> In the rural environment, I expect journeys longer than
> around 30 miles
> would be much faster by helicopter
I'd think you're being a bit optimistic on that 30 mile limit. Not a lot of
literature, but the CRD review is still useful- even though it is a cost
effectiveness study it also looked at transfer times and showed them to be
somewhat shorter in rural areas, but with longer response and scene times as
you'd expect:
The costs and benefits of helicopter emergency ambulance services in England
and Wales NHS Centre for Reviews and Dissemination
Original article:
Snooks H A, Nicholl J P, Brazier J E, Lees-Mlanga S. The costs and benefits
of helicopter emergency ambulance services in England and Wales. Journal of
Public Health Medicine. 1996. 18(1). 67-77.
Results of the review
For the study carried out in England and Wales, there was no evidence of any
improvement in vehicle response times when the helicopter service was used
in comparison with the land ambulance service.
The figures (in minutes) were as follows:
Cornwall, 12.0 (intervention) and 10.0 (control);
Sussex, 8.6 and 8.1;
London, 8.7 and 6.7.
On-scene time figures were:
Cornwall, 24.3 (intervention) and 20.6 (comparator);
Sussex, 31.9 and 27.9;
London, 30.5 and 24.8.
The transfer time figures were:
Cornwall, 13.6 and 24.0;
Sussex, 10.4 and 16.4;
London, 9.9 and 8.3.
Where of course the helicopter is useful is in covering areas where there
are no roads (or extremely long and winding roads)- for example islands,
mountainous areas, areas deeply indented by sea (or river with no bridges).
Not so useful in the UK.
Another point on centralisation: As Adrian says, the vast majority of
patients with possible MI are not suitable for thrombolysis/ PTCA. Equally a
fair number of patients who are not obvious at the start end up having MIs.
The trouble is that unless you're very liberal with your triage criteria you
risk finishing up with a fair number of cases ending up in places with
little experience- but take away your barn door MIs from a hospital and it's
difficult to support a CCU. This is a classic example of an intervention
where efficacy and effectiveness are likely to be very different (as indeed
was shown to apply to prehospital thrombolysis as a whole).
Matt Dunn
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