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Mapping the Patient and Family Liaison Role in UK Helicopter Emergency Medical Services: A Service Evaluation

Open AccessPublished:May 28, 2022DOI:https://doi.org/10.1016/j.amj.2022.04.003

      Abstract

      Objective

      Patient and family liaison practitioners are a relatively recent addition to UK helicopter emergency medical services to support patients with their recovery. A service evaluation was completed that mapped the current provision of patient and family liaison practitioner roles in helicopter emergency medical services in the United Kingdom.

      Methods

      An online survey was distributed to key stakeholders involved with UK helicopter emergency medical service patient and family liaison practitioner roles. Quantitative survey results were described, and open-ended questions were analyzed using content analysis.

      Results

      Twenty UK helicopter emergency medical services responded to the survey. Nine of these services employ patient and family liaison practitioners with 4 additional helicopter emergency medical services planning to initiate the role. There is variation in the employment models used between the services. The patient and family liaison practitioner role provides important benefits to patients and their families, clinicians, and the helicopter emergency medical service.

      Conclusion

      Nine UK helicopter emergency medical services employ patient and family liaison practitioners. This role benefits patients, their families, helicopter emergency medical service clinicians, and helicopter emergency medical service charities. Further research is required to understand how the role works in practice and to understand how to maximize the benefits to stakeholders.
      In the United Kingdom, there are 21 helicopter emergency medical services (HEMS) charities and not-for-profit organizations and 1 National Health Service–funded air ambulance service (Table 1) in the United Kingdom. UK HEMS charities on average collectively complete 25,000 missions a year.

      Air Ambulances UK. Saving lives – Air Ambulances UK. Available at: http://www.airambulancesuk.org/saving-lives/#topten. Accessed June 22, 2020.

      UK HEMS can provide both air and ground transport and are often staffed with a doctor and a specialist practitioner in critical care. UK HEMS provide critical care treatment for patients with time-critical conditions, and these patients are often conveyed to major trauma centers.
      • Beaumont O
      • Lecky F
      • Bouamra O
      • et al.
      Helicopter and ground emergency medical services transportation to hospital after major trauma in England: a comparative cohort study.
      Patients who are attended by UK HEMS often have significant psychological and physical challenges as a result of their injuries or illness,

      Dorset and Somerset Air Ambulance. Patient and family liaison nurses. The Dorset and Somerset Air Ambulance Charity. Available at: https://www.dsairambulance.org.uk/patient-and-family-liaison-nurses. Accessed June 22, 2020.

      and conveyance to a facility distant from home comes with additional challenges for patients and their families. In recent years, a new role of patient family liaison practitioners (PFLPs) has evolved to further support patients who have been attended by UK HEMS. PFLPs have been a relatively recent addition to some UK HEMS, with the first appointment of such a role being in London Air Ambulance Service in 2013.

      Dorset and Somerset Air Ambulance. Patient and family liaison nurses. The Dorset and Somerset Air Ambulance Charity. Available at: https://www.dsairambulance.org.uk/patient-and-family-liaison-nurses. Accessed June 22, 2020.

      ,

      London Air Ambulance Charity. Beyond the acute phase: the UK's first patient liaison nurse for trauma patients. London's Air Ambulance. London's Air Ambulance Charity. Available at: https://www.londonsairambulance.org.uk/news-and-stories/charity/uks-first-patient-liaison-nurse-for-trauma-patients. Accessed June 22, 2020.

      Table 1UK Helicopter Emergency Medical Services (HEMS) Funding and Resources
      CountryFundingResources
      England
       Cornwall Air Ambulance

      Cornwall Air Ambulance. What we do. Available at: https://cornwallairambulancetrust.org/what-we-do/. Accessed March 15, 2022.

      Charity1 × HEMS

      2 × RRVs
       The Air Ambulance Service

      The Air Ambulance Service. Our helicopters. Available at: https://theairambulanceservice.org.uk/our-helicopters/. Accessed March 15, 2022.

      Charity2 × HEMS

      RRVs
       Devon Air Ambulance

      Devon Air Ambulance Trust. Operations. Available at: https://www.daat.org/Pages/Category/operations. Accessed March 15, 2022.

      Charity2 × HEMS

      2 × RRVs
       Dorset and Somerset Air Ambulance

      Dorset and Somerset Air Ambulance. Our service. Available at: https://www.dsairambulance.org.uk/Listing/Category/our-service. Accessed March 15, 2022.

