Airborne medics save lives
I don't know of any AAmb which would launch just to keep the stats up
Last year (or was it the year before) they flew over 50nm to attend a teenager with a broken arm at a weekend rugby match, when there was a Minor Injuries unit just over half a mile away by road! The Ambulance Service didn't ask for them, but it would seem that they heard of the incident and decided that there might be a good opportunity to show themselves off in front of lots of potential donors. Rather pointless, especially when you consider that the hospital the yoof was taken to was 45 mins drive away (handy for the parents!), when he could have been treated in his home town...
This isn't an isolated episode either. One definite benefit of central funding of Air Ambs would be that they wouldn't then feel any pressure to justify their existence by launching to every incident they hear of, no matter how inappropriate that incident may be for them to attend. Don't even get me started on Air Ambs having a go at mountain jobs and then having eventually to admit that they can't get the casualty and calling for SAR, enormously prolonging the casualty's stay on the crag/hillside...
TorqueOTD,
Hmm - I've heard interesting stories from the area in your profile. No definitive evidence to back it up, but if true then they do the rest of the AAmb community no favours with their approach to the task.
It was with this in mind that I made absolutely sure, on a recent task in Yorkshire where people were trapped on a small island in the middle of a river with water rapidly rising, that the SAR folk really weren't available before we started shuttling them to the safety of the riverbank. Swift-water rescue is not something to be taken lightly, we acknowledge SAR as being by far the most effective method. In this case if we'd delayed any longer these folk would've been in grave danger. Just as we finished the last lift a Seaking arrived overhead (task in the Lake District now complete) and orbited a couple of times before heading home. I rang Leconfield after returning from task to make sure they didn't feel put out; very positive response - I also learned that with only 1 VHF box the SK won't always talk on Scene-of-Search if already chatting to ATC. Worth remembering.
Anyway - back to your point. Your example might not be an isolated incident, but I suspect it may be down to just one operation. The operations I've been involved with certainly don't feel the need to flaunt themselves unnecessarily.
Hmm - I've heard interesting stories from the area in your profile. No definitive evidence to back it up, but if true then they do the rest of the AAmb community no favours with their approach to the task.
It was with this in mind that I made absolutely sure, on a recent task in Yorkshire where people were trapped on a small island in the middle of a river with water rapidly rising, that the SAR folk really weren't available before we started shuttling them to the safety of the riverbank. Swift-water rescue is not something to be taken lightly, we acknowledge SAR as being by far the most effective method. In this case if we'd delayed any longer these folk would've been in grave danger. Just as we finished the last lift a Seaking arrived overhead (task in the Lake District now complete) and orbited a couple of times before heading home. I rang Leconfield after returning from task to make sure they didn't feel put out; very positive response - I also learned that with only 1 VHF box the SK won't always talk on Scene-of-Search if already chatting to ATC. Worth remembering.
Anyway - back to your point. Your example might not be an isolated incident, but I suspect it may be down to just one operation. The operations I've been involved with certainly don't feel the need to flaunt themselves unnecessarily.
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I think the problem stems from not singing off the same song sheet, I’ve been dispatched on quite a few HEMS tasks that lay closer to SAR bases than ours and have called Kinloss to suggest that it may be beneficial to send a Seaking. But in the long run it just confuses the whole issue by involving too many chiefs- Ambulance control, Police, RCC, Air ambulance control desks etc etc. and no one seems to have the balls to make decisions regarding helicopters as I’m sure to a control room operator dealing with aircraft it must be quite a major piece on the chess board to handle.. Still it always looks impressive when SAR, air ambulance and Police ASU turn up having been dispatched due to lack of coordination.
As for the suitability of SAR over air ambulances, I’ve also attended many incidents where we have arrived, packaged the patient and left the scene only to hear that a Seaking is inbound to the same incident after it is all over.
