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Emerg Med J. 2007 July; 24(7): 521.
PMCID: PMC2658423

Author's response

We welcome the stimulating comments of Quinn et al1 in response to our previously published paper. We recognise that the topic breached here is both an emotive one and also very subjective.

It is extremely difficult to conduct a direct comparison of paramedic‐led versus physician‐led performance on exactly the same case, other than through moulage scenarios. No two prehospital care missions are ever the same, and we agree with Quinn et al that there is a multitude of confounding factors, many of which are beyond being controlled for. Therefore, we believe that the situation at the Great North Air Ambulance was unique in trying to address these issues as virtually all controllable confounders (equipment, crew number, mission case mix) were actually matched for both groups (other than entrapments). We also recognise that our study was not powered to look at some of the main issues, as sample sizes in excess of 2000 cases would have been required, clearly exceeding the annual flight mission numbers of virtually any helicopter emergency medical service provider in the UK.

But apart from all that, attendance time is only one performance indicator in prehospital medicine, and in our opinion is of less importance than the quality of care delivered at the roadside and, of course, ultimate patient outcome.

We agree with Quinn et al that observational studies are what they say: observation, and are therefore of a rather low evidence level. But observations do one thing very well: they spark ideas for further research.

Finally, we welcome Quinn et al's call for well‐formulated, structured and collaborative research proposals to address the issues surrounding physician‐delivered prehospital care in the UK.


Competing interests: None declared.


1. Quinn L M, French J, Mackenzie R. Doctors and prehospital on‐scene times: effect is still debatable. Emerg Med J 2007. 24521 [PubMed]

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