RESEARCH AND LIBRARY SERVICES BRIEFING NOTE 98/09 Northern Ireland Assembly Air Ambulances - Research Briefing November 2009 Overview of Research Briefing This research briefing provides an overview of Air Ambulance Services in the UK and some examples from across the world, with sections on England, Scotland, Wales, Northern Ireland and the Republic of Ireland, Norway, Austria, Canada, New Zealand, and Australia. Several important issues for consideration are discussed in more detail including tasking of air ambulances, safety, the potential need for supplementary rapid response vehicles, and the need to plan for the effects of air ambulance admissions on receiving hospitals. The briefing ends with a section of concluding comments highlighting findings from the 2007 Report Trauma: Who Cares?1 and noting several barriers, identified in the literature, which may prevent a greater role for air ambulances in the UK. Contents Page 1. Introduction to Air Ambulances Services in the UK 1 2. Air Ambulances in the UK and Republic of Ireland 2 2.1 England 2 2.2 Wales 4 2.3 Scotland 4 2.4 Northern Ireland and Republic of Ireland 5 3. Examples of Air Ambulance Services Across the World 7 3.1 Canada – Ontario 7 3.2 New Zealand 8 3.3 Australia 9 3.5 Europe 10 4. Other Issues for Consideration 11 5. Concluding Comments 13 1. Introduction to Air Ambulances Services in the UK There are currently 27 Air Ambulance organisations in the UK operating from 34 locations2. Aircraft with two paramedics on board are still the most usual set-up. The principle of a doctor-paramedic team was first used by the London Helicopter Emergency Service (HEMS) in 1988. In total, the Air Ambulance Services of the UK3 undertake over 19,000 missions per year and serve 177 accident and emergency departments. The missions are made up of 40% road traffic collisions, 24% other medical emergencies and 3% hospital transfers. Air Ambulance Charities in the UK collectively generate an annual income of around £46 million or £125,000 raised every day. On average a mission costs £1,229 and the average spend per helicopter is £843,000 per year. The Air Ambulance Charities spend £15m per year in the helicopter industry. 1 Trauma: Who Cares?, A Report of the National Confidential Enquiry into Patient Outcome and Death, 2007 2 www.aeroflight.co.uk/waf/uk/ems/uk-ems-home.htm 3 Amazing Facts about your Air Ambulance, Association of Air Ambulances in the UK, www.airambulanceassociation.co.uk/amazing_facts.php AIR AMBULANCES RESEARCH AND LIBRARY SERVICES In 2007 the Air Ambulance Working Group (AAWG) was set up with experts in the sector to consider future air ambulance practice and procedure. The AAWG note that “correctly used HEMS operations target the most seriously ill or injured patients and those likely to benefit most from early medical input regarding; scene management, triage, treatment and transfer. Other benefits can be recognised in providing rapid, controlled and skilled secondary transfers to tertiary centres for further specialist input after initial resuscitation in a non-specialist hospital”4. The air ambulance sector distinguishes between a Helicopter Emergency Medical Services (HEMS) flights and air ambulance missions. A HEMS flight is a mission governed solely by medical need and carried out by a helicopter operating under a HEMS approval. It aims to facilitate emergency medical assistance where immediate and rapid transportation is essential, by carrying medical personnel, and/or medical supplies, and/or ill or injured persons and other persons directly involved5. An air ambulance mission, by contrast, is usually planned in advance and is one where the aircraft is used as an extension of the ambulance service land vehicles for the transport of patients to and from hospital or from land vehicles to hospital. For example, such a mission can provide for the subsequent transfer of patients delivered initially to a local emergency department by a road crew in order to expedite their care to a specialist unit such as burns, spinal or paediatric intensive care6. The two main staffing models used on HEMS operations are7: The Paramedic–Paramedic model used on over 80% of aircraft. State paramedics operate within the standards set by the Joint Royal Colleges Ambulance Service Liaison Committee whether they operate in road or air ambulances. It is considered internationally that such a model is the best if supported by strong medical oversight and direction via remote telemedicine (such as used in Ontario); The Paramedic-Physician model provides a higher level of clinical expertise for patients and correctly used these HEMS operations provide early advanced medical input normally delivered in a hospital setting. This is the model of care used throughout Europe, Scandinavia, and Australasia. 