Once winches on air ambulances have been introduced and the multi million pound machines start spending more of the day out of the hangar than in (day/night VFR/IMC), I’m sure that emergency services helicopters in Britain will be a very effective force on par with our European counter parts operating in the Alps etc.....
Russell
P.s And before anyone starts harping on about winches again, just think of the flak that must have been encountered by suggesting we take people to hospital by helicopter in the first place, after all you could have a brand new fleet of land vehicles for the price of a helicopter….
As for the suitability of SAR over air ambulances, I’ve also attended many incidents where we have arrived, packaged the patient and left the scene only to hear that a Seaking is inbound to the same incident after it is all over.
Once winches on air ambulances have been introduced and the multi million pound machines start spending more of the day out of the hangar than in (day/night VFR/IMC), I’m sure that emergency services helicopters in Britain will be a very effective force on par with our European counter parts operating in the Alps etc.....
Russell
P.s And before anyone starts harping on about winches again, just think of the flak that must have been encountered by suggesting we take people to hospital by helicopter in the first place, after all you could have a brand new fleet of land vehicles for the price of a helicopter….
Unconflicted - you support the addition of 3 A&E doctors per Air ambulance at a cost of £300k to each charity per year to gain a small benefit for one or 2 patients.
I believe the money would be better spent in other areas of the NHS, regardless of the fact the taxes are supposed to provide these services. The charities could donate funds or sponsor extra posts or provide buildings/renovations where the NHS trusts are overstretched.
It seems the charities are sitting on a huge pile of cash and are looking for ways to spend it quickly so people don't ask questions or stop donating.
The problem with allocating resources based on population is that it doesn't take into account the extra distances involved in less populated areas (the SW for example).
Thud - we have moaned about the avionics fit in the Mk 3 Sea King for years but to no avail - multiband radios are cheap as chips but getting someone in the IPT to fund them is impossible.
I believe the money would be better spent in other areas of the NHS, regardless of the fact the taxes are supposed to provide these services. The charities could donate funds or sponsor extra posts or provide buildings/renovations where the NHS trusts are overstretched.
It seems the charities are sitting on a huge pile of cash and are looking for ways to spend it quickly so people don't ask questions or stop donating.
The problem with allocating resources based on population is that it doesn't take into account the extra distances involved in less populated areas (the SW for example).
Thud - we have moaned about the avionics fit in the Mk 3 Sea King for years but to no avail - multiband radios are cheap as chips but getting someone in the IPT to fund them is impossible.
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As a charity reliant on cash flow, the piles of cash you refer to are cash reserves and are there in the event of a problem with the helicopter requiring an immediate cash solution. These cash reserves prevent the air ambulance being taken off-line due to the unforseen and whilst to the ill informed these funds might seem to be better spent else where, the benefit of this is out weighed by the necessity of maintaining a contingency fund. I'm sure the generous folks who have donated these funds would prefer this rather than seeing a break in a vital service due to lack of financial planning. The millions we are talking about are spread over a couple of dozen charities.
I have also experienced this, but I have also saved a precious SAR asset being dispatched because an air ambulance was able to deal with an incident and also recognised early on during an incident (on arrival at scene) the limitations of the air ambulance and tasked SAR. It depends on availability, the location of the incident the proximity of the nearest asset and of course the weather and daylight. SAR and air ambulances work perfectly well alongside each other (when the SK's VHF works and you don't have to relay messages through D & D), and when the several different control rooms speak to each other.
MS
I’ve also attended many incidents where we have arrived, packaged the patient and left the scene only to hear that a Seaking is inbound to the same incident after it is all over.
MS
Please do not see this as me having a go, I’m just want to know how we can overcome this, it annoys me turning up to a casualty who has been there suffering for hours needlessly or worse yet dead because the wrong asset was deployed.
