Service's future in doubt after critical reports

Two inquiries questioned medical value of pioneering pounds 900,000- a-year operation

Criticism of London's helicopter emergency service yesterday by a London coroner follows two reports which have questioned the future of the air ambulance.

Two weeks ago, a government-sponsored independent report from the University of Sheffield on London's Helicopter Emergency Medical Service (Hems) found that it saved about one extra life a month but that "over all the helicopter caseload however, there is no evidence that it improves the chance of survival in trauma".

In June, a report by the House of Commons health committee on the London Ambulance Services, which co-ordinates Hems,said that on balance there was no case for continuing the service in the long term.

The ambulance helicopter, based at the Royal London Hospital in east London, was donated by Express Newspapers in 1989 and costs pounds 900,000 a year to run.

The London Ambulance Service provides a paramedic and decides when to send it out, and the hospital provides a doctor to fly with it. It answers 1,200 calls a year, returning the patients to the Royal London in about 300 cases.

The idea was to provide a rapid response to accident victims with serious injuries by avoiding delays in heavy traffic.

Dr David Maclean, clinical director of Hems, defended it yesterday but accepted that following the two reports the future of the service was in question. "In our view this is a pioneering venture. It saves lives and improves the outcome of serious injuries. We must be able to prove this."

Dr Maclean said the Sheffield research on the effects of the helicopter on survivalhad not made fair comparisons between patients taken by helicopter and patients taken by ambulance. "The Hems patients are more seriously injured. That is why the helicopter attends."

Dr Howard Baderman, clinical director of accident and emergency services at University College, London, said: "London's accident and emergency consultants meet four times a year and it is accurate to say that except for consultants at the Royal London, there is deepest concern about its use in central London. It is a standing item on our agenda.

"My personal view is that it will probably survive but that its use will be very much modified, probably to situations of prolonged entrapment; to situations where it is very difficult to get an ambulance in - on blocked motorways, for instance and for inter-hospital transfer.

"We would also question the value of having a doctor on board, which is very expensive and when there are now paramedics."

The value of an urban helicopter ambulance is also questioned outside London. Peter Mann is chief executive of the Wiltshire Ambulance Service, which shares a helicopter with the police, covering an area of 1,480 square miles.

"In a rural area like this we can get a patient to hospital in four minutes when it could take an hour-and-a-half in heavy traffic.

"It is brilliant for farming accidents when ambulance personnel might have to walk for five or ten minutes across fields to reach a patient. In a city it means you are messing about on pavements when you could still get a patient to a hospital quickly even in traffic.''