Effect of the Cornwall Helicopter Ambulance on Ambulance Service Response Time

Sir, We read the article by Rouse'with concern. His study of the Cornwall helicopter relies on one feature of the air ambulance to decide its viability, namely the ORCON standard. The author mentions in his article that it "lacks credibility for several reasons" but then sets it as the hallmark for a good service. ORCON only states a response time. This is the second component in the therapy free interval, the first being the time to alerting the emergency services. The Cornwall air ambulance delivers two paramedics to the scene. We are not told if all Cornwall ambulances have one paramedic on board (the other crew member has to drive the land ambulance). The helicopter service may therefore allow more effective deployment of paramedics by increasing their range. It will also allow the patient to be transported to the most appropriate hospital; studies have shown that trauma care is highly variable between hospitals. Land ambulances will usually go to the nearest hospital, which may necessitate futher transfer and therefore