Air ambulance review: Patients have a better chance with a combined doctor-paramedic team - Opinion

'In a rescue helicopter, seconds count, and you want the best team possible.'

THREE KEY FACTS

• The Aeromedical Commissioning Programme is designing NZ’s air ambulance system, with better patient and community health results.
• It aims to provide equitable access to a safe, sustainable and integrated service.
• This programme is the second phase of the long-term reconfiguration of air ambulance services.

Imagine your loved one getting into a car accident on a remote Far North road.

A rescue helicopter lands in a paddock nearby and out steps a highly-skilled paramedic and an experienced pre-hospital and retrieval medicine specialist doctor. Your whānau is in good hands. The expertise of this doctor-paramedic team will give them the best chance of survival possible.

Right now Health NZ and the Accident Compensation Corporation (ACC) are undertaking a major review of the aeromedical services called the “Aeromedical Commissioning Programme” (ACP), intending to transform New Zealand’s air ambulance system to improve patient and community health outcomes, utilising $140 million in government funding. The review comes at a time when demand for rescue flights has increased significantly.

It’s worth knowing that a new study has come out based on work across 10 countries suggesting that the targeted deployment of interprofessional teams combining doctors with paramedics in the pre-hospital care of critically ill patients saves lives. The study examined interprofessional teams of doctors and paramedics in the aeromedical space compared to teams of paramedics only, finding that the doctor-paramedic teams had much higher survival rates: 20% higher.

In major trauma, where even a single additional life saved is critically important, an additional 20% higher survival rate is remarkable. Teamwork, expertise, interprofessional collaboration and complementary skills really do make a lifesaving difference.

Having a paramedic back up the doctor makes the doctor stronger. Having a doctor back up the paramedic makes the paramedic stronger. Each has different skills, training, and experience. Both together is the ideal that we should be striving for if we want higher survival rates for our critically ill and injured patients in Aotearoa New Zealand. Combined teams can pool knowledge and skills and decrease errors, all of which saves lives and reduces costs.

The future is in combined doctor-paramedic prehospital teams and with the Aeromedical Commissioning Programme currently taking place, it’s time to get the ball rolling on an interprofessional combined approach to aeromedicine in New Zealand. The pre-hospital death rate in New Zealand is high, but combined doctor-paramedic teams give us the best chance of changing that.

Linking these teams up with cost-effective in-situ simulation training enhances skills for medical, paramedic, and crewpersons and benefits recruitment and retention, ensuring more skilled professionals remain in New Zealand to provide critical care.

In a rescue helicopter, seconds count, and you want the best team possible: a combined doctor-paramedic team.

Using the NZ Transport Agency’s “Value of a Statistical Life” methodology, estimates show combined doctor-paramedic teams could save $12m per life, or $300m annually, in addition to significantly increased patient survival rates. The main barriers are funding and workforce upskilling.

Paramedics are indispensable to our healthcare system - their expertise, acumen and dedication are irreplaceable. However paramedics have different skills and training than doctors. The key here is that we need teams of both; collaboration can enhance patient outcomes in critical situations.

When time is running out during a rescue flight to the hospital, being able to make diagnoses, give special medications, or undertake complicated clinical procedures are things which doctors are uniquely positioned to provide.

Doctors bring their emergency department and intensive care unit experience to the roadside, paddock, or the patient’s home. The distinction is not in comparing the clinical value of paramedics versus physicians, it’s in recognising how a collaboration between the two adds up to enhance patient outcomes in critical situations.

In a rescue helicopter, seconds count, and you want the best team possible: a combined doctor-paramedic team.

Garnering public awareness and support is crucial to this initiative. People need to know what’s possible, what the latest advances are, and what the latest research shows. The data is clear: by having both paramedics and doctors in rescue helicopters, we can maximise the chances that critically ill patients will survive.

Simply put, when a paramedic and a doctor step out of the helicopter together, the patient is getting the best possible care.

Combined doctor-paramedic teams are already working across most of Australia, the UK and Europe, with incredible success rates.

Kiwis should have the same level of care and the reassurance that they’re getting the best team possible: a combined doctor-paramedic team.