The lottery of pre-hospital physicians

March 24, 2011 by  
Filed under All Updates, EMS, Resus, Trauma

In contrast to numerous other European nations, physicians with critical care skills do not consistently form part of the emergency pre-hospital system in the UK. My colleagues and I described the level of cover provided to patients in England, Wales and Northern Ireland, now available as an open access article online.

The BMJ’s press release is headed: ‘Critical care outside hospital ‘incomplete, unpredictable, and inconsistent’ across UK‘, a statement that has captured the interest of some media outlets, including the first place you would look for health news: bigsoccer.com.

Pre-hospital physician-based critical care provision. (A) Daylight hours. (B) Hours of darkness.

 

Background Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care.

Objective To identify the current availability and utilisation of physician-based pre-hospital critical care capability across England, Wales and Northern Ireland.

Design A postal and telephone survey was undertaken between April and December 2009 of all 13 regional NHS ambulance services, 17 air ambulance charities, 34 organisations affiliated to the British Association for Immediate Care and 215 type 1 emergency departments in England, Wales and Northern Ireland. The survey focused on the availability and use of physician-based pre-hospital critical care support.

Results The response rate was 100%. Although nine NHS ambulance services recorded physician attendance at 6155 incidents, few could quantify doctor availability and utilisation. All but one of the British Association for Immediate Care organisations deployed ‘only when available’ and only 45% of active doctors could provide critical care support. Eleven air ambulance services (65%) operated with a doctor but only 5 (29%) operated 7 days a week. Fifty-nine EDs (27%) had a pre-hospital team but only 5 (2%) had 24 h deployable critical care capability and none were used regularly.

Conclusion There is wide geographical and diurnal variability in availability and utilisation of physician-based pre-hospital critical care support. Only London ambulance service has access to NHS-commissioned 24 h physician-based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability.

Availability and utilisation of physician-based pre-hospital critical care support to the NHS ambulance service in England, Wales and Northern Ireland
Emerg Med J. 2011 Mar 21. [Epub ahead of print] Open Access Full Text

Comments

One Response to “The lottery of pre-hospital physicians”

  1. Minh Le Cong on March 26th, 2011 03:56

    Nice article Cliff

    I struggle to reconcile the fact that across the Atlantic in the USA there exists a completely different philosophy of EMS and trauma care in the prehospital arena to what you are suggesting needs to occur in UK.

    As you know the French, German and Norwegians have been doing this for years already.

    Who knows what the best approach is? With short transport times I would suggest the American trauma research in my view indicates that prehospital critical care doctors adds a mild benefit only.
    And their HEMS trauma research would indicate you don;t need a doctor, as long as your prehospital teams are well trained in prehospital trauma care.