Research published online in the Emergency Medicine Journal indicates that despite considerable advancements in the availability of round-the-clock Helicopter Emergency Medical Services (HEMS) throughout the United Kingdom since 2009, significant regional disparities persist.
Furthermore, the findings suggest a fluctuating provision of advanced, potentially life-sustaining interventions. These include procedures such as blood transfusions and a minimally invasive technique known as resuscitative endovascular balloon occlusion of the aorta, which is employed to control severe hemorrhaging and stabilize blood pressure.
HEMS, commonly referred to as air ambulances, deliver critical advanced medical care to patients suffering from severe injuries or who are critically ill, prior to their arrival at a medical facility. The researchers clarify that in the UK, such advanced care, also designated as Level 3 interventions, can exclusively be administered by prehospital teams comprising physicians.
While voluntary networks of prehospital care physicians exist, such as those affiliated with the British Association for Immediate Care (BASICS), the delivery of these services is inconsistent, contingent upon the available expertise on any given day, they further elaborate.
In 2009, the most recent year for which UK service provision data was compiled, 17 HEMS units were operational across England, Wales, and Northern Ireland. Of these, only 11 included a physician (65%), and merely 4 (23%) consistently maintained a physician-led team throughout the week. Of these, only one was accessible 24 hours a day, 7 days a week.
To assess shifts in service provision, the researchers distributed an online questionnaire in early 2024 to all 21 UK HEMS organizations. The objective was to ascertain the number of physician-staffed teams, their operating hours, and the spectrum of interventions they offered.
All surveyed organizations provided responses. Their replies revealed a notable increase in the number of potentially available physician-staffed HEMS teams, rising from 11 in 2009 to 30 in 2024, with two of these units located in Scotland.
The availability of continuous 24/7 physician-staffed prehospital teams also saw an upward trend, escalating from a single unit in 2009 to eleven in 2024. However, 24/7 accessibility continued to vary across the UK, with the East of England region reporting the highest availability and Northern Ireland, the South West of England, and Northern England indicating the lowest.
Two specific regions had 24/7 services across all their units, whereas four regions lacked such coverage. The times at which services ceased operations also presented variability, with some concluding at 19:00/19:30 hours, while others remained operational until 02:00/03:00 hours.
The inconsistent delivery of advanced interventions within physician-staffed teams persisted. For instance, while 19 services (90%) reported offering blood transfusions, only one (5%) provided resuscitative balloon occlusion of the aorta.
An additional ten HEMS units were potentially available but exclusively offered Level 2 interventions, as they were not physician-staffed.
BASICS schemes were documented in 11 regions, providing either Level 2 or Level 3 prehospital care on a voluntary basis.
Financial support continued to be a significant challenge, as only one of the 21 HEMS organizations received complete government funding. The remaining organizations were either entirely reliant on charitable donations (12) or a combination of charitable and governmental contributions (8).
The researchers acknowledge certain constraints that could influence their findings. While survey participants identified additional prehospital teams within their respective areas, it proved impossible to gauge the accessibility of these units. Moreover, the survey data reflects the situation as of March 2024, and the circumstances may have evolved since then, they conclude.
“While the observed enhancement in access to HEMS is encouraging, the capacity to offer 24/7 access to Level 3 interventions, such as prehospital emergency anaesthesia (PHEA), remains uneven across the nation, with a substantial dependence on the charitable sector. As was the case in 2009, philanthropic funding continues to be the primary source for HEMS operations in the UK,” the researchers observe.
