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Importance/background The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS). Objectives To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS. Design Population-based, linked cohort study using related to patients with ACS conveyed by the EMS to hospital in England and Wales. Exposure PHECG administration. Outcomes Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion. Results Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment. Conclusions Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.

Healthcare is becoming increasingly complex. The pre-hospital setting is no exception, especially when considering the unpredictable environment. To address complex clinical problems and improve quality of care for patients, researchers need to use innovative methods to create the necessary depth and breadth of knowledge. Quantitative approaches such as randomised controlled trials and observational (e.g. cross-sectional, case control, cohort) methods, along with qualitative approaches including interviews, focus groups and ethnography, have traditionally been used independently to gain understanding of clinical problems and how to address these. Both approaches, however, have drawbacks: quantitative methods focus on objective, numerical data and provide limited understanding of context, whereas qualitative methods explore more subjective aspects and provide perspective, but can be harder to demonstrate rigour. We argue that mixed methods research, where quantitative and qualitative methods are integrated, is an ideal solution to comprehensively understand complex clinical problems in the pre-hospital setting. The aim of this article is to discuss mixed methods in the field of pre-hospital research, highlight its strengths and limitations and provide examples. This article is tailored to clinicians and early career researchers and covers the basic aspects of mixed methods research. We conclude that mixed methods is a useful research design to help develop our understanding of complex clinical problems in the pre-hospital setting.

Mixed methods research, a methodology that integrates both qualitative and quantitative data in order to gain a more comprehensive understanding through drawing upon the strengths of each method, is increasingly used in the pre-hospital context. Despite its growing prevalence, little is known about how mixed methods research is conducted and reported in this unique setting. This methodological review builds on our prior systematic review and examines mixed methods studies in the pre-hospital context, mapping and describing how mixed methods research is conducted and reported. We searched MEDLINE, CINAHL Complete, Embase and Scopus bibliographic databases from 1 January 2012 to 3 June 2025, using an updated pre-hospital search strategy. Study screening was undertaken in duplicate. Articles reported in English, explicitly stating the use of 'mixed methods' in the pre-hospital ambulance setting were included, Data related to underpinning philosophical or theoretical framework, rationale for utilising mixed methods, background of the corresponding author, mode of data integration, model of publication and adherence to reporting standards, utilising the good reporting of a mixed methods study (GRAMMS) guidelines, was extracted and analysed. A range of pre-hospital mixed methods research was identified (n = 110). Reporting standards varied, with some studies demonstrating strong integration of qualitative and quantitative data, while others lacked clarity in methodological rationale. Diversity in subject and design reflects the need for flexibility in dynamic pre-hospital environments. This methodological review highlights opportunities for improvement in mixed methods research in pre-hospital care. While the approach supports comprehensive inquiry, it is largely not underpinned by philosophical frameworks which may support methodological rigour. In many cases, mixed methods research in the pre-hospital context is used for practical reasons, and the influence of the pre-hospital setting is observed in adaptable methodologies and a diverse range of subject matter. Our findings offer new insights and guidance for future research design and reporting in this field.

This article consists of a citation of a published article describing research funded by the Health and Social Care Delivery Research programme under project number NIHR130811, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1186/s12873-024-01015-9

This article consists of a citation of a published article describing research funded by the Health and Social Care Delivery Research programme under project number NIHR130811, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1186/s13049-024-01179-0

