| Statements related to terminology | | | |
| 1* | By “prehospital critical care” we mean the application of the clinical knowledge and skills required for the management of severely ill or injured patients and the requirement for the provision of physiological monitoring and organ or system support not usually within the current capability of NHS ambulance services. | 72 | 22 | 6 |
| 2 | By “retrieval” we mean the process of physically transporting a patient while maintaining in-transit critical care. | 75 | 16 | 9 |
| Statements related to epidemiology and rationale | | | |
| 3 | In most cases, patients who develop prehospital critical care needs can have their needs met (or partially met) by treatment or temporising measures instigated by the current range of NHS ambulance service responses. | 47 | 41 | 12 |
| 4 | In some cases, treatment or temporising measures provided by NHS ambulance services are insufficient to meet a patient’s prehospital critical care needs. | 94 | 3 | 3 |
| 5 | This is particularly the case when immediate transport to hospital for patients with severe injury and physiological derangement is impaired by entrapment, or by physical or functional geography. | 91 | 3 | 6 |
| 6 | The epidemiology of the group of patients with prehospital critical care needs that exceed the usual capability of the NHS ambulance service is not well described. | 81 | 9 | 10 |
| 7 | It is commonly estimated that approximately 10% of all 999 calls to ambulance services relate to life-threatening emergencies and that treatment or temporising measures provided by the usual service responses will be insufficient in only 0.5% of cases. | 59 | 9 | 32 |
| 8 | The relative infrequency of patients whose needs exceed the usual capabilities of the ambulance service response does not diminish their importance in terms of their absolute numbers, the patient’s rights and expectations, their cost impact on NHS resources, the obligations of ambulance services and the wider adverse societal impact of suboptimal prehospital critical care. | 78 | 9 | 13 |
| 9 | Research evidence supports the use of properly targeted, equipped and governed specialist prehospital critical care and retrieval teams as a means of improving quality of care, long-term disability and survival among some groups of seriously ill and injured patients. | 65 | 10 | 25 |
| 10 | One of the most important determinants of survival following major illness or injury is the time between the onset of severe illness or injury and appropriate, focused clinical care. | 94 | 6 | 0 |
| 11 | The common simplistic distinction between scoop and run (load and go) and stay and play (stay and stabilise) is artificial. Each patient’s needs should be assessed on an individual basis and the emphasis should be placed on identifying and providing meaningful prehospital interventions without unnecessarily delaying transport to hospital. | 91 | 6 | 3 |
| 12 | In some cases, patients cannot be rapidly transported to hospital because of entrapment or because of restricted access or egress related to physical or functional geography. An effective prehospital system should be able to provide additional (meaningful) critical care interventions at the scene for these patients. | 88 | 3 | 9 |
| 13 | In some cases, the nearest emergency department is not the most appropriate hospital to manage the patient because of limitations in the services available at that hospital. An effective prehospital system should be able to provide additional (meaningful) critical care interventions for these patients while en route to the more distant hospital. | 97 | 0 | 3 |
| Statements related to governance and training | | | |
| 14 | Practitioners involved in prehospital critical care and retrieval services must have considerable clinical training, experience and autonomy and be specialists in this area of clinical practice. | 97 | 3 | 0 |
| 15 | Most healthcare professionals currently utilised by ambulance services do not ordinarily have the necessary breadth of training, experience, skills, equipment or legal authority to allow them to provide specialist prehospital critical care and retrieval services. | 91 | 3 | 6 |
| 16 | The training and development of specialist prehospital critical care and retrieval team paramedics should primarily be based on the current paramedic curriculum, with additional competences drawn from the critical care practitioner, emergency care practitioner and anaesthetic practitioner programmes. | 59 | 19 | 22 |
