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Emerg Med J. 2007 June; 24(6): 450.
PMCID: PMC2658300

Prehospital and retrieval medicine

I would like to clarify some points in the useful review of retrieval medicine provided by Shirley and Hearns.1 Their opening sentence cites an article regarding the provision of prehospital critical care and retrieval services.2 In that article, Dr Bevan and I argued that “immediate care” (previously defined as the provision of skilled medical help at the scene of an accident or medical emergency and during transportation to hospital) should be regulated in the same way as any other specialist undertaking within the National Health Service. We expressed concern that there was no system, training stream or workforce in place across the UK to ensure that the prehospital and in‐transit critical care needs of patients are met in a consistent or organised manner. We did not propose that “those currently involved in immediate care” should be considered as “the core providers of these services” for the future. Rather, we made the point that provision of specialist on‐scene and in‐transit medical support is likely to be “beyond the scope of the occasional or fringe immediate care doctor”. This is an important distinction.

The review also argues that the competences required for transporting a patient from the scene of an accident to an emergency department (primary retrieval) or between two healthcare facilities (secondary retrieval) are “by no means interchangeable”. However, one of the more remarkable features of the established Australian retrieval services referred to in the review is that they do just that: combine primary and secondary retrieval functions. Rather than maintain a divide, we should recognise the overlap and develop a competence and curriculum framework that encompasses all retrieval demands.3

It is also important to highlight that “retrieval medicine” is not actually a formally recognised specialty or subspecialty in Australia. Rather, as with the UK, individual practitioners have developed a personal interest in this area. The lack of a single specialist body or professional group to develop clinical practice and drive service standards has resulted in a disparate range of retrieval services and models both within and between states.4,5,6 The authors make particular reference to the systems in place within the state of New South Wales and the Sydney area. Although elements of this model are highly effective and relevant, the model is currently undergoing a major reconfiguration. Primary, secondary and specialist retrieval services have historically been provided by a number of contracted independent operators using different combinations of transport platforms, clinical teams, and operating procedures. Development of these services has, as in the UK, been driven by local communities, individuals and non‐governmental organisations, with little strategic direction or planning. The recent adoption of a “whole‐system” approach in New South Wales, which properly integrates retrieval services within the wider ambulance service (which also includes a state‐wide fixed‐wing flight nurse‐led retrieval service as well as the land ambulance resource network), will lead to a far better service model in the near future. This is perhaps one of the most important lessons we can learn from the Australian experience.7

In the final paragraph of our article, Dr Bevan and I wrote: “The development of a rigorous, accredited career stream in prehospital and retrieval medicine would fill one of the few remaining gaps in the provision of emergency care in the UK. There is a real opportunity for both individual practitioners and the organisations responsible for regulating and applying standards to now collaborate and reach agreement on the scope of practice, competency framework and licensing arrangements for the subspecialty of pre‐hospital and retrieval medicine.”2 Dr Shirley and Dr Hearns, who have vast personal experience across the spectrum of retrieval services, are exactly the sort of people who should be driving this process. Their review is very welcome.


Competing interests: None declared.


1. Shirley P J, Hearns S. Retrieval medicine: a review and guide for UK practitioners. Part 1: clinical guidelines and evidence base. Emerg Med J 2006. 23937–942.942 [PMC free article] [PubMed]
2. Mackenzie R, Bevan D. A license to practise pre‐hospital and retrieval medicine. Emerg Med J 2005. 22286–293.293 [PMC free article] [PubMed]
3. Clements R, Mackenzie R. Competence in prehospital care: evolving concepts. Emerg Med J 2005. 22516–519.519 [PMC free article] [PubMed]
4. Trevithick S, Flabouris A, Tall G. et al International EMS systems: New South Wales, Australia. Resuscitation 2003. 59165–170.170 [PubMed]
5. Garner A. The role of physician staffing of helicopter emergency medical services in prehospital trauma response. Emerg Med Australasia 2004. 16318–323.323 [PubMed]
6. Rashford S, Myers C. Optimal staffing of helicopter emergency medical services is controversial. Emerg Med Australasia 2004. 16269 [PubMed]
7. NSW Health Department and the Ambulance Service of New South Wales Review of Rotary Wing Services in NSW. Final Report. Berkshire, UK: Operational Research in Health, 2004, (accessed 29 March 2007)

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