Airborne medics save lives
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Airborne medics save lives
From the Health Service Journal
Airborne medics save lives claim helicopter charities
A charter for air ambulances is fuelling debate over the future roles of air and land ambulances. Four independent air ambulance charities have signed up to new standards including a commitment to 'pre-hospital care doctors' on flights.
The first UK helicopter emergency medical service charter covers skills, additional training and supervision. It has been adopted by Great North Air Ambulance and services for London, Essex and Hertfordshire, and Kent, Surrey and Sussex.
The charities believe on-board doctors will help save lives and cut costly hospital transfers.
Conventional crews such as London Ambulance Service trust are trialling new ways of working, including taking some patients with coronary symptoms straight to specialist treatment centres. Most land ambulances do not have on-board doctors.
Kent, Surrey and Sussex Air Ambulance chief executive David Philpott told HSJ that fewer emergency departments and increased traffic, combined with efforts to improve patient care, will mean a move away from simple 'swoop and scoop' air ambulance services.
Doctors at the scene can refer severely injured patients directly to specialist centres rather than the nearest hospital. He called on the government to increase funding to reflect this shift in practice.
Mr Philpott estimated each on-board doctor costs up to £300,000 a year, which would mean an annual bill of nearly £7m to fund doctors on all 23 air ambulance helicopters operating in the UK. All 15 UK air ambulance services operate as charities.
London's Air Ambulance chief executive Andrew Cameron said services will increasingly be about getting senior medics to patients at trauma scenes to stabilise the injured.
A Department of health spokeswoman said the DoH recognised air ambulances could be 'an effective way of getting better and faster access to hospitals and valuable in supporting inter-hospital transfers', and added that the NHS already met the cost of most clinical staff. She said: 'It remains for NHS trusts to decide whether they provide any additional funding to air ambulance charities.'
A spokesman for the Ambulance Service Association said it was unrealistic to have doctors on all land ambulances but paramedics would welcome the chance to play a greater role in referring cases to a specialist service rather than the nearest district hospital.
'Our mandate is to take people to the nearest hospital. If paramedics were properly trained and skilled then certainly they could play an increased role in deciding where a patient should be taken.'
A charter for air ambulances is fuelling debate over the future roles of air and land ambulances. Four independent air ambulance charities have signed up to new standards including a commitment to 'pre-hospital care doctors' on flights.
The first UK helicopter emergency medical service charter covers skills, additional training and supervision. It has been adopted by Great North Air Ambulance and services for London, Essex and Hertfordshire, and Kent, Surrey and Sussex.
The charities believe on-board doctors will help save lives and cut costly hospital transfers.
Conventional crews such as London Ambulance Service trust are trialling new ways of working, including taking some patients with coronary symptoms straight to specialist treatment centres. Most land ambulances do not have on-board doctors.
Kent, Surrey and Sussex Air Ambulance chief executive David Philpott told HSJ that fewer emergency departments and increased traffic, combined with efforts to improve patient care, will mean a move away from simple 'swoop and scoop' air ambulance services.
Doctors at the scene can refer severely injured patients directly to specialist centres rather than the nearest hospital. He called on the government to increase funding to reflect this shift in practice.
Mr Philpott estimated each on-board doctor costs up to £300,000 a year, which would mean an annual bill of nearly £7m to fund doctors on all 23 air ambulance helicopters operating in the UK. All 15 UK air ambulance services operate as charities.
London's Air Ambulance chief executive Andrew Cameron said services will increasingly be about getting senior medics to patients at trauma scenes to stabilise the injured.
A Department of health spokeswoman said the DoH recognised air ambulances could be 'an effective way of getting better and faster access to hospitals and valuable in supporting inter-hospital transfers', and added that the NHS already met the cost of most clinical staff. She said: 'It remains for NHS trusts to decide whether they provide any additional funding to air ambulance charities.'
A spokesman for the Ambulance Service Association said it was unrealistic to have doctors on all land ambulances but paramedics would welcome the chance to play a greater role in referring cases to a specialist service rather than the nearest district hospital.
'Our mandate is to take people to the nearest hospital. If paramedics were properly trained and skilled then certainly they could play an increased role in deciding where a patient should be taken.'
estimated each on-board doctor costs up to £300,000 a year,
Not sure exactly how this figure was arrived at. Does it mean 3 consultant anaesthetists per unit per year or one GP working on his days off?