      Charity1 × HEMS

      2 × RRVs
       East Anglian Air Ambulance

      East Anglian Air Ambulance. East Anglian Air Ambulance charity. Together we save lives. Available at: https://www.eaaa.org.uk. Accessed March 15, 2022.

      Charity2 × HEMS

      2 × RRVs
       Essex and Herts Air Ambulance

      Essex and Herts Air Ambulance. About EHAAT. Available at: https://www.ehaat.org/about-us/about-ehaat/. Accessed March 15, 2022.

      Charity2 × HEMS

      4 × RRVs
       Great North Air Ambulance

      Great North Air Ambulance. What we do. Great North Air Ambulance Service. Available at: https://www.greatnorthairambulance.co.uk/our-work/what-we-do/. Accessed March 15, 2022.

      Charity3 × HEMS

      2 × RRVs
       Great Western Air Ambulance

      Great Western Air Ambulance Charity. About us. Available at: https://greatwesternairambulance.com/about-us/. Accessed March 15, 2022.

      Charity1 × HEMS

      2 × RRVs
       Hampshire and Isle of Wight Air Ambulance

      Hampshire and Isle of Wight Air Ambulance. About us. Available at: https://www.hiowaa.org/what-we-do/the-service-we-provide/. Accessed March 15, 2022.

      Charity1 × HEMS

      3 × RRVs
       Air Ambulance Kent Surrey Sussex

      Kent Surrey Sussex Air Ambulance Charity. Helicopters used by Air Ambulance Kent Surrey Sussex. Available at: https://www.aakss.org.uk/about-us/our-fleet/. Accessed March 15, 2022.

      Charity3 × HEMS

      4 × RRVs
       Lincolnshire and Nottinghamshire Air Ambulance

      Lincolnshire and Nottinghamshire Air Ambulance. History. Lincs & Notts. Available at: https://www.ambucopter.org.uk/about/history/. Accessed March 15, 2022.

      Charity1 × HEMS

      2 × RRVs
       London's Air Ambulance

      London's Air Ambulance Charity. HEMS. Helicopter ambulances & rapid response vehicles. Available at: https://www.londonsairambulance.org.uk/about-us/our-fleet. Accessed March 15, 2022.

      Charity2 × HEMS

      5 × RRVs
       Magpas Air Ambulance

      Magpas Air Ambulance. About us. Our mission, vision & values. Available at: https://www.magpas.org.uk/our-service/about-us/. Accessed March 15, 2022.

      Charity1 × HEMS

      RRVs
       Midlands Air Ambulance

      Midlands Air Ambulance Charity A. Home. Available at: https://www.midlandsairambulance.com/. Accessed March 15, 2022.

      Charity3 × HEMS

      2 × RRVs
       North West Air Ambulance

      North West Air Ambulance Charity. Our fleet. Available at: https://www.nwairambulance.org.uk/what-we-do/our-fleet/. Accessed March 15, 2022.

      Charity3 × HEMS

      4 × RRVs
       Thames Valley Air Ambulance

      Thames Valley Air Ambulance. How we help. Available at: https://www.tvairambulance.org.uk/our-services/how-we-do-it/. Accessed March 15, 2022.

      Charity1 × HEMS

      4 × RRVs
       Wiltshire Air Ambulance

      Wiltshire Air Ambulance. Home. Available at: https://www.wiltshireairambulance.co.uk/. Accessed March 15, 2022.

      Charity1 × HEMS

      2 × RRVs
       Yorkshire Air Ambulance

      Yorkshire Air Ambulance. Yorkshire Air Ambulance helicopter bases & fleet. Available at: https://www.yorkshireairambulance.org.uk/about/our-fleet-and-airbases/. Accessed March 15, 2022.

      Charity2 × HEMS
      Wales
       Wales Air Ambulance

      Wales Air Ambulance. About Wales Air Ambulance. Welsh Air Ambulance Charitable Trust. Available at: https://www.walesairambulance.com/about-wales-air-ambulance. Accessed March 15, 2022.

      Charity4 × operational HEMS

      3 × 12 h/d service

      1 × 24 h/d service

      Scotland
       Scotland's Charity Air Ambulance

      Scotland's Charity Air Ambulance. Available at: https://www.scaa.org.uk/about-scaa. Accessed March 15, 2022.

