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A Piece from The Guardian about the HEMS in the UK.

Quote:Surgeons in the sky: doctors help air ambulances reach new heights

The numbers of medics going direct to patients by helicopter is slowly growing – saving lives in places such as London, where a surge in knife crime means every second matters

Zoë Smeed is one of a new breed of frontline emergency doctors who do not wait in hospitals for the patients to arrive – but go to them, and at high speed.
In the past few weeks she has arrived, by helicopter or fast car, at the scene of stabbings, shootings, fires, industrial accidents and road smashes. (She narrowly missed a job in which a zookeeper was attacked by a rhino. A colleague was scrambled to that one.)
“Itâ€s very different to working in a clean, well-lit emergency department,” said Smeed. “You can be treating a patient trapped in a car upside down in a ditch with the rain pouring down and the blue lights flashing. Itâ€s a real team effort. You are working with paramedics, police and firefighters. But itâ€s very rewarding. You are giving seriously unwell people a much better chance of survival.”

In days gone by, ambulance staff would race to a scene, patch a patient up as best they could and get them to hospital as quickly as possible.
But it has become increasingly clear that if a doctor with specialist skills and equipment can get to the scene of a nasty crash, accident or attack, and often stay with thepatient as they are conveyed to hospital, there is a much better chance of saving the patient.
Today, people such as Smeed, who is stationed at Magpas Helimedix in Cambridgeshire, are able to carry out procedures ranging from a thoracotomy – a surgical incision to the chest wall used to treat life-threatening conditions such as cardiac arrest after a trauma – to amputations.
They can protect a patient by putting them into an induced coma to help prevent brain damage or staunch severe bleeding.
Eighty miles south, on the streets of the capital, such techniques are vital. Medics attached to Londonâ€s air ambulance say they are facing a dramatic increase in violent crime, and patients can die within minutes of a catastrophic bleed or cardiac arrest, whether caused by heart disease or crime.
“Stabbings were relatively rare for me when we started,” said Gareth Davies, medical director of the service. “We saw it maybe once a week, but now we see it two or three times a day. That is just the number of stabbings serious enough to warrant a helicopter. Weâ€ve had to adapt.
“Whatâ€s changed is itâ€s not just drug dealers in dark alleys at night-time, itâ€s now a disease that affects children, children in the playground in broad daylight. Weâ€ve had to attend a child in a playground on a Monday morning. It used to be what we call the drugs and guns club. Now people donâ€t sort a fight out with a punch – itâ€s with a knife.”
Perhaps surprisingly, the biggest difference between the air ambulance and a conventional ambulance, according to Davies, is not the fact that one flies but rather the skills to be found onboard. “We are bringing the hospital to the patient. Doctors can do just about everything we can in the resus room in the emergency department.” And doctors, fully qualified in emergency departments around the world, are queuing up for the six-month rota on the flying hospital.
Until relatively recently, the accepted wisdom was that the only place to treat serious trauma was the hospital. The likes of Londonâ€s air ambulance and Magpas challenged this idea. Davies said he realised such a service was needed when he watched a doctor brought in by helicopter to help an injured motorcyclist at a race on the Isle of Man. “The irony was the general public wouldnâ€t get that service, it was only the riders at the race,” he said. “It seemed obvious to me that the public deserved the same standard of care if they crashed a bike or fell off a roof.”
Not everyone in the NHS was convinced. Davies battled against bureaucracy to turn the air ambulance into the service he wanted; the cynics within the NHS nicknamed him and his colleagues “the orange cowboys” after the colour of their jumpsuits.
“It was not a ‘golden childâ€,” said Davies about the launch 27 years ago. It was set up as a charity and now costs £6m a year to run. But the ethos of its service, to transcend the NHSâ€s bureaucratic borders, remains the same. Helicopters by day and fast response cars by night will stabilise the most critical patients on the street and deliver them to the most appropriate hospital, be that a mile or 25 miles away.
There is a touch of the maverick, the outsider, about the likes of Londonâ€s air ambulance, Magpas and, to a greater or lesser extent, the other 35 rotary air ambulances that cover the UK (and attend on average 70 incidents a day). The devolved governments of Wales and Scotland have launched national services, but most are run locally, driven forward by medics prepared to think outside the norm and funded through charitable donations. Much of the time, doctors are giving up their free time to join flights – and are not paid.
But the result is that the service is fragmented and variable. For example, Magpas flies 24 hours a day but at night London air ambulance uses cars rather than a helicopter. Some services do not have doctors onboard but rely on critical care paramedics – committed and talented professionals but with fewer skills than emergency doctors.
A key way of improving the service is to formalise training. The General Medical Council now recognises PHEM – pre hospital emergency medicine – as a sub-speciality. A training programme has been set up and a handful of doctors are now fully qualified. Another 30 – including Smeed – are currently in programmesacross England and Wales.
One of the architects of the PHEM scheme, Rod Mackenzie, a consultant in emergency medicine at Cambridge University hospitals and a Magpas doctor, said the aspiration was for each NHS ambulance service to have immediate access to qualified PHEM experts 24 hours a day. That would mean up to 750 doctors trained in the sub-speciality. “Weâ€ve come a long way, but weâ€ve a long way to go,” he said.
Nick Foster is one of the few PHEM graduates who has a full-time post in this specialised area. As a pre-hospital emergency physician for South Central ambulance service, his raison dâ€Ãªtre is to get to the most difficult of jobs.
Recently, he was scrambled to help an ambulance crew struggling with a patient who had fallen from a height. She was only a minuteâ€s drive from hospital but had a significant injury to the frontal lobe of her brain, which was causing her to be aggressive. “Within five minutes of arriving you can have calm and get a patient like that on the way to where she needs to be,” said Foster.
Foster said PHEM doctors also made a huge difference when children were having a cardiac arrest. “Paediatric cardiac arrests are so rare, just about everyoneâ€s worst nightmare – a three- or four-year-old whose heart has stopped beating. You see the relief in peopleâ€s eyes – emergency workers and parents – when you rock up in your red jumpsuit as the cavalry.”
They cannot always have all the answers. “Sometimes you have to say weâ€ve done all that can be done. There isnâ€t anything else a hospital could do. This patient has had everything. Weâ€re going to have to stop. Iâ€ve had to do that more than once. Even with paediatric cardiac arrests. I think it gives some solace that everything that could be done has been done.”
There is frustration among professionals such as Foster that the service is – in his words – “a little bit piecemeal” across the UK. “There are some very good systems, but theyâ€re all slightly different. They should be joined up.”
He understands why the UK government does not invest in a national service – it would cost tens of millions of pounds to pay for a service that currently saves lives through donations. “But at some point in the future a national streamlined service would be better,” said Foster.
Another PHEM graduate, Scott Grier, works as a hospital registrar in anaesthetics and intensive care in the south-west of England. On days off he volunteers as a critical care doctor for the Great Western air ambulance.
For him, pre-hospital work is often about tending to the most seriously injured people in the strangest of places. One of his unforgettable jobs was helping a patient who had fallen into a pile of rubbish at a processing plant. “That was the worst place Iâ€ve been. The patient had suffered significant injuries to the abdomen and pelvis after falling vertically into a pile of shredded household rubbish. Extricating him and treating him was a challenge.
“This job takes you to fields, motorways, pubs, anywhere you can imagine and a lot of places you canâ€t. You have to deliver the same world-class care regardless of where you are. You are seeing people right on the edge of life and you can make a genuine difference.” - Home of the real emergency service personnel.
Another recent piece on the London HEMS.

And they got their second helicopter recently. All through donations. - Home of the real emergency service personnel.