Table 1 Comparison of HEMS Clinical Crew Staffing Models and Qualifications

Germany

(Eich et al., 2009)

Ambulance–based emergency physician

• Extensive experience in a doctor-staffed ambulance (attended at least 300 incidents as ambulance-based emergency physician)

• Hold an Advanced Life Saving Certificate

• Completed a 4-month rotation in paediatric anaesthesia

The Netherlands

(Gerritse et al., 2010)

Anaesthesiologist or trauma surgeon staffed and specialised nurse

• Board certified trauma surgeon or anaesthesiologist with 6 months’ extra training in adult and paediatric emergency care, pain management and extrication technique

• Nurse training not described

Norway

(Bjornsen et al., 2018)

Doctor-staffed by anaesthetic flight physicians

• Board certification in anaesthesiology

• Experience in paediatric anaesthesiology

• Completed a course in trauma care

• Have knowledge and proficiency in CPR

Great Western Air Ambulance Service, United Kingdom

(Von Vopelius-Feldt, 2014)

Prehospital critical care consultant and critical care paramedic for “80% of shifts”

• Doctors undertake a training programme with “specific competencies and mentored practice, coupled with theoretical and simulation training”

• Critical care paramedics “completed a university-based theory and practical training course with mentoring and supervised experience, followed by the successful completion of a comprehensive qualifying assessment.”

Warwickshire and Northamptonshire Air Ambulance, United Kingdom (Fullerton, 2009)

2 crew mixes: doctor and paramedic OR paramedic-paramedic. Dependant on staff availability

• Paramedic crew undergo 40 h’ additional clinical training

• Doctors comply with eligibility requirements, including at least registrar level training and extensive training & exposure to acutely ill patients

Bristol

Great Western Air Ambulance and Wiltshire Air Ambulance, United Kingdom (Von Vopelius-Feldt, 2014)

2 crew mixes:

doctor and paramedic OR paramedic-paramedic. Dependant on staff availability

• Senior registrar or consultant in emergency medicine or anaesthesia

• Critical care paramedic with over 5 years’ experience and postgraduate certificate in pre-hospital critical care

Midlands Air Ambulance, United Kingdom (McQueen, 2015)

• Doctor-staffed for high severity trauma

• Paramedic-staffed for support of ambulance crews when doctor unavailable or call would not benefit from doctor intervention

• Paramedics “have received additional training and operate as critical care paramedics.”

• Doctor is senior trainee in emergency medicine, critical care or anaesthesia and has undergone specialist training to deliver enhanced prehospital care, RSI

Suwon, South Korea (Jung, 2016)

• Multi-disciplinary staff for severe trauma (5 trauma surgeons, 1 emergency physician, a nurse practitioner and emergency technician

• Emergency technician staffed for minor injuries in inaccessible locations

• Emergency technicians give basic life support procedures with phone support from the hospital medical team

Japan (Abe, 2014)

• Doctor and nurse staffed

• No specific details provided

Air Ambulance Victoria, Australia (Andrew, 2015)

• Intensive Care Flight Paramedic and air crewman

• Existing Intensive Care Paramedics complete an additional 9-months’ postgraduate training in aeromedical rescue. Also acquire skills including paediatric RSI, mechanical ventilation, insertion of arterial lines and invasive monitoring, administration of a wider range of medications

• Air crewmen have 120 h training to fulfil the role of Emergency Medical Technician

Greater Sydney Area HEMS, Australia (Burns, 2017)

• Doctor and paramedic staffed

• Doctors are board-certified senior registrars from Emergency Medicine or Anaesthesia; minimum of 5 years’ postgraduate experience

• Paramedics are critical care specialists with a minimum of 10 years’ experience and additional training in pre-hospital and retrieval medicine.

East Denmark (Afzali, 2013)

• Doctor and paramedic staffed

• Consultant anaesthesiologist experienced in intensive care pre-hospital

• Paramedic with special training in navigation and radio communication techniques.

Central Denmark (Rognås, 2013)

• Doctor and EMT staffed

• Anaesthesiologists with at least 4.5 years’ experience in anaesthesia. All work in and outside operating theatre as part of their daily work.

Finland (Heinanen, 2018)

• Doctor staffed

• Mainly anaesthesiologists specialised in emergency care

France (Desmettre, 2012)

• Team from hospital led by emergency physician

• No details provided

Dalarna, Sweden (Kornhall, 2018)

• Doctor and HEMS crewmember

• Doctor has board certification in anaesthesiology

• HEMS crewmember is registered pre-hospital nurse

Pittsburgh, United States (Sperry, 2018)

• Paramedic and flight nurse staffed

• Not described