Rasyob,
I think everyone of whatever outfit would agree with this - we're all on the same side, and all of us are familiar with the frustration of a casualty being compromised because the wrong (or less appropriate) asset was sent. Unless anyone has any better ideas, the best way to progress the issue is to liaise closely with the local Ambulance Control, to give them the best chance of understanding what the various types of helicopter (ie SAR, Air Amb, Police) bring to the party. It is also worth taking every opportunity to remind the emergency services control room staff that they won't be charged for requesting SAR to do a rescue - this myth still lives on (perpetuated by at least one Air Amb operator I could name - wonder why they'd do that?!), and it still causes delays in SAR being used - only time and patience will allow us to convince the relevant people that SAR can be a vital and free asset at many types of incident. Leconfield have been notably successful in spreading the message at training days with control room staff of their various local emergency services, and the amount of tasking they have received has rocketed this year as a direct result.
TOTD
Crab,
Noted re the VHF fit and I do sympathise; after all, look how long it took MoD to give you FLIR/TI!
However, I still think your points about allocation of resources are more a "NHS vs Private" argument. This is not public funds we are talking about, it is money given to Air Ambulances by people who know precisely where it will be spent. Er, unless we're talking about the good folk of Wiltshire, but that's another story. Now, if all money spent in the UK on healthcare is going to be given to the NHS then fine, your argument holds sway. However, as long as people who wish to spend money on non-NHS resources are allowed to do so then I'm afraid your case doesn't work. Further, you might think only "one or two" people benefit - my own experience strongly indicates otherwise.
As for the points about "certain operator(s)" being economical with the actuality about SAR costs, capabilities and so forth - a bit of a theme seems to be appearing. In the police world the Home Office would assume the role of overseer and would have a quiet word with the unit(s) involved. Which agency has similar regulatory oversight of Air Ambulance operators?
Noted re the VHF fit and I do sympathise; after all, look how long it took MoD to give you FLIR/TI!
However, I still think your points about allocation of resources are more a "NHS vs Private" argument. This is not public funds we are talking about, it is money given to Air Ambulances by people who know precisely where it will be spent. Er, unless we're talking about the good folk of Wiltshire, but that's another story. Now, if all money spent in the UK on healthcare is going to be given to the NHS then fine, your argument holds sway. However, as long as people who wish to spend money on non-NHS resources are allowed to do so then I'm afraid your case doesn't work. Further, you might think only "one or two" people benefit - my own experience strongly indicates otherwise.
As for the points about "certain operator(s)" being economical with the actuality about SAR costs, capabilities and so forth - a bit of a theme seems to be appearing. In the police world the Home Office would assume the role of overseer and would have a quiet word with the unit(s) involved. Which agency has similar regulatory oversight of Air Ambulance operators?
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It is also worth taking every opportunity to remind the emergency services control room staff that they won't be charged for requesting SAR to do a rescue
MS
Minself - I fully agree with the contingency fund argument but if that is so important why blow £300K of it on doctors? The charities involved must be very sure of their projected donations if they can afford to run their helicopters and 3 doctors every year. Or do they already have such a huge surplus that they can afford such luxuries with ease? Of the medical professionals (including doctors) I have talked to, most seem to think that doctors on AA will have a limited and possibly negative effect (more likely to stay and play at the scene than scoop and run to the A&E).
As to charging - as far as I am aware the policy is that we do not ever charge. I have never done a non-critical inter-hospital transfer, they are usually critically ill patients needing specialist care unavailable at their primary hospital. Before the ARCC tasks a SAR asset for a medtransfer, the NHS has to show that there is no other way of transporting the patient available and that without the use of SAR, the patient's life is in danger.
The ARRC keep trying to get the message across to ambulance controls that we are free but even in the good ones we are 3rd on the list of call out priority behind land ambulances and air ambulances. We improved the knowledge in the Devon area by inviting 2 paramedics/technicians to fly with us every Friday so they understood our capabilities and limitations - but all the work seems to have to be done by the SAR units - there is precious little initiative taken by the NHS trusts or Ambulance authorities.