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One GP working on his day off 
. The amount will also include employers NI, pension contributions and the cost of the extra fuel required to lift his weight!
Seriously (!), that figure is too high; I cannot see how it's derived.
Cheers
Whirls
. The amount will also include employers NI, pension contributions and the cost of the extra fuel required to lift his weight! Seriously (!), that figure is too high; I cannot see how it's derived.
Cheers
Whirls
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Oh well, I really should know better but here goes. Head above parapet....begin.
The word Doctor can be a little generic in use as can the term Pilot.
I am sure that I could find enough PPL pilots to fly my aircraft for 365 days of the year on their days off at a cost to me of....Nil (Well no, but bear with me for the sake of example). Some of their standards might be very high.
Alternatively I might just pay for 3 full time CPL or ATPL holders with the right background and experience such as is often debated on this forum.
The cost to me has to include not just 3 line pilot salaries but the training, equipment, CP, TRE etc. The total costs to me are pretty high, but you get what you pay for.
Now, when that gynaecologist approaches me with their latex gloves twanging on their wrist I might just welcome their approach depending on my situation. Alternatively, if it is to remove my brain tumour, then thanks but I would rather the neuro surgeon started from the north pole and not the south!
The figure of up to £300,000 per anum is the estimated total cost to a charity to employ a full time, fully HEMS and Pre Hospital Care trained doctor who is supervised on a 1:1 ratio of clinical governance by a qualified PHC HEMS Consultant with guaranteed immediate advisory access, HEMS crewmember qualified and PPE equiped, 365 days a year.
As with the line pilot, 3 times basic salary is not the final figure, its all the other on costs.
The launch of the charter is an attempt to try and suggest a gold standard to work to. No one claims it is the only one, or even the right one, but it is a start.
BTW I totally agree with TTT whose conclusion was spot on.
I have had the privilege of working with a whole variety of HEMS teams that include many mixtures.
Police Observer /Paramedic
Technician / Paramedic
Basics Doctor / Paramedic
HEMS Doctor / Paramedic
Perhaps I should include Winchman / Paramedic to complete the possibilities.
If my life were hanging on a thread then I would be a lucky person to see any of those teams turn up, who all make a valuable contribution to the HEMS world.
IMHO the strongest team of all would be a trained HEMS Doctor partnering a HEMS Paramedic, (or very soon CCP) who had the abilty to intervene when needed and fly me straight to the most appropriate place for treatment (not the nearest DGH please!). That combination of skills is world class.
Now back below the parapet. I really should have known better.
The word Doctor can be a little generic in use as can the term Pilot.
I am sure that I could find enough PPL pilots to fly my aircraft for 365 days of the year on their days off at a cost to me of....Nil (Well no, but bear with me for the sake of example). Some of their standards might be very high.
Alternatively I might just pay for 3 full time CPL or ATPL holders with the right background and experience such as is often debated on this forum.
The cost to me has to include not just 3 line pilot salaries but the training, equipment, CP, TRE etc. The total costs to me are pretty high, but you get what you pay for.
Now, when that gynaecologist approaches me with their latex gloves twanging on their wrist I might just welcome their approach depending on my situation. Alternatively, if it is to remove my brain tumour, then thanks but I would rather the neuro surgeon started from the north pole and not the south!
The figure of up to £300,000 per anum is the estimated total cost to a charity to employ a full time, fully HEMS and Pre Hospital Care trained doctor who is supervised on a 1:1 ratio of clinical governance by a qualified PHC HEMS Consultant with guaranteed immediate advisory access, HEMS crewmember qualified and PPE equiped, 365 days a year.
As with the line pilot, 3 times basic salary is not the final figure, its all the other on costs.
The launch of the charter is an attempt to try and suggest a gold standard to work to. No one claims it is the only one, or even the right one, but it is a start.
BTW I totally agree with TTT whose conclusion was spot on.
I have had the privilege of working with a whole variety of HEMS teams that include many mixtures.
Police Observer /Paramedic
Technician / Paramedic
Basics Doctor / Paramedic
HEMS Doctor / Paramedic
Perhaps I should include Winchman / Paramedic to complete the possibilities.
If my life were hanging on a thread then I would be a lucky person to see any of those teams turn up, who all make a valuable contribution to the HEMS world.
