| Theme | Statement no | |
| Terminology | ||
| “(This statement) denigrates the existing high skill levels of current ambulance clinicians.” | (1) | |
| “I understand the term retrieval to mean the deployment of a specialist team from a large centre to a smaller centre to provide on-site assessment, resuscitation and transfer to definitive care.” | (2) | |
| Epidemiology and rationale | ||
| “We do know that early and effective interventions make a difference to outcomes.” | (3–5) | |
| “There is very limited good quality evidence to suggest that additional interventions can improve outcome….” | (3–5) | |
| “Prehospital advanced life support and basic trauma care are of good standard but current training and clinical governance of current ambulance staff training are not of a high enough standard to allow critical care interventions.” | (3, 4) | |
| “Patients with critical care needs cannot be adequately treated by the ambulance service alone even simply in terms of airway, breathing or circulatory support.” | (3) | |
| “With short on-scene times and rapid transport to an appropriate emergency department, this is or should be possible for the vast majority, especially within or close to the UK’s conurbations.” | (3) | |
| “Serious trauma is rapidly diminishing within the UK. In 29 years of service and with a critical care (non-medical) background, I can think of very few patients who would fall into this category and did not survive.” | (4, 5) | |
| “…Due to political constraints, there is a mismatch between need and quality provided.” | (3–5) | |
| “Patients with survivable injuries cannot have their airway compromise and chest injuries treated by paramedics. This results in avoidable deaths, especially in cases of entrapment and prolonged transfer. I have experience of many cases to support these statements.” | (4, 5) | |
| “The costs of the morbidity if they (patients) survive are huge and pale into insignificance compared with the costs of service provision to save them.” | (6, 7) | |
| “In many cases when an appropriate facility is close at hand and the journey time short, then scoop and run is the best policy, especially when interventions are required that cannot be delivered prehospital.” | (10–13) | |
| “The evidence, in trauma patients, suggests that only two interventions have proven benefit: short on-scene times and pre-alerting the receiving hospital.” | (10–13) | |
| “There are few places in the UK where it is not better to take the patient to an appropriate A&E (sic) ASAP. There are very few entrapments that cannot be immediately expedited on medical authority.” | (10–13) | |
| Governance and training | ||
| “This is an area that is appropriate for subspecialisation for clinicians with a general critical care background.” | (14, 15) | |
| “There is no obvious need for prehospital medical staff to be doing such work full time but they should normally be working in critical care or emergency medicine, have critical care skills (particularly airway management) and regularly be undertaking prehospital (duties).” | (14, 15) | |
| “Prehospital care and retrieval are arguably the most demanding and high-risk areas of medicine.” | (14, 15) | |
| “What about appropriately trained and experienced nurses who can be as good as a paramedic!!” | (19) | |
| “I know of no evidence to support the use of paramedics of any background in the circumstances you describe.” | (19) | |
| “There are areas of the country where geography makes a lesser standard of training all that is likely to be achieved or to be justifiable?” | (19) | |
| “The prehospital care arena is not and must never become the preserve of anaesthetists!” | (20) | |
| “It is a shame that there is so much national variation in out-of-hospital care due to reliance on voluntary groups.” | (20) | |
| “Over the years the volunteer workforce has been highly predictable and very reliable.” | (20) | |
| “Our continued reliance on volunteers to provide prehospital care is bizarre and archaic. It is an embarrassment to the NHS and is a source of great amusement for our European colleagues who are light years ahead of us!” | (20) | |
| “All concerned should be directly employed by the NHS and should be subject to the same clinical governance, guidelines and offer similar standards of care as hospital-based clinicians.” | (20) | |
| “The ambulance service has in general failed to involve doctors in prehospital care and has an inflated view of the (limited) role of paramedics.” | (21) | |
| Clinical interventions | (22–34) | |
| “But why would anyone do these in the prehospital setting?” | ||
| “These are all the things that the modern PHC doctor has to bring to the party. The game has moved on!” | ||
| “Unless individuals do many of these skills very frequently they will not be able to do them right when it counts.” | ||
| “…the assumption that all BASICS doctors can provide this service is somewhat flawed… the skill set required to mitigate the above is held by a very few.” | ||
| “My own experience is that airway management, advanced pain management, chest drainage and triage to definitive care (are important clinical interventions).” | ||
| “Some paramedics (approximately 40% here and about 10% elsewhere) have the ability to perform some of the above procedures to a high standard (in some cases, better than non-specialist trained doctors).” | ||
| Service operations | ||
| “Current activation systems (with the exception of HEMS London) do not work and need to be radically revised.” | (35) | |
| “What?? I wasn’t thinking of using a set of roller-skates!! I do hope that there aren’t going to be any more pointless questions. Let’s replace the ambulance service, which works well in 99.9% of cases with Magpas doctors? No.” | (36, 37) | |
| “I think many of the regional helicopter services are grossly over-used just so that they can justify their existence.” | (37) | |
| “There is simply no evidence that such teams need their own transport. They can be transported by trained drivers in ambulance or police vehicles. A dedicated helicopter is preposterous and counter to all the available evidence.” | (36, 37) | |
| “Helicopter medical resources are hugely expensive and benefit an extremely small number of patients. The vast sums of money involved could greatly benefit many other patients and establish the system of excellence you seek to set up.” | (37) | |
BASICS, British Association for Immediate Care; HEMS, helicopter emergency medical services; PHC, prehospital care.
BASICS, British Association for Immediate Care; HEMS, helicopter emergency medical services; PHC, prehospital care.