Background The use of bystander video livestreaming from scene in Emergency Medical Services (EMS) is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of its use in major trauma incidents. Objectives: (i) To obtain data required to design a subsequent RCT. (ii) To test trial processes. (iii) To embed a process evaluation. Design A feasibility RCT with embedded process and economic evaluations where working shifts (n=62) in six trial weeks were randomised 1:1 to video livestreaming or standard care only; and two observational sub-studies: (i) assessment of acceptability in a diverse inner-city EMS that routinely uses video livestreaming; and (ii) assessment of staff wellbeing in an EMS that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff (n=25) and bystander callers (n=2). Setting A pre-hospital EMS in South-East England, with follow-up in associated major trauma centres and trauma units; Sub-studies in (i) London and (ii) East of England EMS. Participants (i) Patients involved in trauma incidents (n=269); (ii) bystander callers (n=11); and (iii) ambulance service staff (n=67). Intervention Video livestreaming using GoodSAM Instant-on-Scene. Main outcome measures Progression to a definitive RCT based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥50% requests to activate livestreaming resulting in footage being viewed; (3) Helicopter Emergency Medical Services stand-down rate reducing by ≥10% due to livestreaming; (4) no evidence of psychological harm to bystanders or staff caused by livestreaming. Results Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts we randomised by individual call which contributed four eligible incidents (2 control; 2 intervention), thereby totaling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch), and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in viewed footage; and two were indeterminate due to insufficient data: (3) 2/6 (33%) stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations, or interviews. In sub study (i), dispatch staff reported that non/limited English language and older age may present barriers to video livestreaming. Limitations Poor recruitment of patients and bystanders limited assessment of appropriateness of dispatch decisions and potential psychological harm. Conclusions Video livestreaming is feasible to implement, acceptable to both bystanders and dispatchers, and may aid dispatch decision-making, but further assessment of benefits and harm is required. Future work Findings support the design and conduct of a future multi-centre study taking account of different triage systems and dispatch personnel, potentially using an alternative to an RCT due to rapid uptake of video livestreaming in this setting.

BackgroundEmergency Medical Services (EMS) play a critical role as the initial point of contact for patients with trauma injuries, where making timely and accurate dispatch decisions is crucial for determining the speed and effectiveness of the response. Assessing injury severity and the appropriate EMS resources needed based on audio medical emergency number calls (e.g. 999/911/112) alone presents challenges. The prevalence of smartphones among the UK population offers a unique opportunity by enabling callers to send live video feeds to Emergency Operations Centres. This study explores the use of video livestreaming in emergency dispatch of prehospital enhanced care teams to determine how and why it impacts decision-making and situational awareness during trauma incidents and whether this varies by patient/caller, incident or dispatcher characteristics. Methods A multimethod qualitative observational study was undertaken comprising 200 hours of non-participant ethnographic observation of the use of video livestreaming in routine practice, and 14 semi-structured interviews with staff within two critical care services in London, UK who used the technology. Data collection and analysis were underpinned by naturalistic decision-making models that emphasise the role of situational awareness. Data were analysed and triangulated using the framework method.Findings We identified three phases in the decision-making process for use of video livestreaming in emergency dispatch: (i) Evaluation and Determination, (ii) Integration and Observation, and (iii) Resolution and Response. Phase 1 addresses why video livestreaming is used and the patient/caller, incident and dispatcher characteristics and identifying primary drivers and barriers. Phase 2 explores how livestreaming impacts situational awareness, focusing on visual cues such as clinical indicators, mechanisms of injury, and environmental factors. Phase 3 examines the impact on dispatch decision-making and immediate care advice. An overarching theme emphasises the role of dispatchers' clinical experience and expertise in using video livestreaming effectively. ConclusionsVideo livestreaming has the potential to impact situational awareness and decision-making in emergency dispatch, as reported by participants and observed during the study, particularly in response to complex and ambiguous trauma scenarios. The technology's effectiveness depends on dispatcher expertise, caller characteristics, and incident complexity. Further research is needed to evaluate its use across different EMS contexts.

Research is fundamental in generating evidence to inform best practice. Not only does it drive improvements in patient care, but it also fosters the ongoing advancement of a profession. As the paramedic profession grows, so does the need for robust research.Paramedic Research: Principles, Designs and Methods harnesses the expertise of over 40 contributors, from across the UK and beyond, each offering a wealth of insight and experience. The result is a practical resource which guides you through the entirety of the research process, from identifying areas needing investigation and designing research questions to data collection, analysis and presenting your findings in a meaningful way.Context is everything, so this book draws on examples of research undertaken in settings that are familiar to unplanned, urgent and emergency care staff. This allows you to focus on the essential elements of research philosophies, principles and constructs without needing to learn about new healthcare environments.If you are hoping to master the transformative power of research within the prehospital and emergency care setting, understand its relevance and embrace it as an integral component of clinical practice, then this book is for you.

