Philip Brigham


This study reviews the evaluative literature of air ambulances in other countries and concludes it has little relevance to Britain. Other reviews are undertaken of the British ambulance service, evaluative economics, and market istructures. The relationship between effectiveness, efficiency and equity is explored. It is concluded that there is a role for ak ambulances in servicing rural areas within the revised structure of the' NHS. This is tested by three studies of the Cornwall A k Ambulance. Initially, the resources and standards of the ambulance service in Cornwall are investigated by analysis of routine data spanning two years. It is concluded that standards of response and times to hospital are poor in North Cornwall. This was deduced from the modelling of response times and time to hospital for incidents from every electoral ward in the county. Two options of 'land ambulance only' and 'land ambulance with the air ambulance' are tested for effectiveness, equity and efficiency. The first study considers the effectiveness of service provision, while the second study considers geographic equity with the use of simple regression analysis to indicate the cost of service provision at differing levels of rurality. The^third uses a cost benefit analysis framework to indicate the costs and benefits associated with air ambulance use in a rural area. The contribution to knowledge is highly significant in the modelling of routine data to assess the effectiveness, efficiency and equity relationship, in appraising accessibility. This is the first study to apply economic principles to the ambulance service within the recently revised NHS.

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