Research by Air Ambulance Charity Kent Surrey Sussex shows critical role of the Helicopter Emergency Medical Service in the Covid-19 response

Alongside its primary service of providing 24/7 pre-hospital emergency care for the 4.5 million people who live in its region, since April 2020, KSS, in partnership with SECAmb, has extended its service to include the transfer of patients between Intensive Care Units (ICUs) in and beyond Kent, Surrey and East and West Sussex in order to alleviate pressure on the NHS during the COVID-19 pandemic.

Since the start of 2020, KSS has completed 164 critical care transfers and has continued to deliver its primary service, without interruption, throughout.   

Now, the charity – which relies on public donations and fundraising for the £15.2M it costs each year to operate its service – has conducted a retrospective study and case review of its first 50 transfers, and the findings show how the transfer of seriously ill patients, including those with COVID-19, by HEMS services can be achieved safely with specific planning, protocols and precautions in place. 

The findings also highlight how a charity like KSS can work collaboratively in partnership with SECAmb to deliver critical services to support a regional ambulance service and the wider NHS and indicate how regional planning enables even greater patient benefit.  

The COVID-19 pandemic has challenged health systems across the globe. In particular, a major demand has been placed on critical care facilities. A significant proportion of COVID-19 patients require treatment with critical care interventions, including ventilatory support. This unprecedented demand has led to ICU resources being put under significant strain on both regional and national levels.

Despite measures taken, the ambulance service and critical care capacity in many hospitals remains under significant pressure, and hospitals are experiencing acute demand and have needed to request critical care transfers to other ICUs. 

The situation reached a peak between December 2020 and March 2021 when the Alpha variant rapidly spread through the South East of England – the region which KSS and SECAmb serve. 

Pre-hospital critical care teams like KSS – whose senior clinicians are experienced in providing complex multi-organ support in an out-of-hospital setting - were asked at very short notice, in partnership with SECAmb, to increase their capacity and adapt to being able to transfer seriously ill patients, often over large distances.

Within days of being tasked by the NHS to transfer intensive care COVID-19 positive patients, KSS had developed a Standard Operating Procedure to enable this extension to its service. A Duty Clinical Manager and on-call Transfer Consultant – with experience in both pre-hospital emergency medicine and current ICU COVID-19 care – oversaw each transfer request which, due to the complexity and instability of these critically ill patients, needed to be considered on a case-by-case basis. The highest risk transfers were escalated to the charity’s Medical Director for further review and final decision making.

Transfers were carried out by KSS’s Duty Transfer Crew, comprising of a Transfer HEMS Doctor and a Transfer Paramedic. All Transfer HEMS Doctors were additionally Consultants in Anaesthesia or Intensive Care Medicine, with recent or on-going experience of caring for COVID-19 patients in ICUs.

A training model was developed and implemented, and all transfer team members undertook training in Critical Care COVID-19 Transfer Medicine.

The highly infectious nature of COVID-19 required specific protective measures to be taken to safely transfer these patients, to minimise the risk to HEMS crews. Escorting clinicians need to wear ICU-level PPE throughout, and familiarity between members of the team was shown to be very important given the potential challenges of operating in this equipment.

Although the majority of transfers to date have been by road using a SECAmb dedicated transfer ambulance, the charity’s AW169 helicopter was adapted to protect the pilots from COVID-19 infection risk and has also been used for transfers. KSS was one of the first Air Ambulance Charities to transfer patients by air.

The KSS study describes an operational framework that could be useful for other Emergency Medical Services tasked with setting up this service.

Dr Duncan Bootland, Medical Director at KSS, said: “The transfer of critical ill patients, be it from the scene of an accident or between hospitals, requires high levels of clinical ability allied to strict and high standards of care. All critically ill patients, and particularly those being treated for COVID-19 infection, who need to be moved between hospitals present challenges in terms of ensuring that the standard of care they receive is maintained at every point of the transfer. Our team worked tirelessly, providing training and education to our staff and rapidly creating standard operating procedures and the highest levels of clinical processes, to ensure that the levels of critical care alongside the levels of comfort and care were matched during every step of each patient’s journey.

We are very proud that we were able to bring our experience and high levels of clinical care that we have developed over many years in order to support the NHS and our community when it was most needed. This paper describes the efforts of a wide group of professionals at KSS over an unprecedented time in healthcare.”

David Welch, CEO of KSS, said:

“Our healthcare service continues to face unprecedented challenges, and now more than ever it is vital that we work together to ensure the best possible outcomes for patients within the communities we serve. This study highlights the critical role of charities like KSS working in partnership with SECAmb and the NHS to ensure we achieve this.

“It costs £15.2M each year to continue to operate our service every hour of every day. 86% of our total income comes through the tremendous support that we receive from our community. This has allowed us to continue to operate 24/7 throughout the pandemic despite increased costs and cancellation of all major fundraising events and to extend our service to include critical care transfers which from January 2021 were then funded through commissioning funds.

In 2021 we experienced the highest demand for our service in our 32-year history, responding to 3,051 incidents,  a 19% increase on the previous year.”

“My sincere thanks goes to all our supporters and volunteers, whose generosity means that we can be there for the most seriously ill patients in their hour of need, and to our extraordinary crews, who have been operating at the frontline of the COVID-19 pandemic, delivering life-saving, critical care across our region 24/7. Their expertise, determination and dedication are an inspiration.”

The study has been published by the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.