Help from the heavens

Some say it's a lifesaving innovation. Others feel it's a waste of mone y. Esther Oxford rides with the Helicopter Emergency Medical Service

Propellers thunder, the noise is deafening. Below, a class of schoolchildren gaze up, faces flattened, eyes watering from the blast. One little boy bursts into tears; another shrieks as the school's green plastic rubbish bin hurtles across the gra velledplayground. Enter the Royal London Hospital's helicopter at Wood Green, north London, scene of a traffic accident.

The helicopter touches down lightly. Two men jump out and run to where blue sirens are dancing. The crowd of macintoshes, shopping bags, and peering, inquisitive faces pulls back: Steve Bree, 28, rushes through. Across his back is written the magic word:"Doctor".

"Hi, Steve Bree from the Royal London. How can I help?" he says. The Helicopter Emergency Medical Service (Hems) relies on Dr Bree to keep relations with ground rescue services sweet. So, instead of beginning work on the victim's injuries, he goes through the protocol. Then he clears the victim's breathing passage, straps her spine, checks her pulse, looks for bleeding and examines her chest. When he is sure that the woman is in a stable condition and a hospital bed has been found for her, he gathers his things and leaves. Another call has come through. This time it is a builder who has fallen off scaffolding.

In the helicopter, minutes later, he answers the question: was the helicopter service really needed, or was that a wasted call-out? "The woman struck her head on the kerb as she fell," he says. "She could have had severe head injuries." In the event, shewas found to have blood in her ear and a possible fractured pelvis. Couldn't ground ambulance paramedics have managed without him? No, Dr Bree says. Immediate diagnosis, preferably within the first hour, is important if secondary injuries such as brain damage or paralysis are to be avoided.

The importance of the 60 minutes following injury was first recognised by the Royal College of Surgeons in 1988. A study commissioned by the college found that one in three accident victims died because they failed to receive attention during the crucialfirst hour.

Simple treatments such as clearing the airway and feeding the patient with fluids can save a patient's life, explains Dr Bree, who has worked with Hems for five months. But unless a doctor is there within the "golden hour" the chances of complications occurring escalate.

Richard Earlan, a consultant at the Royal London, presented the report to Express Newspapers. Within a year the helipad and helicopter were launched at a cost of £5m.

Most of the patients referred to Hems are picked from the 999 calls coming into the London Ambulance Service control room at Waterloo. The idea is that the helicopter can bring the hospital to the roadside within minutes. "Early intervention improves thepost-accident survival rate and shortens the hospital stay," Dr Bree says. With hospital beds costing up to £2,000 a day, fast recovery is beneficial to all.

People in east London are proud of the service offered by their local hospital. When the roar of the helicopter starts up, six floors above White-chapel market, heads turn skywards. Former patients are also keen supporters.

That day the Hems team had received two letters, one from a woman who had been raped and stabbed on a south London common. "Thank you for being so kind. And thank you for saving my life," she wrote. The other was from a man who had been lifted off a railway track after an attempted suicide. "I've realised that life is worth living," his letter said, in a shaky scrawl, "even though I have lost an arm."

But Hems has its enemies, too. Dr Martin Sarner, chairman of the consultants' committee for University College Hospital, is one of its most vocal opponents. He says that the money spent on the service (£1.5m a year, almost entirely financed by the Department of Health) could be better directed at modernising the control room at Waterloo, investing in better management personnel, and improving the lifesaving skills of London's ground ambulance crews.

A small number of ground ambulance paramedics feels the same way. "Hems is an expensive gimmick," says one. During winter the helicopter is called out an average of four times a day, yet it still costs a fixed amount of money to run. Far better to spend the money "squandered" by the helicopter ambulance crew on restructuring the London Ambulance Service. "God knows, it needs it," he says.

Figures released by the Royal London Hospital seem to support Dr Sarner's argument. Figures for 1993 show that a third of the 1,000 annual missions (each costing about £1,000) are wasted because of hoax calls, the patient dying on scene or cancellations.

Hems is also guilty of intervening "inappropriately", claims Dr Sarner. Nearly two-thirds of patients admitted to hospital are taken to the Royal London. Many are interesting or publicity-attracting cases, rather than straightforward road accident victims. Could this be cherry-picking, he wonders?

The Royal London, Dr Bree says, has the most experienced trauma team in London. Flying the patient back to base also saves vital minutes. The hospital offers a prompt, reliable, and highly skilled service. He says that wasted calls will be gradually filtered after the control room at Waterloo installs a computer system to screen callers and prioritise patients.

Resistance from the ground ambulance crews is harder to handle: some do their best to obstruct the service. Dr Bree says he has been refused access to a patient ("They barred the doors") and has arrived at an accident only to find that the patient has been taken away by ambulance crews. "It's professional jealousy," he says.

But the air ambulance team is keen to improve relations. "We are there to complement the work of ground ambulance paramedics, not to rival them," Dr Bree says. Paramedics from London's ambulance stations have been invited to spend a day with the team to "refresh" their skills and encourage them to be more helicopter-friendly.

"Hems relies on the goodwill of the ground ambulance paramedics to refer work on to us. The last thing we want to do is upset anyone," Dr Bree says.

At the building site in north London, a crowd stands on the pavement, necks craned. A builder has fallen six feet on to scaffolding and hit his head. He lies motionless. He can move his toes and talk, but his rib cage, arms and back ache.

As the sun goes down, and the air becomes icy, Dr Bree goes to work, giving oxygen, putting a collar on the man's spine, inserting a drip and checking for complications. Soon there is only lamplight to guide him and encouraging comments from the crowd ofparamedics, firemen and police who have gathered.

"Failure in this job is very public," he says. "If I were to make a mistake, everybody would know about it."

The builder is lowered from the scaffolding and taken to a nearby hospital. The ground paramedics go with him. Disappointed that the show has come to an end, the crowd disperses, until only the helicopter enthusiasts remain. One is a little girl: can shehave an autograph? Another is a middle-aged man. Would we mind if he had a quick look inside the helicopter? Then the mother: could we please pass on her thanks to the flying doctor who had saved her daughter's life 11 months ago?

Dr Bree and the helicopter crew answer each request before climbing back into the air ambulance. The helicopter lifts. For a while it hovers, then dips and climbs. "Who's for a pint?"asks the pilot.