2. Air Ambulances in the UK and Republic of Ireland 2.1 England The first civil helicopter-based air ambulance in the UK was opened in Cornwall in 1987. The distance to the major hospitals from many parts of Cornwall means that the air ambulance has become a lifesaving mode of transport. In 1988 a report by the Royal College of surgeons recommended “setting up a network of trauma centres geared specifically to dealing with the types of injuries sustained in major accidents, to which patients would be flown by a national fleet of EMS [emergency medical 4 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, Section 1.3, page 6 5 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, Section 2.2.3, page 13 6 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, Section 2.2.3, page 13 7 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, Section 2.2.4, page 14 Providing research and information services to the Northern Ireland Assembly 2 AIR AMBULANCES RESEARCH AND LIBRARY SERVICES service] helicopters”8. The recommendation for the trauma centres has not yet been realised, however many counties and authorities have set up their own air ambulance programmes. In England 17 air ambulances services were in operation at 1st July 20089. The majority of these air ambulance services are independent charities with the remainder being NHS Corporate Trustees or independent charities with NHS representation on their Boards. The NHS usually meets the cost of ambulance personnel who work on the air ambulance. The two main funding models reflect the relationship between the funding charity and the Ambulance Services10: Several charities are established as ‘Owner/Operator’ Charities. These provide the air ambulance Service and support the NHS Ambulance Services; ‘Grant-Giving’ Charities are essentially those that provide the funding for the service but the operational and clinical management are the responsibility of the NHS Ambulance Service. In both models there is a ‘Memorandum of Understanding’ between the Charity and the participating NHS Ambulance Service(s) defining the roles and responsibilities of all members of the parties and the reporting and communication arrangements11 . In addition to the Association of Air Ambulances (the representative body for the Air Ambulance Services in the UK), in 2006 the Association of Air Ambulance Charities was launched to support and co-ordinate the charitable trusts that fund Air Ambulance Services in the UK12. One of the current issues facing many air ambulance services in England is surges in demand for the services which puts a strain on the finances of the particular charities involved. For example, the Great North Air Ambulance Service was called out 154 times in April 2009 compared to 75 times in April 2008. The Charity involved believes that this is due to improved relationships with the North-East Ambulance Service (NEAS) as the “helicopters are quite often activated by NEAS if a 999 call sounds serious enough to warrant air support”13. The potential for night flying is another pressing problem as under Civil Aviation Authority rules helicopters require specialised equipment to fly at night and such equipment is too expensive for most air ambulance charities. Wiltshire has got around this problem by having a shared police and air ambulance helicopter, which is only one of two in England to be shared in this way but means that it can fly at night. 8 Air Ambulances, House of Commons Hansard, Westminster Hall Adjournment Debate, 27th Feb. 2008 9 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, page 10 - Cornwall Air Ambulance; County Air Ambulance (Shropshire); Devon Air Ambulance Trust; Dorset and Somerset Air Ambulance; East Anglian Air Ambulance; Essex and Herts Air Ambulance Trust; Great North Air Ambulance Service; Great Western Air Ambulance; Hampshire and Isle of Wight Air Ambulance; Kent Air Ambulance; Surrey/Sussex Air Ambulance; Lincolnshire and Nottinghamshire Air Ambulance, London’s Air Ambulance; North West Air Ambulance; Thames Valley and Chiltern Air Ambulance; Warwickshire and Northamptonshire Air Ambulance; Derbyshire, Leicestershire and Rutland Air Ambulance; Wiltshire Air Ambulance; and Yorkshire Air Ambulance. 10 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, Section 2.2.1 and 2.2.2, pages 7-8 11 Framework for a High Performing Air Ambulance Service, Air Ambulance Working Group, August 2008, Section 2.2.2, page 9 12 www.aeroflight.co.uk/waf/uk/ems/uk-ems-home.htm 13 Popular air ambulance in plea for funding, Daily Star, May 22, 2009 Providing research and information services to the Northern Ireland Assembly 3 AIR AMBULANCES RESEARCH AND LIBRARY SERVICES It has been held up as a model of service that should be considered throughout the country14. 2.2 Wales The Wales Air Ambulance Service has three helicopters based in the North (Caernarfon), Mid Wales (Welshpool) and the South (Swansea).