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UK Air Ambulance/HEMS - Dispatch Criteria

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UK Air Ambulance/HEMS - Dispatch Criteria

Old 31st Dec 2013, 06:25
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UK Air Ambulance/HEMS - Dispatch Criteria

A question addressed to all UK units outside London which I know acts as a specialist 'trauma response team' -

"Are you happy with your dispatch criteria?"

Are you being used:

1. as a selective 'fly swat' to deal only with incidents labelled 'serious',
2. as an integral part of the Ambulance Service with the intent to make it as effective as possible regardless of the apparent severity of the call,
3. our contribution is rationed to so many sorties a month due to finical constraints so we only go out on the 'important' jobs.

If this scarce and valuable resource is to have optimum effect then I believe we have to address the logistical part of the overall response equation and not just respond to high profile incidents. What say you?

G.
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Old 31st Dec 2013, 08:34
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After 11 years with an regional UK air ambo unit, my leaving present from the medics included one of those great caricature portraits with an characteristic phrase added in a voice bubble.

The phrase they chose to add to sum me up was; "Is it 'HEMS' or 'Air Ambulance'?"

It was never obvious.
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Old 31st Dec 2013, 08:41
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Bertie

Maybe it says a lot about how you see your own operation. I used to use 'Air Ambulance' as the public get what you mean far easier and also because I see the AA as an adjunct to the ground service. A tool that is part of the dispatchers toolkit when it comes to dealing with anything that might prejudice the ongoing efficiency of the service to the whole community.

HEMS is industry 'shorthand' but if you are not careful it can be used to paint yourself out of the big picture when it comes to overall effectiveness of the Ambulance service.


G.
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Old 31st Dec 2013, 19:06
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Sorry; "HEMS or Air Ambulance?", my perennial question as we launched, was in regard to possible use of HEMS exemptions and permissions.

The exemptions and permissions were granted for 'HEMS' flights only, not 'Air Ambulance' flights.

The difference was that a 'HEMS' flight was "where immediate and rapid transportation is essential" An 'Air Ambulance' flight was where this urgency was not deemed to be present and only normal CAT limits could be used.

I simply needed to be told the status of the flight in order to use my HEMS exemptions.
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Old 31st Dec 2013, 19:37
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Geoffers

Who writes your dispatch criteria?

As a HEMS unit we wrote our own and this was approved by our Medical Director who is part of the Ambulance Service Clinical Directorate. This allows us to share it with the Communications centre who dispatch the frontline crews and gives the Control Staff awareness of our clinical parameters. We dispatch ourselves primarily and we also take requests from Comms and Landcrews.

The frontline ambulance role will always throw up the job/patient that doesn't fit the criteria, but we address that by speaking to the landcrew or persons involved which usually helps us to make a decision to dispatch or not.

Works well for us...
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Old 31st Dec 2013, 20:52
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Bertie & Jack

BERTIE - Mission Classification - If you haven't read it already then checkout my booklet about the start of the Cornwall AA (Geoff Newman - go to the 'blog' page.) In there I describe the classifications we used and they shouldn't present any problems with regard to HEMS dispensations.

1, Primary (HEMS) - direct to scene based on information received (may turn out to be anything from a false alarm to a coronary but you can only react on the info received).
2. Secondary - rendezvous with land ambulance for onward transportation to hospital (uses a previous surveyed and approved LZ).
3. Tertiary - Hospital transfer (to and from approved sites).

Does that help?

JACK - Can you put your hand on your heart and say that you are addressing the logistical challenges as well as the clinical ones?


G
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Old 31st Dec 2013, 22:52
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Seasons Greeting Geoff

Having spent the last few years, since the introduction of JAR-OPS, trying to convince old and bold HEMS pilots that the redundant concept of primary, secondary and tertiary missions as per the initial days of UK air ambulance is now redundant, it is painful to find the terms being quoted on here.

I am aware of your background and suspect you are fully aware of the changes but, since it was not that long ago that crews were refusing to take patients in the helicopter because road ambulances had been used to move patients to un-surveyed landing sites (and therefore it had become a 'secondary mission'), I would just like to reiterate that it is the condition of the patient, as judged by the medical system, that defines the HEMS criteria and not the location, i.e. the same exemptions can be utilised (with some limitations) whether the patient is being transferred from hospital to hospital or HEMS site to hospital.

Happy New Year

TeeS
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Old 31st Dec 2013, 23:02
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To amplify the above, here is a cut and paste from my post in 2002 -

Zaplead

Your post brings up a what I perceive to be one of UK HEMS bigger problems. If you ask ten UK EMS pilots how and when they are allowed to apply the available exemptions you will get at least five different views, possibly ten.

One of the confusions is created by the pre-JAR terminology of a Primary Mission. This term, to the best of my knowledge, is not recognised under JAR but as you suggest enabled the following situations-

1. Call to a collapse in a city street, 2 P.M. outside pub - we could apply every exemption under the sun, land in the street cause loads of disruption etc. etc. despite being 80% sure that this was a person who had five too many drinks in the pub. That said, there is 20% chance that this is a life threatening collapse so we could do it. (Yes, I know a wise man will land in the large factory site 800m up the road and get the medics to hitch a lift, but I'm talking about what the rules say I can do!)

