Flying to Save Young Lives Meeting the future need for emergency paediatric and neonatal transfers by helicopter

Transcription

1 Flying to Save Young Lives Meeting the future need for emergency paediatric and neonatal transfers by helicopter children s air ambulance keeping hope alive

2 Contents Executive summary 3 Clinical need 4 Current provision 5 Demand 6 Operating hours 6 Operating days 6 Aircraft capability 8 Aircraft availability 9 Hospital infrastructure 1 Equity of access 12 Recommendations 15 Flying to Save Young Lives Meeting the future need for emergency paediatric and neonatal transfers by helicopter This report from The Air Ambulance Service assesses the current use of helicopters for emergency paediatric and neonatal transfers in the UK and the urgent need to develop new services to meet demand. It is the charity s vision that every child in the UK who requires an emergency helicopter transfer should get one. Executive summary Emergency helicopter transfer services for sick children in the UK currently have capacity to meet only 3% of demand for life-saving flights. This report is published by The Air Ambulance Service charity, which funds and operates the national Children s Air Ambulance and two Helicopter Emergency Medical Services (HEMS). It is based on data compiled by the Children s Air Ambulance over the period January 214 to June 215. The report is authored by Richard Clayton, Director of Operations, The Air Ambulance Service. The author is grateful for the help and assistance of clinicians and clinical partners. To meet demand for transfers and remove inequity of access to services a significant expansion of service provision and capability is required. Key improvements identified in the report include: > > Moving to a seven day a week service > > Increasing aircraft operating hours > > Improving aircraft capability > > Improving hospital infrastructure > Better and more equitable commissioning The Children s Air Ambulance recommends adoption of the report s findings to ensure all demand for paediatric and neonatal transfers is met by

3 Clinical need Every year, approximately 6, babies and children in the UK require an emergency transfer between local hospitals and specialist paediatric centres. 1 However, due to the distances involved, the severity of illness, and the need to save time, an estimated 6 children per year would benefit from transfer by helicopter, which is up to four times quicker, on average, than road transport. The most common medical conditions for children requiring urgent transfer are Cardiac, Respiratory, Neurological and Gastrointestinal. 1 1 PICANET, (215). Paediatric Intensive Care Audit Network: 214 Annual Report Tables & Figures (published September 214). [online] Universities of Leeds and Leicester., p.33. Available at: Annual-Reporting/PICANet_214_ Annual_Report_Tables_and_Figures.pdf [Accessed 26 Aug. 215]. Current provision The Children s Air Ambulance, the UK s first and only dedicated paediatric helicopter transfer service, has been flying in England and Wales since 213. It is run by The Air Ambulance Service charity and receives no government funding. Based at Coventry Airport, the Children s Air Ambulance works in partnership with specialist NHS paediatric transport teams covering London, South East, South Coast, South West, North West, Yorkshire, North East and Wales. Currently, the Children s Air Ambulance has capacity to meet around 3% of the requests it receives to rapidly transport children by helicopter. Alex, who weighed just 2lbs 2oz at birth, was in and out of hospital for the first four months of his life. While at his local hospital in Margate, he rapidly deteriorated, developing bronchiolitis and experiencing severe breathing difficulties. He needed an urgent transfer to specialist care in London. Due to the severity of his condition, he needed continuous ventilation, and had to spend as little time out of hospital as possible. Thanks to the Children s Air Ambulance and the South Thames Retrieval Team, Alex got to the care he needed in just 28 minutes. Bella was six months old and on holiday with her parents when she started to become ill. After being put to bed one night, her parents heard her scream and found her unresponsive and grey. She was rushed to hospital in Ipswich, which then arranged for her to be taken to Addenbrooke s Hospital in Cambridge, where scans revealed that half of her heart was failing to function properly and confirmed she would need urgent open-heart surgery at Leeds General Infirmary 15 miles away. She was flown to Leeds by the Children s Air Ambulance, arriving in just 57 minutes, while the same journey by road took her parents four hours. She will be three years old this November, and has grown into an independent, happy little girl. 4 5

4 12 Combined Requests Activity Requests 8 6 Demand Figure 1 illustrates potential mission numbers for paediatric transfers. Data shows the busiest months for mission requests are October through to April, when children are at their most vulnerable from cardiac and respiratory diseases. The green line indicates the total number of monthly helicopter transfer missions identified by clinicians. figure:1 2 The grey line indicates the total number of transfer mission No. of Combined Requests requests made to the Children s Air Ambulance. (Jan 14 Jun 15) 2 12 Activity Requests 2 Combined Requests Jan-14 Jan-14 Feb-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Combined Requests 2 5 Combined Requests Mon Mar-14 Apr-14 Tues May-14 Jun-14 Jul-14 Wed Aug-14 Sep-14 Thur Oct-14 Nov-14 Dec-14 Fri Jan-15 Feb-15 Sat Mar-15 Apr-15 May-15 Sun Jun-15 Jun-15 6 Combined Requests Combined Requests Operating hours Currently, the Children s Air Ambulance service operates between 7:-17: / 9:-19: (depending on time of year). The data in Figure 2 shows a demand for services to be available 7: 3:. figure:2 No. of Combined Requests by Request Hour (Jan 14 Jun 15) Activity Requests Combined Requests 2 5 Mon 1:hr 2:hr Jan-14 3:hr Tues Feb-14 4:hr 5:hr Mar-14 6:hr Apr-14 7:hr Wed May-14 8:hr 9:hr Jun-14 1:hr Thur Jul-14 11:hr Aug-14 12:hr 13:hr Sep-14 Fri 14:hr Oct-14 15:hr Nov-14 16:hr 17:hr Sat Dec-14 18:hr Jan-15 19:hr Feb-15 2:hr Sun 21:hr Mar-15 22:hr Apr-15 23:hr May-15 24:hr Jun-15 2 Combined Requests Operating days Currently, the service is available Monday to Friday. The data in Figure 3 shows a demand for seven-day-a-week services. figure:3 No. of Combined Requests Requests by Day of Week (Jan 14 Jun 15) 5 1:hr 2:hr Mon 3:hr 4:hr 5:hr 6:hr Tues 7:hr 8:hr 9:hr Wed 1:hr 11:hr 12:hr 13:hr Thur 14:hr 15:hr 16:hr Fri 17:hr 18:hr 19:hr Sat 2:hr 21:hr 22:hr 23:hr Sun 24:hr 6 Combined Requests 6 5 7