| 17 | Of all the hospital-based disciplines, prehospital critical care activity most closely reflects modern emergency department resuscitation room activity in terms of early assessment, focused interventions and coordinated multidisciplinary care. | 66 | 13 | 21 |
| 18 | The training and development of specialist prehospital critical care and retrieval team physicians should primarily be based on the current emergency medicine curriculum, with additional competences drawn from the anaesthetic, intensive care medicine and paramedic curricula. | 83 | 10 | 7 |
| 19 | Regardless of their training and background, members of specialist prehospital critical care and retrieval teams should undergo common multiprofessional training and assessment that is specifically related to the clinical practice of prehospital critical care and retrieval medicine within their operational environment (as defined by epidemiological and operational analysis). | 77 | 13 | 10 |
| 20 | Prehospital critical care and retrieval medicine is a specialist professional endeavour that should primarily be undertaken by individuals who are trained to recognised national standards, who are part of a recognised NHS workforce and who operate within properly managed and governed professional structures. | 100 | 0 | 0 |
| 21 | Regional NHS ambulance trusts should be responsible for ensuring that appropriately trained, equipped and governed prehospital critical care and retrieval services are available across their geographical area of responsibility. | 66 | 25 | 9 |
| Statements related to clinical interventions | | | |
| In the context of the current ambulance service range of responses, typical prehospital critical care interventions that may exceed the capability of the usual ambulance service response include… |
| 22* | Complex clinical decision-making (eg, balancing the risks and benefits associated with complex or high-risk on-scene clinical interventions) | 81 | 16 | 3 |
| 23 | Prehospital emergency anaesthesia (ie, anaesthetic decision-making and the safe induction and maintenance of an anaesthetic) | 97 | 0 | 3 |
| 24* | Complex clinical transport decision-making (eg, balancing the risks and benefits associated with hospital triage and mode of transport) | 62 | 19 | 19 |
| 25 | Prehospital procedural sedation (ie, sedation decision-making and administration of procedural sedation to facilitate clinical management and/or physical extrication) | 91 | 0 | 9 |
| 26 | Resuscitative surgery (eg, prehospital thoracotomy) | 84 | 10 | 6 |
| 27 | Organ-specific support (eg, manipulation of critical care interventions to optimise neuroprotection in major head injury or lung protection in major chest injury) | 91 | 3 | 6 |
| 28* | Management of complex wounds, fractures and dislocations | 62 | 19 | 19 |
| 29* | Clinical management of complex incidents with multiple patients | 69 | 22 | 9 |
| 30 | Regional anaesthesia (eg, nerve blocks around the ankle or wrist to facilitate safe extrication) | 88 | 0 | 12 |
| 31 | Administration of drugs and infusions (including vaso-active drugs and blood) | 72 | 9 | 19 |
| 32* | Disease or condition-specific management in the prehospital phase (eg, the recognition and management of life-threatening asthma or sepsis) | 63 | 28 | 9 |
| 33 | Use of complex monitoring and near-patient investigative techniques such as invasive haemodynamic monitoring (eg, an arterial line), the use of ultrasound (for vascular access or focused abdominal sonography) and blood gas analysis (for optimisation of ventilation) | 78 | 13 | 9 |
| 34* | Provision of alternative forms of analgesia or higher doses of analgesic agents | 72 | 13 | 15 |
| Statements related to service operations | | | |
| 35 | Prehospital critical care and retrieval teams should be activated and dispatched using mechanisms and criteria that clearly target those patients and incidents in which there is likely to be greatest need and potential benefit. | 94 | 0 | 6 |
| 36 | To be operationally effective, a dedicated prehospital critical care and retrieval team should have immediate access to a suitably equipped rapid response vehicle for land-based responses. | 91 | 9 | 0 |
| 37 | To be operationally effective, a dedicated prehospital critical care and retrieval team should have immediate access to a suitably equipped helicopter for appropriate aeromedical responses. | 69 | 16 | 16 |
| 38 | Prehospital critical care and retrieval services should be geographically focused and should be fully integrated within the wider critical care and emergency care pathways within the region in which they operate. | 97 | 0 | 3 |