action="{{ route('care.queue.recall', $appointment) }}">
                     @csrf
-                    <button type="submit" class="rounded-lg border border-indigo-200 bg-white px-2.5 py-1 text-[11px] font-medium text-indigo-700 hover:bg-indigo-50">Call again</button>
+                    <button type="submit" class="rounded-lg px-2 py-1 text-xs font-medium text-indigo-700 hover:bg-indigo-100/60">Call again</button>
                 </form>
             @endif
-            @if ($canConsult)
+            @if ($openUrl)
+                <a href="{{ $openUrl }}" @class([
+                    'rounded-lg px-2.5 py-1 text-xs font-semibold',
+                    // Primary when it is the only meaningful action on the card.
+                    'bg-emerald-600 text-white hover:bg-emerald-700' => $stage === 'in_care',
+                    'bg-indigo-600 text-white hover:bg-indigo-700' => ! $showStart && $stage !== 'in_care' && $stage !== 'done',
+                    'text-slate-600 hover:bg-slate-100' => $stage === 'done' || ($showStart && $stage !== 'in_care'),
+                ])>Open</a>
+            @endif
+            @if ($showStart)
                 <form method="POST" action="{{ route($startRouteName, $appointment) }}">
                     @csrf
                     <button type="submit" @class([
-                        'rounded-lg px-2.5 py-1.5 text-xs font-semibold text-white',
+                        'rounded-lg px-2.5 py-1 text-xs font-semibold text-white',
                         'bg-indigo-600 hover:bg-indigo-700' => $isCalled,
-                        'bg-slate-800 hover:bg-slate-900' => ! $isCalled,
+                        'bg-slate-900 hover:bg-slate-800' => ! $isCalled,
                     ])>
                         {{ ! empty($queueIntegration['enabled']) && $ticketStatus === 'called' ? 'Serve & start' : 'Start' }}
                     </button>
                 </form>
             @endif
-            @if ($openUrl)
-                <a href="{{ $openUrl }}" @class([
-                    'rounded-lg px-2.5 py-1.5 text-xs font-semibold',
-                    'bg-indigo-600 text-white hover:bg-indigo-700' => ! $canConsult,
-                    'border border-slate-200 bg-white text-slate-700 hover:bg-slate-50' => $canConsult,
-                ])>Open</a>
-            @endif
-        @elseif ($stage === 'in_care')
-            @if (! empty($queueIntegration['enabled']) && $appointment->queue_ticket_uuid && $isCalled && $canConsult)
-                <form method="POST" action="{{ route('care.queue.recall', $appointment) }}">
-                    @csrf
-                    <button type="submit" class="rounded-lg border border-indigo-200 bg-white px-2.5 py-1 text-[11px] font-medium text-indigo-700 hover:bg-indigo-50">Call again</button>
-                </form>
-            @endif
-            @if ($openUrl)
-                <a href="{{ $openUrl }}" class="rounded-lg bg-emerald-600 px-2.5 py-1.5 text-xs font-semibold text-white hover:bg-emerald-700">Open</a>
-            @endif
-        @elseif ($stage === 'done' && $openUrl)
-            <a href="{{ $openUrl }}" class="rounded-lg border border-slate-200 bg-white px-2.5 py-1.5 text-xs font-semibold text-slate-700 hover:bg-slate-50">Open</a>
-        @endif
-    </div>
+        </div>
+    @endif
 </article>
diff --git a/resources/views/care/specialty/ambulance/dispatch-card.blade.php b/resources/views/care/specialty/ambulance/dispatch-card.blade.php
index e15438b..708911e 100644
--- a/resources/views/care/specialty/ambulance/dispatch-card.blade.php
+++ b/resources/views/care/specialty/ambulance/dispatch-card.blade.php
@@ -1,4 +1,8 @@
-{{-- Single EMS call card on the ambulance dispatch board. --}}
+{{--
+  Single EMS call card on the ambulance dispatch board.
+  Stacked layout: ticket badge, patient info, then an action footer —
+  narrow columns never push buttons over the text.
+--}}
 @php
     $appointment = $visit->appointment;
     $patient = $visit->patient;
@@ -8,6 +12,7 @@
     $nextStage = $column['next_stage'] ?? null;
     $nextLabel = $column['next_label'] ?? null;
     $isCompleted = ($column['key'] ?? '') === 'completed';
+    $showAdvance = $canAdvanceStage && $nextStage && $nextLabel;
 @endphp
 <article
     role="link"
@@ -16,25 +21,39 @@
     onclick="if (! event.target.closest('a, button, form, input, select, textarea, label')) { window.location.href = this.dataset.href }"
     onkeydown="if ((event.key === 'Enter' || event.key === ' ') && ! event.target.closest('a, button, form, input, select, textarea, label')) { event.preventDefault(); window.location.href = this.dataset.href }"
     @class([
-        'group relative flex gap-3 rounded-xl border px-3 py-3 transition cursor-pointer hover:shadow-sm',
-        'border-amber-200 bg-amber-50/70' => ($column['key'] ?? '') === 'check_in',
-        'border-indigo-200 bg-indigo-50/50' => ($column['key'] ?? '') === 'dispatch',
-        'border-sky-200 bg-sky-50/50' => ($column['key'] ?? '') === 'on_scene',
-        'border-violet-200 bg-violet-50/50' => ($column['key'] ?? '') === 'transport',
-        'border-emerald-200 bg-emerald-50/50' => ($column['key'] ?? '') === 'handover',
-        'border-slate-100 bg-white opacity-90' => $isCompleted,
+        'group relative flex cursor-pointer flex-col rounded-xl border bg-white transition hover:shadow-sm',
+        'border-amber-200' => ($column['key'] ?? '') === 'check_in',
+        'border-indigo-200' => ($column['key'] ?? '') === 'dispatch',
+        'border-sky-200' => ($column['key'] ?? '') === 'on_scene',
+        'border-violet-200' => ($column['key'] ?? '') === 'transport',
+        'border-emerald-200' => ($column['key'] ?? '') === 'handover',
+        'border-slate-100 opacity-80' => $isCompleted,
     ])
 >
-    <div class="min-w-0 flex-1 space-y-1.5">
-        @if ($ticketNumber)
-            <span class="inline-flex rounded-md bg-slate-900 px-2 py-0.5 font-mono text-[11px] font-semibold tracking-wide text-white">{{ $ticketNumber }}</span>
-        @endif
+    <div class="min-w-0 space-y-2 px-3 pb-2.5 pt-3">
+        <div class="flex items-center justify-between gap-2">
+            @if ($ticketNumber)
+                <span class="inline-flex rounded-md bg-slate-100 px-2 py-0.5 font-mono text-[11px] font-bold tracking-wide text-slate-700">{{ $ticketNumber }}</span>
+            @else
+                <span></span>
+            @endif
+            <span @class([
+                'h-2 w-2 shrink-0 rounded-full',
+                'bg-amber-400' => ($column['key'] ?? '') === 'check_in',
+                'bg-indigo-400' => ($column['key'] ?? '') === 'dispatch',
+                'bg-sky-400' => ($column['key'] ?? '') === 'on_scene',
+                'bg-violet-400' => ($column['key'] ?? '') === 'transport',
+                'bg-emerald-400' => ($column['key'] ?? '') === 'handover',
+                'bg-slate-300' => $isCompleted,
+            ])></span>
+        </div>
+
         <div class="min-w-0">
             <p class="truncate text-sm font-semibold text-slate-900">{{ $patient?->fullName() ?? 'Patient' }}</p>
             <p class="mt-0.5 truncate text-xs text-slate-500">
                 {{ $patient?->patient_number ?? '—' }}
                 @if ($reason)
-                    <span class="text-slate-300"> · </span>{{ \Illuminate\Support\Str::limit($reason, 40) }}
+                    <span class="text-slate-300"> · </span>{{ \Illuminate\Support\Str::limit($reason, 48) }}
                 @endif
             </p>
             @if ($appointment?->practitioner?->name)
@@ -43,14 +62,14 @@
         </div>
     </div>
 
