I had the pleasure of setting up the UK's first AA in 1986/7 so perhaps can shed some light on the deliberations we went through to justify the concept.
When I was doing the basic research in the autumn of 1986 I went to the Chief Officer (Len Holden) of what was then my nearest Ambulance Service - Cornwall - to gather inside information rather than tackle the 5 Chief Officers that managed the services in what was our original target base - Staverton (20 minute radius of Staverton covers 5 independent areas). Len asked me to consider Cornwall as the target base because they desperately needed a solution to what was a dual problem. One was logistical and the other clinical. The quality of care delivered by CAS was, by today's standards, poor given that the concept of the paramedic was in its infancy in the UK and they had no formally qualified paramedics but did have a programme to introduce what were called 'extended trained' ambulancemen some of whom had paid for their own training.
The NHS resources the ambulance services of the time on a 'per capita' basis thus we had a large rural (comparitively) underpopulated area that had very meagre resources compared with the land area to be covered. Also, as a peninsular we had just one neighbour (Devon) to help out at the perimeter of our area and of course we had just one General Hospital with a fully equipped A&E in Truro. We bandy about the question of response times without bearing in mind that the invisible part of the equation (that is never measured and analysed) is the time taken to deliver the patient to hospital and return the ambulance to normal service. In those days there was no telephone-triage so literally every call was answered by a fully equipped Emergency Ambulance and valuable, well trained crews, would spend many hours out of the loop with what we would consider as non-emergency cases today.
The Air Ambulance offerred the prospect of being able to assist with any and all situations, major and minor, as long as it contributed to the overall efficiency of the organisation. It also meant that the few highly trained crews available could be deployed county-wide. I hate to think of the number of times I sat in control during the months preceding our start-up and watched as one by one, in a completely random way, the ambulances disappeared from our state-board as they responded to the various 999 calls and we were literally left completely devoid of any ability to react. We would agonise with fingers crossed as eventually the resources came back on-line and we could breath again. Nobody keeps those statistics but if they did they would realise just what a powerful tool the AA is. I wish we had made a note of every time the only asset available was the AA for that kind of statistic is NEVER revealed for if the people of the UK knew just how often their ambulance services had run out of resources they would be up in arms. When it does come to public notice it makes the headlines but the one asset never discussed is how much we depend on Lady Luck to cover our arses.
People seem to get up-tight about carrying non-urgent patients in the AA but you have to bear in mind that the next call, the one the road crew miss, maybe a heart attack that a local crew could have responded quickly to but now, instead, they are on a long trip to hospital (1.5 hours worst case) with a minor injury. This could take the asset out of service for half a shift (4 hours) whilst it delivers the patient, re-stocks and returns (no blues and twos) to its operating area.
We developed 3 levels of mission. Primary (direct to mission site), Secondary ( rendezvous with ambulance, relieve them of the patient and deliver same to hospital. We could do in 10 or 15 minutes what would have taken far far longer). Tertiary (inter-hospital transfer).
When we make bold statements like 'we saved a life' we often need to modify that to 'we were part of a team that saved a life' but I, like Griffo, remember a few cases where the AA made it possible for that team to have the chance to save a life and without the AA the patient would not be here today.
My plea is not to get hung-up on response times or even outcomes because this approach never considers the overall logistical contribution to the overall effort and the fact that the reason why the road crew were able to save a life was because the AA had made it possible for them to be there and not heading for a far off A & E with a non-urgent patient. The fact is that an Ambulance Service WITH an AA is better placed to win the battle than one WITHOUT.
G
