Understanding the Current UK HEMS Provision for Patients Presenting With Nontraumatic Brain Pathology (NTBP)

UK helicopter emergency medical services (HEMS) are often tasked to nontraumatic brain pathology (NTBP) patients, yet national provision and triage practices are unclear.

Cross-sectional online survey using REDCap software of UK HEMS distributed via the National HEMS Research and Audit Forum. Survey data were summarized descriptively.

Fourteen of a potential 21 UK HEMS responded (67%). All respondents (14 of 14; 100%) reported attending to patients with NTBP. Bypass to specialist neurocenters was reported by 7 of 14 (50%); 4 of 14 (28%) had direct admission pathways to stroke thrombectomy services. Dedicated standard operating procedures/pathways existed in 3 of 14 (21%), a formal triage tool or rule-based criteria in 1 of 14 (7%), and a commissioned pathway in 1 of 14 (7%). Clinician judgment guided bypass in 4 of 14 cases (28%); 1 service cited factors such as functional status, time since onset, Glasgow coma scale, age, frailty, or comorbidities. Core interventions were widely available: hypertonic saline, rapid sequence induction/prehospital emergency anesthesia, sedation, and vasoactive support (14 of 14; 100%) and levetiracetam and neuroprotective-ventilator strategies (13 of 14; 93%). Adjunct diagnostic methods were used infrequently, accounting for only 1 of 14 instances (7%) for each modality. These methods included biomarker point-of-care tests, ultrasound (such as transcranial color-coded duplex and optic nerve sheath assessment), pupillometry, and blood gas analysis. Reported systemic barriers encompassed variability among networks and restricted access to helipads.

NTBP care is routine within UK HEMS, but triage decisions are heterogeneous and infrequently supported by formal pathways or commissioned networks. Standardized, network-supported bypass criteria that potentially incorporate point-of-care diagnostics and biomarkers could be developed and evaluated. Broader, multiagency studies capturing case volume and outcomes are needed to inform national guidance.