More meat?
The Royal College of Surgeons recommended regional trauma centres supported by a network of air ambulances way back in 1988, so its by no means a new idea.
Whilst it seems some bodies in the UK could see the systemic changes required, the Continent went about implementing them. I was fortunate enough to visit and study several HEMS programs whilst fine tuning our own. That included Germany (Border Poice, ADAC), Austria (OAMTC), Switz (REGA and Air Zermatt), and Norway (Norsk LuftAmbulanse or "NOLAS").
Although all are similar, Germany is probably the easiest to understand: they have set up a network where almost the entire country is within 15mins of a trauma helicopter. The helicopter is crewed by a doctor, a pilot, and a paramedic/crewman. They fly from the accident site to the most appropriate specialist hospital for the injuries sustained.
London HEMS have collected an enormous amount of pre hospital data that clearly indicates the benefit of early physician intervention in severe trauma, and in particular for penetrating traumas. Whist this data can only be compared "retrospectively" it is almost overwhelming.
Norway also add chest pains to their response triggers! They are nearing the end of a retrospective study that indicates getting doctor level care and the right drugs to chest pain patients changes the average stay in intensive care for such patients from 9 weeks down to less than two. Completion of this study has the potential to demonstrate 30 minutes of a doctor's time pre hospital, and a helicopter response, saves up to 7 weeks of an intensive care bed space!
Here in Australia, we are substantially through a Head Injury Retrieval Trial (HIRT) whose aim is to prove/disprove the benefit of rapid doctor/paramedic team intervention in the pre-hospital environment. For the first time in pre hospital trauma research, the study is completely randomised (not retrospective, i.e. there is a control group who are not responded to, and a trial group who are responded to) and it should provide some outcomes that accountants may just have to listen too.
HIRT operates in a small area in and around Sydney in which there is expected to be between 40 and 80 severe head injuries p.a., each of which is going to cost the health system between AUS4M and $10M, with the odd case going far higher (a recent payout cost was $22M for a single patient!!!) Lets put aside the enormous social (family in particular) costs of such injuries for a moment, without ever forgetting them in this discussion, and consider financial aspects alone. HIRT takes approx $4.5M p.a. to run. Therefore successful intervention on just one patient per year systemically "pays" for the year of responses. That means that the other 450 or so severe trauma responses are "free" to the system - even though you are using a doctor and a helicopter.
Once these two studies are complete and London HEMS gets some time to definitively publish their data - you may find yourself with more meat than a small AA system can chew off. Perhaps the intuitive outlook of subject matter experts in 1988 may be worth listening to after all...???