New Pediatric Air Ambulance

[Tallsar]

762 raised the most salient point a few posts ago. The UK is blessed with a SAR helo force spread around the country at 15 or 45 mins readiness....the latter being particularly relevant as it's a night standby, which I do no believe any civvy airamb helo yet provides in the UK - so it's a 24hr service accessible to any NHS hospital with the right need.
This service has always been available, by national Inter-department government agreement for the NHS to use on a repayment basis (actually a fixed per flying hour charge) which can be waived in the event of genuine life saving situations. Over the decades it has been used very often for baby/child medevacs, and overall provides a very cost-effective country wide service as required. Indeed, because the the SAR force uses large aircraft, there is little difficulty carrying the large medical equipment such as the incubator, and of course, a sometimes large medical team - something impossible or very restricted in the smaller cabs used by UK airamb units. Setting up a dedicated helo in one location seems of limited practical merit as some of the transfer distances involved would seem potentially ridiculous. The cost-effectiveness of such a dedicated service must be in significant doubt too. IMO it would be better that such a charity raises money to have suitable equipment available at the relevant locations to fit on the ac, and also spends time campaigning and educating all the pediatric doctors and NHS authorities and airamb units about how best to deal with types of paediatric cases in helo transfer and the
optimum use of the helo resources available....it still disappoints me that some AA control rooms don't always have the right viewpoint on what us available to them via the ARCC at Kinloss.

[herman the crab]

The other reason I can see a project like this struggling is due to the limited number of hospitals that have helipads [in the UK] compared with the US for example.

Having to transfer from ward to remote helipad by ambulance delays and increases the risks no end.

HTC

[Thomas coupling]

Tallsar: totally disagree. The SeaKing couldn't be less useful to fulfil the role of an AA or HEMS cab.
It is:
Unreliable
Unavailable
Ill equipped
and is the equivalent of an articulated truck being used instead of a mercedes ambulance.

Can you imagine this process taking off and half a dozen requests each week to ARCC for specialist hospital transfers of children/trauma patients. The MoD will soon put a stop to that.
How many hospitals can accomodate a SeaKing? A handful, if that.
The trauma of flying in the back of a SeaKing is enough to finish the patient off what with noise / dirt / hydraulic fluid / and very ugly aircrew!

The future is barely sustainable with all these HEMS cabs and the odd AA dotted here and there. There needs to be a national common approach and in that strategy, a "wing" of the 'national HEMS department needs to be a specialist unit for kids/special treatment patients. That is where this thread would best work.
Until then - too many HEMS outfits fighting for too few sponsors/charitable incomes.

PS: There are a number of night HEMS and AA's in the UK already.

PPS: Hospital transfers do not constitute 'life saving' thus would not probably support the ethos that life saving trips by the MoD are 'free'. The bill would thus escalate out of control if all AA's were paid for.

[timex]

Just a question or two.

How many transfers are done in a week?

How many AA are capable of Night transfers? (ISTR they could recover to base at night).

What weather limitations do the Night AA have?

[jivusajob]

Interesting arguments on both sides.

However all this is going on in Scotland right now where there is 24hr Air Ambulance cover and the aircraft do a large amount of their work at night. There are plenty of hospitals with suitable landing sites and there are a large numbers of secondary sites around the country where local Coastguard or fire service teams put out lights at pre surveyed sites. All this is much cheaper than using the MOD. Yes they do charge.

On the transfer side. The two Scottish Air Ambulance helicopters regularly carry out specialist retrieval tasks. This includes babies, children and adults with specialist air aware and trained Neonatal and Paediatric teams and the Emergency Medical Retrieval Service. Each service requires a slightly different role fit to the aircraft but the longest rerole (Incubator fit) only takes 15mins. The aircraft is always reroled before the team is ready.

Is there a need for a specialist retrieval helicopter in the UK be it babies, children or adults. Not sure, possibly. Is the work out there. Oh yes

[Floppy Link]

...all this is going on in Scotland right now...

Finger on the pulse! Helimed 5 was on a paediatric job as you posted

[helisdw]

The main objective of any Air Ambulance Service is to "Scoop and Run", get the patient airborne and to the nearest hospital capable of giving the patient the best possible treatment.

To argue otherwise shows an enormous ignorance of what both helicopter and fixed wing air am.bulances are there for

Whilst this thread is to debate the merits of a dedicated paediatric air ambulance, the inevitable mention of allied HEMS work has been made.

