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London Air Ambulance going 24H

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London Air Ambulance going 24H

Old 4th Feb 2010, 08:56
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London Air Ambulance going 24H

London radio station LBC is this morning reporting (and on their website here) that London's Air Ambulance will commence 24 hour operations from next month after London Ambulance Service agreed to fund the paramedics after 1am (their apparent cut-off time at present).

I'm sure there's a whole lot more to it than that!
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Old 4th Feb 2010, 09:32
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FYI, fast response cars are used during the hours of darkness, NOT the helicopter.


HTH
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Old 4th Feb 2010, 10:58
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Helihub

The LBC report states:

"Until now the London Air Ambulance and their rapid response vehicles - which are used after dark - were only available until 1am because of a shortage in funding.
But the London Ambulance Service will now pay for extra staff through the night."

This only suggests that the staff will be available beyond 1am not that the helicopter will be operating during the night.

PR
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Old 4th Feb 2010, 13:57
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Yep, you're right. Their website report is angled differently from the verbal report going out over the airways, which did state the helicopter was going 24H.
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Old 4th Feb 2010, 14:03
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That said, Auntie Beeb's version of the story has a bold enough headline

"London's Air Ambulance to begin 24-hour service"

London's Air Ambulance to begin 24-hour service


London's air ambulance flew 1,741 missions in 2009

London's Air Ambulance is to operate 24 -hours-a-day, seven-days-a-week, after the organisation secured new funding.
Until now the helicopters have only flown around the clock on weekends. The service has closed between 0100 GMT and 0700 GMT on weekdays.
But London Ambulance's decision to fund the wages of all airborne paramedics means the service will go fulltime.
In 2009 the air ambulance flew 1,741 missions, 410 of which were at night. It attended the 7/7 terrorist attacks.
'Keep Londoners safe'
The new 24-hour service will start on 1 March.
Consultant Dr Gareth Davies said: "The decision by the London Ambulance Service to fund our paramedics means that we can become the first air ambulance service in the UK to provide medical teams around the clock.
"The extra funding will prove to be invaluable for our service, which is dedicated to helping keep Londoners safe day and night, every single day of the year."
Typically air ambulance crews attend to the most serious cases in London, such as shootings, stabbings and the worst traffic accidents.
The charity is part-funded by the NHS but also relies on public donations.
HH
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Old 4th Feb 2010, 22:47
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Ok, please correct me if I'm wrong but I thought that both Sussex and Wiltshire with their joint HEMS, were both 24hr due to the availability of their FLIR and night sun?

The BBC report is very misleading in the way it implies the chopper is going 24hrs. Typical
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Old 5th Feb 2010, 07:38
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Not sure what all the fuss is about.

Our HEMS paramedics, including our manager, have been doing 12 hr night shifts for years! (just not on the helicopter!)
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Old 5th Feb 2010, 10:47
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The charity is part-funded by the NHS but also relies on public donations.

Does anyone have any idea what that part funding is. That seems a little unfair if they get some cash from the NHS and the other charity operators don't get a look in
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Old 5th Feb 2010, 14:07
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Almost like the headline was designed to confuse.

The London helicopter that is part of the London HEMS is NOT going 24 hours. It remains day only. However, for some time the same "HEMS" organisation has provided a car rapid response service for London. This uses the same emergency doctors and paramedics that normally work in the helicopter (when it is working). Indeed, there is a small part of central London in which the London HEMS will always respond by car. That is because there are no suitable landing sites and/or the area is so close to the Royal London Hospital (where the hele is based when on-shift) that a car will usually be quicker.

All that has happened is that this fast response car service is now to operate 24/7. Given the horrible things that happen after dark in London that sounds like very good news.

The other part of the story (if I understand it correctly) is that henceforth the paramedics will be paid for by LAS. This implies that previously the HEMS charity paid for them. If that is true then it will come as a welcome reduction in costs for a charity that is short of a few pennies. The UK NHS did declare some while ago that it would provide paramedics for all HEMS for free - perhaps this is just fulfilling that commitment for London.

