Areport produced by the Association of Air Ambulances (AAA) has highlighted that 60% of air ambulance landing facilities are inadequate in the UK, raising concerns that this could lead to greater morbidity and mortality.
The report, which was produced by the AAA after the issue was raised at the All Party Parliamentary Group for Air Ambulances (APPGAA) Annual General Meeting in October 2013, focuses on the treatment of major trauma—the biggest killer of people under 50 years of age.
On average, 70 people are treated by air ambulances in any one day. Patients attended will often be critically ill, suffering from major trauma, burns, cardiac or neurological illness. However, despite the severity of the conditions presented, air ambulances frequently have to land some distances from the hospital in inadequate facilities, which require a land ambulance to complete the journey to definitive care.
The report reviewed the 29 Major Trauma Hospitals for adults and children in the UK and concluded that only seven have suitable helipads. A further eight have landing facilities with operational issues and the remaining 15 sites require a secondary land transfer by land ambulance or vehicle (See Table 1).
| State | Lit | Staffed | Dist (m) | Comments | ||
|---|---|---|---|---|---|---|
| Adult and Children's Major Trauma Centres | ||||||
| 1 | Addenbrooke's Hospital Cambridge |
|
No | No | 200 m+ | Temporary onsite landing facilities requiring secondary road transfer |
| 2 | Frenchay Hospital Bristol |
|
No | No | 150 m+ | Paed MTC via BRI Helipad to open April 2014 Southmead Adult MTC Ground level pad April 2014 |
| 3 | James Cook University Hospital Middlesburgh |
|
Yes | No | 20 m | |
| 4 | John Radcliffe Hospital Oxford |
|
Yes | No | 200 m+ | Requiring secondary vehicle transfer |
| 5 | King's College Hospital London |
|
No | No | n/a | |
| 6 | Leeds General Infirmary |
|
Yes | Yes | 20 m | Rooftop helipad |
| 7 | Queen's Medical Centre Nottingham |
|
No | No | n/a | |
| 8 | Royal London Hospital |
|
Yes | Yes | 80 m | Rooftop helipad |
| 9 | Royal Victoria Infirmary Newcastle |
|
Yes | Yes | 50 m | Rooftop helipad |
| 10 | St Mary's Hospital London |
|
No | No | n/a | |
| 11 | St George's Hospital London |
|
Yes | Yes | Roof top | Rooftop helipad opening March 2014 |
| 12 | Southampton General Hospital |
|
Yes | Yes | 100 m | |
| Adult Major Trauma Centres | ||||||
| 13 | Derriford Hospital Plymouth |
|
No | Yes | 50m | On-site grass landing facility for day use only |
| 14 | Hull Royal Infirmary |
|
No | No | n/a | |
| 15 | Northern General Hospital Birmingham |
|
No | No | n/a | |
| 16 | Queen Elizabeth Hospital Birmingham |
|
Yes | Yes | 60 m | Car park rooftop helipad, road crossing with traffic control lights. Not approved for night use |
| 17 | Royal Preston Hospital |
|
No | No | 60 m | |
| 18 | Royal Sussex County Hospital Brighton |
|
No | No | n/a | |
| 19 | University Hospital Coventry |
|
Yes | No | 110 m | Car park helipad with no covered walkway |
| 20 | University Hospital of North Staffordshire Stoke on Trent |
|
Yes | Yes | 20 m | |
| Children's Major Trauma Centres | ||||||
| 21 | Alder Hey Children's Hospital Liverpool |
|
No | No | n/a | |
| 22 | Birmingham Children's Hospital |
|
No | No | 20 m | On roadside requiring road closure. Cannot be used without police presence |
| 23 | Royal Manchester Children's Hospital |
|
No | No | n/a | |
| 24 | Sheffield Children's Hospital |
|
No | No | n/a | |
| Collaborative | ||||||
| 25 | Manchester Collaborative MTC a) Salford Royal NHS Trust |
|
No | No | n/a | |
| b) Manchester Royal Infirmary |
|
No | No | n/a | ||
| c) University Hospital South Manchester |
|
No | No | 100 m | ||
| 26 | Liverpool Collaborative MTC a) Aintree University Hospital |
|
No | No | n/a | |
| b) Walton Centre |
|
No | No | n/a | ||
| c) Royal Liverpool University Hospital |
|
No | No | n/a | ||
Key:
The effect this has on the delivery of care to patients is clear: while the care itself isn't generally affected, it is the delays to the provision of that care that can be potentially life-threatening for the patient.