Practical guidance for aspiring and established clinical academic paramedicsIn Research-focused Careers for Paramedics, a team of distinguished paramedic researchers provide practical guidance to support clinical academic career development. Written to support paramedics across the globe who have an interest in research, this book offers a guide through the stages of a research-focused career, from novice to expert. Supported by international case studies from 15 paramedics at various stages of their own research-focused career, this book provides real-world guidance for aspiring and established clinical academic paramedics.Readers will find:Expert advice on career development, mentorship, networking and funding applications for research grants and fellowshipsComprehensive explorations of the paramedic education systems across multiple countriesPractical discussions of the authors' four-stage career model of paramedic research: novice, competent, proficient, expertReal-world case studies shedding light on the opportunities and challenges posed by each stage of the paramedic research career modelPerfect for practicing paramedics with an interest in research, Research-focused Careers for Paramedics will also benefit students of paramedicine and researchers with a background in paramedicine.

Introduction A qualitative exploration into the views, opinions and decision-making of paramedics involved in undertaking prehospital 12-lead electrocardiograms (PHECGs) for stroke patients was undertaken, in order to gain a deeper understanding of the clinical and occupational context that the paramedics work within; the acceptability of the paramedics in using PHECGs for stroke patients and the consequences and influences of their decision-making. Methods Data were collected via semi-structured interviews and analysed using the framework method with the underpinning theoretical framework of cognitive continuum theory (CCT). A purposive sample of 14 paramedics were recruited and interviewed. Results Five themes were generated from the analysis of the interviews: • “Time is brain”: minimising delays and rapid transport to definitive care • Barriers and facilitators to undertaking PHECGs for stroke patients • Recognising and gaining cues • Maintaining patient dignity, self-protection and fully informed consent • Education, experience, and engagement with evidence. Conclusion The study showed mixed views on the usefulness of PHECGs, but all participants agreed that PHECGs should not cause additional delays. Paramedic decision-making on recording PHECGs relies on intuitive and quasirational cognitive modes and requires a number of clinical, logistical and ethical considerations. The findings suggest careful consideration of the benefits and potential drawbacks of incorporating PHECGs into prehospital stroke care.

Background Use of bystander video livestreaming from scene to Emergency Medical Services (EMS) is becoming increasingly common to aid decision making about the resources required. Possible benefits include earlier, more appropriate dispatch and clinical and financial gains, but evidence is sparse. Methods A feasibility randomised controlled trial with an embedded process evaluation and exploratory economic evaluation where working shifts during six trial weeks were randomised 1:1 to use video livestreaming during eligible trauma incidents (using GoodSAM Instant-On-Scene) or standard care only. Pre-defined progression criteria were: (1) ≥70% callers (bystanders) with smartphones agreeing and able to activate live stream; (2) ≥50% requests to activate resulting in footage being viewed; (3) Helicopter Emergency Medical Services (HEMS) stand-down rate reducing by ≥10% as a result of live footage; (4) no evidence of psychological harm in callers or staff/dispatchers. Observational sub-studies included (i) an inner-city EMS who routinely use video livestreaming to explore acceptability in a diverse population; and (ii) staff wellbeing in an EMS not using video livestreaming for comparison to the trial site. Results Sixty-two shifts were randomised, including 240 incidents (132 control; 108 intervention). Livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to determine appropriateness of dispatch), and caller recruitment (to measure potential harm) were low (58/269, 22% of patients; 4/244, 2% of callers). Two progression criteria were met: (1) 86% of callers with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in footage being obtained; and two were indeterminate due to insufficient data: (3) 2/6 (33%) HEMS stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations or interviews, but insufficient survey data from callers or comparison EMS site to be confident. Language barriers and older age were reported in interviews as potential challenges to video livestreaming by dispatchers in the inner-city EMS. Conclusions Progression to a definitive RCT is supported by these findings. Bystander video livestreaming from scene is feasible to implement, acceptable to both 999 callers and dispatchers, and may aid dispatch decision-making. Further assessment of unintended consequences, benefits and harm is required. Trial registration Trial registration: ISRCTN 11449333 (22 March 2022). https://www.isrctn.com/ISRCTN11449333