As to charging - as far as I am aware the policy is that we do not ever charge. I have never done a non-critical inter-hospital transfer, they are usually critically ill patients needing specialist care unavailable at their primary hospital. Before the ARCC tasks a SAR asset for a medtransfer, the NHS has to show that there is no other way of transporting the patient available and that without the use of SAR, the patient's life is in danger.
The ARRC keep trying to get the message across to ambulance controls that we are free but even in the good ones we are 3rd on the list of call out priority behind land ambulances and air ambulances. We improved the knowledge in the Devon area by inviting 2 paramedics/technicians to fly with us every Friday so they understood our capabilities and limitations - but all the work seems to have to be done by the SAR units - there is precious little initiative taken by the NHS trusts or Ambulance authorities.
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Crab, this does sound a huge amount of money for having a team of full time doctors on the air ambulance for the few of the units that have chosen to provide this option. These particular units might have a more comfortable financial situation than those that haven't chosen to employ a team of full time doctors but for the vast majority of air ambulances £300k would be an unacceptable expenditure, year on year. Some air ambulances rely on a pool of doctors who work free of charge and in their spare time in addition to the pramedics, admitedly providing doctors on air ambulances in this adhoc way possibly isn't the most efficient way of putting doctors on air ambulances but for the majority of air ambulance charities it is the only way. With regards to the argument of swoop and scoop Vs extended doctors intervention on scene, IMHO having seen both, both have their merits depending on the situation but if I was the patient I would want to be treated by the most medically qualified person at the scene.
I am glad to hear it, it sounds like there is a lack of knowledge in some of the air and land ambulance control rooms on the subject of SAR, its use and importantly that it costs the ambulance service nothing.
As to charging - as far as I am aware the policy is that we do not ever charge.
OK Crab, I'm beginning to realise that there are those that can't be persuaded and those that won't be persuaded.
You're using some pretty strong terms:
("why blow £300K of it on doctors?", "more likely to stay and play at the scene"),
relying on second-hand, subjective evidence:
("Of the medical professionals (including doctors) I have talked to, most seem to think that doctors on AA will have a limited and possibly negative effect", "a small benefit for one or 2 patients")
and indulging in some fairly heavy-handed unfounded speculation:
("It seems the charities are sitting on a huge pile of cash and are looking for ways to spend it quickly so people don't ask questions or stop donating").
Finally, you haven't moved from your stance that the whole thing is an NHS issue:
("I believe the money would be better spent in other areas of the NHS, regardless of the fact the taxes are supposed to provide these services. The charities could donate funds or sponsor extra posts or provide buildings/renovations where the NHS trusts are overstretched.")
From the top:
Charities are far more accountable to their donors than the NHS, or the MoD for that matter. Furthermore, if charities were to be seen to be frittering money away then people would simply stop donating. If only the same could be said for Gov't funded organisations like the 2 I've just mentioned...
Doctors working in the properly-structured environment that exists in places like London, Kent et al don't "stay and play" - they provide appropriate treatment and ensure that the casualty then gets the further care he/she requires.
Try talking to medical professionals who actually know, from first-hand experience, what working in such an environment involves. Better yet, try listening to what such doctors might have to say.
Charities have a responsibility to their donors, as alluded to above, to ensure that any surplus funds are allocated in the best manner possible. If a charity sees a way to improve an already-excellent service then it is their duty to do so.
Finally, they're called "Air Ambulance" charities 'cos that's where their money goes. People give them funds in the knowledge that they will specifically spend the money on a means of getting rapid intervention/treatment/extraction on the fortunately-rare occasions when things all go horribly wrong. Should the Charity Commission or whatever it's called this week catch such an organisation donating money to prop-up NHS building shortfalls or whatever there'd be hell to pay - quite rightly. If you haven't gripped the difference between medical services people expect from the Gov't (the NHS) and medical services funded through other means ( eg BUPA, Air Ambulance charities) then we're not going to get anywhere 'til you do.