It is important to highlight that the concept of "scoop and run" is now out-dated. There is an increasing realisation that high quality trauma care is achieved by delivering a doctor and critical care paramedic(s) to the scene of an incident for early advanced management/stabilisation. In some cases, the most appropriate action is to facilitate a rapid transfer to definitive care (e.g uncontrollable haemorrhage) but in others (e.g head injury) the provision of critical care interventions at an early stage is being recognised as key to improving morbidity/mortality rates.

Previous research suggested "stay and play" to be detrimental, but the evidence base is littered with methodological flaws and modern changes to practice mean that early stabilisation is probably the way to go, especially in the UK where blunt trauma predominates.

The subsequent mode of transfer to the most appropriate treatment facility should then judged on a case-by-case basis. This may be by helicopter, but equally a ground-based transfer may be more suitable (for a number of reasons). Therefore, it should not be the main objective of an air ambulance to "scoop and run" - although I acknowledge that at present this appears to be the model in some areas.

This article from the Telegraph elucidates a bit more about the emerging Trauma Networks - I hasten to add that I am neither a regular Telegraph reader or affiliated with LAA!

London's Air Ambulance, saviour of the skies - Telegraph

Simon

[DX Wombat]

A (now retired) Neonatal Nurse's point of view. Before I go any further please let me make it clear that I have the greatest respect for the Air Ambulance crews and the work they do.
Having recently asked on this forum about tv programmes always saying that Air Ambulances had to be back at base before official night and received some very helpful replies. I have to say that because the vast majority are not allowed to fly at night they would be a waste of time as babies and children in general are awkward (but loveable) little perishers who usually choose the worst possible time to need long distance aerial transport. They (the helicopters) are also small and unable to carry more than the baby and, at most two members of staff. Transfer of a neonate is not a simple case of popping the baby into an incubator and bunging it and a member of staff into a helicopter.
A neonate requiring transfer will probably be going to a specialist hospital many miles away - 200, 300 or more miles. The baby also requires a large amount of specialised equipment. Our transport incubators were fitted to standard ambulance trollies and had their own built in ventilators. Infusion pumps were fitted to the trolley and spare gas cylinders were located underneath the incubator. There is no earthly reason for a transport incubator to be fitted to anything other than a standard ambulance trolley (apart from cost and weight.) A transport incubator set-up such as I have described is heavy. I think ours weighed in the region of sixteen stones. The staff accompanying the baby need to have sufficient room to be able to move around and get to the baby at all times and space to accomodate the (in our case two) big, heavy rucksacks of emergency equipment and maybe a coolbox with blood/specimens/ drugs requiring refrigeration. Whilst I was still working we needed to transfer two babies by air. On both occasions ARCC sent us a nice big Chinook. Sadly we needed the police to stand guard over it to keep the local little dears at bay. Both transfers entailed some flying after dark. (I told you babies were awkward). As far as I am concerned, the best bet will always be the RAF as they have helicopters and staff available 24/7 and will always find one even if it isn't in the closest location.
Spinwing, I'm afraid you are wrong. A specialist neonatal helicopter service is not required. What is needed is a helicopter big enough to do what I have mentioned above and SAR through ARCC provides this. Neonatal transfers by helicopter are rare and undertaken only after great thought on the part of the medical team. They are also expensive - although the welfare of the baby is always the paramount consideration.

The trauma of flying in the back of a SeaKing is enough to finish the patient off what with noise / dirt / hydraulic fluid / and very ugly aircrew!

In the case of neonates they are highly unlikely to care but the accompanying staff maybe a different kettle of fish - especially with regard to the last mentioned disadvantage.

[spinwing]

Mmmm .....

Wombat ... thank you for joining in .... your UK expertise with this subject is just what may be needed here.

Spinwing, I'm afraid you are wrong ...... A specialist neonatal helicopter service is not required

Alas you may probably be correct with this statement .... (sigh )

As I indicated in my previous post ... I have no desire to tell you folks how or what to do ... and most likely your experiences with the UK requirements will be different to mine here in the more remote southern hemisphere... certainly we do not have dedicated military SAR cover on 24/7 standby at all times.

