Air Ambulance
A Brief History

For almost as long as powered flight had become a reality in the early years of this century the immense potential for aircraft to transport goods and people at speed over long distances and with little regard for terrain, was soon recognised. Even before the First World War a Dutchman named deMooy, who was Chief of Dutch Medical Services, realised that surface transport of casualties was a major cause of death among combatants. To counteract this he devised a huge stretcher which was to be suspended beneath a balloon and drawn along by horses. During the Great War the first true Air Ambulance flight was made when a Serbian officer was flown from the battlefield to hospital by a plane of the French Air Service. Records kept by the French at the time indicated that, if casualties could be evacuated by air within six hours of injury, the mortality rate among the wounded would fall from 60 per cent to less than 10 per cent - a staggering reduction!

The first recorded British ambulance flight took place in 1917 in Turkey when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a de Havilland DHH in 45 minutes. The same journey by land would have taken some 3 days to complete. In the 1920s several services, both official and unofficial, started up in various parts of the world. In Queensland, Australia, a plane hired from Quantas at the rate of 2 shillings (lop) per mile became operational in 1928. The aircraft was a de Havilland model 50 with a cruising speed of 80 miles an hour and fuel consumption of some 8 to 10 miles per gallon. It carried a pilot, doctor and nurse, and also had room on board for one stretcher patient. In its first year the de Havilland made fifty mercy flights covering approximately 20,000 miles to treat 225 patients for various illnesses and injuries. It was claimed that the lives of 25 people had been saved, thanks to the medical care provided by what subsequently became known as "The Royal Flying Doctor Service of Australia" and renowned the world over

In Britain sick passengers were ferried by air from the Western Isles of Scotland to the mainland in the early I 930s. The first such flight to be recorded was on 14th May 1933 when a fisherman suffering from a perforated stomach, with consequent risk of peritonitis, was flown from Islay to Glasgow's Western Infirmary in a DH Dragon owned by Midland and Scottish Air Ferries. This service, sponsored by the Department of Health for Scotland through local authorities, was gradually developed, and continues to this day operated by Loganair using fixed-wing aircraft from bases at Glasgow; Kirkwall in Orkney and Lerwick in Shetland.

Many countries now have air ambulance services and the advent of the helicopter has added an extra dimension to the effectiveness of such operations.

In Switzerland, with the increasing interest in winter sports during the early post World War 2 years, the use of air ambulances evolved from the increasing difficulties experienced in mountain rescue work. Initially fixed-wing aircraft were used, landing medical teams with equipment as close as possible to the injured parties so that rapid first aid treatment could be applied prior to evacuation. The major disadvantage was the lack of suitable landing sites close to where the incident had occurred in what was inevitably a mountainous region. To overcome this it was even at one stage proposed to parachute medical personnel with equipment and sledges into the rescue area. Although training was undertaken there is, however, no documentary evidence to suggest that this technique was ever put into practice.

As technology advanced helicopters, because of their greater maneuverability and flexibility in being able to land practically anywhere, became more widely used in all kinds of air-rescue work. It was in the war-torn battle zones of Korea during the early fifties that the value of the helicopter for moving wounded troops quickly from the combat area was first widely realised. Probably the most publicised use of helicopters in the rescue role is the work undertaken by the RAF Air-Sea Rescue Services. Although they are not a true air ambulance service, they do, obviously perform that function as part of their general duties.

Today EMS helicopter programmes are well established throughout the United States and many countries in Western Europe. The US has some 200 operations whose services are paid for primarily by the patients and their insurance companies. As well as Switzerland, France, Austria, Italy Scandinavia and the former West Germany all have very successful versions of the helicopter-based EMS, the benefits of which have in some instances been particularly well-documented. In Germany for example, there is now a network of helicopters which has evolved over the past twenty years to cover the entire country Statistics which have been gathered over this period of time show:-

They have achieved a 3% success rate in cases of cardiac arrest. These are impressive figures, indeed, so why has Britain, one of the major helicopter users in the world, lagged so far behind in this field? It has been suggested that a lack of will at national government level, coupled with decidedly differing local interests, has resulted in the idea never receiving formal backing from the health authorities generally Moreover, cost obviously has been a major deciding factor with a fixed NHS budget leaving little room for the introduction of major and relatively expensive innovations such as air ambulances.

Only in the past few years has this country faced with a developing and ever more complex system of motorways, leading to increasingly horrific accidents, come to address itself seriously to the prospect of using flying ambulances where access to conventional emergency vehicles would prove extremely difficult. A major step forward came in 1988 when a report made by the Royal College of Surgeons recommended the setting up of a network of trauma centres, geared specifically to dealing with the types of injury sustained in major accidents, and to which patients would be flown direct by a national fleet of EMS helicopters.

If this plan were to be implemented it would herald the dawn of a new era in the treatment of trauma victims in this country

In the meantime, several counties have taken the initiative into their own hands, Cornwall leading the way with the first Air Ambulance Service in 1987. They were followed by Kent, Scotland, the West Midlands, London and Devon, most of whom are funded by charitable donations given by members of the public. Various others have watched these developments with interest, and it seems possible that they will follow in due course.

How long it may be before there is a nationally funded and co-ordinated air ambulance network in Britain along the lines envisaged by the Royal College of Surgeons is anyone's guess. Only time and the experience gained from these pioneering early services will tell.