OK - you think the NHS should have more funds and you don't think money should go to Air Ambulances so that they can "up their game". Fine, help vote in someone who'll sort out the Health Service and only donate to charities that don't have properly-trained, supervised doctors on board. However, let those who've done the research, tried the alternative and found it better get on with their work without the sniping, eh? Oh, and crack on with the excellent SAR stuff you folk do so well - much appreciated.
ps - were you a student of mine at Shawbury? I seem to remember chatting to someone with your debating methods between 1984-6
You're using some pretty strong terms:
("why blow £300K of it on doctors?", "more likely to stay and play at the scene"),
relying on second-hand, subjective evidence:
("Of the medical professionals (including doctors) I have talked to, most seem to think that doctors on AA will have a limited and possibly negative effect", "a small benefit for one or 2 patients")
and indulging in some fairly heavy-handed unfounded speculation:
("It seems the charities are sitting on a huge pile of cash and are looking for ways to spend it quickly so people don't ask questions or stop donating").
Finally, you haven't moved from your stance that the whole thing is an NHS issue:
("I believe the money would be better spent in other areas of the NHS, regardless of the fact the taxes are supposed to provide these services. The charities could donate funds or sponsor extra posts or provide buildings/renovations where the NHS trusts are overstretched.")
From the top:
Charities are far more accountable to their donors than the NHS, or the MoD for that matter. Furthermore, if charities were to be seen to be frittering money away then people would simply stop donating. If only the same could be said for Gov't funded organisations like the 2 I've just mentioned...
Doctors working in the properly-structured environment that exists in places like London, Kent et al don't "stay and play" - they provide appropriate treatment and ensure that the casualty then gets the further care he/she requires.
Try talking to medical professionals who actually know, from first-hand experience, what working in such an environment involves. Better yet, try listening to what such doctors might have to say.
Charities have a responsibility to their donors, as alluded to above, to ensure that any surplus funds are allocated in the best manner possible. If a charity sees a way to improve an already-excellent service then it is their duty to do so.
Finally, they're called "Air Ambulance" charities 'cos that's where their money goes. People give them funds in the knowledge that they will specifically spend the money on a means of getting rapid intervention/treatment/extraction on the fortunately-rare occasions when things all go horribly wrong. Should the Charity Commission or whatever it's called this week catch such an organisation donating money to prop-up NHS building shortfalls or whatever there'd be hell to pay - quite rightly. If you haven't gripped the difference between medical services people expect from the Gov't (the NHS) and medical services funded through other means ( eg BUPA, Air Ambulance charities) then we're not going to get anywhere 'til you do.
OK - you think the NHS should have more funds and you don't think money should go to Air Ambulances so that they can "up their game". Fine, help vote in someone who'll sort out the Health Service and only donate to charities that don't have properly-trained, supervised doctors on board. However, let those who've done the research, tried the alternative and found it better get on with their work without the sniping, eh? Oh, and crack on with the excellent SAR stuff you folk do so well - much appreciated.
ps - were you a student of mine at Shawbury? I seem to remember chatting to someone with your debating methods between 1984-6
Thud, the NHS provide the paramedics for AA because there is a clear need for them - if there was such a clear need for all AA to have doctors on board would they not provide them? They don't so the question is why?
Many of the posters on this thread seem to disagree that doctors are absolutely needed on AA.
Personally I think the paramedics do an excellent job - if you want them to have doctor skills then pay them more and give them extra training.
I accept that my idealist concept whereby money that comes from the public, via donation or taxes, should be used for the greater good, doesn't fit within current political or financial constraints. However, if charities are sitting on large surpluses of cash (that info came from other posters, not me) then maybe they should be looking at ways of providing better AA cover (numbers of aircraft, 24/7 ops) or even procuring larger helos for the increase in numbers of inter-hospital transfers that everyone is expecting.
PS I left Strawberry in early 84 to go to 72 so it's probably not me you are wistfully remembering
Many of the posters on this thread seem to disagree that doctors are absolutely needed on AA.
