London's Air Ambulance
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Gareth Davies, Medical Director |
Jonathan Jenkins, CEO
London's Air Ambulance is a British registered charity that operates a Helicopter Emergency Medical Service (HEMS), dedicated to responding to serious trauma emergencies in and around London. Using a helicopter by day and rapid response vehicles by night, the service performs advanced medical interventions at the scene of the incident in life-threatening, time-critical situations.
London's Air Ambulance was founded in 1989 in response to a report by the Royal College of Surgeons which documented cases of patients dying unnecessarily because of the delay in receiving prompt and appropriate medical care. The charity was the first in the UK to carry a senior doctor in addition to a paramedic at all times on a helicopter, introducing a system that reduces the death rate in severe trauma by 30–40%.
From its base at the Royal London Hospital in Whitechapel, East London, a helicopter can reach any patient inside the M25 London orbital road, which acts as the service's catchment area, within 15 minutes. Missions commonly involve serious road traffic collisions, falls from height, stabbings and shootings, industrial accidents and incidents on the rail network. The team can perform advanced life-saving medical interventions, including open heart surgery, blood transfusion and anaesthesia, at the scene. The charity operates 24 hours a day, serving the 10 million people who live, work and travel within the M25. The service treats an average of 5 patients every day.
Pre-hospital emergency medical care
London's Air Ambulance has been at the forefront of innovation in pre-hospital emergency medical care since its inception in 1989. The service has adopted elements of medical, military and aviation culture to deliver the highest standards in intensive care to the roadside. The governance system and Standard Operating Procedures developed by the organisation are seen as a benchmark for other air ambulances across the world.
London sees some of the highest level of trauma in the world and the service is internationally renowned for clinical excellence and pioneering procedures. Innovations introduced by the service can dramatically increase patient’s chances of survival and recovery.
London’s Air Ambulance was the first service in the world to perform open heart surgery (thoracotomy) at the roadside. The service has the world’s highest survival rates from this procedure in pre-hospital environment, with patient’s chances of survival rising from zero to 18%.
London’s Air Ambulance was the first service in the UK to carry a senior doctor in addition to a paramedic at all times, provide a 24/7 advanced trauma care outside of hospital, provide general anaesthetics on scene, and carry blood on board and administer blood transfusion on the roadside. From 2018, a consultant in Pre-Hospital Emergency Medicine will be present on most shifts, in addition to the other physician and paramedic.
In 2014 London's Air Ambulance performed the first pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the world. Other key treatments performed by the service include surgical chest draining (thoracostomy), surgical and non-surgical Rapid Sequence Induction (RSI), pelvic splinting (crucial to prevent blood loss in high impact crashes and crush injuries), advanced pain relief and sedation. The service started a trial of a portable brain scanner which can detect blood clots on the brain in April 2015.
The current helicopters used are two McDonnell Douglas MD 902 Explorer aircraft, registration G-EHMS, and G-LNDN. They are notable as they do not use a tail-rotor. This is a useful feature, as the helicopter must routinely land in confined inner city areas. Both helicopters wear the same red-based livery, with green and yellow flashes, although G-LNDN additionally has the masonic Square and Compasses symbol on each side, and the words "London Freemasons" lettered under the doors, to reflect the significant funding of the aircraft from that organisation. G-LNDN is identical to G-EHMS in model, equipment and crew. Only one helicopter is operational per day - the other acts as a spare in case of break down, maintenance or, in a major incident, both helicopters are able to deploy.
The helicopters usually cruise at 130 knots, at an altitude of anywhere between 500 and 1,000 ft. A regular fuel load, around 400 kg, allows for one hour's flying time.
MD 902 Explorer helicopter G-EHMS entered service in October 2000, replacing the earlier SA 365N Dauphin, registered G-HEMS. From 6 March 2012, the helicopter became the UK's first air ambulance to carry emergency blood supplies, allowing transfusions to be administered at the scene of an accident rather than later in hospital. A specialised refrigerator installed in the helicopter allows the transport of four units of the universal O-negative blood type which can be stored in the aircraft for up to 72 hours (unused stocks can be returned to the hospital).
In 2015 London's Air Ambulance service launched a public appeal to raise £6,000,000 to purchase, convert, equip, and operate a second helicopter. Of the total needed, just over £4,000,000 represented the purchase price of the aircraft. In January 2016 London's Air Ambulance took delivery of the second MD 902 Explorer, registration G-LNDN. This was in part due to a £2,000,000 donation by London Freemasons, which covered half the purchase price. The United Kingdom Government contributed £1,000,000, using funds obtained from fines imposed on banks, with the remaining £1,000,000 being raised by public subscription.
Following a children's competition, the two helicopters were given names which are displayed on the side of each aircraft. In February 2016, G-LNDN was named 'Walter' after the winning entrants grandfather, on the basis that he lives "in the moon and stars with the angels so he would help keep the helicopter safe in the sky when it's helping people"; whilst in April, 'Rowan' (meaning 'little red one') was chosen as the name of G-EHMS, after that entrants sister.
Rapid response cars
At night or when the helicopters are offline the medical crew, including a paramedic and senior trauma doctor, still respond to emergencies, but travel in a specially equipped rapid response car. The six cars, Škoda Octavias and also Škoda Superbs, occasionally operate during the day, carrying backup medical teams to major incidents, or responding to local incidents or those that occur while the helicopter team is already deployed. They are noticeable from other ambulance vehicles as they are painted in red with high-visibility markings to display their ‘advanced trauma team', status.
A four-wheel drive Skoda Superb is also operated 7 days a week by the Physician Response Unit (PRU).