I believe if you look at the charity website there is oblique reference to some funding of the London HEMS by the NHS. I have been told that the "London NHS" has been persuaded to provide some funds for the London HEMS, on the grounds that the London HEMS saves the London NHS money. This is because the initial care provided by the London HEMS improves outcomes and shortens the average stay in hospital. As far as I know, this is the only HEMS in England and Wales which benefits in this way. The whole thing is driven by the emergency trauma "centre of excellence" that is the Royal London.

Those in contact with UK news may have seen that there has been recent adverse comment about the emergency trauma setup in the UK and its poor performance. There is a move afoot to drop local A&Es (as recipients of serious trauma) and go to specialist regional trauma centres. The Royal London system works well in London: it may be more difficult to make it work so well in other parts of the UK. How HEMS fit into this is interesting: it would seem to be a natural part of such a setup, rather than an afterthought. It might also call for regular inter-hospital transfer and night time use of heles (not in the HEMS role).

Last edited by Helinut; 5th Feb 2010 at 14:22. Reason: Add comment about part NHS funding
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Old 5th Feb 2010, 15:47
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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.

I'm sure many air ambulances bypass the local A&E in favour of a larger hospital with CT scanners, burns units, ITU etc, so in some (small) way it already happens.

And I believe that the NHS pays the wages for Paramedics and Technicians on many (if not all) of the air ambulances around the country, so that that particular element doesn't come out of the charity. I believe this is what they refer to as 'part funding'. Maybe London HEMS has additional funding from the NHS on top of this?

TTT
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Old 5th Feb 2010, 16:10
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Am I to cynical or could it be to divert attention from other happenings
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Old 5th Feb 2010, 16:18
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In that case we need more Helipads within walking distance of these regional A&Es.


The continent have worked out a long time ago that for every pound spent on the Air Ambulance you save three pounds in the hospital. No brainer really.
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Old 5th Feb 2010, 21:01
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BS,

I am not sure you think like a local NHS manager (fortunately).

Helipad = largely unused space : Car Park = Source of Revenue

You can even take it further than that (if you are a tiny bit cynical):

What do helicopters bring to hospitals? - Very sick people who spend a long time occupying beds and operating theatres. Who knows how the screwy pricing system works in the NHS. There could easily be an incentive to move such patients on......
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Old 6th Feb 2010, 17:15
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& I thought I was cynical
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Old 6th Feb 2010, 20:00
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I know Helinut, but that is shortsighted thinking for you.

I was asked if I can put any meat on my statement, so I will have to scour the world now.
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Old 6th Feb 2010, 22:49
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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...???
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Old 7th Feb 2010, 15:25
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Traditionally there have been two approaches to trauma patients colloquially known as "scoop and run" and "stay and play". The success of HEMS (either airborne or on the roads) largely depends on the latter - in that an experienced anaesthetist/surgeon is on the crew and provides immediate trauma life support.
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Old 7th Feb 2010, 18:53
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Cheers Helmet fire.

If one ever watched that programme by Professor Winston, showing how quickly the body responds after it's been damaged, then common sense would have us all running to the NHS to get this blanket service of the ground.
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Old 7th Feb 2010, 21:28
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Brilliant Stuff

You mistake my role - I am a messenger and don't hold those views myself. However, there is a lot of inertia in the system. Now is not the best time to be asking the NHS to go out and spend new money on something new. All the existing stakeholders are trying to maintain the status quo.

The recent National Audit Office report on this topic may add some urgency. There is a regional trauma centre Tsar too, but whether that will help remains to be seen.
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Old 8th Feb 2010, 13:47
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Sorry Helinut that was bad English on my part.

I meant it was short-sighted by the powers that be I know exactly what your thoughts are since the two of us have discussed this before.

Again apologies for not being clear enough.
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