London's Air Ambulance
|Gareth Davies, Clinical Director
Graham Hodgkin, Chief Executive Officer
London's Air Ambulance, also known as London HEMS (Helicopter Emergency Medical Service), is a British registered charity that operates an air medical service dedicated to responding to serious trauma emergencies in and around London. Using helicopters by day and road vehicles by night, it functions as a mobile emergency department 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 provide 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. Of up to 5,000 999 ambulance calls made every day in London, up to seven of the most critical are passed to the air ambulance.
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.
Key treatments further 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.
The helicopters usually cruise at 130 knots, at an altitude of 1,500 ft. A regular fuel load, around 400 kg, allows for one hour's flying time. Although the MD 902 Explorer is a quieter model aircraft than its predecessor, a number of noise complaints are still filed relating to HEMS.
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. 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.
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, 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.
The service costs £3.5 million a year to run (figures for 2012/2013), but is only partly funded by the National Health 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 33,000 missions since its inception in 1989. In 2014, London's Air Ambulance attended 1,806 patient missions.
- 603 Road traffic collisions
- 480 Penetrating trauma (stabbings and shootings)
- 434 Falls from height
- 289 Other (incidents on the rail network, industrial accidents, asphyxiation, drowning etc.)
Over the past 24 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 Bishopsgate and Aldwych 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.
The crew usually consists of one advanced trauma doctor, one advanced trauma paramedic, one pilot and one co-pilot. There is occasionally an observer, who is a doctor or paramedic in training.
On arrival at the Royal London Hospital helipad, specialist ground 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.
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".
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 and regularly flies in the helicopter to the scenes of accidents.
Concerns were expressed in the media after the London Air Ambulance 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
Davies has been responsible for many innovations in pre-hospital care such as the Physician Response Unit (PRU), which brings the doctor to the patient in their home, preventing an unnecessary waste of ambulance resources. The PRU also operates from the Royal London Hospital in a rapid response car.
The PRU is staffed by a doctor and an Emergency Care Practitioner (ECP). Compared to just sending out an ECP in a car or an ambulance crewed by a paramedic and an emergency medical technician, a higher level of diagnostics and treatment can be initiated on-scene, giving the optimal outcome for the patient, and saving expensive procedures that could otherwise have been initiated.
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- Cost details outlined at Londonist website.
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- 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
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