My own experience is that of having being flight crew (& as a Chief Pilot) of an NETS/HEMS & SAR dedicated operation. This operation WAS required to have our machines configured very differently for Neonate tasking ... and whilst you may tell me I am wrong certainly the Director of NETS at the Royal Women's Hospital here Melbourne was the guy writing the requirements ... and I'm pretty sure he was right.

All I wish is that if a dedicated operation was to start that it be a success and not be blighted by the vested interest of others.

Cheers

[[email protected]]

All this is much cheaper than using the MOD. Yes they do charge.

No we don't.

We would charge for a routine transfer but that would be very unlikely to be accepted by the ARCC. If it is an emergency and the child needs immediate transport to a hospital or from one hospital to another for lifesaving treatment (ECMO, transplant etc) - there is no charge.

TC - I would love to see an ECMO team operate in the size of helo used for HEMS and AA in UK - see DX Wombat's post for reasons why not. Is a HEMS/AA cab going to make a low level night transit because of bad weather? Or are you just going to use the aircraft and crew that are trained for exactly that sort of thing?

The fact that not all hospitals have a dedicated HLS doesn't seem to have reduced the amount of med transfers we do into Regent's Park and other sites - it doesn't take long to get the patient into an ambulance and away to hospital. Many hospitals with their own HLS often require an ambulance transfer from the LS to the hospital building.

As for Sea King availability - seems to be improving

[timex]

http://www.scottishambulance.com/Use...10%20final.pdf

Quite an "interesting" read, mentioning use of SAR and quite a lot of FW options.

[jivusajob]

Crab,

I don't really want to be drawn into a 'no we don't, yes we do' argument with you, which would detract from the discussion topic. But the facts should be stated correctly.

In Scotland, and I make no comment about anywhere else in the UK because I don't know the facts about anywhere else in the UK, MOD charges to the Scottish Ambulance Service run to circa £1million per year for air transfers. Please check with your northern colleagues before you jump down my throat on this.

I have a huge regard for the work done up here by MOD and MCA aircraft. Their availability for AA type tasking is invaluable when the Scottish Ambulance Service aircraft are not available or the weather is out of CAA limits for them.

However, the vast majority of work up here is done by the Scottish Ambulance Services own fleet. 2 x EC135 and 2 x Beach 200 KingAirs. The ambulance service simply could not afford to do the work by MOD assets. A large amount of the this work as I have already stated is done at night and the ambulance service do not do transfers at night by air unless there is an urgent clinical need. Of note the helicopters average about 100hrs per month with about 70% transfers to 30% HEMS.

Back to the discussion point. On the transfer side although everybody would want a bigger aircraft there are inevitably financial constraints. But it should be noted that MOD aircraft are used for weather reasons generally not cabin size reasons. While I understand Wombats comments, everything stated about the incubator including integrated oxyen, syringe drivers, monitors etc is available on the airtransport incubator used by the specialist Neonatal transfer teams used in Scotland. The incubator has it own trolley that fits in a land ambulance and a bespoke floor in the EC135 means in rolls into the cabin from the rear doors and locks in place. Two midwives and a paramedic are also carried and the Neonatal teams seem very happy with the setup. For specialist paediatric or adult retrieval the only additions required to the aircraft are the brackets to secure addition monitors, ventilator and syringe drivers. Again the teams that use this setup seem very happy with it.


Also an ECMO transfer system is being developed at this time.

So does the UK need a specialist paediatric helicopter?. Maybe. Could this work be done by existing Air Ambulances? Yes. The concept and equipment needed has been proved in Scotland. If you look at the hours flown by AA in England and Wales then yes there would seem to be the availability also. Do they need to extend to night time operations. Yes, but again concept proved up here. Would this type of work detract from local HEMS tasking. Yes. So maybe a joint Neonatal/Paedatric/Adult retrieval helicopter would be of use or better regional tasking of HEMS assets.

A Chinook, yes please but I really don't think it would look good in yellow!