According to Clive Dickin, National Director of the AAA, one of the ways in which these delays can be reduced is by looking at the most value for money landing facilities:
‘The simple thing you have to consider here is that it is not always about sticking a helipad on a roof. It is important when developing landing facilities to consider a helipad that will be fit for the majority of aircraft that will use it, not the minority.’
Many hospitals have taken a ‘one size fits all’ route so they look for a very large landing facility that can accomodate larger aircraft. However, if you look at the number of actual missions that air ambulances carry out each year (just over 20 000, in comparison to approximately 1 000 for search and rescue), the facilities that are needed are for small helicopters, not large.
The factors that dictate the location of helipads is also something that has to be taken into consideration. ‘There is always restrictions on sites,’ says Dickin.
‘If you look at Addenbrookes [Hospital Cambridge], for example, the hospital has developed and grown over the years, but the actual ED, the MTC, is at the heart of the hospital, so the only option they potentially have is building a rooftop helipad. Apparently that is cost-inhibitive and the hospital cannot justify that at the moment. So you have a landing site that is about half a mile away on the extremities of the actual campus of the hospital, and ultimately you have to have a land ambulance meet the aircraft to convey the patient for about half a mile. And, of course, that takes time.’
The key factor then is about looking at locations such as car parks and considering more sensible ground-level approaches that could be more cost-effective. But as Dickin highlights, not all hospitals have found the right balance of what is cost-effective yet best for the patient:
‘If you look at the University Hospital Coventry, car parking has actually taken priority over the landing facilities. If you look at an aerial photo it shows the helipad beyond the car park. Why was it not the other way around and the helipad put closer to the emergency department? Instead it is some 150 metres. That's not a huge distance, but when you're having to push a patient, potentially who is in cardiac arrest and not on a chest compression device, that is quite a distance and those minutes are extremely important.’
Some hospitals have found innovative ways in which to combat this problem. For example, Southampton General Hospital has built a raised platform above a car park. Helipads built more thatn 3 metres from the ground require the presence of fire marhsals when helicopters are taking off and landing, which involves an additional revenue cost. However, by building a helipad approximately 2.4 metres above ground, Southampton General Hospital has been able to eliminate this unnecessary cost. A number of hospitals have built helipads only to have restrictions on their operation, resulting in them not being fully manned 24/7. This obviously presents a problem when you have a patient who is treated by a night HEMS aircraft.
The APPGAA have shared the information from the report with all MPs and members of Lords, as well as liaising with the Department of Health, highlighting the report findings and seeking clarification on whether the provision of air ambulance helipads can be addressed. However, in terms of who can implement the change in the provision of helipads, MPs and the Department of Health do not have direct control. Intstead it is up to the Boards of the hospitals to recognise that these facilities are extrememly important. That being said, this does not mean that MP's and the Department of Health cannot play their part. As Dickin comments:
‘Through the MPs and Department of Health we are highlighting the fact that you can find very cost-effective, very sensible, but also extremely useful ways of positioning helipads so that they are nearby to the actual entrance to the Major Trauma Centre or the correct care pathway.’
Both the APPGAA and the AAA are calling on the Government to endorse a policy of recognition of parity for all patients arrival facilities. The report argues that it is unacceptable and not in keeping with the principle of ‘Equality of Care’ for patients to have reduced access to definitive care, in comparison to a patient arriving on a land ambulance. This is heightened by the fact that air ambulance patients are typically in need of time-critical care. Just over 50% of patients treated by air ambulances go to MTCs each year, so although it is important to focus on land ambulances, it is equally important to put in as much focus on helipads.
Looking to the future, the AAA is planning to publish a further report in Autumn 2014 exploring all care pathways within England. Once that report is published, it will again be highlighted to the Department of Health. The conversations the AAA is having with the relevant organisations is described by Dickin:
‘We have an ongoing process at the moment, engaging with the Department of Health and the hospitals through the air ambulance charities, that includes also the HELP [Helicopter Emergency Landing Pads] appeal, who are obviously specifically fundraising for helipads throughout the country and we will be looking to step up the profile through this report in making sure landing facilities are treated as high a priority as land transport facilities at these centres.’
Although there are well-developed plans for landing facilities at a number of UK hospitals, including: Bristol Royal Infirmary/Bristol Children's Hospital/Bristol Southmead; Derriford Hospital, Plymouth; Hull Royal Infirmary; and St George's Hospital, London, it is clear that improvements are still needed within other areas of the country if appropriate care is to be given.