Although the first UK air ambulance charity was formed in Cornwall in 1987, the pace of change since then has been quite staggering. In 2000, a grant from a fund established by the Automobile Association (AA) of £14 million was distributed to existing air ambulances and to those who required ‘seed funds’ to start. Dorset and Somerset Air Ambulance (DSAA) was one of the latter. The service launched in March 2000, operating out of Henstridge in Somerset in a BO105 with two paramedics and a pilot as crew. The aircraft, pilots and engineering support all came from Bond Air Services and the paramedics were seconded from the Ambulance Service. On the first day of operations, DSAA came online at 08:00 hrs and at 08:52 hrs, was tasked with its first mission.
In the first three years of operation, aircraft costs were met by the AA grant and medical costs were met by the UK’s Ambulance Service. Charity staff were therefore able to concentrate their efforts on establishing a fundraising model that was resilient, rather than be pressed into short-term gains. This model still operates today.
The clinical model
DSAA’s original model of operation was pretty much the standard of the time and changed very little for many years. The principle was to get to the patient as quickly as possible, carry out immediate assessment, stabilise them and package them for transportation to hospital. As the years have passed, what was initially a single model for delivery has developed into a multitude of models. Variances in aviation and clinical governance, ownership of aircraft and employment of clinical staff are all now part of the mix. Over the years, there have been cries for a more consistent, national approach. Economies of scale in procurement and ease of understanding for bodies such as the Department of Health and the Civil Aviation Authority are but two arguments for taking that line. However, it fails to recognise why such variability exists in the first place.
The way DSAA operates is subject to several variable factors – geography is an obvious one, but the key factor is that of the UK National Health Service (NHS) environment in which it sits. Funding, staffing, logistics and priorities for categories of care are all subject to local influences and shape the environment in which an air ambulance operates.
In 2011, DSAA started looking for ways to further develop its clinical capability. Given that it remained strategically committed to a twin paramedic model of delivery, it was decided that the best course of action was to upskill the paramedics already working on the helicopter. Thus, the crew undertook post-graduate level education, which would provide them with a qualification they could take with them anywhere. Bill Sivewright, Chief Executive of the DSAA, said: “We elected to fund a course accredited by the University of Hertfordshire which would be delivered onsite at our Henstridge airbase. A ‘flying faculty’ of consultants would act as mentors for the paramedics both on land and in the air. The Service Level Agreements required to secure the doctors from local hospitals enabled us to establish close working relationships with them and has benefited our patients who experience a much smoother transition from air ambulance into hospital.” Having secured approvals from South Western Ambulance Service NHS Foundation Trust (SWASFT) and the University (which had never run the education this way before), the course started in 2013. From the outset, data was gathered to examine the effect that having doctors in the mix had on clinical delivery. Within a very short time, it was apparent that the enthusiasm of the paramedics for the exposure they were getting to high-grade consultant mentorship in real-world experience, coupled with the consultant’s complete buy-in, was delivering much more than the sum of the parts. In 2015, DSAA’s commitment to this project was recognised nationally when it won a Health Service Journal Award for Improving Outcomes through Learning and Development.
The charity was not, of course, the first organisation to have doctors as part of the team. However, terms such as ‘Doctor on Board’ and ‘Doctor Led’ did not sit comfortably with our team ethos. So, in 2015, it embarked on a restructuring exercise that saw the formal creation of a Critical Care Team.
The development of the service in aviation terms has been much more straightforward than that of clinical development. It started the service flying the BO105; in 2007, the ‘upgrade’ was made to the EC135 – a much more modern aircraft, offering more space, more payload and improved safety. “This aircraft became one of the most prolific air ambulance platforms and served as a fantastic development tool for our service,” noted Sivewright. So, if the EC135 was so good, why did another change occur?
In April 2012, the National Trauma Network was established by the NHS. This pooled expertise and facilities into Major Trauma Centres (MTC) around the country and became the preferred destination for all patients suffering major trauma. Without a MTC in Dorset or Somerset, patients who would have previously been taken to the county hospitals would now have to be flown to Southampton, Bristol or Plymouth. Although the flight-time increase could be measured in tens of minutes, that is a very long time in the life of a critically ill or injured patient. Therefore, the crew needed the ability to fully treat a patient en-route to hospital. “Further examination of the requirement also revealed something quite simple,” added Sivewright. “If the patient was at the centre of our thinking, and on scene the patient is at the centre of the ‘treatment zone’, should the patient not be at the centre of the cabin of the air ambulance?”
Once this logic was applied, the choice of a successor aircraft was quite straightforward, he explained. That is not to say that factors such as cost, safety, and potential for night operations were not considered, but only one platform offered DSAA the cabin format to meet its fundamental requirement – the AW169.
Sivewright said: “During our first 17 years of operations, Bond Air Services (latterly Babcock Mission Critical Services) acted magnificently as our air operator with both the BO105 and the EC135. We are now delighted to be in partnership with Specialist Aviation Services. Not only have they demonstrated their significant commitment to the AW169, they have also introduced us to the MD902 whilst we waited for the European Aviation Safety Agency to certify what we consider to be the most advanced air ambulance helicopter in the country today.”