2. Call from road ambulance crew to assist them with a patient in a city street who has been hit by falling scaffolding pole. Patient has massive head and chest injuries an airway problem and possible spinal injuries - he needs to be in a trauma unit now! During the ten minutes that we will take to travel to the scene, the road crew will package the patient and transport him to a large factory site 800m up the road suitable for our landing. -"I am very sorry road crew, but by loading your patient onto the vehicle and conveying him up the road you have turned this into a secondary mission - I am now unable to land at an unsurveyed landing site in a congested area to pick him up. Please feel free to turn round and drive four miles through the traffic jam to a pre-surveyed secondary site"

Thankfully, JAR does away with Primary, Secondary and Tertiary (inter-hospital) missions and splits it into HEMS and Air Ambulance where HEMS is a response to a location at which a person is in urgent need of medical treatment etc. (I do not have the full definition in front of me so please don't savage me for not quoting it) and Air Ambulance is a routine movement of a patient, usually pre-planned, carried out to normal AOC criteria. The term "Life Threatening" is not used within the definitions although it does still appear in CAA exemptions.

I feel very strongly that because EMS pilots are, by the very nature of the operations, isolated from each other we are diverging in our understanding and interpretation of the rules (with all of us convinced that we have the correct perception of them).

I would be a very happy man to see a conference organised involving EMS line pilots, Aircrew Paramedics etc from around the U.K. to discuss the future but I suspect we all work too many hours to attend.

Cheers

TeeS
Hope that makes sense.

TeeS
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Old 1st Jan 2014, 00:22
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Tees

Happy New Year

I guess I am trying to push the discussion towards that corner of the ongoing debate about public service helicopters that involves the contribution the AA can make to the overall effectiveness of our public services. I will try to keep the debate within the confines of the NHS although there are times when it is tempting to want to cross the boundary into the territory currently 'owned' by others.

As long as the focus is on the condition of the patient who is the subject of the current callout there will never be much, if any, consideration for the plight of the next patient to dial 999.

Triage is fashionable these days but I am guessing that the road ambulances still have to deal with some pretty minor stuff and that in rural areas this can take a vehicle and highly trained crew out of service for some considerable time even though the patient'c condition is far from life threatening.

Now if we rejigged our thinking around making the whole organisation more effective we could use the AA as a general purpose tool (within reason of course) to remove (at high speed) such minor cases that have such a deleterious effect on the response times. (not as a matter of course but when the overall pattern of resource availability looks like it's going down the Swanney - see example in my booklet). Deal as quickly as possible with the calls you have and get them out of the system expeditiously. That way you have the best chance of being there when you are really needed.

We desperately need to think Team UK rather than just Team NHS.

G.
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Old 1st Jan 2014, 08:27
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A Happy New Years day from a rather windswept UK HEMS unit.

Thanks for the reminder of the old dispatch terms, Geoff, not used since about 2002 and the advent of JAROPS.

With the advent of the corporate manslaughter and homicide act, in 2007 and the ever changing public perception of 'acceptable risk', I always requested a 'HEMS' confirmation from my medical crew on launch, as about 50% of the time 'Control' didn't have a clue.

Perhaps some of what you initially asked on this thread is answered here:

http://www.associationofairambulance...20Document.pdf
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Old 1st Jan 2014, 11:52
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Bertie

Many thanks for connecting me with that document, it fills in a 13 year gap in my experience very well. I now understand where you are coming from.

If I can be so bold it seems to me that the conclusions implied by the texts are that clinical necessities trump all and that outcomes are King. Presumably that statement is based on individual patient outcome rather than overall outcomes throughout the Ambulance Service.

It seems to me that the apparent flexibility underwritten by the section on Major Incidents - to undertake tasks not directly related to the condition of a patient - provide the umbrella to cover you for the implications of the section on corporate manslaughter. Nothing I envisage would entail using the helicopter outside the safety-case developed for the 'Major Incident' scenario.

As I have indicated the system has matured to the extent that the clinicians (who back in 1987 didn't want to know and many fought us tooth and nail) are now 'enlightened' to the extent that anything that doesn't involve somebody who can benefit from their advanced skills is not worthy. I say think about the next call when you are in distant rural location and the loss of 'your ambulance' for 4 hours means that Uncle Jimmy dies because Mrs Smith's epistaxis couldn't be managed at home.

I have many times mulled over the question of statistics and I wonder if these days data is kept on:

1. Transport time to hospital.
2. Time taken to return a vehicle to its designated station.
3. No of minutes where no ambulance resource was available.

Maybe your more up-to-date knowledge can help?



G.

Last edited by Geoffersincornwall; 1st Jan 2014 at 13:04. Reason: Removed some irrelevant stuff
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Old 1st Jan 2014, 12:41
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I always used to sell the 'force multiplier' aspect of our helicopter! --A 15 minute flight in our helicopter could result in a road ambulance and crew remaining available in a rural location for many hours.

We averaged approx 45 minutes from 999 call to hospital over a 10 year period with a paramedic crew. A 'very fast' ambulance that could help both patient and the Service.

With doctor lead medical teams on a helicopter, the focus is often different.
The helicopter is used as a rapid intervention vehicle to get definitive medical care to the patient. Once stabilised it may now be better for the patient to be transported to hospital by road vehicle!

Several UK HEMS 'models' exist these days, depending on the composition of the medical team carried. Some 'traditional' but superfast blue light ambulances, others more like airborne surgical tools.

But I'll still want to know why a 6 car RTC, reported in to ambulance control only by the police, with no details of any casualties, is a HEMS job?
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Old 9th Apr 2014, 04:54
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Air ambulances provide the best possible facilities to the patients. The medical experts as the crew help a lot during the medical travel. Emergency medical travel assistance should be called asap in case of need so that the doctors may help you.
"With doctor lead medical teams on a helicopter, the focus is often different.
The helicopter is used as a rapid intervention vehicle to get definitive medical care to the patient. Once stabilised it may now be better for the patient to be transported to hospital by road vehicle! "

I completely agree with this. A patient must be transported to hospital by road vehicle only after their condition is stablised.
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