      National Health Service2 × HEMS

      2 × fixed wing aircraft
       Scottish Air Ambulance

      Scottish Ambulance Service. Scottish Ambulance Service - air ambulance. Available at: http://www.scottishambulance.org/InvolvingPatients/WhatWeDo/TheParent.aspx. Accessed March 15, 2022.

      Charity2 × HEMS

      2 × RRVs
      Northern Ireland
       Air Ambulance Northern Ireland

      Air Ambulance Northern Ireland Charity. ABOUT – Air Ambulance NI. Available at: https://airambulanceni.org/about/. Accessed March 15, 2022.

      Charity1 × operational HEMS

      RRVs = rapid response vehicles.
      The role of the PFLPs is to support patients treated by HEMS with their long-term recovery. PFLPs aim to bridge the gap from the often traumatic scene of injury or illness, supporting patients during their recovery in hospital and beyond hospital discharge.

      Dorset and Somerset Air Ambulance. Patient and family liaison nurses. The Dorset and Somerset Air Ambulance Charity. Available at: https://www.dsairambulance.org.uk/patient-and-family-liaison-nurses. Accessed June 22, 2020.

      ,

      London Air Ambulance Charity. Beyond the acute phase: the UK's first patient liaison nurse for trauma patients. London's Air Ambulance. London's Air Ambulance Charity. Available at: https://www.londonsairambulance.org.uk/news-and-stories/charity/uks-first-patient-liaison-nurse-for-trauma-patients. Accessed June 22, 2020.

      The PFLP role is broad; patients often have no recollection of being treated at the scene by HEMS, and if patients wish, the scene and clinical treatments administered by HEMS can be sensitively explained. PFLPs can refer patients for appropriate rehabilitation and link patients to new and ongoing peer support networks.

      London Air Ambulance Service. Going behind the scenes at London's Air Ambulance Service. Online first aid. May 13, 2019. Available at: https://onlinefirstaid.com/london-air-ambulance/. Accessed June 23, 2020.

      PFLPs follow up patients who have been attended by HEMS and where appropriate visit patients and build a relationship to support those patients and their family through the pathway of recovery.
      The PFLP role in UK HEMS is evolving, and now is an ideal time to evaluate how the role is being implemented nationally. Before this can occur, there needs to be some understanding of how many UK HEMS have implemented the PFLP role in practice. A service evaluation was completed using a survey that aimed to map the current provision of PFLP roles in UK HEMS.

      Methods

      The UK HEMS PFLP provision was mapped using an online survey. The online survey questions are detailed in Table 2. Key stakeholders in UK HEMS were contacted and asked to participate through existing social media channels and via Air Ambulance UK. In addition, existing UK HEMS networks of PFLPs and prehospital research networks were contacted to assist with survey distribution to any relevant stakeholders. The survey was distributed between May and July 2021. Quantitative survey results were described and answers to 2 open-ended questions were analyzed in NVivo (QSR International Pty Ltd, Burlington, MA) using content analysis.
      Content analysis. Encyclopedia of Survey Research Methods.
      Themes were identified and agreed on without the need for arbitration between 2 researchers (K.K. and R.C.). The results were circulated to respondents and a professional network of PFLPs to check for agreement and accuracy. No changes were made after feedback from this network.
      Table 2Online Survey Questions
      Survey Question
      1Which air ambulance are you responding on behalf of?

      Drop-down list
      2Does the service currently employ practitioners in a patient and family liaison role?

      Yes (if yes go to question 4)

      No (if no go to question 3)

      Comment box
      3Does the service have any plans to introduce patient and family liaison practitioners?

      Yes

      No

      Do not know

      Comments

      End of survey
      4When did the service introduce the patient and family liaison practitioner role?

      Free text
      5How many patient and family liaison practitioners does the service employ?

      Free text
      6What is the clinical background of the patient and family liaison practitioners in your service?

      Paramedic

      Nurse

      Other–free text
      7How are patient and family liaison practitioners employed in your service?

      Full time

      Part time

      Mixed role e.g., clinical/patient and family liaison practitioner

      Other – free text
      8Please can you briefly describe the role of the patient and family liaison practitioner in your service?

      Free text
      9Please can you briefly describe what you perceive to be the benefits of the patient and family liaison practitioner role?

      Free text
      10Are there any other comments you would like to make regarding the patient and family liaison role?

