News / Events Blog How far we have come At our helicopter naming ceremony back in January, CEO Bill Sivewright reflected on just how far we had come since the launch of the Charity 18 years ago. The Beginnings Although the first UK air ambulance charity was formed in Cornwall in 1987, the pace of change since then has been quite staggering. Interestingly, it coincided with the early development of the Paramedic as a nationally recognised clinician. At the time, the proportion of patients attended by air ambulances compared to those attended by road ambulances was, unsurprisingly, tiny. That is why the pressure to form air ambulances did not come from any national agenda or strategy, but from local community initiatives. Dorset and Somerset Air Ambulance is born In 2000, a grant from a fund established by the Automobile Association (AA) of £14 million was distributed to existing air ambulances and to those who required ‘seed funds’ to start. Dorset and Somerset Air Ambulance (DSAA) was one of the latter. We launched the service in March 2000, operating out of Henstridge in a BO105 with two paramedics and a pilot as crew. The aircraft, pilots and engineering support all came from Bond Air Services and the paramedics were seconded from the Ambulance Service. On the first day of operations, we came on line at 08.00am and at 08.52am we were tasked to our first mission. Funding In the first three years of operation, the aircraft costs were met by the AA grant and medical costs were met by the Ambulance Service. Charity staff were therefore able to concentrate their efforts on establishing a fundraising model that was resilient, rather than be pressed into short term gains. This model still operates today. Our focus remains on establishing and maintaining the broadest base of support whilst supporting those who fundraise on our behalf. Our lottery is now one of the most successful society lotteries in the country; what is most gratifying is that many of our members simply regard it as regular giving. The Clinical Model Our original model of operation was pretty much the standard of the time and changed very little for many years. The principle was to get to the patient as quickly as possible, carry out immediate assessment, stabilise them and package them for transportation to hospital. As years have passed, what was initially a single model for delivery has developed into a multitude of models. Variances in aviation and clinical governance, ownership of aircraft and employment of clinical staff are all now part of the mix. Over the years, there have been cries for a more consistent, national approach. Economies of scale in procurement and ease of understanding for bodies such as the Department of Health and the Civil Aviation Authority are but two good arguments for taking that line. However, it fails to recognise why such variability exists in the first place. The way we operate is subject to a number of variable factors. Geography is an obvious one but the key factor is that of the NHS environment in which we sit. Funding, staffing, logistics and priorities for categories of care are all subject to local influences and shape the environment that we as an air ambulance operate in. Our main NHS partner organisation is the South Western Ambulance Service NHS Foundation Trust or SWASFT. They cover the largest geographic area of any ambulance service in the country and uniquely, now have five air ambulance charities operating within their area. Clinical Development In 2011 we started looking for ways to further develop our clinical capability. Bearing in mind, we were still strategically committed to a twin paramedic model of delivery, our only course of action was to up skill our paramedics. We decided that the best way forward would be for our crew to undertake post-graduate level education which would provide them with a qualification they could take with them anywhere. We elected to fund a course accredited by the University of Hertfordshire which would be delivered onsite at our Henstridge airbase. A ‘flying faculty’ of consultants would act as mentors for the paramedics both on land and in the air. The Service Level Agreements required to secure the doctors from local hospitals enabled us to establish close working relationships with them and has benefitted our patients who experience a much smoother transition from air ambulance into hospital. Having secured approvals from SWASFT and the University (who had never ran the education this way before) we finally started the course in 2013. From the outset, we gathered data to examine the effect that having doctors in the mix had on our clinical delivery. Within a very short time, it was apparent that the enthusiasm of the paramedics for the exposure they were getting to high-grade consultant mentorship in real-world experience, coupled with the consultant’s complete buy-in was delivering much more than the sum of the parts. In 2015, our commitment to this project was recognised nationally when we won a Health Service Journal Award for Improving Outcomes through Learning and Development. We were, of course not the first organisation to have doctors as part of the team. However terms such as ‘Doctor on Board’ and ‘Doctor Led’ did not sit comfortably with our team ethos. So in 2015, we embarked on a restructuring exercise which saw the formal creation of a Critical Care Team. The Aircraft The development of our service in aviation terms has been much more straightforward than that of clinical development. We started our service flying the BO105; a tried and tested workhorse that served us very well for seven years. In 2007 we ‘upgraded’ to the EC135. This was a much more modern aircraft, offering more space, more payload and improved safety. This aircraft became one of the most prolific air ambulance platforms and served as a fantastic development tool for our service. So if the EC135 was so good, why did we change? In April 2012 the National Trauma Network was established by the NHS. This pooled expertise and facilities into Major Trauma Centres (MTC) around the country and became the preferred destination for all patients suffering major trauma. Without a MTC in Dorset or Somerset, our patients, who would have previously been taken to the County Hospitals, would now have to be flown to Southampton, Bristol or Plymouth. Although the flight-time increase could be measured in tens of minutes, that is a very long time in the life of a critically ill or injured patient. We therefore needed the ability to be able to fully treat a patient en-route to hospital. Further examination of the requirement also revealed something quite simple; if the patient was at the centre of our thinking, and on scene the patient is at the centre of the ‘treatment zone’, should the patient not be at the centre of the cabin of the air ambulance? Once this logic was applied, the choice of a successor aircraft was quite straightforward. That is not to say that factors such as cost, safety, potential for night operations were not considered but only one platform offered us the cabin format to meet our fundamental requirement. During our first 17 years of operations, Bond Air Services (latterly Babcock Mission Critical Services) acted magnificently as our air operator with both the BO105 and the EC135. We are now delighted to be in partnership with Specialist Aviation Services. Not only have they demonstrated their significant commitment to the AW169, they have also introduced us to the MD902 whilst we waited for the European Aviation Safety Agency to certify what we consider to be the most advanced air ambulance helicopter in the country today.