title: Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice.
abstract: BACKGROUND
  Critics of air ambulance doctors question their contribution and believe on-scene time is prolonged. Two helicopter emergency medical service (HEMS) models operate in the West Midlands, one with doctors and the other without. A study was undertaken to compare on-scene time, management and decision-making between the two units.
  
  
  METHODS
  Cases were assessed over an 18-month period, identifying on-scene time, incidence of rapid sequence induction (RSI), management of patients with a Glasgow Coma Scale (GCS) score of 3, femoral fracture, pneumothorax or those with myocardial infarction.
  
  
  RESULTS
  There were 5275 HEMS activations during the study period. The presence of a doctor had no effect on on-scene time (27 (2) min vs 26 (2) min, p = NS). Advanced management of femoral fractures (nerve block, ketamine or RSI), pneumothorax (chest drain) or RSI (when patients were matched for GCS score) by doctors took no longer than conventional paramedic management. Doctors performed RSI on 38% of trauma patients and 13% of medical patients with a GCS score <15. Patients were more likely to be treated and discharged from the scene when seen by a doctor (8.7% vs 4.6%, p<0.001) and were less likely to be transported to hospital (27% vs 44%, p<0.001). For patients with a GCS score of 3, doctors were more likely to cease resuscitation efforts and confirm death at the scene (70% vs 16%, p<0.001).
  
  
  CONCLUSIONS
  Appropriately trained HEMS doctors provide advanced management and decision-making. This is without a negative effect on on-scene time, even when performing complex procedures. They are more likely to declare death or discharge patients at the scene, increasing the availability of this limited resource.
authors.affiliation: County Air Ambulance, Warwickshire and Northamptonshire Air Ambulance, Coventry, UK. j.k.roberts@bham.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Roberts
authors.forename: K
authors.initials: K
authors.lastname: Blethyn
authors.forename: M
authors.initials: M
authors.lastname: Foreman
authors.forename: A
authors.initials: A
authors.lastname: Bleetman
mesh_terms: D017732:Air Ambulances / Q000706:statistics & numerical data*; D003128:Coma / Q000628:therapy; D003657:Decision Making; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D005264:Femoral Fractures / Q000628:therapy; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D010351:Patient Discharge; D011030:Pneumothorax / Q000628:therapy; D011364:Professional Practice / Q000706:statistics & numerical data*; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data