Expanded doctor-led air ambulance services are improving access to advanced pre-hospital care across the UK, yet significant regional and overnight gaps highlight ongoing challenges in delivering equitable life-saving treatment.
Study: Access to helicopter emergency medical services in the UK: analysis of services in 2024. Image credit: Jaromir Chalabala / Shutterstock
In a recent study published in Journal of Emergency Medicineresearchers evaluated national access to helicopter emergency medical services (HEMS) in the UK and assessed how availability and advanced interventions varied by region and time.
Background
When a person suffers a serious injury or sudden critical illness, minutes can mean the difference between life and death. In the UK, advanced life-saving interventions such as pre-hospital emergency anesthesia can only be carried out by pre-hospital physician-based teams. However, access to this level of care is often inconsistent across regions.
A national review in 2009 revealed that doctors were being guided around the clock HEMS services were extremely rare. Since then, trauma networks, training pathways and service delivery models have evolved substantially. This raises a critical question: has access to physician-based prehospital care improved for patients regardless of where or when emergencies occur? Assessing whether progress has translated into fair and reliable national coverage remains essential.
About the Study
A national service analysis was conducted using an online survey distributed to all HEMS services operating across the UK. The survey was circulated between January and March 2024 to medical and operational leaders in each service. One response per service was allowed, with subsequent clarification where discrepancies occurred. Participation was voluntary and without compensation.
For classification purposes, based on the doctor HEMS The group was defined as one in which a physician was present on more than 95 percent of the operative shifts. Groups that did not meet this threshold were included in total service counts but were excluded from analyzes of advanced prehospital care capacity. Data collected included funding structures, staffing models, mission functions, working hours and the range of interventions provided.
To enable regional comparisons, respondents reported service availability at standardized times of the week and weekend both during the day and overnight. Population density data were used as a proxy for clinical demand, based on publicly available national statistics. Primary outcomes focused on the number and functional coverage of physician-based teams, while secondary outcomes examined intervention availability and the presence of additional prehospital critical care resources.
Study Results
All 21 HEMS services operating in the UK responded to the survey, providing full national coverage.
The analysis estimated an increase from 11 GP-based teams in 2009 to around 30 teams in 2024, representing around a 2.7-fold increase, including services in Scotland. This reflects a significant expansion of potential access to advanced prehospital care.
Despite this progress, 24-hour availability remained uneven. In 2024, about half of services provided continuous 24-hour physician-based coverage. This marked an improvement on 2009, when only one service operated at this level, however significant regional gaps remained. The East of England had the highest overnight availability, while Northern Ireland, South West England and parts of Northern England had no consistent overnight GP coverage.
Some services stopped operating in the early evening, while others remained active until dawn. Not all routine aircraft operate overnight. Some relied instead on ground response vehicles.
Population-adjusted access also varied significantly. Nationally, the ratio was about 0.63 HEMS groups per million people, including all groups, not just physician-based units. Availability tended to be higher in less densely populated areas and lower in major urban centers such as London. These disparities highlight how geography, population distribution, service configuration, and delivery practices shape access in the real world.
All physician-based teams were able to provide advanced prehospital Level 3 interventions, including prehospital emergency anesthesia, surgical airways, thoracostomies, amputations, resuscitative thoracotomies, and resuscitative hysterotomies. However, the availability of other advanced procedures varied. Most groups carried blood products. Many provided regional anesthesia and arterial line placement. less dried plasma offered. and only one service reported the ability to perform resuscitative balloon aortic occlusion.
Beyond HEMSall regions reported access to additional prehospital critical care assets. These included paramedic-led teams capable of providing mid-level interventions and volunteer medical responders affiliated with the British Association for Immediate Care. Funding models varied substantially, with most services relying partly or entirely on philanthropic funding, while only one service was fully supported by government funding. The study did not directly examine the causal relationship between funding structure and service availability.
conclusions
Access to a doctor HEMS in the UK has improved significantly over the past decade, with more groups and greater coverage than previously reported. However, access to advanced prehospital care is still highly dependent on geography and time of day.
Persistent variation in opening hours, intervention availability and funding models raises concerns about equity of access. Given the evidence suggesting potential survival benefits in some settings, together with the acknowledged uncertainty, these findings highlight the need for coordinated national policy, sustainable funding mechanisms and system-wide planning to ensure that advanced prehospital critical care is available to all patients who need it, regardless of location or time. The authors note that this survey alone cannot fully characterize access to all prehospital critical care resources nationwide.
