The Emergency Medicine Journal has long supported the development of medical pre-hospital care in the UK, and is the official journal of both the Faculty of Pre-hospital Care and BASICS. This commentary is the first in a series of pre-hospital case reports from the Helicopter Emergency Medical Service (HEMS) which provides services in London and the South East England. London HEMS was the first air ambulance in the UK to carry a doctor-paramedic team and celebrated its 21st year of operation last year. The service still operates with a doctor, a paramedic and two pilots, but is in many other ways dramatically different from the service provided 20 years ago. Tougher selection criteria, structured training and the implementation of a comprehensive clinical governance structure have transformed the service.

Specialist Registrar posts for HEMS have been accredited by the College of Emergency Medicine for core training, although it is acknowledged …