Air ambulance charities across the UK are working together this month to celebrate National Air Ambulance Week (NAAW). The nationally coordinated event was started by the Association of Air Ambulances (AAA) in 2012. As we look to raise awareness of air ambulances, it is worth taking some time to consider the rapid development they have undergone since the first dedicated helicopter unit went into service in Cornwall in 1987.
Great Britain is now covered by 21 air ambulance charities which provide 36 emergency helicopters (helicopter emergency medical services (HEMS)) and 2 dedicated inter-hospital transfer aircraft. In July 2017, Northern Ireland's first air ambulance undertook its first mission, ensuring the entire UK is now covered by air ambulance services.
Air ambulances have expanded geographically, providing increasingly complex interventions, and are increasingly available at night as of 2012. The prevalence of doctors on board most aircraft is also on the rise, and has had a dramatic effect. The ability to quickly and safely provide interventions that were previously only available in the hospital has radically changed the service. The role of the air ambulance team has moved from providing aeromedical evacuation to delivering crucial pre-hospital interventions.
A number of services now operate aircraft during the hours of darkness. Others have taken a decision that, for the area they cover, night flight is not the most effective means of moving patients. The increasing ability to provide enhanced care means that, despite this, many of these services deploy road-based resources overnight.
The development of the pre-hospital emergency medicine (PHEM) training programme for doctors has further transformed air ambulance operations. Paramedics are now routinely involved in the training of our future colleagues. The PHEM programme is currently restricted to doctors but the Faculty of Pre-Hospital Care (FPHC) does not discriminate between professions for its examination and accreditation processes, opening the door for paramedics to be externally recognised as level 8 PHEM practitioners in their own right.
Academically, air ambulance paramedics have had to increase their understanding of critical care interventions. A number of universities now offer pre-hospital critical care modules and programmes at Masters level. Paramedics are now critically appraising interventions, which were unheard of in the pre-hospital field, and are producing research to guide the ongoing development of their services.
In an era of increasingly stretched ambulance resources, air ambulance crews are continually looking for ways to support their colleagues in the wider ambulance service. The frequency with which these teams see the full range of traumatic injuries allows them to provide enhanced care, and rapidly de-escalate incidents by applying experience, underlying knowledge and clinical decision-making skills.
There are a number of challenges for air ambulance paramedics. Clinical interventions are becoming increasingly complex and require a significant level of academic and practical knowledge. Further innovations are continually evaluated and air ambulance crews are helping to drive forward both pre-hospital and in-hospital advances. Interventions that would have been unthinkable in 1987, such as resuscitative endovascular balloon occlusion of the aorta (REBOA), are carried out with further advances likely—pre-hospital extracorporeal membrane oxygenation (ECMO) being one.
Continuing service development must be balanced with the demands of a service delivered by charities. Air ambulances are fortunate to be highly visible and well-supported by the public but it is incumbent on those involved with the delivery of clinical care to reach out to the public and explain its value.
The arrival of doctors on board air ambulances could have reduced the impact of paramedics, leaving them to fulfil a support role. On the contrary, paramedics deliver complex and specialist care including anaesthesia and pre-hospital blood transfusion. Far from being side-lined, the profession has shown that it is adaptable and can progress rapidly into unknown fields.
These advances have led to air ambulance paramedics occupying more specialised roles, often directly employed by charities. This move away from the traditional secondment model offers advantages in terms of career development and training investment. The reduced rotation of paramedics through air ambulance units is however a disadvantage. Services employing staff directly must work to ensure that skills and knowledge are disseminated to the wider paramedic community. Air ambulance paramedics must also remember the immense strain on the wider ambulance service, and the broader base of clinical knowledge that they must maintain.