[DX Wombat]

Spinwing, the set-up needed does vary from place to place. Much of Australia but not, as you know, Victoria, is covered by the RFDS. Your distances from home hospital to specialist centre can be vast and there are precious few places suitable for a diversion should it become necessary. I don't know if it still happens but babies with a congenital heart defect born in WA had to be transferred to Melbourne. Try doing that here and there would be uproar at the distance involved. There is a lot of debate at the moment about transferring babies from Yorkshire to Liverpool or Newcastle and it makes me very cross to hear people whinging about the "dreadfully long" distance to travel. Mind you, such is the unwillingness of people here to travel, that when I first moved here I kept hearing about a place by the name of Queensbury which was apparently located about 50 yards short of the North Pole. People talked in hushed tones about this remote place. It is less than four miles from the city centre.
Scotland is a different place as it has so many remote areas and islands - all part of its charm but can be a problem in an emergency but their arrangements are well thought out and work.

A Chinook, yes please but I really don't think it would look good in yellow!

Oh I don't know, could be fun, but maybe pink would be better with a few teddy bear, bunny and duck transfers.

[[email protected]]

Jivusajob - I suspect - although I will check with the ARCC - that because the Scottish Air Ambulance is funded by the Scottish NHS, unlike the rest of the UK where charities provide the AA, the MoD charges the SNHS when SAR helos are used to complete transfers that the Scottish AA can't do due to weather, size, night etc. This does not happen in the rest of the UK.

The Scottish Ambulance Service webpages have links to consultation documents suggesting that the air ambulances need to be bigger and better equipped (icing clearance specifically) to provide the service in the future - it will be interesting to see if Mr Salmond's SNP decide to up the budget in order to afford this greater capability. I believe the contract is due for renewal in 2013.

Also an ECMO transfer system is being developed at this time

using what?

[DX Wombat]

Is someone really proposing the use of ECMO in flight? Strewth! We transferred our babies to specialist ECMO centres. Maybe I'm being a bit too cowardly or cautious but in-flight ECMO seems a step too far to me. I shudder to think what might happen if one of the vital connections became disconnected or fell out during the flight inserting them is a delicate operation under ideal circumstances but in a vibrating helicopter? Crazy.

using what?

Assuming you mean which type of helicopter it would need to be a Chinook.

[[email protected]]

Dx - we take the ECMO team to the casualty, they carry out whatever medical intervention is required, then we fly the team plus casualty to the specialist ECMO hospital.

[DX Wombat]

Thanks crab that makes slightly more sense although I'm not sure what would happen if all four ECMO units, one of which is in Scotland, wanted it at the same time. Back to the trusty Chinook probably.

[Sven Sixtoo]

In 24 years in the business I cannot remember two simultaneous ECMOs. That may of course have been limited by the ECMO teams. But I can remember being airborne for 4 hours below 300' overland at night to get the ECMO team to the casualty, then a further 2.5 hours in and out of actual icing at FL35 ending with an ILS on minimums to overshoot and land at the hospital HLS to deliver causalty, team and relatives. I defy you to do that even in a 76, never mind the average UK 3-tonne AA.

Iain

[DX Wombat]

Sorry Sven, that was meant to be tongue in cheek, but it does still raise the question of what happens if the helicopter is grounded for some reason such as maintenance, the CAA pulling its airworthiness cert because it wanted it painted lilac with green stripes ..... To my mind it would seem more sensible to stick with the known and more widely available offerings from SAR. I said earlier that I have the greatest respect for the AA - that applies to SAR too and in some ways to a greater extent as they are not fair weather fliers as the AAs are forced to be (apart from the few). I was in Troon recently and lost count of the number of times I saw Rescue 5 from HMS Gannet airborne and I gather it is like that most of the time. For my own part I would be happier flying with someone trained in low level, bad weather, night flying than flying in less than optimal conditions with someone who does not get to practice in the grotty stuff which the SAR pilots do. Those pilots amaze me with their ability and willingness to go that step further to provide help where it is needed.

[Sven Sixtoo]

DX

I think we are on the same wavelength!

There may well be an application for charity support to pedeatric transfer. It's just that I believe there is a workable fleet of aircraft already available and any money that can be raised should be applied to supporting the medical teams so that the service delivery is as it should be. Unfortunately raising money to pay medical staff for 24-hr standbys and to buy airtransportable neonatal equipment for all major obs/gynae/maternity units is desperately unsexy (forgive the pun).
I repeat, if you need to move somebody around the UK for lifesaving reasons between difficult places at difficult hours phone ARCC Kinloss. They will find you the best asset, and if LIFE IS AT RISK it will be free at point of use.

The boys and girls are sitting around in 12 locations 24/7. You don't need to find them, you just have to call. They really are the A-team.

Iain