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.
- Major incidents
- prehospital care
- prehospital care
- critical care transport, prehospital care, doctors in PHC
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Competing interests PH is a consultant in paediatric intensive care in Southampton, clinical leadership fellow for South Central trauma system project and training officer for the charity BASICS Hampshire. GN is a specialist registrar in emergency medicine in Leicester and a pre-hospital physician with the MAGPAS Emergency Medical Team. RM is a consultant and senior lecturer in emergency medicine in Leicester, the medical director of the emergency medical charity, Magpas, a member of BASICS, the Faculty of Pre-hospital Care and the Department of Health's Transport of the Critically Ill and Pre-hospital and Inter-hospital Transfer working groups. He also chairs the curriculum, training and assessment subcommittee of the Intercollegiate Board for Training in Pre-hospital Emergency Medicine. GP is a consultant in paediatric intensive care in Birmingham and is the clinical director of the ongoing National Confidential Enquiry into Head injury in Children. CR is a consultant in emergency medicine in Sydney, Australia and former chairman of BASICS Hampshire.
Provenance and peer review Not commissioned; externally peer reviewed.
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