Draft National Air Ambulance Strategy released
Thursday 2 December 2004
Draft National Air Ambulance Strategy released for public consultation
The Accident Compensation Corporation has released a Draft National Air Ambulance Strategy for public consultation, on behalf of an interagency steering group, outlining a proposed model for the provision of air ambulance services in New Zealand.
The Draft Strategy looks at the long-term future for air ambulances in New Zealand. ACC contracts are already in place until October 2006. This will ensure current services are maintained and the transition is smooth and controlled.
In seeking to ensure New Zealanders receive world class emergency medical care, the Draft Strategy acknowledges evolving technology and professionalisation of emergency transport services, and looks to ensure that these enable improvements in patient outcomes.
The Draft Strategy focuses on three key issues identified during more than 12-months of consultation and discussion on enhancing the patient-focus, effectiveness and efficiency of New Zealand’s air ambulance services: clarity in the role and definition of air ambulance services in New Zealand; effective operational co-ordination of air ambulance operations; and improving the air ambulance funding model and contracting process.
The Draft Strategy makes a total of 19 recommendations across these issues.
Key themes in the Draft Strategy include: earlier access to more specialist skills leads to better outcomes; faster is not always better—the balance of clinical opinion is that it is better to wait slightly longer for better quality clinical care than to save up to half an hour through faster access to care that is not as practised, as familiar, or of the same clinical standard; and there is a need to preserve the capability of local rescue helicopters and pilots with local knowledge to respond to the occasional call for urgent rescue.
The Draft Strategy notes there are two key services provided by air ambulances: the provision of emergency response to the need for pre-hospital care and transportation to a health facility; and the transfer by air of patients from one health facility to another.
In the case of emergency air ambulance services, the draft strategy proposes: an enhanced standard of Helicopter Emergency Medical Services (HEMS) coverage, particularly in respect of clinical crewing by advanced paramedics and closer integration with major DHB emergency departments and ICU retrieval teams; the preservation of local community rescue helicopters in areas more peripheral to the likely HEMS coverage; and national co-ordination of inter-hospital transfers by air, supported by a network of intensive care air ambulances and associated DHB clinical retrieval teams.
The Draft Strategy also proposes that HEMS air ambulances should be located in seven centres, based largely on population and a 45-60 minute range from base. It is suggested that these centres might be located in: Whangarei; Auckland; Hamilton or Tauranga; Hastings; Wellington; Christchurch; and Dunedin.
It also notes that further work is required around the services from Palmerston North and the Central Plateau. Due to population, location, and support infrastructure, the Draft Strategy notes that rescue services need to be maintained at: New Plymouth; Greymouth; Gisborne; Queenstown; and Invercargill.
The Draft Strategy notes that fixed wing air ambulances, with very few exceptions, provide services that are exclusively inter-hospital transfers.
Two categories of fixed wing air ambulances are proposed, balancing local DHB needs for operational flexibility and cost effectiveness with improved national co-ordination and support: It is proposed that intensive care fixed wing air ambulances (“tier one”) be based in larger centres which have the infrastructure and staff to support clinical retrieval teams, such as: Auckland; Wellington; and Christchurch. It is also proposed that stretcher care fixed wing air ambulances (“tier two) be based in areas of need as determined by DHBs (such as Hastings, by arrangement with Hawkes Bay DHB). They would be integrated with a national flight desk and be available in support of the intensive care fixed wing air ambulances.
The Draft Stategy notes that two centres, for reasons of time, geography, workload and support of the local DHB suit rotary wing air ambulances as their primary mode of inter-hospital transfer: Whangarei (by arrangement with Northland DHB for Kaitaia-Whangarei and Whangarei-Auckland); and Hamilton (by arrangement with Midland DHBs)
The Draft Strategy concludes the Dunedin regional tertiary service, for reasons of workload, does not require additional fixed or rotary wing aircraft. With Invercargill and Queenstown barely 80-nautical miles (or 35-minutes) by helicopter from Dunedin, there is sufficient capacity in their existing HEMS service, with support as required from the Christchurch based fixed wing intensive care air ambulance.
The Draft National Air Ambulance Strategy was developed in partnership with the Ministry of Health and Ambulance New Zealand, together with the Air Rescue/Air Ambulance Division of the Aviation Industry Association. The Draft Strategy balances clinical advice from leading specialists, clinical colleges and international literature with the strong desire by communities for the preservation of local services.
A copy of the Draft National Air Ambulance Strategy and a “feedback document” are available on the ACC public website at http://www.acc.co.nz/for-providers/news-for-providers/