AimStroke is a leading cause of mortality and disability across the globe. Emergency Medical Services assess and transport a large number of these patients in the prehospital setting. Guidelines for UK ambulance services recommend recording a 12-lead electrocardiogram in the prehospital environment, providing this does not add to significant delay in transporting the patient to hospital; however, this recommendation is not based on any evidence.MethodsA systematic review was conducted to search and synthesise the literature surrounding the use of prehospital electrocardiograms in acute stroke patients, focusing on the prevalence of abnormalities and their association with prognosis and outcome. Online databases, references from selected articles and hand searches were made to identify eligible studies. Two authors independently reviewed the studies to ensure eligibility criteria were met. Main outcomes were presence of abnormality on electrocardiogram, mortality and disability. No studies set in the prehospital environment were found by the search; therefore the eligibility criteria were widened to include hospital-based studies. A total of 18 studies were subsequently included in the review.ResultsAlthough the prevalence of electrocardiogram abnormalities appears common in hospitalised patients, their prognostic impact on mortality, disability and other adverse outcomes is conflicting amongst the literature. There is a lack of research surrounding the use of prehospital electrocardiogram in acute stroke patients.ConclusionFuture studies should be based in the prehospital environment and should investigate whether undertaking an electrocardiogram in the prehospital setting affects clinical management decisions or has an association with mortality or morbidity.Conflict of interestNone declaredFundingThis work was supported by School of Health Sciences PhD bursary – ����Vlog, and South East Coast Ambulance Service NHS Foundation Trust.

IntroductionUse of the prehospital 12-lead ECG (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found that although PHECG use was associated with improved 30-day survival, a third of patients (typically women, the elderly and those with comorbidities) under EMS care did not receive a PHECG.The overall aim of the PHECG2 study is to update evidence on care and outcomes for patients eligible for PHECG, specifically addressing the following research questions: (1) Is there a difference in 30-day mortality, and in reperfusion rate, between those who do and those who do not receive PHECG? (2) Has the proportion of eligible patients who receive PHECG changed since the introduction of primary percutaneous coronary intervention networks? (3) Are patients that receive PHECG different from those that do not in terms of social and demographic factors, or prehospital clinical presentation? (4) What factors influence EMS clinicians’ decisions to perform PHECG?Methods and analysisThis is an explanatory, mixed-method study comprising four work packages (WPs). WP1 is a population-based, linked-data analysis of a national ACS registry (Myocardial Ischaemia National Audit Project). WP2 is a retrospective chart review of patient records from three large regional EMS. WP3 comprises focus groups of EMS personnel. WP4 will synthesise findings from WP1–3 to inform the development of an intervention to increase PHECG uptake.Ethics and disseminationThe study has been approved by the London-Hampstead Research Ethics Committee (ref: 18LO1679). Findings will be disseminated through feedback to participating EMS, conference presentations and publication in peer-reviewed journals.Trial registration numberNCT03699137

Objectives: To investigate the association between pre-hospital 12-lead electrocardiogram (PHECG) use in patients presenting to emergency medical services (EMS) with acute stroke, and clinical outcomes and system delays.Methods: Multi-centre linked cohort study. Patients with verified acute stroke admitted to hospital via EMS were identified through routinely collected hospital data and linked to EMS clinical records via EMS unique identifiers. Ordinal and logistic regression analyses were undertaken to analyse the relationship between having a PHECG and modified Rankin Scale (mRS); hospital mortality; pre-hospital time intervals; door-to-scan and door-to-needle times; and rates of thrombolysis.Results: Of 1161 eligible patients admitted between 29 December 2013 and 30 January 2017, PHECG was performed in 558 (48%). PHECG was associated with an increase in mRS (adjusted odds ratio [aOR] 1.30, 95% confidence interval [CI] 1.01-1.66, p = 0.04) and hospital mortality (aOR 1.83, 95% CI 1.26-2.67, p = 0.002). There was no association between PHECG and administration of thrombolytic treatment (aOR 1.06, 95% CI 0.75-1.52, p = 0.73). Patients who had PHECG recorded spent longer under the care of EMS (median 49 vs 43 minutes, p = 0.006). No difference in times to receiving brain scan (median 28 with PHECG vs 29 minutes no PHECG, p = 0.32) or thrombolysis (median 46 vs 48 minutes, p = 0.37) were observed.Conclusion: The PHECG was associated with worse outcomes and longer delays in patients with acute ischaemic stroke.