The service costs approximately £10 million per year to run. Barts Health NHS Trust provides the helipad facility at The Royal London Hospital and remunerates the doctors seconded to and consultants permanently associated with the service. London Ambulance Service employs and remunerates the paramedics seconded to the service. London's Air Ambulance is a registered charity (number 801013) and the service is funded through charitable donations and corporate donors. The charity also runs a lottery for £1 a week to raise funds for the service, and holds a number of small and large scale fundraising events throughout the year.
Missions and major incidents
London’s Air Ambulance has attended more than 38,000 missions since its inception in 1989. In 2014, London's Air Ambulance attended 1,797 patient missions and 3 major incidents.
- 533 Road traffic collisions
- 560 Penetrating trauma (stabbings and shootings)
- 412 Falls from height
- 292 Other (incidents on the rail network, industrial accidents, asphyxiation, drowning etc.)
Over the past 29 years, the service has coordinated medical response to the majority of London’s major incidents, including the 7/7 bombings, the Soho nail bombing, the Grenfell Tower Fire, the Bishopsgate, Aldwych, Westminster and London Bridge terrorist attacks and Paddington, Cannon Street and Southall rail crashes. On 7 July 2005, London’s Air Ambulance dispatched 18 teams and flew medical supplies to the bomb sites across London, triaging and treating over 700 patients.
Advanced Trauma Team
The helicopter crew consists of a Pilot and co-Pilot, in addition to an advanced trauma doctor, paramedic and, on most missions, a consultant. At night or in adverse weather conditions, the same medical crew operate from a rapid response car, which is driven by the paramedic on blue lights and navigated by the doctor.
Helipad Fire & Rescue
On arrival at the Royal London Hospital helipad, the dedicated helipad ground crew (fire crew) receive the patient and a dedicated, express elevator carries the patient to the accident and emergency department on the ground floor—where a trauma team with A&E doctors, general surgeons, specialist trauma surgeons, and anaesthetists assemble to assess and treat them.
Fire crew must always be present when a helicopter lands or takes off from the helipad.
In 2004 the service was featured heavily in the BBC television series Trauma. In 2009 a standalone documentary about the Air Ambulance was made for the BBC by North One Television. It showcased the service in a number of emergencies and was called Medic One: Life and death in London. In 1994 they featured in a special episode of the BBC series 999 entitled 'The Flying Doctors. They also featured in BBC Two's An Hour to Save Your Life.
The HEMS Clinical Director is Dr. Gareth Davies. Davies is also an Accident & Emergency and Pre-hospital Care Consultant working at The Royal London Hospital.
Concerns were expressed in the media after the charity dismissed its Chief Executive in 2009. The Charity Commission promptly made recommendations on governance to the Trustees, but did not express an opinion over the dismissal.
Physician Response Unit
The Physician Response Unit (PRU) is run by the service in partnership with Barts Health NHS Trust and London Ambulance Service NHS Trust. The service was remodelled in October 2017 to become a 12-hours a day, 7 days a week service thank to funding from Tower Hamlets Together.
The PRU is staffed by a senior doctor and a London Ambulance Service EAC. The PRU carries advanced medication, equipment and treatments usually only found in hospital, such as instant result blood tests, urine tests and sutures to stitch serious wounds. In the remodelled service's first six months, 68% of patients were treated in the community.
- "Helicopter Emergency Medical Service (HEMS) - Barts and the London NHS Trust". Bartsandthelondon.nhs.uk. Retrieved 2012-02-22.
- Botker et al. "A systematic review of controlled studies: Do physicians increase survival with pre-hospital treatment?" Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2009, 17:12.
- "REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta". Retrieved 12 August 2016.
- "World's first pre-hospital REBOA performed". Retrieved 12 August 2016.
- "Balloon surgery stops fatal bleeding at roadside". BBC News. 17 June 2014. Retrieved 12 August 2016.
- "Portable brain scanner trialled by London's Air Ambulance". BBC News. 30 December 2015. Retrieved 1 January 2016.
- "The Helicopter". London's Air Ambulance. Archived from the original on 24 July 2013.
- Neil Bowdler (6 March 2012). "Air ambulance first in UK to carry blood". BBC. Retrieved 6 March 2012.
- Cost details outlined at Londonist website.
- "Your 2nd helicopter has landed – London's Air Ambulance". londonsairambulance.co.uk. Retrieved 2018-02-04.
- "Capital gets second air ambulance in 'momentous day for Londoners'". Evening Standard. Retrieved 2016-02-06.
- London's Air Ambulance (4 April 2016). "Second Name Your Helicopters competition winner revealed". London's Air Ambulance. Retrieved 18 May 2016.
- London's Air Ambulance (19 February 2016). "Six year old Fulham resident names our new helicopter". London's Air Ambulance. Retrieved 18 May 2016.
- "Finances". http://londonsairambulance.co.uk/. London's Air Ambulance. Retrieved 31 October 2014. External link in
- "Finances – London's Air Ambulance". londonsairambulance.co.uk. Retrieved 2018-05-16.
- "The Royal London's A&E and HEMS staff featured in BBC series Trauma". Barts and the London NHS Trust. 31 March 2004. Archived from the original on 2 May 2009.
- "BBC One - Medic One - Life and Death in London". Bbc.co.uk. 2009-06-01. Retrieved 2012-02-22.
- Laura Donnelly and Alison Moore, Air ambulance chief sacked after he raised financial concerns, Daily Telegraph, 28 November 2009
- Tania Mason, Charity Commission provides governance advice to air ambulance charity, Civil Society, 20 January 2010
- "Remodelled PRU to be a seven day service for the first time – London's Air Ambulance". londonsairambulance.co.uk. Retrieved 2018-05-16.
- "London'sAirAmbulance on Twitter". Twitter. Retrieved 2018-05-16.
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