IMHO the strongest team of all would be a trained HEMS Doctor partnering a HEMS Paramedic, (or very soon CCP) who had the abilty to intervene when needed and fly me straight to the most appropriate place for treatment (not the nearest DGH please!). That combination of skills is world class.
Now back below the parapet. I really should have known better.
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Alternatively, the figure of £300k could have just been journalist nuisance sorry, licence!
Having worked in the NHS as an accountant, I would have said TTT's was much more realistic. Only a difference of £100k but that's still a 33% error.
Cheers
Whirls
Having worked in the NHS as an accountant, I would have said TTT's was much more realistic. Only a difference of £100k but that's still a 33% error.
Cheers
Whirls
As an organisation the Medical profession appears a strange place to outsiders, AOG's point about a HEMS doc being supervised 1:1 by a dickie bow is a valid point, remember - all docs are considered to be "training" except Consultants...
Is there any research out there on the skills & equipment level of responders vis a vis the stay & stabilise or scoop & scoot argument? Given the relatively short transport times this would appear to be especially relavant to HEMS ops and the costs involved.
Is there any research out there on the skills & equipment level of responders vis a vis the stay & stabilise or scoop & scoot argument? Given the relatively short transport times this would appear to be especially relavant to HEMS ops and the costs involved.
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I think the Dutch modelled their service after the German system (operated by the automobile club and university hospitals) but performed a study to demonstrate that even in a country with many ambulances available, the doctor on board made a significant difference in the cost of treatment for the patient and therefore it was deemed economically viable to continue the project.
That study should be available.
That study should be available.
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I don't see why the monetary figure should be relevant - what is relevant is that Air Ambulance services have to rely on charity!
When you look at the complete and utter cr*p that tax payers' money is spent on, surely there must be a very strong case for services to be publicly funded?
http://paulcoulthread.fotopic.net/p44089317.html
http://angliaone.org.uk
When you look at the complete and utter cr*p that tax payers' money is spent on, surely there must be a very strong case for services to be publicly funded?
http://paulcoulthread.fotopic.net/p44089317.html
http://angliaone.org.uk
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There are arguments for and against Government funding of air ambulances. The most obvious one against is that of control.
Currently air ambulance units can decide where best to spend their resources and, with a smaller management structure, can make quicker changes if circumstances change. Having air ambulances as part of the NHS will force them to operate under that regime with long, drawn-out procurement processes, a myriad of reports and forms to complete and probably an extra tier of management.
Cheers
Whirls
Currently air ambulance units can decide where best to spend their resources and, with a smaller management structure, can make quicker changes if circumstances change. Having air ambulances as part of the NHS will force them to operate under that regime with long, drawn-out procurement processes, a myriad of reports and forms to complete and probably an extra tier of management.
Cheers
Whirls
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Thanks Whirls - i must admit, I was thinking that after I'd made the post, the problems of control
Got to admit, though, it does seem ridiculous that, if the support of the public, or other benefactors were to dry up, these services would not be able to operate and yet OUR money is being squandered on all kinds of ridiculous, excessive scemes that don't benefit us at all?
Got to admit, though, it does seem ridiculous that, if the support of the public, or other benefactors were to dry up, these services would not be able to operate and yet OUR money is being squandered on all kinds of ridiculous, excessive scemes that don't benefit us at all?
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I am a relative outsider to the AAir Ambo scene, but I am going to toss in my tuppence worth.
The Golden Hour is critical to any trauma and IMHO it would be essential to get the patient stable eneough to transport, then transport them to a facility that has the necessary resources, ie CAT scan, ER, neuro/ortho etc surgeons and that is best achieved by the guys who know that field best, the Advanced Life Support Paramedics.
Unless the doctor is a specialist trauma doctor then he does not belong in the helicopter, and if he IS a specialist trauma doctor then he is best utilised in an environment where he has access to the resources he needs because unless the ambo is a Chinook or S61 he will not be able to access what he needs to best make use of his skills and abilities.
That is my tuppence worth, I will now crawl back under my stone and leave them what knows (or thinks they do) to continue this debate.
The Golden Hour is critical to any trauma and IMHO it would be essential to get the patient stable eneough to transport, then transport them to a facility that has the necessary resources, ie CAT scan, ER, neuro/ortho etc surgeons and that is best achieved by the guys who know that field best, the Advanced Life Support Paramedics.
