Four of the U.K.'s most influential ambulance charities have signed up to a charter designed to inspire new benchmark standards. The London, Great North, the Essex & Herts and Kent, and the Surrey & Sussex Air Ambulances believe the U.K. HEMS Charter will "establish a robust governance framework for effective clinical delivery."

Dr Ramzi Freij, clinical lead for Accident and Emergency services at Queens Nottingham, one of the UK's busiest A & E Departments says: "The Charter has been 18 months in the making and establishes a robust governance framework for effective clinical delivery."

It takes much of its inspiration from the European HEMS and Air Ambulance Committee's (EHAC) recommendations on Crew Resource Management (CRM). The original consultation document was drafted by experts in pre-hospital care.

The air ambulance charter founders say the charter sets basic competency thresholds, additional training require-ments and clinical supervision ratios for pre-hospital care doctors. "In practice, this amounts to one suitably qualified consultant per two HEMS doctors, with end-of-phone advice available from the scene of an emergency on a 365 day-a year 'on-call' basis."

They say an independent clinical advisory group with international reputations will underpin clinical governance. "These internationally recog-nised higher standards of governance and clinical care were originally pioneered by London's Air Ambulance and the London Ambulance Service NHS Trust."

Dr Freij says: "For too long air ambulances have been little more than land ambulances that happen to fly, retrieving patients from accident scenes and medical emergencies and flying them to the nearest district general hospital, often with unfor-tunate consequences. The U.K. HEMS Charter turns that philosophy on its head, and puts patient outcome to the fore, by ensuring that a suitably qualified pre-hospital care doctor diagnoses and treats at the scene.

"The transfer of the patient, often to a hospital outside of the normal critical care pathway, will ensure better patient care. This philosophy also anticipates the future A & E landscape following conclusion of the Acute Services Review".