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Just watched Emergency Helicopter Medics and Air Ambulances seem to be funded through charities, but how are the medical crews funded? I can't quite decide having read google
Is it an NHS posting for paramedics paid for by the NHS?
The consultants seem to work normally at hospitals, is their helicopter service part of their NHS duties, or is it voluntary during their days off?
TIA
I think the medical staff are employed by the NHS. The aircraft, pilot and maintenance costs are covered by the charities.
For those ran by charities the charities pay their wages.
In the charity air ambulance I worked for. All wages paid for by th charity.
For Yorkshire, I think the ambulance trust seconds paramedics to the air ambo. The trauma medic i know of looked into it and I think for him it would have been 50% volunteer, 50% on works time with employers support.
It’s different from charity to charity, meaning all of the above may be correct. Most air ambos are rolling in dough though, it’s a business model that sucks in money hand over fist. To the detriment of less exciting but equally deserving charities, I fear (opinions are my own, etc)
The Scottish Ambulance Service has 2 helicopters and 2 planes. So they are paid for through the usual NHS / government funding.
I think all of the other air ambulances are charity funded.
Most air ambos are rolling in dough though, it’s a business model that sucks in money hand over fist. To the detriment of less exciting but equally deserving charities, I fear (opinions are my own, etc)
And what charities would those be, pray tell? Do you actually know what the hourly running cost of an up-to-date chopper, fully kitted out as an ambulance is, plus crew? Especially one like the Wiltshire Air Ambulance, which is available 19 hours a day. It replaced one shared with Wiltshire Police, who had it taken away, and now share a chopper with Bristol, North Somerset and South Gloucestershire, so you can imagine who gets the lion’s share. Wiltshire is a very large, spread-out county and ambulances take a long time to get to the major A&E units in Bristol, Swindon and Salisbury; a chopper can get anywhere in the county in nine minutes...
But I guess you’ve never had a close relative saved by having an air ambulance available, so don’t really care about lives saved verses cost. [img] 
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Lol. I do, yes. I have some insight. (Like I said; all views are my own).
Your excitable response kind of proves my point; what other UK charity commands such fierce support in the face of (very) faint criticism? I’m not criticising btw; air ambulances do valuable, if sometimes overemphasised, work. It’s just this sort of support that makes fundraising so easy; it is dripping with both virtue and excitement. Hospices, homeless shelters, cancer support etc just can’t compete.
Out of interest; are charities accounts in the public domain? Is it possible for you or I to actually find out how much they have in the bank and what their balance sheets look like? IANAA.
Out of interest; are charities accounts in the public domain? Is it possible for you or I to actually find out how much they have in the bank and what their balance sheets look like? IANAA.
Yes
Most air ambos are rolling in dough though, it’s a business model that sucks in money hand over fist.
Interesting, I didn’t know that.
..Out of interest; are charities accounts in the public domain? Is it possible for you or I to actually find out how much they have in the bank and what their balance sheets look like?
Ah, ok. Neither did you.
I can't quite get my head around the concept. If they are the most effective way to get patients into hospital you'd have thought they would get paid for out of the same budget as ambulances that drive on roads. Why it should be funded out of donations I can't quite fathom. But then again so is the RNLI.
Genuine question - do Bristows who now run the air sea rescue instead of the RAF/RN ever do hospital transfers and the like anymore? Growing up I spent my teenage years living in a house about 50m from the helipad at the Kent and Canterbury hospital and the wessex that came in there seemed to be doing more urgent hospital transfers than deliveries from the sea. Or is that now done by air ambulance only?
Ah, ok. Neither did you.
Oh, I do. I asked if they were available publicly.
I can’t quite get my head around the concept. If they are the most effective way to get patients into hospital you’d have thought they would get paid for out of the same budget as ambulances that drive on roads.
They are not in the least bit cost effective; but they undoubtedly save lives, very expensively. Hence the charitable status.
Cost effective .......
So what you are saying is if air ambulance was a drug NICE would not sanction its use by the nhs? Are the scots setting a different level for what constitutes justifiable cost effectiveness or does the different geography of the land change the formula?
Why it should be funded out of donations I can’t quite fathom. But then again so is the RNLI.