Unless the doctor is a specialist trauma doctor then he does not belong in the helicopter, and if he IS a specialist trauma doctor then he is best utilised in an environment where he has access to the resources he needs because unless the ambo is a Chinook or S61 he will not be able to access what he needs to best make use of his skills and abilities.
That is my tuppence worth, I will now crawl back under my stone and leave them what knows (or thinks they do) to continue this debate.
Unstable Load, your post would suggest that your experience of the medical profession is limited in the ways Another Old Git suggested. I've seen Paramedic-only ops and now I've seen pre-hospital-medicine-specialist doctor plus Paramedic ops; the latter is enormously more capable. You can underline all you like, but the standard comment from highly-qualified HEMS paramedics and nurses who now operate with the above-mentioned doctors is "I didn't know how much I didn't know 'til I started working with them!". As an aside, if the doctors and paramedics are part of the crew, not just medical passengers, then their own love of learning new skills and providing feedback to the pilots turns the whole thing into something of a virtuous spiral.
TTT, your points on unnecessary treatment are well made - there is reportedly one paramedic, for example, who is claiming to have done something like 98 RSIs in 7 years. Sounds almost as if its worth investigating for assault charges...
- also, remember that not all helicopters are operated by the Ambulance Service. Those that are operated by the charity on behalf of the Ambulance Service are deciding their own (usually streamlined, politics-free) management systems!
Finally, FlyerFoto: If the system of emergency services being run by charities is so wrong, what would your reaction be to nationalisation of the RNLI?
TTT, your points on unnecessary treatment are well made - there is reportedly one paramedic, for example, who is claiming to have done something like 98 RSIs in 7 years. Sounds almost as if its worth investigating for assault charges...
- also, remember that not all helicopters are operated by the Ambulance Service. Those that are operated by the charity on behalf of the Ambulance Service are deciding their own (usually streamlined, politics-free) management systems!
Finally, FlyerFoto: If the system of emergency services being run by charities is so wrong, what would your reaction be to nationalisation of the RNLI?
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Good question Thud!
Not something I've particularly thought of, either!
My main point, however, is still why do essential services have to rely on charity, when money is wasted elsewhere?
Not something I've particularly thought of, either!
My main point, however, is still why do essential services have to rely on charity, when money is wasted elsewhere?
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why do essential services have to rely on charity, when money is wasted elsewhere?
Cheers
Whirls
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In countries like Germany, Austria and the Netherlands there is a doctor on board. Germany and Austria have had air ambulance services much longer than the UK and so a lot of experience. If it wasn't of any advantage they would surely drop it, because they're NOT goverment funded as well. If the ADAC or ÖMTC can save a euro they will.
Last edited by HillerBee; 27th Aug 2007 at 00:31. Reason: typo
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Thus and blunder,
Guilty as charged with regard to the experience bit, but I do have some mates who are ALS Paramedics and they have a rather negative view on some of the EMS doctors they have worked with.
Cheers,
UL
Guilty as charged with regard to the experience bit, but I do have some mates who are ALS Paramedics and they have a rather negative view on some of the EMS doctors they have worked with.
Cheers,
UL
Apologies for the delay - not everywhere has internet access.
TTT:
...there's Kent and Surrey/Sussex, for starters. Not sure about London; I have no direct experience of their ops. Have a look at some of my pics on the HEMS photos thread to see some of the places I operate.
Bertie:
...sounds like bad experience(s) with particular personalities, possibly P****? (I love the smell of alliteration in the morning). Having now had the chance to see these docs work with proper oversight/governance, decent continuity and the full support of the paramedics, I think that the docs who're selected for the job have no difficulty showing that (deep breath) they really are better all-round than our green- (or red-) suited friends. Mind you, the ones that come in with the right attitude are always willing to acknowledge they can learn something from the folk who've been doing it all their working lives. So long as every sortie gets debriefed, there's no room for nastiness or snide behaviour - everyone gets to benefit (especially the patients).
TTT:
Thud and Blunder – do you know which UK HEMS operations are charity and not Ambulance operated?
Actually T&B - I am making an assumption that you are in the UK, which on reading your post again, may not be the case.
Actually T&B - I am making an assumption that you are in the UK, which on reading your post again, may not be the case.
Bertie:
2.....Why do immediate care doctors generally think that they are better at HEMS than HEMS paramedics?