5 Aircraft capability To meet demand for longer flying hours, quicker journey times and service resilience, helicopters providing paediatric transfers should have: > > Incubator carrying capability > > Extracorporeal Membrane Oxygenation (ECMO) > > A fourth passenger seat for a guardian/parent to travel with their child Aircraft availability Aircraft availability and rapid response times are key requirements of NHS clinical partner teams. Data shows the provision of two aircraft in the right geographic locations (one to the west of London serving the London area, the South East, South West, Home Counties and Wales; and one based in Lancs / Yorks serving the Midlands and the North) will have a significant impact on availability and response times. > > Night flying capability > > Greater endurance (reducing the number of fuel stops) > > Better bad weather capability > > A modern clinical interior and lighter stretcher with more modern clinical equipment. The current service operated by the Children s Air Ambulance uses an AgustaWestland 19. The aircraft is restricted by the weight it can carry it can only carry so much fuel, people and equipment on board before reaching its operational limit. Replacement by a larger and better equipped aircraft, such as the AgustaWestland 169, will deliver all these benefits. 9 min 215 miles 75 min 18 miles 6 min 1 miles 45 min 15 miles 3 min 7 miles 15 min 35 miles 8 9

6 Hospital helipads The majority of paediatric and neonatal specialist units, along with most District General Hospitals, do not have a helicopter landing pad equipped with the type of lighting needed for helicopters to land at night. The Children s Air Ambulance is therefore committed to working in partnership with hospitals and providers to improve helipad infrastructure wherever possible. Dr Shelley Riphagen, Lead Consultant, Evelina London Children s Hospital To have a second helicopter and flight team dedicated to moving critically ill children into paediatric intensive care units in the South of the country, including London, would be a great step forward in ensuring that we offer the very best, world class transfer service to these children and families. 1 11

7 Equity of access According to clinical partners, some areas of England are unable to access specialist NHS air transport teams. This is a particular problem for neonatal patients requiring transfer from areas covered by non-flying teams. It is estimated by clinical partners that it may be difficult or impossible to request helicopter transfers for approximately 2% of paediatric patients and 9% of neonatal patients. In addition, clinical partners confirm access to current service is also limited by: Size of the aircraft space for patient stretcher and three seats; difficult environment to provide critical care; only room for two clinical staff. Number of aircraft one helicopter restricts the equity of access when the aircraft is off-line for maintenance, training or simultaneous requests. Clinical partners believe this issue can be addressed through a national commissioning structure. Location of aircraft although central, the location in Coventry means the helicopter has to fly for at least 3 minutes to pick up the clinical teams which are based at major paediatric centres across the country. Limited hours of operation the need for critical care can occur at any time of the day or night and often doesn t match to the limited hours of the current operation Monday Friday during daylight hours. Restricted access to hospital landing sites the benefits to the patient are maximised if there is an on-site helipad with a short trolley push to the intensive care. Some specialist paediatric centres have no appropriate landing facilities at all. Lack of lit landing sites this restricts activity particularly in the winter. Transport specific equipment to provide the highest level of care for all patients, specialist equipment is required such as an incubator for premature babies and ECMO equipment to support very sick babies with their heart and lung functions during flight. Too many teams flying too few patients results in lack of exposure and limited opportunities to improve skills/systems

8 We know patients are in the best hands travelling with the Children s Air Ambulance. They ve quickly become a valued partner and a key part of the care we offer our most critically ill patients. The prospect of two helicopters, one North and one South, would mean shorter travel times so children get the care they need even more quickly. Recommendations It is the view of The Air Ambulance Service that emergency paediatric and neonatal helicopter transfer services should: > > Operate seven days per week > > Fly 7: 3: Dr Steve Hancock, Lead Consultant, Embrace Yorkshire & Humber Infant & Children s Transport Service > > Improve helipad infrastructure at key hospitals > > Improve helicopter capability (night flying, increased range, larger interior) > > Be available to all in need > > Improve availability through provision of a second aircraft 14 15

9 The Air Ambulance Service Hazell House Burnthurst Lane Princethorpe Warwickshire CV23 9QA * children s air ambulance keeping hope alive Part of The Air Ambulance Service. Registered Company No Registered Charity No *Calls will cost 3ppm plus your access charge