Personally I think the paramedics do an excellent job - if you want them to have doctor skills then pay them more and give them extra training.
I accept that my idealist concept whereby money that comes from the public, via donation or taxes, should be used for the greater good, doesn't fit within current political or financial constraints. However, if charities are sitting on large surpluses of cash (that info came from other posters, not me) then maybe they should be looking at ways of providing better AA cover (numbers of aircraft, 24/7 ops) or even procuring larger helos for the increase in numbers of inter-hospital transfers that everyone is expecting.
PS I left Strawberry in early 84 to go to 72 so it's probably not me you are wistfully remembering
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Correct me if I'm wrong (no doubt someone will), but doesn't the fact that on most Air Ambulances there is a lack of space to work on the casualty enter the equation? What's the point of having a clever doctor if he can't do his stuff in the air? Said clever doctor has to do it all on the ground, draining the aircraft of fuel (assuming it's not shut down) and negating the efforts to achieve the golden hour. With the exception of his/her ability to provide rapid sequence intubation (which helps but isn't essential - there are other ways to manage airways), having a doctor on board an Air Ambulance is over-egging the pudding somewhat, don't you think?
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TTT
You have hit the nail on the head, I believe. Train the Paramedics to anaesthetise and deliver RSI, they are well up to that job. Also increase the meds they can give to include Morphine. Doctors not then needed on the Air Ambulance freeing them up, cost savings all round, increased paramedic skills and still a good level of pre-hospital care for patients.
My two-penny worth after reading this interesting thread.
You have hit the nail on the head, I believe. Train the Paramedics to anaesthetise and deliver RSI, they are well up to that job. Also increase the meds they can give to include Morphine. Doctors not then needed on the Air Ambulance freeing them up, cost savings all round, increased paramedic skills and still a good level of pre-hospital care for patients.
My two-penny worth after reading this interesting thread.
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Also increase the meds they can give to include Morphine
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Some people call it Rapid Sequence Intubation - call it what you like, it does the same thing and if it is the main reason for carrying a doc then he's going to feel mightily redundant and over-qualified a lot of the time.
Last edited by Vie sans frontieres; 14th Nov 2009 at 00:55.
..interesting thread.
.....no extra skills actually required for a UK Paramedic to RSI........
They can already intubate (any cas with a GCS of less than 8) and cannulation (for drug introduction) is a routine skill.
So no extra skills training required ......just the ("god-like" doctor) authority to paralyse somebody by using the additional drugs.
ps....there is no actual limit on amount of morphine a UK Paramedic can administer.
pps... just read the previous post.......spot on!
.....no extra skills actually required for a UK Paramedic to RSI........
They can already intubate (any cas with a GCS of less than 8) and cannulation (for drug introduction) is a routine skill.
So no extra skills training required ......just the ("god-like" doctor) authority to paralyse somebody by using the additional drugs.
ps....there is no actual limit on amount of morphine a UK Paramedic can administer.
pps... just read the previous post.......spot on!
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According to JRCALC, Clinical Practice Guidelines on the Dosage and Administration of Morphine Sulphate for adults the maximum dosage is 20mg?? It might be that different regions have different protocols but certainly where I work the maximum dosage is 20mg, as for the rest of the skills to RSI I take the point that the close confines of the back of the helicopter is not the best place to do this but then again what is easy to do in the back of a helicopter? At least if the option exists and this does not delay the immediate and rapid transportation of the patient to definitive care then in some cases to RSI a patient on scene will be the best option.
..no different protocols for different regions; JRCALC is the UK national document and 20mg is the stated maximum for morphine.....
But the answer is in its title; Clinical Practice Guidelines
All maximums stated in JRCALC are not definitive; they are 'guidelines'. They can be overridden if required.
But the answer is in its title; Clinical Practice Guidelines
All maximums stated in JRCALC are not definitive; they are 'guidelines'. They can be overridden if required.