-    <div class="relative z-10 flex shrink-0 flex-col items-end justify-center gap-1.5" @click.stop>
-        <a href="{{ $openUrl }}" class="rounded-lg border border-slate-200 bg-white px-2.5 py-1 text-[11px] font-medium text-slate-700 hover:bg-slate-50">Open</a>
-        @if ($canAdvanceStage && $nextStage && $nextLabel)
+    <div class="relative z-10 flex items-center justify-end gap-1.5 border-t border-slate-900/5 px-3 py-2" @click.stop>
+        <a href="{{ $openUrl }}" class="rounded-lg px-2.5 py-1 text-xs font-medium text-slate-600 hover:bg-slate-100">Open</a>
+        @if ($showAdvance)
             <form method="POST" action="{{ route($specialtyStageRoute, $visit) }}">
                 @csrf
                 <input type="hidden" name="stage" value="{{ $nextStage }}">
-                <button type="submit" class="rounded-lg bg-slate-900 px-2.5 py-1 text-[11px] font-semibold text-white hover:bg-slate-800">
-                    {{ $nextLabel }}
+                <button type="submit" class="rounded-lg bg-slate-900 px-2.5 py-1 text-xs font-semibold text-white hover:bg-slate-800">
+                    {{ $nextLabel }} →
                 </button>
             </form>
         @endif
diff --git a/tests/Feature/CareQueueBoardPerformanceTest.php b/tests/Feature/CareQueueBoardPerformanceTest.php
index 342af8f..f56d7a6 100644
--- a/tests/Feature/CareQueueBoardPerformanceTest.php
+++ b/tests/Feature/CareQueueBoardPerformanceTest.php
@@ -59,11 +59,12 @@ class CareQueueBoardPerformanceTest extends TestCase
             ],
         ]);
 
+        // Patient queue board is reserved for clinical staff (receptionists are 403'd).
         Member::create([
             'owner_ref' => $this->owner->public_id,
             'organization_id' => $this->organization->id,
             'user_ref' => $this->owner->public_id,
-            'role' => 'receptionist',
+            'role' => 'doctor',
         ]);
 
         $this->branch = Branch::create([
diff --git a/tests/Feature/CareQueueWorkflowTest.php b/tests/Feature/CareQueueWorkflowTest.php
index e135b47..a9d2485 100644
--- a/tests/Feature/CareQueueWorkflowTest.php
+++ b/tests/Feature/CareQueueWorkflowTest.php
@@ -316,6 +316,12 @@ class CareQueueWorkflowTest extends TestCase
     {
         Http::fake();
 
+        // Patient queue is reserved for clinical staff; receptionists are 403'd.
+        Member::query()->where('user_ref', $this->owner->public_id)->update([
+            'role' => 'doctor',
+            'branch_id' => $this->branch->id,
+        ]);
+
         $this->actingAs($this->owner)
             ->get(route('care.queue.index'))
             ->assertOk()