Gaps in Air Ambulance and Ground Ambulance Research Paper

Introduction

Providing emergency help to patients is not always carried out exclusively by ground transport. Air ambulance is one of the modern units that are responsible for fast and safe patients transportation over long distances and as quickly as possible. This type of emergency help has many international standards that should be complied with, in particular, the time of arrival, the terms of the delivery and other significant conventions.

In the process of analysing air ambulance and comparing it with vehicles on the ground, some gaps can be found, which does not allow for a comprehensive review of this service’s activities. To determine the current features of air ambulance and compare it with ground one, it is necessary to conduct a literature review and find out those factors that are distinctive and similar in the two types of emergency medical transportation of patients. As a background for analysis, topical academic studies will be used as justifications for certain arguments and facts. The evaluation of the practice of air ambulance may allow defining current gaps in knowledge about this form of emergency help and its unique characteristics.

International Standards of Air Emergency Work

The practice of air emergency has a number of distinctive features that are typical for this type of patient transport. Nevertheless, as Wilmer et al. (2014, p. 813) note, “there is no national or international consensus on the best method for identifying when air ambulance resources are needed for patients with major trauma.” This factor is associated with some difficulties for caregivers since the lack of clear instructions can slow down the time of care, which, in turn, may lead to undesirable consequences.

Sunde et al. (2015) adhere to the same opinion and argue that there are still no clearly defined international standards in medical emergency services, which is a gap. The mode of patient transportation in different countries may differ, which does not allow establishing the unified system of norms governing this procedure. Powell-Dunford et al. (2014) remark that it is particularly important to systematise the whole process of air assistance in relation to the blood product administration since such a procedure is a priority and requires control. All these nuances are significant gaps, and the participation of officials is mandatory for consideration of this issue.

Regarding the issue of the maximum allowable distance over which air ambulance can move, there are enough studies. For instance, Nolan et al. (2018, p. 162) note that one large service of such an ambulance can cover an area of ​​1 square kilometre, which is a large territory. Ground transport is not able to overcome such a distance in a short time; therefore, it is irrational to send it. As Tien (2018) notes, all the types of air vehicles can reach a target quickly for many hundreds of kilometres, which is particularly relevant during large-scale incidents when the help of many rescue teams is required.

According to Aspiotes et al. (2018), minimum downtime and fast contact with patients testify to the professionalism of critical care providers and the quality of the organisation of transporting patients by air. Thus, this issue has many discussions and is not a knowledge gap.

Performance Indicators of Air Ambulance

Fast emergency time is an essential criterion for minimising the dangerous outcomes of incidents. As Rehn et al. (2017, p. 806) argue, in London Air Ambulance units, “an emergency response represents a time saving of 54.9%.” According to the authors’ research, the response time here has become faster for 14 minutes, which is a success (Rehn et al. 2017, p. 806). In some other states, this type of assistance is also common. In the island state of Haiti, over the past 40 years, a significant reduction in mortality has been achieved due to the rapid response of air emergency services (DeGennaro et al. 2016, p. 1001). In other states, for instance, in the north, the service of such patient care is also common, and here, as Gunnarsson et al. (2015, p. 25697) remark, the average flight time takes 19 minutes.

Air ambulance is used for different cases and can be a common practice to help patients. According to Juelsgaard et al. (2018), not only incidents but also other difficult situations, for example, hypertensive crises are the cause of emergency transportation in Denmark. In Thailand, one of the advantages of using air units is the reduced risk of accidents compared to land transport. As Pattanarattanamolee et al. (2017, p. 732) argue, in 2013, it was registered “61 ambulance crashes, with 130 injured occupants and 19 deaths.” Hungarian healthcare officials have also moved to the new practice of providing emergency assistance by air. According to Soti et al. (2015), one of the basic achievements of local medical units is the reduction in patient transportation time and, as a result, timely first aid measures.

Rules for Dispatching Air Emergency Services

Dispatching air emergency services is accompanied by a set of rules and regulations that need to be followed to ensure stable and efficient operation. Kupas et al. (2015) note that in the US, there are special protocols for trauma care, providing for patient transportation, but these standards differ from state to state. In the countries of the European Union, there are also special acts establishing the procedure for the provision of emergency assistance by air in accordance with the local laws (Kompanje et al. 2014). Special requirements apply to paediatric cases and, according to Michailidou et al. (2015), air emergency assistance to children is world widespread and high priority.

Østerås, Brattebø and Heltne (2016) provide more specific data regarding the technical features of air medical help. For instance, the authors argue that “helicopter flights at night and in low visibility are associated with a higher level of risk, and helicopter pilots follow stricter flight rules” (Østerås, Brattebø & Heltne 2016, p. 665). As a result, relevant boards strictly control the activities of the air emergency units, and dispatcher monitoring is the essential component of efficient and safe activities.