      Free text

      End of survey

      Results

      In total, there were 35 responses to the survey representing 20 UK HEMS for a 95% response rate. All services were represented by 1 respondent, except for Devon Air Ambulance (2 respondents), Great Western Air Ambulance (4 respondents, PFLP model not employed in this service), and Air Ambulance Kent Surrey Sussex (2 respondents, PFLP model not employed in this service). Nine HEMS have practitioners employed in the patient and family liaison role. One HEMS does not have the PFLP role but offers support via a “Patient and Relative Hub.” Four HEMS have plans to introduce the PFLP role in the near future. The length of time in the role, clinical backgrounds, and service provision of the current models are provided in Table 3.
      Table 3Patient and Family Liaison Practitioner (PFLP) Employment Models
      HEMSYear IntroducedNumber EmployedClinical BackgroundEmployment Model
      London20131Nurse1 × FT
      East Anglia20164Nurse4 × PT
      Thames Valley20183Paramedic1 × FT, 2 × PT (employed by the charity but based in HEMS, community, and major trauma center)
      Devon20193ParamedicMixed role: clinical/PFLP
      Dorset & Somerset20182Critical Care NursePT/mixed role: clinical/PFLP
      The Air Ambulance20201ParamedicFT
      Lincolnshire and Nottinghamshire20201Police OfficerPT
      Wales20201NurseFT
      Essex & HertfordshireUnknown2ParamedicMixed role: clinical/PFLP
      FT = full-time; HEMS = helicopter emergency medical services; PT = part-time.

      Content Analysis of Open-Ended Questions

      The PFLP Role

      Content analysis of the respondents’ description of the PFLP role identified 3 themes (Fig. 1): obtaining clinical feedback for crews, providing support for patients and their families, and positively representing the charity. The main element of the role is to provide support for patients and their families for the recovery process or bereavement. However, there was also an important aspect in supporting the operational crews with clinical feedback and providing a positive representation for the HEMS charity. One respondent defined the role as follows: “Act as a point of contact for both patients (and) families within the recovery phase assisting with background and knowledge of prehospital care. Obtain clinical feedback from hospitals and patients for crew to enable clinical learning.”

      Benefits of the PFLP Role

      Content analysis of the respondents’ description of the benefits of the PFLP role identified 3 main themes (Fig. 2): benefits for patients and their relatives, benefits for clinicians, and benefits for the service. One respondent described this as follows: “Increased support for those involved in a traumatic incident. Provides signposts towards charities and services that may help them. To gain feedback to allow our service to be at its best for all. To bridge any gaps between the crews, our patients, families and non-clinical staff. To become the face of the charity for channelling support.”
      Benefits for patients and their relatives encompassed bereavement support for relatives, patient and family support regarding recovery, and information provision. Benefits for clinicians included a facilitated clinician and patient reunion and the provision of clinical feedback to aid in learning and development. The benefits for the service included the facilitation of clinical education, a positive representation of the charity, and patient family support for research activities.

      Discussion

      The results of this survey indicate that the PFLP is a new and developing role in UK HEMS with PFLP models initiated within the last 8 years and variation in employment models. Participants indicated that their view is that the PFLP role is of substantial benefit to patients, families, HEMS clinicians, and HEMS charities. This finding is in line with research concerning liaison nursing roles in intensive care units
      • Tabanejad Z
      • Pazokian M
      • Ebadi A.
      A systematic review of the liaison nurse role on patient's outcomes after intensive care unit discharge.
      and general practice.
      • Tavabie JA
      • Tavabie M.
      The patient liaison officer: a new role in UK general practice.
      The survey results indicate variation nationally in the implementation of the PFLP role and in the different types of employment model initiated in UK HEMS. Respondents identified in the survey responses that the PELP role has been initially challenging to establish. In addition, respondents identified the need to further understand the evidence base for and the impact of the PFLP role in this complex area of care. Furthermore, there is a need to identify the most appropriate models of working to maximize the benefit to all stakeholders concerned.
      A limitation of this service evaluation is that it consisted of a small survey conducted in UK HEMS to map the provision of the PFLP role. Respondents were self-selecting, and there may have been bias in the way participants responded. Well-designed research is required to further explore this role as it develops.

      Recommendations for Further Research

      The benefits to stakeholders and the most optimal ways of working in this role are not well understood. It is important to conduct further research to better understand how to optimize the PFLP role for the benefit of patients, families, and HEMS clinicians and charities.