Introduction Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller’s smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS.Methods and analysisThe SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming.Ethics and disseminationThe study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents.Trial registration numberISRCTN11449333.

Background Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as ‘callers’ in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers’ smartphones to emergency medical dispatch centres. Methods A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews. Results Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers’ (referred to as ‘dispatcher/s’ in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols. Conclusion Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.

BACKGROUND: Stroke is a leading cause of mortality and disability across the globe. Emergency Medical Services assess and transport a large number of these patients in the prehospital setting. Guidelines for UK ambulance services recommend recording a 12-lead electrocardiogram in the prehospital environment, providing this does not add to significant delay in transporting the patient to hospital; however, this recommendation is not based on any evidence. METHODS: A systematic review was conducted to search and synthesise the literature surrounding the use of prehospital electrocardiograms in acute stroke patients, focusing on the prevalence of abnormalities and their association with prognosis and outcome. Online databases, references from selected articles and hand searches were made to identify eligible studies. Two authors independently reviewed the studies to ensure eligibility criteria were met. Main outcomes were presence of abnormality on electrocardiogram, mortality and disability. No studies set in the prehospital environment were found by the search; therefore the eligibility criteria were widened to include hospital-based studies. A total of 18 studies were subsequently included in the review. RESULTS: Although the prevalence of electrocardiogram abnormalities appears common in hospitalised patients, their prognostic impact on mortality, disability and other adverse outcomes is conflicting amongst the literature. There is a lack of research surrounding the use of prehospital electrocardiogram in acute stroke patients. CONCLUSION: Future studies should be based in the prehospital environment and should investigate whether undertaking an electrocardiogram in the prehospital setting affects clinical management decisions or has an association with mortality or morbidity.

Background Helicopter Emergency Medical Services (HEMS) are a scarce resource that can provide advanced emergency medical care to unwell or injured patients. Accurate tasking of HEMS is required to incidents where advanced pre-hospital clinical care is needed. We sought to evaluate any association between non-clinically trained dispatchers, following a bespoke algorithm, compared with HEMS paramedic dispatchers with respect to incidents requiring a critical HEMS intervention. Methods Retrospective analysis of prospectively collected data from two 12-month periods was performed (Period one: 1st April 2014 – 1st April 2015; Period two: 1st April 2016 – 1st April 2017). Period 1 was a Paramedic-led dispatch process. Period 2 was a non-clinical HEMS dispatcher assisted by a bespoke algorithm. Kent, ����Vlog & Sussex HEMS (KSS HEMS) is tasked to approximately 2500 cases annually and operates 24/7 across south-east England. The primary outcome measure was incidence of a HEMS intervention. Results A total of 4703 incidents were included; 2510 in period one and 2184 in period two. Variation in tasking was reduced by introducing non-clinical dispatchers. There was no difference in median time from 999 call to HEMS activation between period one and two (period one; median 7 min (IQR 4–17) vs period two; median 7 min (IQR 4–18). Non-clinical dispatch improved accuracy of HEMS tasking to a mission where a critical care intervention was required (OR 1.25, 95% CI 1.04–1.51, p = 0.02). Conclusion The introduction of non-clinical, HEMS-specific dispatch, aided by a bespoke algorithm improved accuracy of HEMS tasking. Further research is warranted to explore where this model could be effective in other HEMS services.