Perritt (2017) also states that any departures and landings of the teams of air ambulance should be controlled in accordance with specific procedures. The author notes that it “is a demanding process that requires detailed engineering calculations of runway length, height above sea level, nearby obstacles, aircraft approach speeds, rates of dissent, and rates of climb” (Perritt 2017, p. 119). This study provides comprehensive information on the features of flight control rules, and there is no any research gap in this area.

Comparison of Air Ambulance and Ground Ambulance

There are academic studies that are aimed at comparing the indicators of efficiency and productivity of the two types of ambulance – air and ground. Chesters et al. (2014) consider the data obtained in the process of studying these categories of emergency assistance and provide some relevant facts. The authors argue that “treatment and transport by a helicopter-based team compared with a ground ambulance-based team was associated with a longer on-scene time (36.9 min vs 25.3 min)” (Chesters et al. 2014, p. 67). These parameters make one think about the need to take action on this issue and consider this gap.

Another essential criterion for evaluating and comparing emergency types is the use of geographic information systems (GIS) in the practice of medical units. Aminzadeh et al. (2017) note that these systems allow the ambulance of both air and ground services to establish contact with specific trauma centres, thereby ensuring effective interaction and contributing to quick response to calls for help.

Shahriari et al. (2017) consider different ways of communication between air and ground services based on existing technologies. The authors argue that special channels of communication help to improve the results of the joint practice of providing emergency assistance and demonstrate relatively high efficiency. However, Shahriari et al. (2017) do not mention GIS as one of the important components of the timely intervention of both air and ground medical specialists. Therefore, there is a research gap in this topic, which is a flaw.

Providing Air Emergency Help in Cities and Rural Areas

One of the significant topics in the study of the procedure of providing air emergency assistance is its accessibility in all areas, including both urban and rural regions. Dhindsa et al. (2017) give an example of cases in which patients are transported to medical centres not from cities but their outskirts. The authors note that it would take about 45 minutes for ground ambulance to reach certain places, while air transport is more mobile and speedy (Dhindsa et al. 2017, p. 343).

Previous studies show ambiguous indicators regarding the time of emergency assistance when using helicopters. However, for rural areas, it is more convenient for pilots to get to places that are not as densely populated as megacities, which increases the likelihood of quick patient transportation. However, this study has a gap; in particular, it does not mention the relevance of aid centres near urban neighbourhoods, for example, Red Cross facilities. Also, the authors do not focus on the international standards of air and ground emergency based on the use of GIS (Dhindsa et al. 2017). These gaps impose limitations on the relevance of the study.

Another study on the availability of air ambulance services for people from different regions is presented by Røislien et al. (2018). The authors research the system of medicine in Norway and, in particular, its features of the organisation of emergency care and argue that significant differences in urban and rural life “constitute a challenge for the desired equality in health care” (Røislien et al. 2018, p. 42).

It is due not only to the geographical features of the country and its severe weather conditions but also the distant location of rural areas from major cities. Since a significant part of the state borders is washed by the sea, a large percentage of the population lives around the perimeter of the country, and air emergency services have to make long flights. Moreover, it affects the accessibility to Red Cross centres, which also complicates the task for units. However, the authors do not mention this nuance in their research, which makes it insufficiently complete (Røislien et al. 2018). As a recommendation, it would be essential to pay attention to the peculiarities of the work of ground ambulance units and their experience for comparison.

Current Research Gaps Between Air and Ground Ambulance Based on GIS

Over the past years, quite many academic works have been published concerning the organisation of air emergency unit activities and the characteristics of their control. However, some research gaps do not provide the relevant picture of such an important phenomenon as the use of GIS by both air and ground ambulance services for integrated and collaborative practice. From all the reviewed academic sources, only Shahriari et al. emphasise the importance of auxiliary geographic systems in the context of cooperation between the two types of ambulance to improve their activity outcomes. As a justification, the following Table 1 cites some studies over the past years where this theme is partially affected, but the final conclusions do not correspond to the required research topic.

Table 1. Gaps in Studies on Air and Ground Ambulance Cooperation Based on GIS.

Conclusion

The detailed literature review of relevant academic work may allow drawing conclusions regarding the existing research gaps in the topic of air emergency units’ activities. Comparing data with ground ambulance crews may help to find the best ways of establishing communication between teams for providing the most effective help. Based on the results of the review, there are some research gaps, and few articles provide relevant and valuable information to be considered in the context of potential instructions for changes. The conducted work may be utilised as a guide for studying current problems in the field of air and ground ambulances and the ways of modernising these areas of medicine.

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