The RNLI has more money than it knows what to do with.
It is very happy being a charity, allows it to do and spend exactly as it likes.
It also doing a very good job at pissing off a lot of it's core volunteers at the moment.
Are the scots setting a different level for what constitutes justifiable cost effectiveness or does the different geography of the land change the formula?
I would imagine that geography and infrastructure have a lot to do with it.
Ballpark figure for keeping an air ambulance and crew operating for an hour?
i guess £600 per hour?
i guess £600 per hour?
According to to the East Midlands service faq they reckon each mission averages out at a cost of £2.5k and they average 2000 missions a year.
Being callous I wonder how many missions result in a life saved that otherwise would not have been. 1 in 4 maybe (figuring some missions the victim dies anyway and others would have survived if taken in a conventional ambulance). So (huge guess) £10k a life. That does not sound too bad. Clearly if every trip in to hospital cost that we’d be broke in days but for the most extreme cases....
Being callous I wonder how many missions result in a life saved that otherwise would not have been. 1 in 4 maybe
I bet its wwy lower than that 1/10 or less. Based on idle musing of a Trauma surgeon watching these Air Ambulance programmes
If your really curious, you should be able to find their annual reports and accounts here http://beta.charitycommission.gov.uk
The Scottish equivalent here https://www.oscr.org.uk
Just be aware that depending on how income is raised the ROI on fundraising can vary significantly which in turn affects the expenditure ratios. E.g. retail costs a lot but is very reliable, legacies provide a lot for not much but are prone to big drops and rises.
The RNLI has more money than it knows what to do with.
It is very happy being a charity, allows it to do and spend exactly as it likes.
It also doing a very good job at pissing off a lot of it’s core volunteers at the moment.
Yep the debacle with the RNLI sacking the crew and 'taking their boat back' in Jersey last year wasn't their best move.
Knowing a member of the crew and what actually occurred to what the RNLI put out was interesting.
Leaving the Island without a boat and crew was truly stupid.
Anyway - back on topic - Air Ambulance is a valuable asset however it's funded.
Interesting that Scotland Chopper & Plane are NHS funded though.
Scotland has both state and charity air ambulances.
The NHS also have fixed wing aircraft. I can’t remember the numbers but iirc the NHS aircraft do a lot of medical retrieval work bringing people to major hospitals for treatment from the Western and Northern isles. The helicopters do plenty of full on emergency work as well. Not sure how much, if any, retrieval work the English and Welsh aircraft do? Possibly the Cornish and Welsh aircraft?
Genuine question – do Bristows who now run the air sea rescue instead of the RAF/RN ever do hospital transfers and the like anymore?
yes (I think technically Bristows operate it, the MCGA run it), they still do some hospital transfers, but usually only if there is some reason an air ambulance can’t (like weather conditions or space for specialist kit or extra people that won’t fit in the back, e.g. an expectant mother might be flying with a midwife and baby incubator too).
Are the scots setting a different level for what constitutes justifiable cost effectiveness or does the different geography of the land change the formula?
The first thing to realise is that the are two different opperators in Scotland. The Scottish Ambulance Service (NHS) operates to Helos and Two fixed wing aircraft. These are staffed by paramedics, and don’t usually carry a doctor. They are very much an extension of the service the ambulance service routinely provides both transporting life threatening emergency cases and moving patients to/between hospitals. Bear in mind the operating area covers everything from Shetland, to the outer Hebrides, to Campbeltown and Eyemouth and everything in between and that major hospitals are somewhat sparse with specialist treatments sometimes only available at one hospital. By road and ferry it could take >8 hours from some places to get to a cancer specialist in Glasgow, and then your crew need to get back to where they came from (and the local area might be left without a vehicle). If you have a response time target for an island with a few thousand people on it, the frequency of calls won’t justify having staff and vehicles available 24/7, but if you have to wait for a ferry (which out of hours might involve the crew being called out specially) then you’ll be measuring response time in hours.
obviously that means they have aircraft which can be utilised for genuine trauma calls too (although it would be very rare to see them land in any of the cities because without a Doc they aren’t bringing extra skills per se and you still need to transport the patient the distance to the air craft and from the helipad to the hospital which may not add up to a massive time saving).
