Twenty-five years of London's Air Ambulance paramedics

Development of the serviceDuring the early years, London's Air Ambulance (LAA) functioned almost entirely as an aeromedical service during daylight hours. A range of drugs were used for anaesthesia and sedation, with individual clinicians employing a variety of approaches to these interventions based on previous experience. Dispatch of the aircraft was handled by specialised emergency medical dispatchers within the LAS control room, and mission cancellation rates were relatively high. The subsequent introduction of LAA paramedics led to improvements in cancellation rates and more clinically focused targeting of the team (Earlam, 1997). The goal of the service has always been to improve patient safety and deliver high-quality clinical interventions, and over time a number of Standard Operating Procedures (SOP) were developed to provide structure and governance of specific aspects of the service, such as the provision of anaesthesia, sedation and analgesia.Roles became more clearly defined for doctors and paramedics, and checklists modelled on those used within the aviation industry were produced to further enhance safety in potentially high-risk procedures such as rapid sequence induction (RSI) anaesthesia. It quickly became clear that whilst the use of a helicopter provided a means of rapid deployment of a specialised trauma team during the day, there were also a number of major trauma patients with unmet clinical needs throughout the night. With this in mind, sponsorship for the provision of a rapid response car was obtained, and the team began to provide cover until midnight or 01:00 hours on certain nights of the week. As staffing levels increased, the frequency and duration of these shifts were increased incrementally, culminating in the introduction of a full 24 hour service in 2010.

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