title: Enhanced care team response to incidents involving major trauma at night: are helicopters the answer?
abstract: BACKGROUND
  Challenges exist in how to deliver enhanced care to patients suffering severe injury in geographically remote areas within regionalised trauma networks at night. The physician led Enhanced Care Teams (ECTs) in the West Midlands region of England do not currently utilise helicopters to respond to incidents at night. This study describes this remote trauma workload at night within the regional network in terms of incident location; injury profile and patient care needs and discusses various solutions to the delivery of ECTs to such incidents, including the need for helicopter based platforms.
  
  
  METHODS
  We present a retrospective analysis of incidents involving Major Trauma occurring in the West Midlands Regional Trauma Network in England over a one year period (1st April 2012 until the 31st March 2013). Anonymised patient records from the Trauma Audit and Research Network (TARN) for patients that had been conveyed to hospital by ambulance/air ambulance were cross-referenced with the West Midlands Ambulance Service NHS Foundation Trust (WMAS) Computer Assisted Dispatch (CAD) archive for the same period. Data were abstracted from the combined dataset relating to injury severity (ISS/ICU admission/death at scene or as inpatient); ECT resource activations/scene attendances; incident location and the need for enhanced level care.
  
  
  RESULTS
  A total of 603 incidents involving Major Trauma were identified during night time hours. Enhanced Care Team resources attended scene in 167 cases (27.7%). Of the incidents not attended by an ECT 179 (41.1%) were due to falls and 91 (20.9%) involved a 'Road Traffic Collision'. A total of 36 incidents (6.0% of total at night) occurred in locations identified as being greater than 45min by road from the nearest major trauma centre. In these cases 13 patients had enhanced care needs that could not be addressed at scene by the attending ambulance service personnel.
  
  
  CONCLUSIONS
  There is limited evidence to support the need for night HEMS operations in the West Midlands regional trauma network. The potential role of night HEMS in other regional trauma networks in England requires further evaluation with specific reference to the incidence of Major Trauma and efficiency of existing road based systems.
authors.affiliation: Clinical Trials Unit, University of Warwick, Gibbet Hill, Coventry CV4 7AL, UK; Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill DY5 1TX, West Midlands, UK. Electronic address: carl_mcqueen@hotmail.com.
authors.forename: Carl
authors.initials: C
authors.lastname: McQueen
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill DY5 1TX, West Midlands, UK. Electronic address: timnutbeam@nhs.net.
authors.forename: Tim
authors.initials: T
authors.lastname: Nutbeam
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill DY5 1TX, West Midlands, UK. Electronic address: nick.crombie@midlandsairambulance.com.
authors.forename: Nick
authors.initials: N
authors.lastname: Crombie
authors.affiliation: EMRiS Group Health Services Research Section, School of Health and Related Research, University of Sheffield Regent's Court, Regent's Street, Sheffield S1 4DA, UK; Trauma Audit and Research Network, Health Sciences Research Group, Manchester Academic Health Sciences Centre, Mayo Building Salford Royal Hospital, Eccles Old Road, Salford, Manchester M6 8HD, UK. Electronic address: fiona.lecky@manchester.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
authors.affiliation: Trauma Audit and Research Network, Health Sciences Research Group, Manchester Academic Health Sciences Centre, Mayo Building Salford Royal Hospital, Eccles Old Road, Salford, Manchester M6 8HD, UK. Electronic address: thomas.lawrence@manchester.ac.uk.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lawrence
authors.affiliation: West Midlands Ambulance Service NHS Foundation Trust, Millennium Point, Waterfront Business Park, Waterfront Way, Brierley Hill DY5 1LX, West Midlands, UK. Electronic address: karen.hathaway@wmas.nhs.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Hathaway
authors.affiliation: West Midlands Ambulance Service NHS Foundation Trust, Millennium Point, Waterfront Business Park, Waterfront Way, Brierley Hill DY5 1LX, West Midlands, UK. Electronic address: steve.wheaton@wmas.nhs.uk.
authors.forename: Steve
authors.initials: S
authors.lastname: Wheaton
mesh_terms: D000328:Adult; D000368:Aged; D017732:Air Ambulances / Q000191:economics / Q000706:statistics & numerical data*; D000401:Aircraft; D000552:Ambulances; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration*; D004739:England / Q000453:epidemiology; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009104:Multiple Trauma / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Enhanced care teams; Helicopter emergency medical service; Pre-hospital care; Trauma