the second operator in scotland is called “Scotland’s Charity Air Ambulance”. They operate one helo and pretty much respond only to 999 calls (rather than “routine” transfers). I don’t think they routinely fly with Doctors on Board either (unlike many of the English HEMS services).
to complicate the Scottish picture even more, there is an emergency medical retrieval service which is (now) nhs funded and provides specialist doctors, nurses etc for doing transfers usually from rural hospitals, either being delivered by SAAA or the a CG one.
in that sense Scotland has some unique geographic challenges; it also has one ambulance service for the whole country, and some umbrella bodies for NHS nationally which make it somewhat different from just being a large English region.
convert
I can’t quite get my head around the concept. If they are the most effective way to get patients into hospital you’d have thought they would get paid for out of the same budget as ambulances that drive on roads.
I have seen AA deployment in (what seemed to me as someone who knows nothing about it!) very odd circumstances - for example, recently near me an AA was dispatched to collect a patient suffering from what was reported as a heart attack, but that person was less than a mile away from the local major A&E, meaning an ambo would be be there either from the local depot or the hospital in less than five minutes.
Not sure (from the point of view of the uninformed outsider) how that worked out as being more efficient!
Yep the debacle with the RNLI sacking the crew and ‘taking their boat back’ in Jersey last year wasn’t their best move.
Knowing a member of the crew and what actually occurred to what the RNLI put out was interesting.
Leaving the Island without a boat and crew was truly stupid.
The best thing that can be said is there is a lot of he said, she said.
My anecdote: Knowing a couple of different people (volunteer and RNLI employed) that spent some time down there just before the decision to take the boat back until another crew was established, some of the lies made up about them by the locals (and stupidly enough, obviously lies as there was paperwork to prove otherwise) didn't paint some people in a very good light...
And don't get me wrong, I think the RNLI can sometimes do better. But I at least recognise that they have a tough line to walk between giving us volunteers freedom, and having to cover themselves in times that are getting ever more litigious. There was a *massive* difference between what was just reported by the media about Whitby lifeboat and why a couple of volunteers were let go. But the RNLI has to keep quiet as the crew still have the right to appeal. That doesn't seem to stop the individuals concerned from spreading "their side of the story" left right and centre though.
For interest - a random selection of air ambulance services. My conclusion, they're not skint (numbers taken from the link above for the latest year, but if you look at the previous years, it's a consistent trend of income being larger than spending).
Kent, Surrey & Sussex Air Ambulance Trust
Income £12.4m Expenditure £9.6m Net assets £21.8
Yorkshire Air Ambulance Limited
Income £8.3m Expenditure £4.8m Net assets £22.7m
Welsh Air Ambulance Charitable Trust
Income £10.7m Expenditure £9.2m Net assets £7.3m
Midlands Air Ambulance Charity
Income £13.0m Expenditure £8.6m Net assets £24.14m
It depends, what those numbers don’t tell us is why. All charities should build and maintain reserves to a scale appropriate for the size of the charity. It’s also perfectly feasible they are recovering from/or preparing for a major capital investment, e.g. new aircraft, own aircraft rather than contracted, new hanger, new base of operations.
They might not not be doing any of those things and just stashing it in a cupboard to roll around in.
Its also worth remembering weve we’ve only really had these things for 30 years or so. So it’s quite common to see multiple air ambulance charities doing similar things at similar times.
for example, recently near me an AA was dispatched to collect a patient suffering from what was reported as a heart attack, but that person was less than a mile away from the local major A&E, meaning an ambo would be be there either from the local depot or the hospital in less than five minutes.
An ambulance station does not mean there is an ambulance there, all trusts are very busy meaning most crews are never in. It could be no crew was available for quite some time, also the neares hospital is not always the most appropriate.
As Drac says, the nearest hospital is not always the most appropriate. For example if you have a heart attack around North Devon, the nearest hospital (Barnstaple) doesn't have a PPCI (inserting stents in blocked coronary artery) capabilty so the most appropriate hospitals are either Exeter or Taunton (depending on where you are). You're looking at the best part of an hour to reach either of those hospitals by road, and time is (heart) muscle.