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Introduction
Following the NHS Next Stage Review, 1 a number of highly critical reports 2 3 and the appointment of a national clinical director for trauma care, the Department of Health initiated the development of regional networks for the management of major trauma. 4
The trauma network is intended to encompass all elements of the patient's journey from injury to rehabilitation-including the average 55 min pre-hospital phase. 2 There is increasing public, professional and political recognition that physician-based critical care during this phase is associated with increased survival for selected patients. 5-10 There is also a sense of inequity in access to, and availability of, physician-based, on-scene medical support to the ambulance service. Many consider that levels of clinical care for the critically injured should be equitable and consistent irrespective of geography or time of day or whether the patient is at the scene, in-transit to hospital or in an emergency department-critical care being a clinical process and not a physical place. 2 11 12 The recent recommendation from the Major Trauma Clinical Advisory Groups for 24 h deployable 'enhanced care' teams to provide critical care support to ambulance services reflects these views. 13
To assist with the development of the pre-hospital component of the evolving trauma networks, we sought to identify the current availability and utilisation of physician-based pre-hospital critical care services across England, Wales and Northern Ireland.
Methods
Between April and July 2009, we conduced a postal survey of all 13 regional NHS ambulance services, 17 air ambulance charities and 34 organisations affiliated to the British Association for Immediate Care (BASICS) operating in England, Wales and Northern Ireland. The survey was constructed and distributed as a freedom of information request and covered the topics listed in box 1 . Follow-up was by repeat letter and, where necessary, telephone contact with the relevant clinical lead.
Box 1 Topics included in the postal survey
NHS ambulance trusts
Number of pre-hospital immediate care doctors available to the Ambulance service
Number of activations of pre-hospital care doctors
Number of scene attendances by pre-hospital care doctors for 2007 and 2008.
British Association for Immediate Care Schemes (BASICS)
Exact geographical area of operational activities
Number of doctors clinically active in pre-hospital care
Professional background of each clinically active member...