So many facets to this discussion..... there literally could be several threads
First: I am an outsider. Not involved in the UK AA or SAR scene. And not much time to get across the whole discussion, however, I thought since we have some from the US contributing, I might throw a different perspective in. I fully appreciate that what I say may not be reflected in the reality that you guys face in the UK, as I am sure you will understand that some of your "truths" do not apply in my environment.
The thread was initially (and is entitled) about night flights, so I will start with that.
First Big call: Night EMS flights
can be flown as safely, or very nearly as safely as day flights. "Can be" is the phrase, not "are currently", because it depends on which part of the world and where you look for trends.
So we turn to homonculus (are you going to tell us all what the name means and why the spelling?) and his/her constant argument in this and other threads that there is no benefit medically to AA flights. I disagree with this,because UK AA flights are not the only types of AA, and stating that AA flights don't show benefit is to capture all types of AA flights around the world. We use doctors on our AA flights as do most of Europe but not so with the typical Anglo and American models. So I accept that when you say "AA Flights" you are arguing about a slightly different animal from the alternative perspectives such as the one I am proposing here.
I know a lengthy argument about peer reviewed empirical evidence will ensue: however, I believe that the HIRT (Head Injury Retrieval Trial) in Sydney proved that Per Protocol and Treatment Received level evidence clearly indicated a demonstrable benefit, even if Intention To Treat was inconclusive due to contamination by the change to standard care during the trial. So we can go around and around on this and still hold different views at the end.
From my perspective, lets just assume that AA flights do help people, even if there can be disagreement on the empirical evidence at hand. Lets put it more bluntly: your child is trapped by compression and unconscious. Would you prefer (regardless of evidence of benefit):
a. Volunteer medical responder.
b. Ambulance Officer.
c. Paramedic Officer and Ambulance Officer.
d. AA arrives: Emergency/Anesthetic Consultant
and Paramedic
and 2nd Paramedic
and Ambulance Officer.
Anyone NOT choose d? There will be some for the sake of argument on pprune, but really.... I think we would all like d, even in the face of "no peer reviewed evidence".
I would hasten to add that doctors (where trained appropriately) are the key to this proposition. I agree with homonculus and TC, that sending a paramedic only on an AA flight is definately beneficial in terms of getting a pre hospital expert (paramedic) to the scene faste, but it is still a bit "akin to attaching rotors to an ambulance" and upping the costs consequently, and I agree with homonculus, the benefits of this would generally come down to the speed of the scoop and run as no higher level of care will be provided. I am NOT saying that the befit of speed is not tangible as per the inference from homonculus. I think getting a paramedic there more quickly and conveying the patient to hospital more quickly is a great benefit. But if having the paramedic is needed, lets add the doctor (not replace the paramedic). Now, we have an asset that, although expensive, can bring a higher level of clinical care, not just the pre-hospital expertise faster.
Now speed. TC says:
L
et me get this right. You're telling me that a helicopter can respond <20 mins. It can also carry a pilot (possibly 2), crewperson, paramedic and doctor/consultant.
You're telling me that team can perform roadside operations in the open air come rain or shine, day or night. They can then convey the survivor to hospital and bypass the receiving trauma team, pop them on a trolley and whisk them down to the CAT scanner circumventing the A and E team????
What I am about to say may not work in the UK, and may not be safe or applicable. But please accept that it can be done (and has been done) safely elsewhere. During the HIRT (Head Injury Retrieval Trial) in Sydney, NSW, the team was able to respond well within those times, day AND night, and for over 6 years. Typically, they were first on scene in a majority of cases (including even the CBD of Sydney) and recorded an average lift off time of 6 minutes from the phone call. That is, 6 minutes from START of the phone call of the victim, not from the end of the phone call from co-ordination to the helicopter crew.
As consultant level doctors
and the highest level of paramedic training in NSW (this differs throughout the world), they could and did perform a variety of roadside "operations". In the open air. In the rain. At night. And their times at triage in casualty before CT, etc, are demonstrably less, depending on the semantics of the trial outcomes I referred to above. No-one bypasses the receiving trauma or A and E teams, and I think I can excise that from the quote: but I am talking about when a trauma team of significant experience and seniority walks in with a trauma patient, sometimes a team that is equivalent or more experienced than the team at the hospital.... you must accept that that creates a different dynamic at the triage, and a dynamic that will always favour the patient. Imagine if the head of that trauma centre walked in accompanied by the highest level of pre hospital expertise (paramedic) with the casualty because the head of the trauma centre was the doctor on the helicopter. Would that help? A little bit??
So, I accept that my view is based on (and limited by) my experiences - again, I do not know how this translates into the UK environment, but for us, AA flilghts are capable of
being the "golden hour" level of care in many cases, can fly safely at night, and can respond quicker than ground resources even in heavily covered areas, but can respond with a higher level of care than that provided by ground alone. They SUPPLEMENT ground capabilities, they DO NOT replace. And, when they cannot fly, no worries, there is still an extremely efficient ground response that can deal with the problems or scoop and run as per normal.
The above concentrates on pre hospital, however we also perform a significant number of inter hospital flights as well. On one operation of ours, we fly approx 850 hours of inter hospitals per annum, 60% of which is night.
Does the UK system of paramedic or police office/medic system (without redesign) support the notion of AA flights at night in the UK? Not from the discussion above, but if you do want the benefits and you do want the capability to provide those benefits safely by night, there are other ways to do AA that are worth considering. Some of these would and facilitate the safety and the benefits of AA flights experienced elsewhere in the world.
in my opinion
