Collaboration is key 

Helping patients and families in their moments of distress and need is a privilege. Pre-hospital care in the South West is evolving through collaborative efforts across and beyond the region, and DSAA is playing a central role. Closer collaboration with South Western Ambulance Service NHS Foundation Trust (SWAST), other air ambulances in the South and South West, the hospital networks, community networks, preventative networks and with research networks, is a key part of DSAA achieving the most for the people of Dorset and Somerset and the broader South West.

Providing pre-hospital care

Dorset and Somerset Air Ambulance (DSAA) has consistently pushed the boundaries of pre-hospital care. But what are the available types of ambulance service care for severely injured and ill patients?

Pre-hospital Standard care – The NHS Ambulance services in England provide a standard level of ambulance service care. This is provided by paramedics and nurses and emergency care assistants. The clinical content of care encompasses regionally and nationally defined procedures and medications.

Pre-hospital Enhanced care – DSAA provides enhanced pre-hospital care with paramedics and nurses who are qualified to master’s level. These clinicians are known as Specialist Practitioners in Critical Care (SP-CC). They bring diagnostic skills, critical thinking and significant operational experience to incident scenes, enabling them to provide advanced, autonomous care across a wider range of conditions and circumstances. When SP-CCs encounter situations that fall outside established clinical guidelines or protocols, they are allowed to apply general principles of care to manage patients. This is enabled through telephone support from a senior clinician. DSAA provides enhanced care via two outreach cars in Dorset and Somerset, which operate 12 hours a day, 365 days of the year.

Pre-hospital Critical Care – DSAA delivers critical care through multi-professional teams consisting of an SP-CC and consultant-grade doctor. These teams can diagnose and treat a wide range of conditions and apply principles to manage complex and novel challenges in the pre-hospital environment. Their content of care includes instituting life-saving interventions such as surgical procedures, pre-hospital anaesthesia and life support. DSAA provides critical care via helicopter and critical care car (when the aircraft is offline), 19 hours a day, 365 days of the year.

Why does DSAA provide pre-hospital critical care?

Over the past 25 years, DSAA has treated patients who had little chance of survival without pre-hospital critical care. Cases have included severe life-threatening allergic reactions, life threatening sepsis, heart attacks, chest stabbings, motorcycle and car road traffic collisions, falls from height, to name only a few. Patients have received DSAA advanced care and survived to hospital, with intact brains, enabling them to continue life beyond their event.

This assertion has a professional evidence base from thorough reviews of care data from across England, Wales and Scotland. Published data on trauma patients demonstrate a 2-3-fold reduction in death in patients receiving pre-hospital critical care, versus patients of equal severity not receiving such care, demonstrating the huge potential of critical care delivery in the pre-hospital setting for these patients. DSAA provides critical care for patients because it is an evidence-based approach to reducing death and disability in populations, and the people of Dorset and Somerset deserve these life chances.

Reaching patients

The very existence of such severely injured and ill patients during our operating hours promotes thought about equity of access. Critically ill and injured people who are not recognised by society as needing pre-hospital critical care will not receive it.

Finding these patients is challenging and underpins the reason for DSAA to invest so much time and effort on ‘Outreach’ and ‘Tasking’. Specialist practitioners on our two outreach cars aim to empower the broader ambulance service and other emergency services to escalate care appropriately and rapidly. The work of our colleagues on the centralised Helicopter Emergency Medical Service (HEMS) desk in Exeter profoundly affects the lives of patients through first recognising them and then choosing the balance of resources to support the patient.

Preventing people becoming patients

The human body has structural integrity; it has particular stress and strain attributes which are the same across humanity and have not changed for millions of years. Applying very large force to the human body breaks it. This sounds barbaric and abstract. However, it is a daily occurrence in Dorset and Somerset.

In the UK every year, 1,700 people are killed in road traffic collisions and 28,000 people are severely injured. Our DSAA teams witness this destruction. They hold the hands of broken humans from road traffic collisions associated with speed and they try their best to salvage those humans to become functioning people once again. It is on this backdrop of witnessing and indeed counting the number of injured people cared for, that it becomes clear that we have the data, the narrative and the obligation to influence the status quo. Pre-hospital care systems have a significant contribution to make to public health, and air ambulances should be leading this – DSAA is playing its part.

Improving care into the future - the importance of data

Once a patient is recognised to be critically ill or injured, they need the severity and consequences to be minimised. DSAA’s whole clinical provision is aimed at achieving this. But to drive improvement in pre-hospital critical care, it is essential for us to focus on assessing our service against objective patient-centred outcomes.

To do this, we need high-quality data about the care we provide, which is linked to the ongoing pathway of care and outcomes for each patient. We then need to analyse that data and interpret it for the benefit of the people of Dorset and Somerset. This has never been achieved at scale and is closer to realisation than ever before. In 2025, DSAA within the clinical governance of SWAST, is submitting our clinical data to the national Pre-hospital Research and Audit Network (PRANA, www.prananet.org). By the end of 2025, for the very first time, we will be able to review the outcomes of all patients treated by DSAA across the past decade. We anticipate that this new capability will support us to further develop the care we provide for the region through our expanding research programme and our quality improvement activity.

Thank you from the operational team

The ongoing opportunity to deliver and adjust the care that we provide for the evolving needs of the community is a very special gift. The operational team respect this opportunity and thank the people of Dorset and Somerset for their charitable donations and generosity. Without this support, our work would not be possible.