      Conclusion

      The PFLP role is a relatively new and expanding role introduced into a proportion of UK HEMS. HEMS use different models of employment to include different occupational backgrounds and a variation of part-time and full-time working and mixed clinical/PFLP roles. The PFLP role is viewed by respondents as a positive addition to the HEMS team. The perceived benefits of the role are not just patient focused but also family, clinician, and service focused. The role is perceived to facilitate the provision of a holistic package of care for patients and their families attended by HEMS and allows for important clinical feedback to HEMS teams. Further research is required to understand how the PFLP role works in practice and to understand how to maximize the patient and additional stakeholder benefits from this role.

      References

      1. Cornwall Air Ambulance. What we do. Available at: https://cornwallairambulancetrust.org/what-we-do/. Accessed March 15, 2022.

      2. The Air Ambulance Service. Our helicopters. Available at: https://theairambulanceservice.org.uk/our-helicopters/. Accessed March 15, 2022.

      3. Devon Air Ambulance Trust. Operations. Available at: https://www.daat.org/Pages/Category/operations. Accessed March 15, 2022.

      4. Dorset and Somerset Air Ambulance. Our service. Available at: https://www.dsairambulance.org.uk/Listing/Category/our-service. Accessed March 15, 2022.

      5. East Anglian Air Ambulance. East Anglian Air Ambulance charity. Together we save lives. Available at: https://www.eaaa.org.uk. Accessed March 15, 2022.

      6. Essex and Herts Air Ambulance. About EHAAT. Available at: https://www.ehaat.org/about-us/about-ehaat/. Accessed March 15, 2022.

      7. Great North Air Ambulance. What we do. Great North Air Ambulance Service. Available at: https://www.greatnorthairambulance.co.uk/our-work/what-we-do/. Accessed March 15, 2022.

      8. Great Western Air Ambulance Charity. About us. Available at: https://greatwesternairambulance.com/about-us/. Accessed March 15, 2022.

      9. Hampshire and Isle of Wight Air Ambulance. About us. Available at: https://www.hiowaa.org/what-we-do/the-service-we-provide/. Accessed March 15, 2022.

      10. Kent Surrey Sussex Air Ambulance Charity. Helicopters used by Air Ambulance Kent Surrey Sussex. Available at: https://www.aakss.org.uk/about-us/our-fleet/. Accessed March 15, 2022.

      11. Lincolnshire and Nottinghamshire Air Ambulance. History. Lincs & Notts. Available at: https://www.ambucopter.org.uk/about/history/. Accessed March 15, 2022.

      12. London's Air Ambulance Charity. HEMS. Helicopter ambulances & rapid response vehicles. Available at: https://www.londonsairambulance.org.uk/about-us/our-fleet. Accessed March 15, 2022.

      13. Magpas Air Ambulance. About us. Our mission, vision & values. Available at: https://www.magpas.org.uk/our-service/about-us/. Accessed March 15, 2022.

      14. Midlands Air Ambulance Charity A. Home. Available at: https://www.midlandsairambulance.com/. Accessed March 15, 2022.

      15. North West Air Ambulance Charity. Our fleet. Available at: https://www.nwairambulance.org.uk/what-we-do/our-fleet/. Accessed March 15, 2022.

      16. Thames Valley Air Ambulance. How we help. Available at: https://www.tvairambulance.org.uk/our-services/how-we-do-it/. Accessed March 15, 2022.

      17. Wiltshire Air Ambulance. Home. Available at: https://www.wiltshireairambulance.co.uk/. Accessed March 15, 2022.

      18. Yorkshire Air Ambulance. Yorkshire Air Ambulance helicopter bases & fleet. Available at: https://www.yorkshireairambulance.org.uk/about/our-fleet-and-airbases/. Accessed March 15, 2022.

      19. Wales Air Ambulance. About Wales Air Ambulance. Welsh Air Ambulance Charitable Trust. Available at: https://www.walesairambulance.com/about-wales-air-ambulance. Accessed March 15, 2022.

      20. Scotland's Charity Air Ambulance. Available at: https://www.scaa.org.uk/about-scaa. Accessed March 15, 2022.

      21. Scottish Ambulance Service. Scottish Ambulance Service - air ambulance. Available at: http://www.scottishambulance.org/InvolvingPatients/WhatWeDo/TheParent.aspx. Accessed March 15, 2022.

      22. Air Ambulance Northern Ireland Charity. ABOUT – Air Ambulance NI. Available at: https://airambulanceni.org/about/. Accessed March 15, 2022.

      23. Air Ambulances UK. Saving lives – Air Ambulances UK. Available at: http://www.airambulancesuk.org/saving-lives/#topten. Accessed June 22, 2020.

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